The Kaposi's Sarcoma Clinic at the University of California, San Francisco: An Early Response to the AIDS Epidemic

In the spring of 1981, Marcus A. Conant, a dermatologist in private practice in San Francisco and a member of the clinical faculty at the University of California, San Francisco (UCSF), learned from a colleague of the outbreak of an aggressive form of Kaposi’s sarcoma among male homosexuals in New York City. Within twenty-four hours, a case of this rare malignancy was confirmed in San Francisco. ¹ That summer, Conant organized a clinic at the university to evaluate and study patients with the puzzling condition. Kaposi’s sarcoma was subsequently recognized to be the most visible component of a syndrome that by the spring of 1982 was being called acquired immune deficiency syndrome, or AIDS.

The early history of the Kaposi’s Sarcoma Clinic, located in one of the three cities in the United States in which the AIDS epidemic was first manifest, presents an apt subject for examining a local instance of the complex interplay of forces, both social and biological, that shapes disease recognition and definition, the organization of an initial biomedical response, and some of the factors influencing these simultaneous processes. ² This paper focuses on one group of health professionals in one city in the first year after the recognition of a cluster of malignancy and rare infections that later was perceived as a syndrome associated with cellular immune deficiency. Part of a larger study of the biomedical and nursing response to AIDS in San Francisco in the epidemic’s first three years, ³ it is necessarily a limited and local examination, which considers only some elements of the intricate interactions involved in constructing an explanatory framework for and medical response to a new disease. ⁴

Few if any previous AIDS histories have provided a detailed account of medical organization and the process at the local level of constructing a new disease category. ⁵ Books by Randy Shilts and Carol Pogash, which include substantial descriptions of aspects of San Francisco’s medical response, are journalists’ accounts intended for a general audience, not serious historical analyses. ⁶ The subject of this paper is a clinic that predates AIDS units elsewhere and that has been overlooked in previous historical accounts, except for the book by Shilts. ⁷

The First Published Announcements

On 3 July 1981 the Centers for Disease Control (CDC) issued a report entitled “Kaposi’s Sarcoma and Pneumocystis Pneumonia among Homosexual Men—New York City and Los Angeles.” It began:

During the past 30 months, Kaposi’s sarcoma (KS), an uncommonly reported malignancy in the United States, has been diagnosed in 26 homosexual men (20 in New York City . . . ; 6 in California). The 26 patients range in age from 26–51 years. . . . Eight of these patients died . . . all 8 within 24 months after KS was diagnosed. . . . The occurrence of this number of KS cases during a 30-month period among young, homosexual men is considered highly unusual. ⁸

Unlike classical KS, usually a slowly progressive tumor, this new form was aggressive and associated with serious infections, including four cases of biopsy-confirmed Pneumocystis carinii pneumonia (PCP). ⁹ A month earlier, the CDC had reported in its bulletin, Morbidity and Mortality Weekly Report, an outbreak of this unusual pneumonia in five young men in Los Angeles whom the report described as “all active homosexuals.” ¹⁰ The 3 July MMWR reported ten additional cases of PCP, bringing the total number of cases among homosexual men in California to fifteen. Why was PCP, an infection rarely seen in the United States (and then usually in patients who were immunosuppressed because of cancer therapy), suddenly appearing in one specific demographic group? The two MMWR reports constituted a medical alert: Previously healthy young men with no apparent reason to acquire KS and PCP were contracting and dying from them.

The editorial note accompanying the 3 July MMWR notified its readership of the anomalous nature of the cancer outbreak:

The occurrence of this number of KS cases during a 30-month period among young, homosexual men is considered...