Before AIDS: Gay Health Politics in the 1970s by Katie Batza (review)

Before AIDS cogently analyzes 1970s’ gay health activism—primarily among affluent white gay men—in the United States. Using archival research and interviews, Katie Batza challenges the narrative that gay health services emerged during the AIDS crisis in the 1980s. Simultaneously, her findings counter the portrayal of gay men in the 1970s as focused solely on sexual freedom; they also sought sexual health. The medical infrastructure developed in the 1970s proved indispensable in responding to the AIDS crisis. Batza chronicles how radical social movements inspired activists to reimagine the meaning of gay health. In turn, interactions with the state led to both the expansion and the deradicalization of gay clinics. The book is organized thematically, with each chapter comparing and contrasting how these key themes played out at Boston’s Fenway Community Health Clinic, Chicago’s Howard Brown Memorial Clinic, and Los Angeles’ Gay Community Services Center.

Medical homophobia marred gay men’s health care in the 1960s and 1970s. Doctor’s visits “often led to misdiagnosis, judgment, ostracism, and treatment for their sexuality rather than their medical ailments” (p. 1). Coupled with the threat of violations of confidentiality that risked family abandonment, job loss, eviction, and so forth, homophobia often caused gay men to delay or avoid medical care. Within this context, gay men (and lesbians) took collective action to forge accessible, gay-positive STI (sexually transmitted infection) testing clinics, outreach and testing in bars and bathhouses, primary care, research, and other services.

Radical social movements, local political contexts, and Great Society funding catalyzed the clinics’ formation. The dynamic milieu of the black power, antiwar, feminist, gay liberation, and other movements provided ideological and strategic models for gay health activists. A Black Panther Party clinic inspired former antiwar activists to start the Fenway clinic as part of a broader antigentrification campaign. Medical students and doctors radicalized by the antiwar movement and frustrated with homophobic medical training and care established Howard Brown.

Los Angeles clinic organizers more explicitly employed gay liberation politics, promoting the concept of “oppression sickness”—“the ways in which homophobia literally made gay people sick” (p. 25). Framing oppression—not homosexuality—as pathological was integral in shifting from a medical model to a health justice model in all three clinics. Sex positivity, paired with gay cultural expertise (e.g., use of nonclinical language such as “rimming”), garnered trust among patients. Health care access expanded and improved greatly by the end of the decade.

Gay health activists took advantage of Great Society (and other) grant funding. Research collaborations, professional organizations, and relationships with government agencies led to a better understanding of gay health for both health care providers and gay patients. State funding fostered the growth of the clinics, but compliance with government laws and regulations also impeded efforts to fight oppression. Ideological rifts around bureaucratization and professionalization developed within the Los Angeles and Boston clinics between those committed to social justice activism and those committed to service provision. Sexism pervaded the clinics. Male activists drew upon feminist critiques of mainstream medicine, but typically dismissed lesbians’ health needs. Radical gay men and lesbians often left the clinics or were pushed out. By 1980, the clinics had shifted from volunteer-run collectives fighting “oppression sickness” to hierarchical bureaucracies with million-dollar budgets providing more narrowly defined medical care.

Batza challenges the common AIDS narrative depicting gay men as pathologically hypersexual and hedonistic in the 1970s. She documents gay men’s collective efforts to fight homophobia and improve health care. Batza also argues that contrary to the common “AIDS abandonment narrative”—in which state abandonment gave rise to oppositional health activism—gay health activism was enmeshed with the state. The state provided resources instrumental to the growth of gay health care. In turn, the national gay health infrastructure created in the 1970s immediately responded to the AIDS crisis in the 1980s, providing frontline education, prevention, testing, medical care...