B.A.R. covers HIV and AIDS for 40 years

The early 1980s
The June 10, 1982, edition included an announcement of a Sisters of Perpetual Indulgence fundraiser to produce the Play Fair safer sex brochure. Co-authored by Sister Roz Erection and Sister Florence Nightmare (aka Bobbi Campbell), both nurses, it may be the first published advice that gay men use condoms.

A short item in the July 1 issue announced the opening of the Kaposi's Sarcoma Research and Education Foundation, which would become the San Francisco AIDS Foundation. The founders included Conant, UCSF's Dr. Paul Volberding, B.A.R. publisher Bob Ross, and activist Cleve Jones. This was the second such organization after Gay Men's Health Crisis in New York City, founded by author Larry Kramer and others in January 1982.

A June 24 news brief noted that the CDC was increasingly concerned about the new epidemic, which now exceeded 400 cases in more than 20 states and 10 countries. Some had been reported among heterosexual men and women, mostly injection drug users, raising suspicion that it was caused by an infectious pathogen. In July, the condition was dubbed acquired immune deficiency syndrome, or AIDS.

But other theories were still in play, including drug use, sexually transmitted diseases, and gastrointestinal parasites overwhelming the immune system. Campbell penned a letter in the October 7 issue advising fewer sex partners, less recreational drug use, wearing a condom, and monogamy. "Admittedly, these recommendations consider health, not fun, as a priority," he wrote.

AIDS soon made the front page, including a report about California Congressman Phillip Burton's efforts to secure funding for research, which was thwarted by President Ronald Reagan's veto. Locally, Mayor Dianne Feinstein agreed to a $3.5 million budget supplement to fund groups, including the KS Foundation and Shanti, which started in 1974 to care for people with life-threatening illnesses.

In 1983, concern erupted over the safety of the blood supply. Some argued that sexually active gay men should be screened and excluded from donating, while others favored voluntary deferral. The federal Food and Drug Administration's policy that men who have sex with men should refrain from donating blood indefinitely was finally revised in 2020.

On March 17, 1983, the B.A.R. reprinted a blistering essay by Kramer, "1,112 and Counting," which originally appeared in the New York Native. News editor Paul Lorch, who had been reluctant to focus on a gay disease, changed course. "The time has come to start scaring some of the shit out of ourselves," he wrote in the first of four consecutive editorials on the topic. A group of people with AIDS responded with an open letter to the KS Foundation, complaining that Lorch's sensationalistic approach "fuels the fires of fear, guilt, and homophobia."

The B.A.R.'s letters and opinion section began to fill up with debates about AIDS and what it meant for the gay community and movement. "[W]e men must — temporarily, we hope — change our sexual lifestyles in order to save our lives," community leaders Ron Huberman, Cleve Jones, and Bill Kraus wrote in the May 26 issue. "[W]hat a perversion it is of Gay Liberation to ignore the overwhelming scientific evidence, to keep quiet, to deny the obvious — when the lives of Gay men are at stake."

People living with AIDS began to come together as a community. Candlelight marches in January and May 1983 are thought to be the first time they gathered in public demonstrations. In the July 7 issue, Dan Turner described his experience at the National AIDS Forum in Denver, where a group took the stage to assert that they were not "victims" or "patients," but "people with AIDS" (the Denver Principles).

Around the same time, San Francisco General Hospital opened Ward 5B, the first dedicated inpatient AIDS unit in the country. Frequent B.A.R. contributor Mike Hippler penned a five-part series about his experiences visiting the ward.

In the October 27, 1983, issue, Dion B. Sanders broke the story that some 40% of people with AIDS are minorities, shattering the stereotype that it is a disease of white gay men.

The epidemic revealed both rifts and solidarity between gay men and lesbians. "The moral judgments of many lesbians against gay men fester like an abscess in our community," wrote Teresa Scannell, a nurse and lesbian blood drive organizer, in the January 13 edition. But women — lesbians and bisexual women in particular — stepped up in large numbers to care for their brothers. And as SF lesbian and gay health services coordinator Pat Norman noted at a September forum on lesbians and AIDS, the homophobia and political fallout of AIDS affected gay women as well as men. Over the years, activists would call attention to women who were themselves living with HIV and AIDS, who often did not have access to the same level of care and services.

Lorch ended the year with an editorial expressing thoughts that were likely widely shared: "Placing the entire gay liberation dream against the reality of the killer of liberated sex, I found myself for the first time unsure of the direction, the point, the need of our movement."

The March 22, 1984, issue featured a report on the plight of homeless people with AIDS, some of whom were kicked out of a hotel after the San Francisco Examiner revealed that they were being sheltered there. This would become a persistent thread in the local epidemic. In 2019, the San Francisco Department of Public Health reported that just 33% of homeless people with HIV had an undetectable viral load.

Bathhouses
The battle over bathhouses heated up in the spring of 1984. Gay supervisor Harry Britt said these venues should no longer be associated with pleasure — they should be associated with death. Gay journalist Randy Shilts used his platform at the San Francisco Chronicle to support their closure. The Northern California Baths Association suggested that theocrats were manipulating public fears about AIDS to further their ultimate aim of closing not only bathhouses, but all gay businesses and organizations.

The April 5 edition devoted 11 of its 14 local news pages to AIDS, largely related to the bathhouse closure. Then-San Francisco Health Director Dr. Mervyn Silverman scheduled a March 30 news conference to announce his decision but ended up calling for more deliberation. Community organizations came down on both sides of the issue.

Lorch's editorial, entitled "Killing the Movement," included a list of 16 gay men and one lesbian who "would have empowered government forces to enter our private precincts and rule over and regulate our sex lives." It would be one of his last editorials before he was replaced.

On April 9, Silverman finally announced that the city was taking steps to eliminate bathhouses, bookstores, and sex clubs as places of sexual encounters. This triggered a series of legal challenges and court cases, even as most of these venues closed on their own. Ultimately, in November, Judge Roy Wonderallowed the baths to stay open but ruled that they may not have private rooms and monitors must halt high-risk sexual activity.

Yet this was not the end of the saga. In 1996, the Coalition for Healthy Sex, made up of venue owners, public health officials, and prevention workers from community agencies, proposed legislation to regulate commercial sex clubs, which were still operating under Wonder's conditions.

But the issue proved as controversial as before. Instead of legislation, updated DPH regulations were introduced in February 1997, but some stakeholders demanded evidence that prohibiting private rooms and monitoring patrons actually helped prevent HIV transmission.

PrEP arrives
Debates about sexual behavior — complete with blaming and shaming — never seem to go away. AIDS prevention efforts in the city started early. Over the years, the Stop AIDS Project's community surveys provided insights into how gay and bi men were modifying their risk. The June 26, 1986, Pride issue reported that new infections had dropped dramatically thanks to "radical changes" in sexual behavior, and Stop AIDS ran a four-page spread proclaiming "Congratulations, Gay San Francisco!" As things went the other direction in the late 1990s, Stop AIDS spearheaded efforts to address crystal meth use. Eventually, Stop AIDS, along with the Magnet sexual health clinic and the Stonewall Project's substance use services were integrated into SFAF.

Cynthia Laird, then an assistant editor, reported on the discussion in the late 1990s about using antiretroviral post-exposure prophylaxis (PEP), previously limited to occupational HIV exposure, as a "morning-after pill" following sex. As Terry Beswick reported in the July 27, 2000, issue, barebacking, or sex without condoms, arose as a contentious issue around the turn of the century. In the May 20, 2004 edition, assistant editor Matthew S. Bajko reported that some men were turning to serosorting, or having sex only with people of the same HIV status.

Much of this became moot in 2012, when the FDA approved the Truvada pill for PrEP, which reduces the risk of acquiring HIV by 99%. Gay and bi men in San Francisco were among the most eager early adopters. More recently, researchers reported that cabotegravir injections given every other month appear to offer even more protection.

Testing, prevention, and treatment
Lorch's successor, news editor Brian Jones, took a keen interest in the science of AIDS, and the paper shifted toward more in-depth reporting about the latest research on immune function, disease progression, and treatments.

In the spring of 1984, both Dr. Robert Gallo at the National Institutes of Health and Drs. Françoise Barré-Sinoussi and Luc Montagnier at the Pasteur Institute in France announced that they had discovered the retrovirus that causes AIDS, which they named HTLV-3 and LAV, respectively. The two countries ultimately would settle on the name human immunodeficiency virus, or HIV.

A test for HIV antibodies against the retrovirus was soon developed. Advocates cautioned that it could not predict who would develop AIDS, but UCSF researchers reported that all the AIDS patients they tested had antibodies. Many people took a long time to progress to what was then called "full-blown AIDS" and lived for years with less severe manifestations known as AIDS-related complex, or ARC.

Death toll climbs
In the latter half of the 1980s, the death toll from AIDS continued to climb. Prominent people lost to the epidemic included Campbell — for many, the first public face of AIDS — in August 1984, actor Rock Hudson in October 1985, Gay Games founder Tom Waddell in July 1987, disco diva Sylvester (Sylvester James Jr.) in December 1988, and photographer Robert Mapplethorpe in March 1989. In March 1987, the DPH reported the highest numbers yet: 123 new AIDS cases and 73 deaths in a single month.

With no good treatments on the horizon, many people saw little point in getting tested. On the contrary, doing so could subject them to insurance denial, getting fired, discrimination, and even criminalization. At both the state and federal level, advocates fought efforts to impose mandatory testing and create registries of people who tested positive. The B.A.R. devoted several cover stories to Lyndon LaRouche's quarantine ballot initiatives. As therapies improved, however, advocates and community organizations increasingly encouraged voluntary confidential testing.

Although U.S. Health and Human Services Secretary Margaret Heckler predicted in 1984 that a vaccine could be available in two years, that prospect dimmed as one study after another led to disappointment. While various approaches triggered antibody production and T-cell immune responses, only one vaccine regimen has ever shown modest efficacy in a clinical trial while many more have failed. Nonetheless, two large vaccine studies are currently underway, and lessons learned from the highly effective COVID-19 vaccines could move the field forward.

Needle exchange, in contrast, proved to be a more effective prevention method. San Francisco activists started an underground needle exchange in 1988, carting supplies through the Tenderloin in a baby carriage. In 1992, city supervisors unanimously passed a measure allowing needle exchange under an emergency use decree from the mayor. Although California law has since changed, federal rules still prohibit funds from being used to purchase syringes. Advocates are now taking the next step, trying to pass a state law to allow supervised injection sites.

The B.A.R. has consistently taken a libertarian stance on the war on drugs. In the August 8, 1996, edition, the paper reported on the state's raid on Dennis Peron's Cannabis Buyer's Club. Peron and his friend Mary Jane Rathbun (aka Brownie Mary) started out providing medical marijuana for people with AIDS. "The needs of people with AIDS and cancer may be beyond the comprehension of the state attorney general, but not that of the average Californian," news editor Mike Salinas wrote in an editorial. And indeed, the medical cannabis initiative Proposition 215 won by a substantial margin that fall.

AZT
After years of trying unproven therapies ranging from vitamin C to ribavirin to Compound Q, in March 1987 the FDA approved AZT, the first effective antiretroviral. The drug blocks HIV replication and reduces mortality in the short term, but it can cause severe side effects. What's more, the virus can mutate and become resistant to the drug. Before long, it was evident that drug combinations would be needed for long-term benefit.

Researchers and activists alike grew increasingly frustrated in the late 1980s and early 1990s as one AIDS conference after another passed without breakthroughs. In fact, the confabs became so lackluster that they were extended to every other year after the 1994 Yokohama meeting. "We may not have a new way to treat these infections or kill the AIDS virus until the end of this century," Conant predicted in 1986. "And the chances of our being able to rid someone of all traces of the AIDS virus are probably nil in our lifetime."

In his report on the 1990 meeting, Dave Gilden — another treatment wonk — raised concern about therapies that lengthen survival but leave chronically ill people facing one disease after another. "[G]etting HIV under control is only half the problem," he wrote. "Rebuilding a shattered immune system then has to be addressed, and for this the conference offered little hope."

The rise of AIDS activism
By this time, AIDS made up a substantial proportion of the B.A.R.'s news coverage. People with AIDS, their loved ones, activists and community organizations kept busy lobbying for more funding, raising money locally, caregiving, providing direct services, and fighting discrimination. Activists urged the National Institutes of Health and the FDA to move drugs through the testing and approval process faster, while demanding that companies make their treatments more widely available prior to approval and lower their prices thereafter.

Much of the anger during the era was directed at Reagan, who did not mention AIDS until four years into the pandemic. Another frequent target was the religious right, which regarded AIDS as a moral failure. In 1987, Congress passed the Helms Amendment, which banned federal funds for gay-friendly safe sex materials.

The Bay Area saw some of the earliest AIDS activism. The AIDS/ARC vigil outside the federal building at United Nations Plaza started in October 1985, with activists chaining themselves to the doors. Their demands included government benefits for people with ARC as well as AIDS, FDA approval of drugs available in other countries, and one hour's worth of the federal budget — reckoned at $486 million — for research. As Dennis Conkin reported, police attempted to bust up the vigil in June 1989, but a few people held on until December 1995.

On November 27, 1985, people with AIDS and their supporters organized a candlelight march from the Castro to the vigil site. Marchers taped hundreds of placards bearing the names of people who had died to the walls. Cleve Jones would later recall that this gave him the idea for the Names Project AIDS Memorial Quilt. The quilt was displayed for the first time on the National Mall during the October 1987 March on Washington, which was led by people with AIDS in wheelchairs.

Project Inform, started by Martin Delaney and Joseph Brewer in October 1985, aimed to educate people with AIDS about treatment options and carry out community-based research. PI tapped into a growing network of buyer's clubs that helped people access unapproved therapies. The group also ran an information hotline that became a national resource. PI remained active until March 2019.

Citizens for Medical Justice carried out some of the earliest AIDS protests, but its first coverage in the B.A.R. was for a September 1986 sit-in at Governor George Deukmejian's Sacramento office after he vetoed an AIDS anti-discrimination bill. The following June, CMJ did a zap at Burroughs Wellcome headquarters in Burlingame, demanding that the company lower the price of AZT. Protesters paid Wellcome another visit in January 1988, marching 15 miles from San Francisco. CMJ changed its name to AIDS Action Pledge and later to ACT UP/San Francisco.

Accompanying his AZT approval article, Brian Jones included a short item about a March 24, 1987, protest on Wall Street by the Lavender Hill Mob demanding approval of alternative therapies. This was in fact the first protest by ACT UP/New York, which Kramer and others had started a couple of weeks earlier.

In June 1987, hundreds of activists demonstrated outside the White House and 64 were arrested. The protesters, including SFAF director Tim Wolfred, Paul Boneberg of Mobilization Against AIDS, and gay veteran Leonard Matlovich, put up a wreath remembering 20,000 dead. Boneberg called the actions a "massive quantum step towards militancy."

On January 31, 1989, a group called Stop AIDS Now or Else (SANE) shut down traffic on the Golden Gate Bridge during the morning rush hour. Some thought the protest went too far, but even SFAF policy director Pat Christen — who said the agency received 100 angry phone calls — agreed that "if we don't have people out there on the streets the issue will be left to die." The following September, SANE disrupted opening night at the San Francisco Opera.

During this era, there was often little distinction between LGBTQ and AIDS activism. In July 1989, Conkin profiled four young gay radicals, some of whom participated in the bridge blockade. One of them, Mike Shriver, said his involvement in AIDS activism "is inextricably linked to the ongoing struggle for gay and lesbian liberation."

ACT UP employed an insider-outsider strategy that combined street protest with negotiation. At times this led to friction when some activists felt others were getting too cozy with the establishment. This came to a head in 1994, when members of ACT UP/New York broke away to form the Treatment Action Group. TAG did an about-face and tried to slow down the drug approval process, bringing them into conflict with Project Inform and its allies.

Activists have had a presence at most International AIDS Conferences, but probably the largest was the week of actions around the sixth confab in 1990. Although Kramer had called for a riot, B.A.R. reporter Michael Botkin characterized the conference as "quiet from both a scientific and political perspective." The most urgent issue was the U.S. ban on travel and immigration by HIV-positive people. Activists held rallies and marches to protest the Immigration and Naturalization Service, raise awareness about women and HIV, and call attention to the crumbling San Francisco Model of community-based care. When Health Secretary Dr. Louis Sullivan rose to speak at the closing ceremony June 28, activists drowned him out with whistles and air horns.

Because of the travel ban, the 1992 AIDS conference, scheduled for Boston, was moved to Amsterdam. President Barack Obama finally lifted the ban in 2010, enabling the 2012 conference to once again be held in the United States. San Francisco was slated to host the conference again (along with Oakland) in 2020, but it shifted to a virtual format due to COVID-19.

The influx of new activists was hard on ACT UP/San Francisco. Soon after the 1990 conference, the group split. One faction went on to form ACT UP/Golden Gate, which was more narrowly focused on AIDS. For several years, the ACT UP/GG writers pool penned a B.A.R. column reporting on the latest developments in new therapies and management of coexisting conditions. [See Writers Pool article.]

Before long, the original group was taken over by a new breed of activists who were skeptical that HIV causes AIDS and eschewed antiretroviral treatment. That group engaged in more disruptive and sometimes violent actions, earning the opprobrium of other activists. ACT UP/GG changed its name to Survive AIDS in March 2000 to avoid the association.

In 2012, coinciding with the 25th anniversary of ACT UP, a group of young activists and a few veterans briefly revived ACT UP/SF in the spirit of the original group. Although their message that "AIDS Is Not Over" resonated with many, the effort was short-lived.

The tide begins to turn
After years of frustration, the mid-1990s ushered in an era of hope. The first protease inhibitor, saquinavir, was approved in December 1995, with two more following in quick succession. This enabled people to build drug cocktails that could keep HIV in check. The reelection of President Bill Clinton in 1996 brought big changes on the policy front — though he didn't escape criticism.

As described in "A tale of (at least) two conferences" — this reporter's first piece for the B.A.R. — the jubilation of hearing promising new research at the 1996 International AIDS Conference contrasted with the continued anger that governments were not doing enough to help people with HIV.

Within a year after combination therapy's debut, AIDS mortality had dropped dramatically. On August 13, 1998, the B.A.R. ran its famous "No obits" cover. During the height of the local epidemic, the paper had run multiple pages of obituaries each week.

Disparities persist
But everything was not rosy. Racial, gender, and geographical disparities became increasingly evident, with Black and Latino people and those living in the South having higher HIV rates, poorer access to treatment, and a lower likelihood of maintaining viral suppression.

As Bob Roehr reported in the July 13, 2000, edition, this inequity was even more stark at the global level. The 2000 International AIDS Conference in Durban highlighted disparities that left most people in low-income countries without access to the effective new treatments. To help close the gap, President George W. Bush launched the President's Emergency Plan for AIDS Relief (PEPFAR) in 2003.

Development of new therapies didn't stop with protease inhibitors. In the August 14, 1997, issue, ACT UP/GG member Matt Sharp wrote about a small Foster City company that was an "ambitious pioneer in nucleotide science." Gilead Sciences' first HIV drug, adefovir, proved too toxic, but its next candidate, tenofovir (originally dubbed PMPA), put it on the path to dominating the HIV drug market for years to come.

The advent of better medications led some to ask whether prompt, potent treatment — "hit early, hit hard" — could potentially eliminate HIV. But as the new antiretrovirals were more widely used, some unexpected side effects emerged. In an effort to limit drug exposure while preserving immune function, treatment guidelines alternately raised and lowered the CD4 cell threshold for starting treatment according to the latest research.

The SMART and START studies confirmed that taking treatment breaks are risky. Some of the problems attributed to the drugs are related to chronic inflammation, which can be reduced if people start treatment early and keep their viral load suppressed. This is important as the HIV population ages and becomes more susceptible to cardiovascular disease and other conditions. In 2019, more than two-thirds of people living with HIV in San Francisco were over age 50.

Pioneering once again, in 2010 San Francisco was the first city to recommend that everyone should start treatment as soon as they are diagnosed with HIV. National and global guidelines followed suit within a couple of years. The advent of once-daily combination pills, well-tolerated integrase inhibitors, and a long-term injectable regimen have made treatment easier and more effective.

What's more, viral suppression not only preserves the health of people living with HIV, it also protects their partners. The HTPN 052 and PARTNER studies showed that people who maintain an undetectable viral load on treatment do not transmit the virus via sex.

Thanks to effective treatment and PrEP, HIV has been on a steady decline in San Francisco. The latest SF DPH HIV Epidemiology Report shows that there were 166 new diagnoses in all of 2019 — fewer than some single months in the past. The city's Getting to Zero initiative aims for zero new cases of HIV, zero AIDS deaths, and zero stigma. But experts caution that COVID-19 could lead to setbacks.

Despite advances in prevention and treatment, there's still no cure for HIV. The late Timothy Ray Brown, known as the Berlin Patient, and Adam Castillejo in London are the only people thought to have been cured of HIV, both after bone marrow transplants. But a larger group of "elite controllers" and long-term non-progressors, who can control the virus naturally, could help researchers learn how others could achieve a functional cure.


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