EXHIBIT CONTENTS
About this Exhibit – Introduction
New Programs: Working Together
A Leader in Research, Education, and Housing
The AIDS Omnibus Act: New Mandates
Responding to AIDS
An exhibit and oral history project from the King County Archives.
Content warning: The archival records featured in this exhibit discuss sexual behavior and illegal drug use. Please direct questions or comments to archives@kingcounty.gov
Copyright King County Archives, Seattle, Washington, June 2016.
Please note: This exhibit features historical materials relating to HIV/AIDS. For current health information, please visit Public Health, Seattle & King County – HIV/AIDS and STD Prevention and Education.
Oral histories produced with support from a 2015 4Culture Heritage Projects Grant.
Introduction
The emergence of AIDS in major U.S. cities demanded an unprecedented response from the Seattle-King County Department of Public Health. Before the syndrome was completely understood and its cause isolated, public health officials embarked on an aggressive program of public education, prevention, patient assessment and counseling, and research.
With leadership and input from individuals personally affected by the disease, the Department worked directly with community organizations to develop programs that addressed the unique needs of at-risk populations and people with AIDS.
The Department’s AIDS Prevention Project would come to serve as a model for public health agencies across the nation, and it informed responses to future public health crises. The spread of HIV/AIDS in King County would be less significant than in cities such as New York and San Francisco. But by 1996, before effective treatment was developed, over 3,000 people in King County would die from AIDS-related diseases, and the impact of the disease is still felt to this day.
About Responding to AIDS
This exhibit describes the response by the Seattle-King County Department of Public Health to the HIV/AIDS epidemic, from 1982 to 1996, using documents, photographs, graphics, audio, and video from the King County Archives.
The exhibit and oral histories are not intended to provide a comprehensive history of AIDS in Seattle-King County, but rather to document one facet of the history: the accomplishments, challenges, and perspectives of Public Health staff.
In addition, the records presented here are only a small percentage of the Archives’ Public Health collection, and the exhibit only touches on some of the complex issues and challenges faced by the program and the community. Researchers are encouraged to contact the Archives to review the collection, which includes records from beyond this exhibit’s 1996 cutoff date.
A printable version of this exhibit is available upon request. Please email us at archives@kingcounty.gov to request a copy. The print version is reformatted to a folio layout and provides transcriptions of the oral history clips incorporated throughout the exhibit. Closed captioning is available under the Oral History section of this exhibit.
The HIV/AIDS Oral History Project
As the Archives processed the records of the AIDS Prevention Project and began research for this exhibit, former Project Coordinator Tim Burak helped us identify people, places, and events in collection photos. On hearing just a few of Tim’s reflections and stories, it became apparent that the unique experiences and perspectives of people working in public health were missing from the familiar narrative of the AIDS epidemic in our region. We hope that the interviews will help complete the historical record.
“The ground shifted with AIDS. Our culture shifted, our language shifted, the way we think about relationships, acceptance of different expressions of sexuality – everything changed with AIDS. I don’t think yet, even decades later, people even realize what a pivotal moment that was.”
Ann Downer, AIDS Prevention Project Education Program Coordinator
AIDS Emerges
In 1981, a rare form of pneumonia and other rare infections began to be reported in otherwise healthy young gay men in Los Angeles, New York and San Francisco.
The cause of AIDS was not yet understood, and there was no treatment and no cure.
By 1982, AIDS was known to be transmitted not only by sexual contact, but also by contact with infected blood, through transfusions or shared injection needles. The deadly nature and the potential for rapid spread of the new disease was soon recognized as a public health emergency.
In November, 1982, King County reported its first case of AIDS. This was an immediate challenge for local public health. The number of cases in the region increased steadily, mostly but not exclusively among gay men. The first deaths in the region occurred in Tacoma and Seattle in the spring of 1983.
The Seattle-King County Department of Public Health participated in public events, organized by health leaders in the gay community, to share the latest medical understanding of the threatened epidemic. By early 1983 community groups had taken the lead in organizing support and services for people with AIDS. The Seattle Gay Clinic (an all-volunteer organization that provided STD screening, physical exams, counseling, and referrals), the Northwest AIDS Foundation, and others would become important partners to Seattle-King County Public Health.
The Chicken Soup Brigade
The Chicken Soup Brigade, which would later merge with the Northwest AIDS Foundation to form the Lifelong AIDS Alliance, began in 1983 as an informal network to help ill and housebound gay men with basic needs like shopping, cooking, and transportation to medical appointments. Seattle Gay Clinic volunteer, Tim Burak, who later served as Project Coordinator for Public Health’s AIDS Prevention Project, helped found the program and proposed the name.
Listen to Tim Burak remembering the first time he helped someone with AIDS through the Chicken Soup Brigade network.
Poised to Respond
Seattle and King County were comparatively well prepared to face the onset of AIDS.
Research
Seattle’s University of Washington Medical School was known for its research into sexually transmitted diseases. Some Public Health Department doctors were also associated with the medical school. One was Dr. Hunter Handsfield, head of Public Health’s STD program. In 1982 he was already studying a lymph-gland disorder that might relate to AIDS. Already a nationally recognized leader in STD research and prevention, Handsfield helped forge policies and made recommendations to the federal Centers for Disease Control for a national response to the emerging epidemic.
A History of STD Outreach
The Public Health Department had a long history (see right) of treating STDs. STD prevention and treatment programs included outreach to men who had sexual contact with other men.
Still, some saw Public Health’s venereal disease clinic services as punitive in tone and insensitive to privacy needs. In 1982, to better understand and respond to the needs of the gay community, Public Health, with input from volunteers from the Seattle Gay Clinic, formed the STD Advisory Committee, focused on STD’s in gay men. Its membership drew from the Public Health Department, Seattle Gay Clinic, and the Dorian Group, a gay rights organization.
Local Support for Gay Rights and Gay Rights Activism
In some areas of the United States, hostility towards gay people slowed or undercut efforts to address the AIDS epidemic. This was less the case in Seattle. The city had passed civil rights ordinances that prohibited discrimination based on sexual orientation in the 1970s. In 1978, citizens’ Initiative 13 sought to repeal these ordinances as they applied to gay people, but broad coalitions formed, and the measure was defeated at the polls by a margin of two to one. This experience of community members working together for common ends greatly helped Seattle and King County respond to the AIDS epidemic four years later.
To read more about the history of gay rights in the City of Seattle, see the Seattle Municipal Archives exhibit, The Gay Rights Movement and the City of Seattle in the 1970s.
Dr. Robert Wood, AIDS Prevention Project Director (1985-2010) discusses how Public Health was able to work with the University and the community in responding to AIDS. (Oral history interview, August 2015.)
Public Health: A History of Reaching Out to Those in Need
I have to really tip my hat to public health nurses, who are some of the most underappreciated people in the world, who welcomed me into their domain as a gay man, [and] who taught me a whole lot about how to provide quality care to people who were not used to getting quality care.
Tim Burak on working in Public Health’s dental program in the 1970s and 1980s.
More on What made Seattle-King County’s Experience Different
Patricia McInturff, AIDS Prevention Project Division Manager. (Oral history interview, September 2015.)
Gary Goldbaum, AIDS Prevention Project Medical Director (1993). (Oral history interview, August 2015.)
From “Social Disease” to “Love Needs Care”
From before 1890 until 1947, Seattle’s Department of Health and Sanitation was responsible for the control of sexually transmitted diseases in the region. Control techniques included contact tracing, anti-prostitution campaigns, hospitalization, and quarantine (in or out of jails).
World War II introduced new populations and social dynamics into the Seattle area, as well as the use of penicillin as a treatment for sexually transmitted diseases. This led to an enhanced postwar campaign by the newly unified (1947) Seattle-King County Department of Public Health. Intervention was based on education, detection, and treatment.
You might have seen this advertisement on a Seattle Transit bus in the 1940s and 1950s. From “The Road to Health,” 1954. Series 872, King County documents collection.
The department’s Venereal Disease Clinic won national attention with its idea of putting posters in public transit coaches with the message that quick and simple tests were available for VD, as well as quick and simple treatment. Rather than reinforcing the stigma of “social diseases,” post-World War II outreach materials treated the problem in a cheery, scientific manner.
The Department sought to reach a new generation in the psychedelic imagery used to promote “Love Needs Care” outreach events staged during the 1960s.
This April 1982 issue of the Seattle-King County Department of Public Health’s employee newsletter, The Carrier, announced the formation of an STD advisory group for gay men, with representatives from the department’s STD clinic at Harborview Hospital, the Dorian Group, and the Seattle Gay Clinic. Access the full newsletter.
Tim Burak, AIDS Prevention Project Coordinator (1985-1995) and Seattle Gay Clinic volunteer, talks about the Clinic’s relationship with the Public Health Department before AIDS. (Oral history interview, July, 2015.)
New Programs: Working Together
Partnerships and Programs Develop
The Seattle-King County Department of Public Health initially focused on providing accurate information about AIDS through community meetings, press releases, newspaper interviews and recorded telephone information. The Department set up an AIDS information hotline at Public Health’s STD Clinic located at Harborview Hospital in Seattle’s First Hill neighborhood. The hotline was originally staffed by a single volunteer, Will Jones, who would later become a paid employee, training new volunteers as the hotline grew.
1983 poster advertising a community forum on AIDS in King County. Sponsored by the Seattle Counseling Service, the Seattle Gay Clinic, the Northwest AIDS Foundation, and the Gay/Lesbian Student Organization at Seattle Central Community College, the forum featured guests from San Francisco: Bobby Reynolds, a man with AIDS, and Jim Geary of the Shanti Project. Public Health worked closely with such community-based organizations.
It may be hard to remember (or for younger people, to imagine) what communication was like before email and the Internet. The 1983 flyer above advertised recorded AIDS information heard over a telephone hotline.
A Community Partner: The Northwest AIDS Foundation
The Northwest AIDS Foundation was the lead organization in the local community-based response to AIDS. Dr. Robert Wood was an early NWAF Board president.
NWAF was instrumental in helping promulgate Public Health’s prevention messages and strategies. State and local officials, including King County Executive Randy Revelle, Seattle Mayor Charles Royer, and City and County Councilmembers, along with other community leaders, served on NWAF’s Honorary Board of Directors. From the mid 1980s, most public funding of other AIDS service organizations passed through NWAF. NWAF later merged with the Chicken Soup Brigade to become the Lifelong AIDS Alliance.
Emergency Funding for a Surveillance and Education Program
In 1983, the Department proposed an AIDS surveillance and education program to provide assessment, referral, and counseling services; to gather data and contribute to national research; and to provide accurate information to at-risk groups and a fearful public. The plan was developed in collaboration with the Seattle Gay Clinic and included funding for the AIDS hotline and one nurse practitioner.
King County Executive Randy Revelle recognized the need to fund AIDS programs without waiting for the next County budget cycle. He understood the implications of AIDS and its coming storm and supported emergency action, in spite of advice to the contrary from some advisors. Tim Burak, Seattle Gay Clinic volunteer and Seattle King County Department of Public Health employee, spoke at a meeting of the American Public Health Association about community involvement in establishing the AIDS assessment clinic.
Listen to the recording of Burak’s presentation from November 15, 1983:
“In Seattle we really couldn’t wait for help….What we are trying to do is get ready”
Tim Burak, Seattle Gay Clinic volunteer and Seattle King County Department of Public Health employee, spoke at a meeting of the American Public Health Association about community involvement in establishing the AIDS assessment clinic. Above, listen to the recording of Burak’s presentation from November 15, 1983.
The Proposal: The AIDS Surveillance and Education Program
Community activists, organized by the Dorian Group, the Greater Seattle Business Association, and the Seattle Gay Clinic, rallied at City Hall and spoke before the Seattle City Council. Representatives from the Northwest Physicians for Human Rights, the Freedom Socialist Party, the Seattle Mayor’s Office, the Seattle Office of Women’s Rights, and Seattle-King County Department of Public Health, all supported emergency funding. Read the proposal here. (Series 1825.1.10 – History files, Seattle-King County Department of Public Health: Prevention Division / HIV-AIDS Program).
The Gay Community’s Involvement in Creating an AIDS Assessment Project
The proposal would establish a formal partnership between the Department and the Seattle Gay Clinic. Tim Burak described this relationship in this 1983 program summary referred to in his APHA presentation Read the full summary here. (Series 1825.1.10 – History files, Seattle-King County Department of Public Health: Prevention Division / HIV-AIDS Program).
What Is Surveillance?
Sharon Hopkins, AIDS Prevention Project Epidemiologist (1983-1999), explains her work and what surveillance means in a public health context. (Oral history interview, September 2015.)
By August 1, 1983, both the Seattle City Council and the King County Council had passed emergency funding ordinances. Together they became the second local jurisdiction in the United States, after San Francisco, to allocate public funding directly for the fight against AIDS. Read the King County Council Ordinance 6476 allocating funds for the proposed AIDS Surveillance Education Program (Series 305 – Ordinance Files, County Council, 6476).
“There is no test for AIDS.
The AIDS clinic does not diagnose AIDS.
It assesses risks…There is a lot more about AIDS that we don’t know, than there is that we do know. A lot of doctors and nurses have been exposed to AIDS and they don’t know what to do about it any more than we lunks on the street do.”
From “My Trip to the AIDS Clinic,” Seattle Gay News, 1984.
What was it like to visit an assessment clinic in the days before there was an HIV test and when there was no known treatment for AIDS?
First person account published in the Seattle Gay News, September 7, 1984. Read the full article here.
Nurse practitioner Joanne Tilton and Frank Chaffee, posing as a patient for the photo, at the AIDS assessment clinic (circa 1986).
Responding to Fear
Fear Of Contagion
People needed accurate information about their risk of contracting AIDS. While discouraging unfounded fears, Public Health staff responded cautiously, as the disease was just beginning to be understood by the medical community.
Through various approaches—including town hall meetings, communication with local media, brochures, direct correspondence, and the AIDS hotline—the Seattle-King County Department of Public Health sought to educate the general public on the latest scientific understanding of AIDS, serving a critical role as public fear grew.
Ann Downer talks about people’s fears around AIDS in the early years. (Oral history interview, August 2015.)
Privacy and Civil Rights
Fear of AIDS led to discrimination against people suspected of having the disease. There were calls for registration lists and quarantine of individuals suspected of being sick with AIDS. Loss of employment and housing were realistic concerns.
Mistrust
While Public Health worked closely with organizations such as the Seattle Gay Clinic, many in the gay community mistrusted the idea of a “surveillance” program, fearing that patient names might appear on government lists that could be used to discriminate against them based on their sexuality or illness. In 1983, the Department had to reassure the community that Seattle police were not maintaining lists of people with AIDS.
The Media
Public Health leaders worked closely with local media to promote public understanding about AIDS and to discourage sensationalist reporting.
In 1984, Seattle’s public television station, KCTS-TV, produced a Peabody-award-winning documentary program, Diagnosis AIDS, about the Seattle-King County response to AIDS. Some public television stations in other parts of the United States refused to air the program, citing its “controversial” nature.
Local efforts working with the media sometimes met with mixed results. In 1986, only one of three major local television stations would air a public service announcement produced by the Northwest AIDS Foundation and funded by Public Health and the federal Centers for Disease Control.
Hunter Handsfield on appearing in a TV news segment. (Oral history interview, September 2015.)
Patricia McInturff on media relations. (Oral history interview, September 2015.)
The AIDS Prevention Project
Scientific progress: HIV Testing
In 1984, scientists discovered the HIV virus, the cause of AIDS, and developed an experimental antibody test. The test was offered by the AIDS Assessment Clinic and the Seattle Gay Clinic. The Puget Sound Blood Center, in conjunction with the Public Health Department, became a leader in developing blood screening policies.
Controversy around testing
When the HIV test became available, medical treatment was limited. People debated testing’s potential benefits and risks.
Ann Downer, AIDS Prevention Project Health Educator. (Oral history interview, 2015.)
Tim Burak, AIDS Prevention Project Coordinator, discusses community concerns over testing in the early years. (Oral history interview, June 2015.)
Hunter Handsfield, Seattle-King County STD Program Director (1978-2005), on Public Health services to AIDS patients before effective treatment was available. (Oral history interview, August 2015.)
Robert Wood, AIDS Prevention Project Medical Director. (Oral history interview, August 2015.)
Federal funding
The federal Centers for Disease Control (CDC), impressed with both Seattle-King County’s ability to obtain local public funding for AIDS work and its collaboration with community groups, awarded the Public Health Department one of the first AIDS Prevention Demonstration Project Grants in the United States, along with Dallas, Denver, Long Beach and New York.
The grant of $365,000 developed model programs: AIDS education for the general public and prevention and control projects among one of the groups of King County citizens at highest risk: men who had sex with men (by far the largest group.) The grant also provided coordination and support for community-based AIDS services, such as the medical resources program of the Northwest AIDS Foundation. A second CDC grant of $70,000 funded epidemiological work.
The Seattle-King County Department of Public Health had made the decision to assume the lead role in applying for and allocating outside funding for local programs. External funding for surveillance, prevention, public education, and support for persons with AIDS would all come through Public Health, with partner organizations as subcontractors. Public Health’s leadership assured that there were no conflicting proposals nor duplication of services.
The grant allowed the Public Health Department to expand its AIDS Program into a more consolidated and independent unit: the AIDS Prevention Project (APP).
The project originally had a staff of thirteen: a medical director, a project coordinator, an epidemiologist, a health educator, two information/outreach specialists, two nurse-practitioners, two health advisors (counselors), and a front office staff of three.
Photos from the AIDS Prevention Project’s open house at its new location on First Hill at the corner of Summit and Seneca.
Dr. Robert Wood (known affectionately as “Dr. Bob”) was hired as Medical Director for the APP, where he served as until his retirement in 2010. Here he discusses his professional and personal background. (Oral history interview, August 2015.)
Tim Burak talks about finding a location for the program. (Oral history interview, July 2015.)
APP staff formed a close-knit unit. In addition to the daily challenge of assessing, testing, and counseling people who might be diagnosed with AIDS or found to be HIV positive, over the years, some staff members, community partners, and friends would also become ill with AIDS and pass away.
Ann Downer reflects on what it was like working in the APP before treatment was available. (Oral history interview, August 2015.)
A Leader in Research, Education, and Housing
Be a Star
With grant funding, the AIDS Prevention Project (APP) undertook research studies.
One of the first (1986) and largest studies was called “Be a Star.” It was a longitudinal study—a study in which data is collected about the same group of individuals over a span of time. The APP developed a way that the subjects (gay and bisexual men) could participate anonymously.
Anonymity was important for those who were concerned that government agencies might not keep their information confidential and who did not want friends or employers to find out that they identified as gay or that they might be HIV-positive.
Being a Star while remaining anonymous
The APP’s innovative solution to ensuring anonymity was to organize participants into six groups, each named for a “camp” cultural icon.
Every six months the men were reminded through public advertisements that it was time for their assigned “star” group to return to the APP for follow-up interviews and optional HIV testing. With these public notifications, there was no need for APP staff to directly contact participants.
In addition to notification through public advertising, participants received wallet-sized reminder cards like the one shown below to help them remember when to return for their follow-up visit. (Series 1825.2.13 – History files, Seattle-King County Department of Public Health: Prevention Division / HIV-AIDS Program.)
Each participant was also assigned a unique code that APP used to track that individual’s data over time without the records being associated with a name.
By the time the study ended in 1992, 2,676 men had participated. Initial data from the study helped the APP target its programming and improve counseling services. Later data assessed the impact of APP interventions on sexual behavior change.
Personal and Profound
Frank Chaffee describes what it was like counseling patients and interviewing study participants. (Oral history interview, January 2016.)
Wide-Ranging Research
Beyond the Be a Star study, the APP conducted research on an array of topics, many in partnership with the University of Washington, the CDC, and Washington State. By 1988, APP research included blind testing of blood samples at blood banks and hospitals to measure the prevalence of AIDS in the general population; surveys of knowledge and attitudes among students in response to AIDS curricula; research on the cost of AIDS care; validation of the completeness of AIDS case reporting; and studies on the effectiveness of counseling intravenous drug users in prevention methods; among other subjects.
Sharon Hopkins describes research. (Oral history interview, September 2015.)
Education Campaigns
Much work under the Centers for Disease Control grant centered on reducing risk-taking behaviors among high-risk groups through clinical and peer counseling, through testing, and especially through education.
Education was carried out through the telephone hotline; a Speakers’ Bureau to respond to hundreds of community requests for up-to-date AIDS information; flyers and brochures; media spots and advertisements containing risk-reduction messages and news of available services; and model school curriculum materials.
Ask Dr. Bob
One form of targeted education was “Ask Dr. Bob,” an advice column by APP Medical Director Dr. Robert Wood, which appeared in the Seattle Gay News. In the column, Wood responded to readers’ questions about safe sex practices and other AIDS-related issues.
Dr. Robert Wood on the “Ask Dr. Bob” column. (Oral history interview, August 2015).
Education campaigns aimed at the general public sought to help people understand risks, ease unfounded fears, and reduce the stigma around being HIV-positive.
Public Understanding
Education campaigns aimed at the general public sought to help people understand risks, ease unfounded fears, and reduce the stigma around being HIV-positive.
In 1986, the Public Health Department helped support the Northwest AIDS Foundation’s “Please Be Safe” campaign, using a road-sign theme, urging people to practice safer sex.
Ann Downer talks about the general public’s knowledge about AIDS around 1986. (Oral history interview, August 2015.)
Fear and Stigma in the Workplace
AIDS education also happened face-to-face. APP educators visited groups who wanted to learn more about AIDS, including work-sites where employees feared contracting AIDS from their co-workers.
Fighting AIDS discrimination at work
In late 1987, King County Executive Tim Hill issued an executive order, the King County Employee AIDS Protocol, prohibiting discrimination against King County employees with AIDS or the AIDS virus. It also required accommodation for County employees who were ill with AIDS, as was the law for other disabilities.
Work-site visits
Karen Hartfield, describes visiting work sites, including one where an employee had been diagnosed with AIDS. (Oral history interview, July 2015.)
Training for Healthcare Providers
Public Health identified and reached out to private doctors who were willing to accept AIDS patients and provided training on safety precautions and how best to treat unfamiliar AIDS-related illnesses. Public Health also coordinated the sharing of clinical information so that doctors in private practice and those at Harborview (the local public hospital specializing in AIDS treatment), could learn from one another’s observations.
Tim Burak and Dr. Bob Wood on how Public Health worked with the medical community to support quality care for AIDS patients.
Housing
The Northwest AIDS Foundation had approached King County in 1985 to help with housing for people with AIDS. In 1986, the Robert Wood Johnson Foundation awarded King County a planning study grant to look at housing disadvantaged demographic groups, including people with AIDS. Public Health hired local AIDS activist Betsy Lieberman, whose research demonstrated the need to fund specialized residential care facilities for AIDS victims. With the opening of Bailey-Boushay House in 1992, King County became a model in compassionate end-of-life housing and care for AIDS patients.
Listen to stories of people who have lived at Bailey-Boushay House, the first housing facility specially designed for people with AIDS, on the Bailey-Boushay Web site (external link).
What’s in a name? MSM
Starting in the 1980s, the academic and clinical research communities used a collective term to describe one of the principal risk groups: men who have sex with men (MSM; sometimes ngi-MSM or MWM). This term was viewed as more clinically accurate, as it included men who had same-sex partners but did not personally identify as gay. The abbreviations may also have reassured people who were uncomfortable using the word, “gay.” Some gay men, however, objected to the use of “MSM,” saying that it reduced one’s identity to only a sexual act. In Seattle in the 1990s, an MSM Task Force reorganized as the Gay Men’s AIDS Prevention Task Force, or GayMAP
Expanding Outreach
The People of Color Against AIDS Network
The People of Color Against AIDS Network (POCAAN), a Seattle-based, multi-racial community coalition, provided HIV/AIDS education and training aimed at Latino, Black, Asian/Pacific Islander and Native American communities.
King County’s administrative director for AIDS programs, Patricia McInturff (formerly Patricia Canova), saw that the AIDS epidemic would not spare communities of color. She supported POCAAN’s principles and committed the Public Health Department to working closely and often with the group. In one early collaborative project, POCAAN, using seed money from the AIDS Prevention Project, created the 1988 “Famous Last Words” educational campaign to increase awareness of AIDS among people of color.
Patricia McInturff talks about the need to reach communities who had fewer resources and political connections than did gay activist organizations. (Oral history interview, September 2015.)
“POCAAN’s coalition building effort is to bring people together across color, gender, sexual orientation, agency affiliation and community lines. POCAAN provides a forum for dispelling myths and fears, and for enabling people of color to work together in unity….We must confront the effects of the isolation caused by homophobia in communities of color, and by the racism of the gay/lesbian community.”
From POCAAN’s mission statement
Poster and brochures from the “Famous Last Words” series, published by POCAAN with support from Public Health:
AIDS News comic book published by POCAAN in 1988 and the storyboard for the comic:
Karen Hartfield describes how Public Health worked with POCAAN. (Oral history interview, August 2015).
At Risk and Hard to Reach
In 1989 the federal Centers for Disease Control renewed the APP’s original Community Demonstration Project Grant. The grant expanded the program to target hard-to-reach populations, including street youth and sex industry workers. The candid personal stories used by outreach programs such as Street Kids AIDS Training and Education (SKATE) and Girlfriends Talking reflected the reality of people’s lives.
Street Kids AIDS Training & Education
With funding from Public Health, POCAAN produced a series of posters that shared stories from homeless youth learning to adopt condom use and other STD prevention strategies.
People in Danger
Karen Hartfield outlines the groups who were at the highest risk of contracting AIDS and who were the focus of the APP’s outreach and education programs.
Girlfriends Talking
The Girlfriends Talking campaign was directed at African American women who were disproportionately affected by AIDS, including women using drugs or working in the sex industry.
Barriers to AIDS Education
Karen Hartfield, APP Education Team Coordinator and founding board member of POCAAN, describes perceptions about AIDS among African Americans in the mid-1980s, when she directed a sexuality education program for parents and their children for the Seattle Urban League. (Oral history interview, August 2015.)
Robert Wood posits that gay stigma prevents some members of minority communities from obtaining early HIV testing and treatment today. (Oral history interview, August 2015.)
Outreach to Latinos and Native Americans
Public Health also supported POCAAN campaigns oriented toward the Latino and Native American communities. The posters below were published in partnership with the Seattle Indian Health Board, the Coalition of Latinos in Washington against AIDS, and the Northwest AIDS Foundation and Planned Parenthood.
Needle Exchanges
Sharing Needles
By 1991, injection drug users accounted for over 25 percent of AIDS cases nationwide. The figure was far lower in King County: three percent, with another nine percent among gay or bisexual men who were also injection drug users.
But with an estimated 12,000 to 14,000 intravenous drug users in King County, over 80 percent of whom shared needles, the risk of AIDS spreading in this community was great. Sharing needles put not only users at risk, but it also risked infecting their sexual partners, as well as the fetuses of pregnant partners.
The Public Health Department’s first strategy was educating users about the risks and distributing bleach to sterilize needles.
Successful Needle Exchanges Abroad and At Home
Needle exchanges originated in Europe, Canada, and Australia around 1984 as a means to minimize the risk of HIV and Hepatitis B transmission among people unable or unwilling to cease injection drug use. New sterile syringes were exchanged for old contaminated ones. Needle sharing and reuse were more likely in states like Washington, where state law prevented the purchase of syringes without a prescription. In the United States, the first publicly funded needle exchange was established in Tacoma in 1988.
Patricia McInturff discusses how she encountered opposition from a colleague and the public, as well as support for needle exchanges from King County Executive Tim Hill and County Councilmember Greg Nickels. (Oral history interview, September 2015.)
Harm Reduction
The idea of distributing free syringes was seen by some as encouraging drug use. But the harm reduction approach to public health argued that even when a person’s behavior (in this case, drug use) doesn’t change, the harmful impact of that behavior could, and should, be minimized. Reducing the harm of contracting HIV and spreading it to others took priority over demanding abstinence.
Gary Goldbaum on how AIDS helped the medical community begin to accept the concept of harm reduction. (Oral history interview, August 2015.)
Seattle’s first needle exchange
Seattle’s own needle exchange began in March 1989, operated by the local branch of the AIDS Coalition to Unleash Power (ACT UP).
Stressing the benefits of public oversight, the Public Health Department successfully took over the program from ACT UP two months later and launched the new program with existing city and county funding. It was to be a two‐year pilot program subject to review and evaluation. The program also included referrals to drug treatment and social and health services and distribution of condoms and bleach.
King County and the City of Seattle, convinced that the program was effective and had not led to an increase in drug use, continued funding the program and have done so to the present day. Seven years later, the Public Health Department could claim that its needle exchange program was “probably the largest legal program in the country” (Dr. Robert Wood, 1996), exchanging over a million needles in that year.
What is ACT UP?
A grassroots activist group, ACT UP formed in Manhattan in 1987 to draw attention to the AIDS epidemic and to help improve the lives of people with AIDS. From its beginnings, ACT UP used politically savvy demonstrations and civil disobedience to critique the roles of homophobia, racism, sexism, and capitalism in what they saw as an indifferent and flawed national response to the AIDS epidemic.
Robert Wood talks about the needle exchange. (Oral history interview, August 2015.)
The AIDS Omnibus Act: New Mandates
In March 1988, Washington State Governor Booth Gardner signed into law the AIDS Omnibus Act. Because of its sweeping scope, public health orientation, substantial civil rights protection, and statewide approach to providing AIDS care services, the Act was considered the most comprehensive and progressive statewide approach to AIDS policy in the United States at the time. It served as a model for legislation in other states.
Expanding Education: Condoms in Schools
The AIDS Omnibus Act required AIDS education in public schools for grades 5 through 12. The Seattle-King County Department of Public Health, which had supported outreach programs to schools since the mid-1980s, now undertook new initiatives.
In 1995, student focus groups at West Seattle High School provided feedback on this pamphlet, “You Are Not Alone.” As a result, Public Health decided to make several changes, including removing the image of the hairy palm in the upper left, because the focus group did not understand the reference.
The AIDS Omnibus Act required school curricula to focus on “the dangers of sexual intercourse, with or without condoms” and to promote abstinence, while also providing accurate information on AIDS prevention. When Washington State’s Advisory Council on HIV/AIDS recommended that condom use be included in AIDS education, the Department found itself in the middle of a public debate.
Educational programs and materials provided detailed information to promote accurate understanding of condom use and STD prevention. Many saw these campaigns as encouraging teen sex. Some objected to teaching condom use in schools with the argument that condoms were ineffective in preventing HIV infection. The Department challenged this view with a report distributed throughout the Seattle School District in 1992. Read the report.
“Concerned Grandparents, Parents, and Teens” of Kirkland, Washington, produced this brochure objecting to the education program prior to public meetings that were required under the Act. Parents had the choice to opt out of AIDS education for their children.
Cover of a brochure produced with input from the West Seattle High School student focus group in 1995.
Cover of brochure (art by Keith Haring) that was independently distributed, along with condoms, at Seattle area schools in 1992 by the local youth caucus of ACT UP.
Controlling HIV while protecting civil rights
Discrimination due to the stigma of being HIV-positive was so potentially damaging that lawmakers saw the need to change long-standing public health policies. With other diseases, there had been less concern for protecting patient privacy. Practices such as reporting names to local and state health offices, forced testing, and notifying partners of an infected individual were standard.
From the beginning of its response to AIDS, the Seattle-King County Department of Public Health had held firm that protecting patients’ privacy was critical to an effective program. They argued that if people trusted the Department and its community partners, they would be more likely to get tested and engage in prevention efforts.
The AIDS Omnibus Act created standard, statewide rules in an effort to balance civil rights and patient privacy with public health and safety. In practice, implementation could still prove challenging.
Gary Goldbaum on how AIDS and the AIDS Omnibus Act changed public health practices. (Oral history interview, August 2015.)
Frank Chaffee served as the Public Health Official who screened cases where mandatory testing or partner notification might be required. (Oral history interview, October 2015.)
The Steven Farmer Case
In 1987, the King County Prosecuting Attorney’s Office charged Seattle resident Steven Farmer with felony exploitation of a minor for taking inappropriate photographs of teenage male prostitutes. (The subjects were 16 and 17—the age of sexual consent in Washington State. The state’s exploitation law, however, protects individuals under 18.) The photos had been seized in what was found to be an illegal search, causing the charges to be reduced to a misdemeanor in a plea bargain.
After receiving a tip and corroboration from Farmer’s acquaintances that Farmer had told them he was HIV-positive, prosecutors sought to increase his sentence, accusing him of deliberate endangerment. Farmer denied he was HIV-positive.
Amidst an increasing public outcry, the court ordered that Farmer be tested for the virus without his consent. The results (positive) were presented in open court by the head of the Public Health Department’s STD Program, Dr. Hunter Handsfield, who appeared at the request of the presiding judge.
The test in question was not performed by Seattle-King County Public Health nor by the AIDS Prevention Project. But the court-ordered disclosure of Farmer’s HIV status by a Public Health official caused people to question whether the Department was protecting patient confidentiality. APP staff worked to rebuild trust and reassure critics that case records were indeed maintained in confidence.
The State Supreme Court later found that the judge had acted outside his authority. In 1994, when he was dying of AIDS in jail, Farmer was granted clemency by Governor Mike Lowry.
The case highlighted legal and civil rights questions around forced testing, rules for which were set out in the AIDS Omnibus ACT. The prosecution was seen by some as deliberately targeting Farmer amidst a wave of anti-gay/AIDS hysteria, with media coverage stoking the public’s fear. Prosecutors held that the case was about protecting vulnerable minors from sexual exploitation and endangerment.
Seattle Gay News piece on the Farmer case, published June 22, 1990, in anticipation of the State Supreme Court ruling. Series 1342 – Issue Files, History files, Seattle-King County Department of Public Health: Prevention Division / HIV-AIDS Program. [1342-1, 1342-6]
A Prosecutor’s Perspective
“There was a real mix of reactions back at that time, obviously illustrated by the fact that the judge had to be escorted out of the courthouse. ….there was a real public health concern and there was a real concern for these kids. They’re vulnerable, they live on the street, they don’t have any support system. You know, when we look at human trafficking issues today – when I look back at that time, at those boys, they didn’t really have anything or anybody. So part of the concern was making sure they’re protected in all respects, not just from HIV but from sexual assault or any kind of exploitation. We didn’t have the kind of mindset back then…the sensitivity that we have today. I think our office had that, but I don’t know if it was as widespread as it is today, where we embrace our vulnerable and try to make sure that they’re protected. ….it was an important moment in history and it was one where you had concerns about public safety…where a judge found there should be a test compelled. Of course our system works when it goes all the way to the Supreme Court and they can say yea or nay, and they said that was exceeding authority. The thing is, our laws are always changed through the courts…. Our courts really have to handle some of these social, impactful issues. I think we had the first Special Assault Unit in the country in Seattle, and we had a long-term prosecutor that was extremely fair and principled, so if a case is to be tested anywhere on that issue, I think King County would be one of the best places, if not the best…to deal with the issue.”
Anne Bremner, Prosecutor in the Special Assault Unit of the King County Prosecuting Attorney’s Office 1983-1988. Bremner prosecuted the initial case against Farmer. (Anne Bremner. Oral history interview, October 2015.)
A Softer Approach
Some felt that public health agencies should take a more aggressive approach to testing, tracing contacts, notifying partners, and reporting HIV infections. The Seattle King County Department of Public Health argued that a softer touch worked better to keep people engaged and to fight HIV’s spread.
Gary Goldbaum explains why Public Health chose not to pursue shutting down bath houses. (Oral history interview, August 2015.)
Hunter Handsfield argues that a heavy-handed approach to HIV testing would have worked against the goal of containing the epidemic. (Oral history, September 2015.)
Frank Chaffee describes how AIDS activism challenged the medical profession to treat people more humanely. (Oral history interview, January 2016.)
Read the draft of the article, “The Partner Notification Field Visit: The Real True Story,” by Frank Chaffee, describing what partner notification was really like. The article was published in the APP’s staff newsletter, The House Organ. From Series 1861 – Subject files, Seattle-King County Department of Public Health: Prevention Division / HIV-AIDS Program. [1861-1-5].
Read the order requiring Medical Examination and Counseling, used in cases where an individual appeared to placing others at risk of contracting HIV. From Series 1861 – Subject files, Seattle-King County Department of Public Health: Prevention Division / HIV-AIDS Program. [1861-3-26]
Frank Chaffee describes enforcing the AIDS Omnibus Act in cases where a person is knowingly putting others at risk of contracting HIV:
(Oral history interview, January 2016.)
Leadership and Recognition
Patricia McInturff led the Department’s response to AIDS as Section Administrator and then Regional Division Director for the Seattle-King County Department of Public Health from 1982 to 1994. She influenced state and national health policy, such as through her service as co-chair of the Ryan White Title I Council and as a member of the National Advisory Committee on HIV/AIDS for the CDC.
In 1992, McInturff was awarded the first Washington State Governor’s AIDS Service Award for Public Service for her work as Regional Division Director. In 1994, she was awarded the Municipal League of King County’s Public Employee of the Year.
Safer Sex: The New Normal?
A Second Wave of Infections
Ten years into the AIDS epidemic, there was still no cure for AIDS. But new drugs showed promise against AIDS-related diseases. Some, thinking that “AIDS could be treated,” began to abandon safer-sex practices. The HIV infection rate began to climb.
The Public Health Department responded with new outreach efforts, stressing the need to continue practicing safer sex and encouraging condom use. More edgy and explicit materials were designed to catch people’s attention and were narrowly distributed to predominantly gay venues.
Dr. Bob on the Resurgence of HIV Infections
How Do You Help People Change?
Frank Chaffee describes the reaction he received distributing condoms before condom use was widely accepted. (Oral history interview, January 2016.)
Gary Goldbaum discusses how APP research has informed Public Health efforts at changing people’s behavior. (Oral history interview, August 2015.)
Karen Hartfield explains the current understanding of how people’s beliefs affect their ability to change. (Oral history interview, July 2015.)
The Condom Campaign
In 1994 and 1995, Public Health promoted condom use to the general public through a series of signs appearing on Metro buses.
(Series 1825.6.20 – History files, Seattle-King County Department of Public Health: Prevention Division / HIV-AIDS Program.)
Public Standards and the Smut Committee
Standards around what content was considered appropriate for the public (what was “decent”) changed over time. In the 1980s, grant-funded outreach and educational materials had to be vetted by the CDC for approval or censorship. Later, the APP was allowed to form its own review committee, informally referred to as the Smut Committee. Members included health educators, medical professionals, and the media. The APP gradually became freer to create attention-getting content that resonated with at-risk groups. Public Health sought to strike a balance: creating materials that were engaging and accurate, while not crossing over into what might be seen as indecency. The most explicit materials were not designed for the general public and were placed in targeted venues such as gay bars or bath houses.
Tim Burak tells how the committee was formed and discusses how standards have changed. (Oral history interview, July 2015.)
The Power of the Word
An award-winning poster designed by the ad firm Cole & Weber (at no charge to Public Health) was intended for a gay male audience, but it drew so much attention that Playboy Magazine asked permission to feature it in its Forum section. Public Health expressed concern that publication outside the intended arena (Seattle’s Gay Pride Parade) might jeopardize the program and would serve no legitimate public health purpose. Playboy editors chose to feature the poster regardless, with a jab at local politics.
Stella Seattle
One prominent campaign from this period was Stella Seattle, a serial comic about a health educator and his friends, illustrated by Dominic Cappello using the pen name Paul Hornby. The single-panel comics were printed on postcards placed in gay bars and bathhouses and were published in gay newspapers. Stella Seattle also had a 1995 calendar, mugs, T-shirts, magnets, posters, and, at the end of its run, a comic book with all of the episodes.
A Stella Seattle telephone hotline helped the APP evaluate the effectiveness of Stella Seattle’s messages. Readers were invited to respond to a question posed by each comic, like “Do you talk about HIV before having sex?” The comic’s production staff would use this feedback to help guide future Stella Seattle topics and story lines.
Well-received by the gay community and considered effective as an HIV prevention and education campaign, Stella Seattle also faced critics. When it first appeared in 1994, the Stella Seattle hotline was jammed with hostile calls.
OutLOUD
Public Health collaborated with the Asian Pacific AIDS Council, Entre Hermanos, the Northwest AIDS Foundation, POCAAN, and YouthCare for the OutLOUD campaign (1994-1996). Outreach materials in the form of tabloids, ‘zines, and trading cards told true stories to provide real-life role models for safer-sex practices.
The Legacy
New Medication: A Sea of Change
In 1994, researchers reported that the medication AZT was found to decrease the chance that babies of HIV-infected women would be born HIV-infected. Testing and treatment for pregnant women were quickly adopted. The new medications were also found to be effective in slowing or preventing AIDS-related illness in HIV-positive individuals. At first, treatment was provided to those who were close to becoming ill with AIDS. Then, from 2009, increasingly earlier treatment proved to be more effective in preventing illness, and, more recently, antiretroviral medications have been found to be effective in preventing new HIV infections.
The availability of effective treatment changed people’s views on testing, partner notification, and HIV case reporting, as early knowledge of one’s HIV-status could prove life-saving. No longer a death sentence, HIV came to be regarded with less stigma and fear. A negative impact of this change was that some people began to abandon safer-sex practices, leading to an increased incidence of other STD’s, in response to which Public Health renewed its education and prevention efforts.
AIDS: No Longer a Death Sentence
The Epidemic Peaks
1996 was the first year the CDC reported a national decline in AIDS deaths, attributed both to new medications and a slowing of the epidemic and new cases of HIV.
In the third quarter of 1996, Dr. Robert Wood, looking back at the first ten years of AIDS control, announced in the state’s HIV/AIDS Quarterly Epidemiology Report “the first (and very welcome) news that the local AIDS epidemic has reached a peak.”
But, continued Dr. Wood, it was no time to slacken efforts. People were still becoming sick and dying. Continued and increased support for prevention programs was needed, including “clear and explicit communications about the behaviors which presented risks, and [about] realistic steps to maintain safety…. Our youth are at greatest risk….”
“I think it has been beneficial for society to have had to struggle with a very serious disease for which there is yet no cure or preventative vaccine. [Instead of relying on medicines], HIV control has had to rely on…behavior change, targeting socially disparate and disadvantaged communities.
“More frighteningly than many diseases, HIV has also highlighted for us the tight interconnections between diseases and social factors like poverty, homelessness, stigmatization, discrimination, and lack of fully effective sex and drug education.
Dr. Robert Wood, 1996
HIV Today in Seattle and King County
By 2015, HIV infection rates had dropped by one-third nationwide. Most of that decline occurred among heterosexuals and injection drug users. On the national level, the infection rate among men who had sex with men remained the same.
But, in contrast to other areas of the country, Seattle-King County showed a decline in HIV among gay men.
In a July 2014 radio interview, Dr. Matthew Golden, director of the Public Health Department’s combined HIV/STD program, credited several historical factors contributing to the department’s comparative success in combating AIDS:
- Better funding for HIV/AIDS prevention and care in Washington State and King County than na
- Excellent collaboration with engaged community groups to bring AIDS prevention messages to groups at risk, particularly gay men
- A demographic that did not disproportionately include injection drug users
- An efficient public health system
AIDS is not History
Public Health continues to fight HIV/AIDS today. Between 1996 and March 31, 2016, over 2,000 people in King County died of AIDS. And, in the past five years, over 1,200 people have been newly diagnosed as HIV-positive.
(Source: Public Health Seattle/King County HIV/AIDS Quarterly Surveillance Report, through March 31, 2016).
Looking Back
The AIDS epidemic has had a lasting impact on the nation, on the region, and on individuals. In the following clips from the oral histories, interviewees reflect on the epidemic and the AIDS Prevention Project.
Heady Times and Sad Times
Patricia McInturff: creating something from scratch.
LGBT Rights
Robert Wood and Tim Burak on how AIDS (and the response to AIDS) led to greater acceptance of LGBT individuals.
Behavior Change and Outreach
Karen Hartfield: bringing the concept of behavior change into the public health, and community-oriented outreach.
Changes in Medical Practice
Gary Goldbaum: how AIDS activism led to changes in public health and medicine, such as accelerated drug testing and trials.
Personal Impact
Sharon Hopkins: the personal impact of working for the AIDS Prevention Project.
Grassroots Fundraising
Robert Wood: AIDS Walks as a model for grassroots fundraising campaigns for other diseases and issues.
Stigma and Quality Care
Gary Goldbaum: how AIDS made us recognize the potential impact of stigma around a disease, and the need for sustained resources to ensure that those in need receive quality care.
The Ground Shifted
Ann Downer: everything changed with AIDS.
Gallery
1940s-1970s: Public Health VD Programs
Early 1980s: AIDS Emerges, Early Outreach and Education
1986-1990: The “Be a Star” Study
1987: Seattle Pride
1988-1990: Seattle Pride
Late 1980s: Outreach to Intravenous Drug Users and the Needle Exchange
The 1990s: People of Color Against AIDS Network (POCAAN)
Famous Last Words
Girlfriends Talking
Street Kids AIDS Training and Education (SKATE)
The Condom Campaign
Stella Seattle
OutLOUD
AIDS Prevention Project Staff
Oral Histories
Interviewed by Michael Brown July 7, 2015, for the King County Archives’ oral history project on the Seattle-King County Department of Public Health’s early response to the HIV-AIDS epidemic.
References and Resources
Records of the Seattle-King County Department of Public Health: Prevention Division / HIV/AIDS Program
Records of the Seattle-King County Department of Public Health: Prevention Division / HIV/AIDS Program
Series 458 – Organizations files 1985-1998
Series 459 – Legislative files 1987-1998
Series 460 – Grant files 1985-2000
Series 462 – Project files 1985-1998
Series 463 – Correspondence files 1986-1997
Series 464 – Departmental files 1986-1997
Series 1770 – HIV/AIDS epidemiological report 1983-2009
Series 1825 – History files 1979-2012
Series 1843 – HIV/AIDS epidemiology profile for community planning, 1996-2008
Series 1861 – Subject files 1986-2010
Note: Access to research data is restricted under HIPAA and Washington State privacy laws.
Accession A15-053: Dr. Robert Wood subject/issue files ( -1996); Brief Street Intercept 1992-1994, Seattle HIV/AIDS Planning Council 1998-2002; Wave #11 (Women, Youth, MSM) 1994
Accession A16-029: Research study materials
Records of the Seattle-King County Department of Public Health: Alcoholism and Substance Abuse Services Division
Records of the Seattle-King County Department of Public Health: Director’s Office
Records of the Seattle-King County Department of Public Health: Regional Division
Accession 09-022. Division Director’s issue files 1985-1993
Records of the King County Council
Records of King County Executive Tim Hill
Seattle Municipal Archives holdings
Funding and policy control over the Seattle-King County Department of Public Health (now Public Health Seattle & King County) is shared by King County and the City of Seattle. provides access to historical records of the City’s executive and legislative branches. Records relating to City oversight of and involvement in the local response to HIV/AIDS during the period covered by this exhibit may be found in the records of Seattle Mayor Charles Royer, Seattle Mayor Norm Rice, and the Seattle City Council. To learn about the history of gay rights in the City of Seattle, see the Seattle Municipal Archives’ digital document library The Gay Rights Movement and the City of Seattle during the 1970s .
The HIV/AIDS Timeline
The AIDS Prevention Project staff maintained a timeline of local and national events relating to HIV and AIDS through the year 2010: The HIV/AIDS Epidemic in King County: A Timeline of Significant Events.
Acknowledgements
Oral history interviews with former and current employees of the Seattle-King County Department of Public Health were produced with support from a 4Culture Heritage Project Grant funded by the 4Culture/King County Lodging Tax Fund.
We are grateful to all who shared their stories for the oral history project. Thanks to Michael Brown, Lawrence Knopp, and David Reyes—volunteers with the Northwest Lesbian and Gay History Museum Project—who generously donated their time planning for and conducting the oral history interviews. Thanks also to King County videographers Tim O’Leary and Judi Chapman for recording the interviews. Professional transcription services were provided by Jackson Street Associates.
A special thank-yous to Archives staff and volunteers: to King County Archives volunteer Kimberly Mann for her work processing the archival collection, researching, writing, and scanning materials for this exhibit, and planning and applying for grant funding of the HIV/AIDS Oral History Project; to King County Assistant Archivist Rebecca Pixler for her work arranging, processing, and describing the collection; researching and writing for the exhibit and interviews; and for her leadership in pulling together and helping guide the oral history team; and to former Assistant Archivist Amy Holloway who processed the records of Dr. Bob Wood.
Finally, sincere thanks to Tim Burak, Patricia McInturff, Hunter Handsfield, and Dr. Bob Wood for reviewing the site and providing critical feedback and helpful suggestions.
Original editing and Web Design and development by former County Archivist Carol Shenk. Web migration to King County Archives website by Emily Cabaniss and Jen Peters. This exhibit was moved to King County’s Bytes and Boxes site in 2023.