In the spring of 1981, exhausted after spending several years participating in the San Francisco gay rights movement, Stan Hadden headed for Sacramento, intent on pursuing a career as an information technology (IT) consultant. A few months later, Hadden secured his first lucrative contract when David Roberti, the president of the California senate, hired him to install a new computer system. As he worked on this contract, Hadden learned that a new and deadly disease—Acquired Immune Deficiency Syndrome (AIDS)—was moving through San Francisco’s urban gay community. Horrified by reports of his old friends succumbing to this terrible illness, Hadden swiftly brought the epidemic to Roberti’s attention, imploring him to introduce legislation to curb its spread. Much to Hadden’s surprise, Roberti responded by offering to recruit him as a full-time legislative assistant specializing in AIDS. After a few weeks of deliberation, Hadden accepted Roberti’s offer, abandoning his plans to pursue a career in IT.Footnote 1 Embracing this serendipitous opportunity, he quickly emerged as a policy expert and would craft some of California’s most important AIDS-related bills. Hadden’s star continued to rise throughout the mid to late 1980s, and he soon achieved notable prominence for a legislative staffer; he was so influential in shaping California’s response to the epidemic that the Sacramento press lionized him as an “AIDS Tsar.”Footnote 2
By excavating the career arcs of individuals such as Hadden, this article traces the history of a nascent gay policy network that emerged in California at the height of the AIDS crisis. It spotlights a small but prominent group of gay men and lesbians who—like Hadden in the vignette above—moved to Sacramento early in the epidemic, determined to build careers as legislative staffers. Personal experiences of the AIDS epidemic sharpened their sense of urgency as they lobbied state legislators for a more robust response to the crisis. Hoping to solidify their relationship with the gay movement, Democratic and Republican lawmakers alike turned to these gay activists for their personal connections and expertise, hiring them as office assistants, policy consultants, and community liaisons. Backed by a bipartisan group of politicians—including the Speaker of the Assembly and the President of the Senate—gay appointees gained unprecedented influence in Sacramento during the 1980s, propelling the Golden State toward the most far-reaching government response to AIDS in the United States.Footnote 3 Legislative debates over antibody testing, biomedical research, and prevention education provided a rich opportunity for gay activists to assert their political clout, forge alliances with powerful lawmakers, and gain a seat at the policy-making table. California spent more than any other state on AIDS during the mid-1980s, including New York, the epicenter of the disease.Footnote 4 In fiscal year 1986, only Massachusetts appropriated more funds per AIDS case than California.Footnote 5 Through the 1980s, California acted as a crucible for the enactment of experimental policies, such as early intervention programs, home care services for People with AIDS (PWAS), and funding for an AIDS vaccine.Footnote 6
An examination of California’s nascent gay policy network complicates existing scholarship on the relationship between AIDS and the state. Although scholarship on AIDS has flourished over the last decade, the resulting literature captures only a sliver of the subnational policy response to the crisis and typically overlooks the complex role played by state governments. For all the ink spilled on the U.S. epidemic, most histories—apart from a few narrow case studies—ignore the arena of state politics and policy making altogether.Footnote 7 By contrast, a rich and voluminous body of work exists on the early history of AIDS activism, and its intersections with, among other things, gay liberation, radical politics, and the “long civil rights movement.”Footnote 8 Other historians, meanwhile, have explored how the search for the first infected case of AIDS, popularly known as “patient zero,” dovetailed with and reinforced homophobic responses to the disease.Footnote 9 Another constellation of historians has focused on the cultural production of Black gay artists—such as David Frechette, Essex Hemphill, and Assotto Saint—who confronted AIDS in the 1980s.Footnote 10 Together, these studies have filled an inexplicable lacuna in the historiography of the 1980s, finally giving the AIDS crisis the attention it merits.
Yet this sizeable body of literature gives short shrift to the critical role of state policy during the epidemic’s early years. Equating the U.S. government with the federal government, many historians have framed the legislative and policy response to AIDS around national political developments, leaving unexamined and unexplained the flurry of HIV-specific laws passed by the states. Much discussion has centered on the various policy divisions within the Reagan administration, the conservative backlash against federal funding for prevention education, and the lack of an effective national approach to the disease.Footnote 11 This focus on federal inaction and indifference is not so much incorrect as incomplete. As this article makes clear, the national focus of current scholarship neglects, perhaps even obscures, critical aspects of state politics and policy that shaped the initial response to AIDS. Though government action on the epidemic was uneven and diffuse, state lawmakers still crafted the majority of HIV-specific laws: between 1983 and 1987, they passed over 180 measures related to the epidemic, whereas Congress enacted its first significant piece of legislation in 1988.Footnote 12 What is more, the states outpaced the national government on non-Medicaid-related AIDS health care expenditure well into the late 1980s.Footnote 13 Meanwhile, traditional containment public health strategies—such as quarantine, isolation, and disease surveillance—remained largely within the legal purview of the states.Footnote 14
By introducing the much-neglected “middle tier” of American government into accounts of the AIDS epidemic, this article expands historical understanding of the diffuse and uneven nature of public health governance.Footnote 15 Anchored in a case study of California, it argues that no conception of the U.S. government’s response to AIDS is complete without “bringing the states back in.”Footnote 16 If we shift our attention away from the Reagan administration and toward the states, the scale and complexity of the government’s interaction with the epidemic becomes clear. Through the 1980s, state action on the epidemic ran the gamut from the proactive approach of California, which centered on patient confidentiality and individual rights, to the coercive response of Texas, which focused on the disease’s perceived threat to the heterosexual population. Between these two poles, states as diverse as Florida, Georgia, and New York enacted an array of AIDS-related legislation that ranged from extremely punitive to mildly progressive.Footnote 17 There is no neat or easy way to characterize such a wide-ranging policy response to AIDS; rather, it was fragmented, uneven, and diffuse.
Finally, the history of AIDS policy making in California casts new light on the contradictory role of the “closet” in the modern gay rights movement.Footnote 18 Although gay policy makers could rely on powerful advocates in the California legislature, the state bureaucracy often lacked the dedication needed to implement key pieces of AIDS legislation. Repeatedly, state health officials declined to collaborate with gay legislative assistants and dragged their feet over the distribution of funding for new AIDS programs. To push back against this recalcitrance, gay policy makers built a clandestine network of “closeted” bureaucrats, using it to ferret out homophobic-fueled obstructionism in the state civil service.Footnote 19 In a somewhat paradoxical fashion, they privately used the closet as a tool to undermine homophobic parts of the state bureaucracy but publicly asserted that “coming out” was critical to increasing the gay movement’s political clout. While institutional homophobia forced many state employees to hide their identities in the workplace, the closet provided gay legislative assistants with a weapon to fight the civil service’s obstructionism. This article thus highlights not only the intergovernmental dynamics that shaped the initial response to AIDS but also the strategies used by gay activists to gain influence at the state level.
Gay Policy Making in Sacramento
The 1970s saw gay rights activists make their first significant inroads into state politics in California. In December 1974, George Raya, Sacramento’s first full-time LGBT lobbyist, successfully pressured the legislature to repeal the state sodomy statute.Footnote 20 Four years later, activists confronted Proposition 6, the nation’s first statewide referendum on gay rights, which would have banned openly gay individuals from teaching in public schools. After a bitter and fierce campaign, and after intense mobilization among gay men and lesbians, California voters overwhelmingly rejected the initiative, by a margin of nearly two to one.Footnote 21 As gay men and lesbians slowly emerged as a legitimate constituency in statewide politics, they blazed ahead with campaigns to broaden legal protections for sexual minorities, including a decades-long push to add sexual orientation to the state’s antidiscrimination laws. This effort, however, failed in the 1970s, and activists were more effective at defeating antigay legislation than securing new civil rights.Footnote 22
The AIDS epidemic further spurred the movement of gay activists into statewide politics. As early as 1983, Steve Morin, a gay psychologist based in San Francisco, worked with state representative Willie Brown to secure the first state funding for AIDS. Later reflecting on the episode, Morin recalled that “on one of my early trips to the state capital … I was joined by Gary Walsh, a friend and psychiatric social worker who had been diagnosed with [Kaposi’s Sarcoma] in December 1982. We discovered in Sacramento that the legislature knew very little about AIDS … Gary would often engage the legislators, look them straight in the eye, roll up his shirtsleeve, and show a KS lesion. It was very difficult to ignore him.”Footnote 23 The legislature’s response to this sustained lobbying effort was threefold: first, it appropriated nearly US$3 million for AIDS research; second, it directed the state Health Department to dedicate more resources to fighting the epidemic; and finally, it established the California AIDS Advisory Committee to provide lawmakers with technical advice on the disease.Footnote 24
As the AIDS crisis unfolded, an influential group of state lawmakers played a pivotal role in formulating a proactive policy response, often relying on their preexisting ties with the gay movement and a coterie of newly employed gay legislative staffers. Having established a close relationship with his gay constituents in the 1970s, Roberti, whose senate seat encompassed the gay urban enclave of West Hollywood, hired Hadden in 1982 to signal his commitment to tackling the disease.Footnote 25 Hadden quickly emerged as a pivotal figure in California’s response to the AIDS crisis. He was affable, forthright, and pragmatic, burnishing a well-deserved reputation as the AIDS Tsar of California.Footnote 26 By 1987, his monthly AIDS newsletter had 25,000 subscribers, and his correspondence reached beyond California to activists in Texas, Illinois, and New York.Footnote 27 Exercising a significant degree of autonomy, Hadden crafted a large portion of California’s early AIDS legislation, including Senate Bill 1251 (SB 1215), a 1985 act that expanded the state budget for prevention education by US$11 million.Footnote 28 Passed by an overwhelming bipartisan majority in both the Assembly and Senate, SB 1215 cemented the state’s leading role in the fight against AIDS: in fiscal year 1985, California accounted for nearly fifty percent of total state spending on the epidemic.Footnote 29
Other state lawmakers also responded to the epidemic by hiring gay legislative assistants. In 1984, state representative Art Agnos, a longtime ally of the San Francisco gay community, hired Larry Bush, a nationally renowned gay journalist, as a speechwriter and political aide. As the Washington D.C. correspondent for The Advocate in the late 1970s, Bush was the first openly gay reporter to obtain press accreditation from the White House.Footnote 30 In 1985, he cowrote Assembly Bill 403 (AB 403), a landmark measure that provided confidentiality protections for those undertaking the AIDS antibody test. The first bill of its kind, it became the model for similar legislation in Florida, Massachusetts, New York, and Wisconsin.Footnote 31
While Democrats stood at the forefront of these efforts to hire gay legislative assistants, the emergence of California’s gay policy network transcended the left–right binary of electoral politics. Equating gay rights with radicalism, historians have generally viewed “gay” and “Republican” as mutually exclusive categories. Yet, as the historian Clayton Howard has recently observed, Republicans played an outsized role in the gay rights movement during the late twentieth century, despite their numbers remaining small.Footnote 32 Even as the intensity of disputes over gender, morality, and sexuality captivated a growing segment of the GOP, not all gay rights organizing sprang from the Democratic Party or the Left. One Republican willing to collaborate with gay men and lesbians was Governor George Deukmejian. Renowned for his low-key style, Deukmejian’s brand of politics emphasized management and procedure over ideology and specific policy goals.Footnote 33 His governorship, from 1982 to 1990, witnessed an unprecedented expansion of California’s penal system, along with cutbacks to welfare, education, and Medicaid.Footnote 34 He was a staunch supporter of the state’s nascent antitax movement, a prominent advocate of “law and order” politics, and an unabashed fiscal conservative.Footnote 35 Upon entering office in 1982, Deukmejian promised to pinch government spending, reduce crime, and stave off tax increases.Footnote 36 One reporter writing in August 1983 explained that “as governor, Reagan promised ‘to cut, squeeze, and trim.’ But he was never as successful in two terms as Deukmejian has been in half a year of a first term.”Footnote 37 Deukmejian signaled, at least rhetorically, a commitment to addressing the AIDS epidemic, but discrepancies between rhetoric and action were a hallmark of his handling of the crisis.
Gay Republicans secured an important victory in 1983, when Deukmejian appointed Bruce Decker, an openly gay political consultant, to chair the California AIDS Advisory Committee.Footnote 38 Coming from a renowned and respected Republican family, Decker was a natural fit for Deukmejian’s brand of conservatism and had assisted the Governor during his 1982 election campaign.Footnote 39 Hoping to turn the GOP into a viable front in the battle for gay rights, Decker established Concerned Americans for Individual Rights in 1984, a political organization formed of “moderate to conservative Gays and Lesbians,” uneasy with the influence of “the Religious Right … on the Reagan Administration and the Republican Party.”Footnote 40 At the group’s inaugural meeting, he declared that “Gays and Lesbians are direct beneficiaries of the Reagan Administration… . Only under a limited and frugal government, a market economy, and a social structure based on free and voluntary association can we as Gay and Lesbian Americans fully be ourselves and realize our potential.”Footnote 41 The values and objectives of Reaganite conservatism resonated with Decker, who championed fiscally conservative AIDS policies like tax credits for corporate funding of biomedical research.Footnote 42 He aggressively supported measures that bolstered the individual rights of PWAS but balked at any hint of aggressive state intervention.Footnote 43
During his tenure as chair of the AIDS Advisory Committee, Decker cultivated a close relationship with Bush and Hadden, working with them to end homophobic bias in the state bureaucracy, to amplify the gay movement’s voice in statewide politics, and to strengthen the legislature’s response to AIDS. Despite their very different partisan allegiances, all three quickly built alliances with one another. At the middle of this policy network stood Hadden, who organized regular bipartisan meetings between Sacramento’s gay legislative assistants.Footnote 44 Throughout the 1980s, memos zipped between Decker’s and Hadden’s offices, as they collaborated on the issues of antibody testing, HIV discrimination, and prevention education.Footnote 45 While they differed sharply over policy specifics and frequently clashed over the state AIDS budget, they shared a commitment to policies grounded in privacy, individual rights, and voluntary behavior change.Footnote 46 Above all, they were political pragmatists, willing to negotiate with lawmakers from across the ideological spectrum to enact their preferred policies.
The California Bureaucracy and the Complexity of the Closet
Even as the AIDS crisis ravaged California’s urban queer communities, the civil service’s institutional homophobia remained a critical roadblock to a more expansive response to the disease. State officials prevaricated on important legislative mandates, actively discriminated against gay employees, and opposed calls for a coordinated response to the epidemic.Footnote 47 To overcome this institutional homophobia, gay policy makers coordinated a loose network of closeted bureaucrats, regularly meeting with them to gather information on the internal workings of the bureaucracy. They reserved special ire for the California Department of Health, accusing it of botching the state’s early response to the epidemic. By the mid-1980s, Hadden had successfully used this information to ferret out homophobia in several state agencies, even as his tactics remained clandestine and illicit.
In the years immediately before the advent of AIDS, gay activists fought to end institutional homophobia in the California bureaucracy. They scored a notable victory in April 1979, when Governor Jerry Brown issued Executive Order B-54-79, which banned antigay discrimination against government employees.Footnote 48 The responsibility for implementing the order fell on the state Personnel Board, which handled most discrimination complaints against the civil service. On April 30, 1980—over a year after Brown issued the order—the agency hired Leroy Walker, an attorney based in Los Angeles, to liaise with local gay activists, root out homophobia in the bureaucracy’s recruitment process, and educate the state civil service about the specific needs of gay employees.Footnote 49 With such a wide range of responsibilities, however, Leroy quickly suffered from burnout, leaving his position after little more than a year.Footnote 50 At this point, the civil service lacked the dedication needed to implement the order, neglecting to hire a replacement for Leroy because of cuts to the fiscal 1982 budget.Footnote 51 With a growing sense of desperation, a group of gay bureaucrats established Advocates for Gay and Lesbian State Employees, a statewide organization that sought to reform the bureaucracy’s hiring practices.Footnote 52 From the outset, it struggled against an avalanche of bureaucratic inertia, failing to persuade the state Personnel Board to implement a training program on sexual-orientation-based discrimination. In an April 1982 letter, the group excoriated the agency’s record, glumly observing that “Very few managers below the Central Office or Personnel levels have even heard of the executive order… . Under the circumstances, the gay and lesbian community must question the commitment of this administration to the protection of gay and lesbian employees.”Footnote 53 A subsequent letter, written in July 1982, labeled Brown’s Executive Order a “useless formality.”Footnote 54 Bearing out this conclusion, statistics collected by the State Personnel Board indicated that gay and lesbian state employees made only two discrimination-related claims between 1979 and 1984.Footnote 55
Antagonism between gay policy makers and the state bureaucracy only escalated during the early years of the AIDS epidemic. Brown’s Executive Order was utterly ineffective at preventing antigay discrimination, and instances of institutionalized homophobia persisted, as officials within the bureaucracy widely ignored discrimination complaints made by gay employees.Footnote 56 In the early 1980s, gay bureaucrats penned scores of letters to Hadden, complaining of the bureaucracy’s institutional homophobia. Some letter writers protested that the state was slow to release funds to AIDS service organizations and actively discriminated against gay-run groups; others wondered why state officials declined to coordinate their efforts across different agencies.Footnote 57 Examples of obstructionism proliferated in the early 1980s; in one particularly egregious incident, officials withdrew funding from an AIDS-prevention education film only after learning that it had been developed by a gay production company.Footnote 58
While numerous state agencies had little appetite for working with Hadden and his colleagues, the Health Department’s initial response to AIDS was perhaps the clearest manifestation of this institutional homophobia.Footnote 59 The coterie of public health officials, bureaucrats, and medical professionals who guided the state’s initial response to AIDS often lacked any previous interaction with the organized gay movement.Footnote 60 Well into the mid-1980s, state health officials only met with gay policy makers in secret and outside of normal business hours, even during important discussions over pending legislation.Footnote 61 Programs conducted through the Health Department suffered from delays, limited funding, and poor administrative oversight, prompting Hadden to note that “the department’s decision-making process, lack of direction and lack of leadership make it more difficult for them to provide services.”Footnote 62 Perhaps most importantly, through 1983 and 1984, several AIDS-related bills failed precisely because of opposition from the Health Department. In the spring of 1984, health officials actively fought for a reduction in funding for prevention education; Agnos and Roberti successfully staved off their efforts but only after tense negotiations with the Deukmejian administration.Footnote 63 That same year, Senate Bill 2244, which would have mandated a coordinated response to AIDS, languished in committee after it faced opposition from state health officials.Footnote 64
Spurred by the Health Department’s recalcitrance, Bush and Hadden began holding secret meetings with a group of closeted state employees, who provided them with confidential information about the bureaucracy’s response to AIDS.Footnote 65 By the mid-1980s, a core of twelve closeted bureaucrats regularly attended these gatherings; most were motivated by their personal experiences of the AIDS epidemic, including close ties and friendships with PWAS.Footnote 66 From 1983 to 1985, they regularly leaked information to Bush and Hadden about the bureaucracy’s internal workings and stances on important AIDS legislation.Footnote 67 As Kenneth Topper, Hadden’s partner and office assistant, recalled years later, “we had people planted in various state organizations, agencies, that would be in position to overhear conversations to know what they were going to try to change, or try to block, and we were able to get around them.”Footnote 68 Armed with information gathered from this clandestine network, Hadden flooded the Health Department with letters of complaint, demanding greater public scrutiny over the allocation of AIDS funding. Tellingly, his correspondence reveals an intimate knowledge of the agency’s internal policies and practices.Footnote 69
Through these behind-the-scenes-machinations, Hadden eventually saw an opening to challenge the Health Department’s entrenched obstructionism, filing a formal complaint with a civil service personnel committee in the autumn of 1984.Footnote 70 At a subsequent hearing in Sacramento, he and his colleagues unleashed a slew of complaints against the Health Department, calling attention to its dismal record on the epidemic.Footnote 71 Though the exact details of this hearing are muddy, Topper took the agency to task for his experience of applying for a job there, pointing to discriminatory remarks made by officials during his interview. He also cited multiple anonymous examples of workplace discrimination against his closeted colleagues.Footnote 72 In its final verdict, the personnel committee decided in Hadden’s favor and appointed an oversight committee to reform the Health Department’s hiring practices. Working for two years, the committee, which included Hadden, pressed the agency to employ medical professionals over career civil servants and engage with gay men and lesbians.Footnote 73 Paradoxically, the Health Department’s failure to establish a constructive relationship with Hadden led to greater scrutiny of its hiring practices, exposing the agency’s homophobic record.
Through the mid-1980s and after, the Department of Health continued to rack up a mixed record. Hoping to deflect any further internal scrutiny, the agency updated its hiring practices, made some meaningful overtures to gay activists, and appointed Hadden to a number of its advisory committees.Footnote 74 Less positively, state contracts administered through the Health Department continued to suffer from unnecessary delay, threatening the financial viability of many AIDS Service Organizations.Footnote 75 Still, Hadden and his colleagues had forged a constructive relationship with the Health Department, successfully rooting out most of its obstructionism. By the dawn of the 1990s, according to one gay bureaucrat, “more and more staff members are coming out to their bosses and each other.”Footnote 76
Hadden’s reliance on closeted bureaucrats sheds light on the ambivalent and contradictory role of the closet within the modern gay rights movement.Footnote 77 In the late 1960s and early 1970s, gay liberationists had proclaimed that coming out was an important marker of gay political strength; they popularized the notion that disclosing one’s homosexuality was an essential element of gay politics and identity.Footnote 78 At the same time, gay rights organizations advanced a strategy that emphasized public visibility, an approach summarized by the popular mantra, “Out of the Closets, into the Streets.”Footnote 79 As the AIDS crisis came into clearer focus, it inspired renewed calls for gay people to “come out of the closet,” as activists sought to counterbalance the mobilization of the Christian Right.Footnote 80 In the autumn of 1988, the National Gay Rights Advocates, a gay rights law firm, organized the first National Coming Out Day (NCOD), an event designed to illuminate the gay movement’s growing political clout. Hadden played a major role in organizing NCOD during the late 1980s, coordinating efforts in Sacramento and San Francisco. In one letter promoting the event, he proclaimed that “NCOD promotes gay and lesbian visibility and urges people to ‘take the next step.’ … NCOD is a call to action, a campaign about truth, power, and liberation.”Footnote 81
Despite publicly asserting that coming out was an essential part of gay identity, Hadden depended on closeted state officials to ferret out homophobia in the California bureaucracy. Paradoxically, he wielded the closet as a weapon against the very employment practices that prevented his colleagues from publicly disclosing their homosexuality. For their part, these bureaucrats believed that concealing their identities, rather than coming out, would provide them with better opportunities to undermine government obstructionism. It is important to stress that the “weaponization” of the closet extended well beyond California. In Illinois, Tim Drake, the cochair of the Illinois Gay and Lesbian Task Force, formed a similar, if less well-developed, network of openly gay and closeted state officials. One individual, who worked for the Illinois House of Representatives, regularly tipped Drake off whenever a lawmaker filed a repressive AIDS bill.Footnote 82 The closet afforded gay policy makers with opportunities to subvert and undermine state repression, serving as an effective weapon against bureaucratic inertia and draconian AIDS measures.
Antibody Testing and the California Legislature
With powerful advocates in the California Assembly and Senate, gay policy makers secured a string of impressive policy victories in the mid-1980s. Because of their preexisting ties with the gay rights movement, lawmakers from San Francisco and Los Angeles proved far more willing than state bureaucrats to work with Hadden and his colleagues. The two most powerful California state legislators—the Speaker of the Assembly and the President of the Senate (Brown and Roberti, respectively)—both had solid liberal credentials and relied heavily on gay appointees when it came to formulating policy. Although Deukmejian won the governorship in 1982 and 1986, Democrats controlled both chambers of the legislature throughout the 1980s, and gay policy elites could rely on long-established relationships with liberal, reform-minded lawmakers. It was not just Democrats who supported proactive AIDS legislation, however: moderate Republicans did so too, especially in the early and mid-1980s.
Predictably, though, a small but influential group of conservative lawmakers championed repressive legislation directed at curbing the spread of the disease. Within the legislature, disputes raged around the question of whether the state should use traditional public health techniques, like quarantine and mandatory testing, to prevent the spread of AIDS. On one hand, gay policy makers argued that these techniques would generate a rift between public health officials and PWAS, deterring at-risk individuals from seeking treatment or testing.Footnote 83 Public health techniques had traditionally dovetailed with and reinforced homophobia, meaning that a coercive, involuntary approach to AIDS would inhibit cooperation between gay men and the state.Footnote 84 Already skeptical of public health officials, gay men would avoid them altogether if the state embraced punitive measures against AIDS. That observation appeared in a policy report issued by Rand Martin, California’s first full-time AIDS lobbyist, in May 1988: “mandatory testing would create either an adversarial relationship between physician and patient or will frighten people away from voluntary testing and counselling.”Footnote 85
On the other hand, conservative lawmakers supported a draconian and moralistic response to AIDS. They justified the use of traditional public health techniques by drawing historical analogies between AIDS and other infectious diseases—most notably, bubonic plague, influenza, and tuberculosis. These illnesses, all communicable through casual contact, had historically prompted coercive containment strategies, leading some conservative Republicans to argue that AIDS should be subject to the same treatment.Footnote 86
The conflict between gay policy makers and conservative Republicans heated up after the Federal Drug Administration (FDA) licensed the first AIDS antibody test in March 1985. ELISA, as the test was called, immediately became a lightning rod of controversy: it was notoriously inaccurate, it sparked calls for mass quarantine, and it opened the way for more extensive contact tracing.Footnote 87 Fundamentally, gay policy elites and conservative lawmakers differed over the question of whether testing should be voluntary or mandatory. Blaming gay hedonism for the outbreak of AIDS, conservatives argued that patient-initiated testing risked sacrificing public health for the sake of the privacy rights of at-risk individuals. They supported more traditional containment and control strategies over noncoercive interventions; for them, HIV ought to be treated like any other communicable disease. Summarizing the attitudes of many conservative legislators, one Republican state senator thundered that voluntary testing violated the “public right to life.”Footnote 88 Gay policy makers, for their part, championed voluntary, anonymous testing, robust antidiscrimination provisions for those undertaking the test, community-based AIDS education, and strict penalties for those who thwarted the privacy rights of antibody-positive individuals. They feared that indiscriminate use of the test would provide employers and insurers with sensitive information on thousands of at-risk individuals, regardless of their infection status, exposing them to workplace and insurance discrimination.Footnote 89 This fear was not without merit: a 1984 survey of PWAS in San Francisco found that 66 percent had experienced some of discrimination in employment, housing, or health care.Footnote 90 Without stringent confidentiality protections, then, the antibody test would dampen trust between gay rights activists and the medical profession and fuel more systemic employment discrimination against PWAS.Footnote 91
With the passage of Assembly Bill 403 (AB 403) in February 1985, the proponents of anonymous testing secured a decisive victory in the California legislature. Drafted by Bush and pushed through the legislature by Agnos, the law furnished antibody-positive individuals with legal protections against employment discrimination and banned insurance companies from using ELISA to screen potential customers.Footnote 92 The immediate impetus behind AB 403 was the FDA’s ruling in early 1985 that blood banks should test potential donors for HIV antibodies, a decision that stoked public fears about the safety of the blood supply. At first, the federal government licensed ELISA only for use in blood banks, prompting health officials to warn that at-risk individuals would donate blood in order to determine their HIV/AIDS status. During a newspaper interview that occurred less than one month before the FDA approved the test, Mervyn Silverman, San Francisco’s Director of Health, asserted that “individuals in populations at high risk for AIDS, who have refrained from donating blood, will resume doing so in order to be tested for exposure to the … virus.”Footnote 93 Several concurrent studies appeared to support this claim: one survey of gay men in San Francisco found that 50 percent were planning to visit a blood bank in order to obtain an antibody test; another study suggested that the figure was closer to 70 percent.Footnote 94 Because ELISA detected only 96 percent of HIV-infected blood samples, health officials warned that at-risk donors could inadvertently contaminate the blood supply.Footnote 95 “It all adds up to a frightening scenario,” noted the Bay Area Reporter: “people who have been exposed to AIDS donate blood to get the antibody test; and 5 percent of that blood slips into the blood supply.”Footnote 96 Responding to these concerns, Agnos tied the passage of AB 403 to the establishment of alternative test sites—government-run clinics that guaranteed anonymity and robust pre- and post-test counseling. As he explained in a press release, “blood banking officials had expressed strong concern that unless such a step were taken, many individuals who believed themselves at-risk for AIDS might have turned to blood donations as a way of being tested… . The result would be a larger number of at-risk donors who could not be screened with fail-safe methods.”Footnote 97 Anonymous testing as a policy idea thus rested on the claim that it would prevent at-risk individuals from contaminating the blood supply.
To galvanize widespread support for anonymous testing, Bush modeled AB 403 on existing laws protecting the confidentiality of people with cancer and liaised with key interest groups to secure their backing.Footnote 98 These negotiations led to endorsements from a cluster of influential interest groups, most notably from the California Life Insurance Company.Footnote 99 Support for AB 403 came from the San Francisco Health Department, the U.S. Conference of Local Health Officers, and most emphatically from the Red Cross, which assisted Bush with the drafting of the bill.Footnote 100 Through February and March 1985, Agnos shepherded AB 403 through various committees, artfully courting the votes of Republican legislators by framing it as a public health measure, rather than as a civil liberties bill.Footnote 101 Years later, reflecting back on the political debate over AB 403, Bush noted that “we were able to educate the legislature that the issue was not a balancing of civil rights against public health, but actions in both arenas which complemented each other to further assure a worried public.”Footnote 102 Less than ten days after Agnos had introduced AB 403, it passed the Assembly with a bipartisan vote of 63-5.Footnote 103 Although several states enacted laws regulating the insurance industry’s use of the antibody test, AB 403 was unusually extensive, providing for anonymous testing, strict penalties for those who disclosed test results to third parties, and counseling for individuals who tested positive.Footnote 104
The debate over AB 403 also signaled the extent to which liberal legislators and gay appointees relied on cost-centered arguments to buttress the political chances of their AIDS legislation. The 1980s heralded a new “era of limits” in California, as the nascent antitax movement constrained the development of the welfare state.Footnote 105 In 1982, Deukmejian leveraged his record as a staunch fiscal conservative to win election as governor; during the next eight years, he cut spending on welfare, education, and Medicaid.Footnote 106 Against this backdrop of budget squeezes and fiscal austerity, Agnos and Bush went to great lengths to portray anonymous testing as a cost-saving device. During behind-the-scenes discussions with state lawmakers, they argued that allowing insurance companies to use the antibody test would raise the number of uninsurable individuals, shifting the cost of AIDS health care onto the state.Footnote 107 In meetings with gay activists, in letters, and in strategy memos, Hadden advanced a similar argument in support of AB 403. While touting the virtues of the bill to the San Diego Democratic Club in 1985, he asserted that without anonymous testing, the state “would have to absorb a larger share of the cost for AIDS patient care.”Footnote 108 Consistently pushed by gay policy makers, such cost-centered rhetoric soon became ubiquitous in debates over antibody testing.
Although the passage of AB 403 revealed the influence of the policy-making network that Bush, Decker, and Hadden had built, it also underscored the drawbacks of their pragmatic approach to politics. The act was propelled through the legislature by mounting fears of a contaminated blood supply, the lobbying efforts of Agnos and Bush, and the fiscal climate of the 1980s. Absent was any sustained discussion of the privacy concerns of people taking the test or the wider needs of those who tested positive. Several activists and liberal lawmakers pointed out that AB 403 appropriated $5 million for alternative test sites, more than the state had cumulatively spent on AIDS prevention education before 1985. “Why,” asked one legislator on the senate floor, “has California, in a flash, been able to come up with $5,000,000 to protect 2% of the potential victims of AIDS, but had spent only $3,900,000 in 1984 for the other 98%.”Footnote 109 In the end, however, Agnos and Bush had turned their intense lobbying and interest group mobilization into a significant policy achievement, one that would withstand a two-pronged attack in the late 1980s from conservative lawmakers and the insurance industry.
The Backlash against Anonymous Testing
While AB 403 sailed through the legislature with overwhelming bipartisan support, it quickly provoked a backlash, as the issue of anonymous testing became a political hot potato. In 1986 and 1987, as fears of widespread heterosexual transmission reached their apex, antibody testing emerged as a central polarizing issue that guided political responses to the epidemic. The first sustained attack on California’s liberal testing regime came in the spring and summer of 1986, when the electorate debated Proposition 64, a menacing ballot initiative that would have quarantined individuals suspected of HIV infection and enforced mandatory testing for certain “risk groups.” In July 1986, Decker and Hadden were part of a group of gay activists and doctors who founded No on 64, a statewide organization that spearheaded the media campaign against the initiative.Footnote 110 Acting as the group’s chief fundraiser, Decker raised over $1 million for television and radio spots, with 90% of donations coming from gay men and lesbians.Footnote 111 Drawing on the same cost-centered rhetoric used by Agnos and Bush to pass AB 403, No on 64 characterized the initiative as a fiscally onerous policy that was out of step with the budget tightening of the 1980s. The group’s campaign literature focused less on the civil liberties of people living with HIV infection than on the financial implications of enforcing a mass quarantine. One newspaper advert produced by the organization listed various reasons to vote against Proposition 64, chief among them being that it would “cost California taxpayers billions of dollars each year, but not one dollar of these massive expenditures will bring us any closer to stopping AIDS.”Footnote 112 Backed by a broad coalition of medical and religious organizations—including the California Catholic Conference of Bishops, the California Medical Association, and the American Red Cross—AIDS activists defeated the initiative by a wide margin in November 1986.Footnote 113
The struggle over Proposition 64 occurred alongside a fierce legislative debate about California’s liberal testing policy. Within the legislature, the driving force behind conservative attacks on anonymous testing was John Doolittle, a Republican state senator from Sacramento. In the summer and fall of 1986, he drafted ten AIDS-related bills, each designed to apply coercive health techniques to HIV. This legislation, among other things, would have overturned the provisions of AB 403, made it a felony for PWAS to donate blood, and enforced mandatory testing against sex offenders.Footnote 114 A controversial figure within the GOP, Doolittle nonetheless wielded tremendous influence in the state legislature. As the party’s caucus chair, he was the second-ranking Republican in the Senate and the chief fundraiser for GOP senatorial candidates.Footnote 115 Reflecting on Doolittle’s legislative expertise, one gay policy maker warned that “his knowledge about AIDS is hardly rivaled in the legislature and he has used that knowledge to lend credibility and reasonableness to his proposals.”Footnote 116 Framing his legislation as a corrective to the state’s “AIDS exceptionalism,” Doolittle told the Sacramento Bee in early 1987 that “all [I] would like is for AIDS to be treated like we treat other venereal diseases … what we’ve done with AIDS is create a whole special set of procedures.”Footnote 117
Such arguments ran parallel to the claim that mandatory testing was a crucial means of preventing AIDS from “crossing over” into the heterosexual population and causing a more widespread epidemic. In 1986, the Center for Disease Control (CDC) reported a spike in cases caused by heterosexual transmission, leading the National Institute of Medicine to claim “that over the next five to ten years there will be substantially more cases of HIV infection in the heterosexual population and that these cases will occur predominantly among the population subgroups at risk for other sexually transmitted diseases.”Footnote 118 Newspapers responded with headlines such as “The Second Stage of the Epidemic” and “Now the Disease of Them is the Disease of Us.”Footnote 119 At the same time, a blizzard of new polls confirmed the public’s growing fear of widespread heterosexual transmission. A Gallup poll conducted in November 1986 claimed that 73 percent of Americans felt that “AIDS will eventually become an epidemic for the public at large,” an increase of 11 percent from fifteen months earlier.Footnote 120 In fact, the CDC’s new figures were not an accurate reflection of the epidemic’s changing contours—the agency had determined in December 1986 that a significant proportion of previously unclassified cases were because of heterosexual contact.Footnote 121
Ignoring these complexities, Doolittle actively buttressed the public’s growing fear of the epidemic, explicitly linking his AIDS legislation to the CDC’s figures on heterosexual transmission. On the floor of the state senate, he declared that “there should be no doubt in anyone’s mind that AIDS is not a ‘gay disease.’ … In fact, the Centers for Disease Control are currently warning us that the number of heterosexual AIDS cases will double by 1991.”Footnote 122 To drive home his point, Doolittle invoked the powerful symbol of the “innocent child,” with one of his bills proposing to reduce mother-to-child HIV transmission by requiring mandatory testing for pregnant women. When he introduced this legislation onto the floor of the state Senate, he tapped into the pro-family, antiabortion rhetoric of the religious right: “frankly the right to privacy is coming in conflict with the right to life and that conflict must be resolved in favor of the greatest right, which is the right to life.”Footnote 123 Doolittle’s legislative proposals, then, drew significant impetus from mounting fears that AIDS was turning into a generalized epidemic, with widespread heterosexual transmission.Footnote 124
If Doolittle’s rhetoric tapped into the public’s growing AIDS hysteria, it also prompted a vigorous lobbying campaign by gay policy makers, who coordinated their efforts under the auspices of one umbrella organization, the Lobby for Individual Freedom and Equality (LIFE), founded, in part, by Hadden and Topper in the spring of 1986.Footnote 125 California’s first statewide AIDS lobbying firm, LIFE concentrated, in its early years, on leading the fight against draconian HIV bills in the state legislature. Marketing itself as a nonpartisan organization, LIFE drew support from a politically diverse set of gay rights groups, ranging from several chapters of the AIDS Coalition to Unleash Power to the Log Cabin Republicans.Footnote 126 These groups found common cause both in their opposition to coercive AIDS legislation and in their support for enhanced legal protections for PWAS. Rand Martin, who served as LIFE’s executive director between 1986 and 1990, built constructive relationships with both Democrats and Republicans, working feverishly to make anonymous testing a point of bipartisan consensus. With Martin at the helm, LIFE established close ties with several Republican lawmakers, most notably state Representative Bill Filante, who sponsored several of the group’s bills during the late 1980s.Footnote 127
Faced with Doolittle’s legislative maneuvering, LIFE ramped up its lobbying efforts in the winter and spring of 1987, coordinating a letter-writing campaign, organizing several lobby days, and courting sympathetic lawmakers. The group quickly formed ties with prominent lawmakers, including Chairman of the Assembly Health Committee Bruce Bronzan. Working in close collaboration with LIFE, Bronzan led the fight against Doolittle’s bills in the Democratic caucus. To ensure success, Bronzan and Rand Martin consulted with the infamous “Gang of Ten,” a group of conservative Democrats opposed to speaker Willie Brown. These negotiations yielded a favorable compromise and most of Doolittle’s bills languished in committee for the rest of the legislative session. As one internal LIFE report put it, “what resulted was the passage of two innocuous Doolittle bills and the redirection of others to interim study, a graveyard for bills that legislators would prefer not voting against.”Footnote 128 In the wake of this bruising defeat, Doolittle’s singular obsession with mandatory testing began to alienate his supporters in the state legislature, and his AIDS-related legislation repeatedly died in committee after 1987.Footnote 129
Mere months after Doolittle’s efforts to repeal AB 403 faltered, the measure faced a new line of attack from the state’s formidable insurance lobby. The AIDS epidemic unfolded against a backdrop of rising health care costs—a trend that compelled many insurers to look for ways to reduce their liabilities.Footnote 130 As they sought to constrain costs, insurance companies claimed that California’s ban on screening prospective customers for HIV antibodies had undermined their business model. A 1988 radio advertisement produced by the industry summed up this argument: “life and health insurance companies have always tested applicants for life-threatening illness… . To set fair premiums, we must know the risks posed by an applicant’s health.”Footnote 131 In the autumn of that year, industry representatives sponsored Assembly Bill 2900 (AB 2900), which would have repealed restrictions on HIV antibody testing for insurance applicants. While AB 2900 received backing from a powerful set of interest groups, including the Health Insurance Association of America, LIFE successfully waged a behind-the-scenes campaign to defeat the bill. Leveraging its reputation as a significant player in state politics, the group reached out to Roberti, who, as President Pro Tempore, referred AB 2900 to the unsympathetic Senate Health Committee, where it died before making it to the Governor’s desk.Footnote 132 Thereafter, the provisions of AB 403 relating to medical insurance remained intact for the rest of the 1980s.Footnote 133
A comparison with other states reveals that California was at the leading edge of implementing a liberal testing regime in the 1980s. While several states enacted laws regulating the insurance industry’s use of the test, only AB 403 remained in place by the end of the 1980s, an indication of the gay movement’s growing political clout in Sacramento.Footnote 134 After insurers mounted a vigorous lobbying effort in the late 1980s, some states—including New York, Florida, Massachusetts, and Wisconsin—overturned laws banning the industry from screening for HIV.Footnote 135 Other states, meanwhile, explicitly permitted insurers to test prospective customers for HIV infection. In December 1987, the Texas Insurance Board ruled that insurers could use ELISA to test current and prospective customers; the industry responded by excluding residents of several gay urban enclaves from coverage.Footnote 136 That same year, by the lopsided margin of 58–0, the Illinois Senate passed a law providing the insurance industry with broad discretion over its use of the antibody test.Footnote 137 A close look at the politics of antibody testing thus highlights the significance of California’s policy leadership during the early years of the AIDS crisis. In addition to enacting the country’s most robust confidentiality protections for individuals taking ELISA, California was the only state that continued to ban medical insurers from using the test in the late 1980s. This policy record was the product of two interlocking factors: a burgeoning network of gay policy makers, who were willing to use clandestine and illicit strategies, and the rapid organizational growth of LIFE, which quickly became an influential player in state politics.
Conclusion
This article has argued that California’s proactive response to AIDS stemmed from the gay movement’s growing influence in Sacramento. While the Reagan administration largely ignored the concerns of national gay lobbying groups, California state lawmakers from across the political spectrum hired gay legislative assistants to work on AIDS. After Bush, Decker, and Hadden began coordinating their efforts in the early 1980s, they achieved some notable policy victories, especially in the area of antibody testing. Capturing the career arcs of these gay legislative assistants also enriches our understanding of the role of the closet in the official gay rights movement. In closing, it is important to stress that from the late 1980s gay policy makers no longer relied on either clandestine tactics or closeted bureaucrats. Rather, Hadden and Decker formed a constructive relationship with the Health Department, one that involved open cooperation on the issues of AIDS testing and HIV discrimination. In the 1990s, an unprecedented number of openly gay men and lesbians entered state employment, partly because Governor Pete Wilson—a self-defined moderate Republican—established close ties with gay Republican groups. In 1990, the Log Cabin Republicans endorsed his gubernatorial candidacy, and in return he appointed several of its members to prominent positions within the state bureaucracy.Footnote 138
By focusing almost exclusively on the federal government, historians of AIDS have hitherto portrayed the U.S. state as a monolith, ignoring recent scholarship on the continued importance of state and local authorities in the late twentieth century. Precisely because of the Reagan administration’s inaction and inactivity, the states acted as policy innovators during the initial years of the epidemic. This article has provided one case study of how this dynamic affected the policy response to AIDS. Early in the epidemic, California surpassed any other state in the sheer range of AIDS-related laws it enacted and took the lead in implementing proactive policies. The result was the formation of an influential gay policy network in Sacramento, which made significant inroads into statewide politics during the 1980s.
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