The San Francisco model of AIDS care began in 1983 in wards 86 and 5B of San Francisco General Hospital. The focus of this model was not only on the health of each patient with AIDS, but also on the well-being of each person. As AIDS was beginning to be treated as a significant epidemic, San Francisco General Hospital recognized the need to create new standards of care for a disease that had never before been experienced. In attempts to grapple with this new disease, San Francisco General Hospital worked closely with the San Francisco AIDS Foundation and the City and County of San Francisco to develop the San Francisco "model for AIDS care". Compassionate care has now become a priority worldwide and an expected standard in hospitals as there places a greater emphasis on the social, psychological, and economic aspects of treatment in addition to the medicine.
History As the gay liberation movement began to gain prominence following the Stonewall riots, gay pride and its affiliated political and social actions asserted the acceptance of homosexuals throughout major cities. With this new ideology, San Francisco became one of these many major centers for gay liberation groups. In 1980, 17% of the city's population was homosexual, and more were attracted to this city for its large gay network and supportive environment. The Castro district contained the majority of the gay population, and thus represented the epicenter of homosexuals in San Francisco. Away from the social stigma against them, this concentrated group of gay men participated freely in social rebellion, including liberal participation in sexual practices that were otherwise prohibited. Gay communes, or communal living systems, were also created to celebrate and publicly acknowledge their prideful acceptance of free sexual preferences. With many gay-friendly meeting places existing and a thriving population of gay men, gay bars and bathhouses were created as another hub for available social interaction.
AIDS in San Francisco AIDS first erupted within the gay population, initiating the quest to understand the disease that would soon become endemic around the world. A sexually transmitted disease, HIV was especially prominent within this city because of San Francisco's abnormal tolerance for sexual freedoms and gay-friendly places. Bathhouses were a major factor for the spread of this disease, as it acted as a sexual outlet for homosexuals to practice risky behavior. Thus, as one of the largest gay communities, San Francisco suffered from a large number of AIDS cases and had the greatest incidence of AIDS until 1994, especially within the more concentrated area of the Castro District. The inception of AIDS was initially thought to be contained within the gay population under the title of GRID (gay related immune deficiency). 71% of 3,064 reported cases were of gay and bisexual men; 12% of these cases were in San Francisco. Yet with the first infant case in San Francisco discovered by Dr. Art Ammann in 1982, fear began to spread throughout the remaining population as many realized the disease could also infect through blood contamination. As such, GRID was renamed to AIDS (Acquired Immunodeficiency Syndrome) in 1982— now encompassing the cases found in hemophiliacs, Haitians, and drug users. Because the CDC could only provide strong evidence that AIDS was an infectious disease, not proof, there was no way to alleviate public panic. Casual contact was considered a threat despite claims by Paul Volberding and other respected AIDS doctors because no proof was able to combat these fears. With homophobia, stigma, and a lack of knowledge for this disease, fear was a major motivating factor in interacting with AIDS victims. At San Francisco General Hospital, some doctors and nurses were unwilling to cooperate with or treat AIDS patients for fear of catching this disease, refusing to even enter an AIDS patient's room. For the gay community, this disease was rapid and terrifying. Friends and partners, once active and well, were now ill, unable to care for themselves, and dying. Not knowing how the disease was spread or what prevention methods were available, the gay community was unknowingly infecting itself and increasing the prominence of this disease in their population.
Care AIDS patients were often ostracized and subjected to homophobic intentions and fear-induced actions. Many treated AIDS as a punishment for the risky lifestyle of the gay community. Consequences of infection included unemployment, increased homophobia, and exclusion. Ryan White, for example, was banned from attending school in his county due to the lack of knowledge and fear of his disease. A New York City TV station refused to interview an AIDS patient for fear of catching this disease. As such, the harsh stigma associated with this disease could also result in a denial for medical treatment in order to avoid the hateful stigma directed towards them. Such stigma thus accelerated the social death of those infected. Excluded from the community and denied the respect of a living person, AIDS infected patients were considered and treated as dead while still alive. This treatment resulted in a lack of will to live, suicidal intentions, and denial for treatment in order to avoid the implications of social death.
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