Examining the crucial relationship between sexuality, race, and class, Beyond the Politics of the Closet highlights the impact gay rights politics and activism have had on the wider American political landscape since the rights revolutions of the 1960s.
2020 | 280 pages | Cloth $49.95
American History / Gay Studies/Lesbian Studies/Queer Studies / Political Science
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Table of Contents
Introduction: Privilege, Power, and Activism in Gay Rights Politics Since the 1970s
Part I. Public Policy Comes Out: The 1970s
1. A Clinic Comes Out: Idealism, Pragmatism, and Gay Health Services in Boston, 1971-1985
2. "A Ray of Sunshine": Housing, Family, and Gay Political Power in 1970s Los Angeles
Ian M. Baldwin
3. Making Sexual Citizens: LGBT politics, health care, and the State in the 1970s
Part II. Confronting AIDS
4. AIDS and the Urban Crisis: Stigma, Cost, and the Persistence of Racism in Chicago, 1981-1996
5. "Don't We Die Too?" The Politics of AIDS and Race in Philadelphia
6. Black Gay Lives Matter: Mobilizing Sexual Identities in the Eras of Reagan and Thatcher Conservativism
Part III. Beyond Liberalism and Conservatism
7. Gay and Conservative: An Early History of the Log Cabin Republicans
8. "No Discrimination and No Special Rights": Gay Rights, Family Values, and the Politics of Moderation in the 1992 Election
9. Homophobia Baiting: Queering the Trayvon Martin Archives and Challenging the Anti-Blackness of Colorblind Politics
Julio Capó, Jr.
List of Contributors
A Clinic Comes Out: Idealism, Pragmatism, and Gay Health Services in Boston, 1971-1985
Today Boston's Fenway Community Health Center is closely associated with the city's LGBTQ communities, as it presides as one of the largest and most influential gay health institutions in the United States, offering a wide array of services, conducting trailblazing research, and consulting the larger medical profession on how to best serve members of the LGBTQ communities. However, even as the first decade of the clinic's existence coincided with the 1970s and gay liberation, gay and to a lesser extent lesbian health, politics, and identities factored only tangentially in the origins and initial growth of the clinic. The clinic began in 1971, serving and unifying the diverse population in the emerging Fenway neighborhood as part of the neighborhood's response to destructive state and municipal urban renewal campaigns. However, by the early 1980s, the enforcement of new government regulations focused on efficiency and professionalism posed a challenge to the Fenway clinic community and opposed the clinic's philosophy and organizational structure. As it struggled to adapt to the new political and economic environment, the clinic reluctantly shifted its focus to the gay (and lesbian, though initially less so) community of larger Boston. Responding to both the AIDS crisis and the lesbian baby boom within months of its new emphasis on gay and lesbian health, the Fenway clinic quickly solidified its reputation as an important gay medical institution. Thus, while consistently centered on "community," the community at the heart of the Fenway clinic shifted over time from the racially and economical diverse residents immediately surrounding the clinic to a constantly expanding community of sexual and gender minorities in the larger city and region.
The clinic's unexpected and protracted coming-out story makes meaningful additions to historical understanding of this time period. First, the federal, state, and local governments played a critical role in creating what became an important and long-lasting gay institution, illustrating that the state's relationship to sexual minorities in this period needs much more nuance and complexity than current scholarship offers. The Fenway clinic's history also decenters the role of gay liberation in 1970s gay institution building. Rather, the "straight" origins of Fenway locate gay health activism within the reverberations of Lyndon Johnson's Great Society domestic policies and a national conversation about health and poverty rather than emanating from gay liberation. Centered in Boston, the Fenway neighborhood's history continues to expand the map of LGBTQ history beyond just New York City, San Francisco, and Los Angeles but does so in a way that highlights the important role of a racially diverse low-income neighborhood rather than a predominantly white middle-class gay enclave. In these ways, the Fenway clinic illuminates the politics of the closet in the age of gay liberation, Ronald Reagan, and AIDS.
The clinic threw out nearly all of its historical records as part of a move in the early 1980s, so the bulk of this history results from oral histories, secondary sources, and tangentially related archives. This approach proved quite challenging at times, as oral history subjects often proved difficult to locate and/or had difficulty remembering specifics. Additionally, the calamity and trauma of the AIDS epidemic of the 1980s often overshadowed or minimized the work of the clinic in the 1970s in many oral history retellings. However, with use of a snowball method for identifying interview subjects as well as a timeline of historical events compiled through newspaper reporting and a menagerie of similar sources ranging from medical journals to personal correspondence found in collections across the country, this history took shape as though a very complex jigsaw puzzle.
The idea of opening a health clinic in the Fenway neighborhood came to two resident activists after they visited a newly opened Black Panther-operated health clinic that earned notoriety in the local press and fame among Boston activists. That clinic not only provided health services to the surrounding community but also politically mobilized area residents. It also stood directly in the path of bulldozers slated to raze the neighborhood in preparation for the Inner Belt Road, or what would have been called I-695, that would demolish the community. The Black Panther's free clinic, consisting of just a trailer, embodied the struggles of neighborhood residents who had limited access to health care and whose poverty had placed them in the sights of redevelopers. David Scondras, the director of community services at the Boston Center for Older Americans in Fenway, remembered how he saw the Black Panther Clinic as "an organizing tool to get everyday people who otherwise were not very political involved in the Black Panther Party. . . . It gave all of us an idea, which was that we should go out to the neighborhood and start organizing our community."
The political strategy behind the Black Panther Clinic resonated with the Fenway activists, as developers and bulldozers from the Boston Redevelopment Authority (BRA) also threatened their financially struggling neighborhood. The duties of the BRA, which was funded by the federal, state, and local governments, were numerous, stretching across the spectrum of urban planning and development and giving the BRA overwhelming and omnipotent political power in every step of the process. One community activist recalled that the BRA urban renewal projects, "also known as urban demolition," were massive, sweeping, and often corrupt. In 1965, the BRA formally set its sights on the Fenway neighborhood. Building upon an expansion plan submitted by the First Church of Christ, Scientist, in the Fenway neighborhood, the BRA created the expansive Fenway Urban Renewal Plan that outlined the demolition and redevelopment of much of the Fenway neighborhood. The approval of the plan by the Boston City Council on November 1, 1965, set the plan in motion. Within two years, the BRA had acquired federal funding. Soon, wrecking balls and bulldozers demolished over three hundred low-income housing units on the eastern border of the Fenway neighborhood as part of the first phase of the Fenway Urban Renewal Plan. Discussing one portion of this first phase of construction, one longtime Fenway activist and resident remembered that "where the new Christian Science Church is, used to be I think eighty apartments and twenty stores and nice little . . . brick buildings. All that was torn down and people were displaced." Initially, the BRA met disorganization among residents of Fenway. In fact, the concept of Fenway as a neighborhood emerged out of the BRA's plan and the residents' response. Aware of both the political power of the Black Panther Clinic and the unmet medical needs of their own racially diverse and economically struggling residents, David Scondras and a Northeastern University graduate nursing student, Linda Beane, teamed up, using their complementary interests to open the renegade Fenway clinic in the Boston Center for Older Americans. The clinic was one of many community-based organizations, including a food co-op, a newspaper, and child care, designed to make residents more politically engaged, unified, and organized to combat the state-approved developers attacking their neighborhood. In short, the clinic served as a larger effort by residents to create a neighborhood and invoke a sense of community in Fenway designed to thwart the BRA and gentrification efforts.
On a summer evening in 1971, the first in a long line of Fenway residents in need of medical care arrived at the Boston Center for Older Americans, a senior drop-in center located on the neighborhood's eastern edge and operated by the First Church of Christ, Scientist. Scondras had decided to use the center's space for an after-hours neighborhood clinic despite the Christian Science Church's teachings that members should maintain their physical and mental health through the use of prayer rather than medicine. Unbeknownst to the center's management or church officials, Scondras with the help of a "Hippie doctor" and Beane began offering health services to Fenway residents, including gay-friendly venereal disease (VD) testing to the resident gay community. Scondras, a recent Harvard graduate, antiwar activist, and computer programmer, had become a resident of the neighborhood while working as an economics instructor at Northeastern University on the neighborhood's eastern border. In Fenway, he continued his work in the antiwar movement that had begun at Harvard and took the job at the Center for Older Americans as a way to get to know neighborhood residents. At Northeastern, the young instructor/political activist with a bushy black beard also befriended Beane, a graduate nursing student at Northeastern who led a student group dedicated to the community health movement and providing free medical care. Beane, a fellow Fenway resident, was also a veteran of the antiwar movement who brought her political acumen to neighborhood issues through organizing Fenway residents at the area's Westland Avenue Community Center.
The teachings of the church, Scondras's decision not to ask if he could use the space, and the quickly increasing number of patients made it impossible for the Fenway clinic to operate out of the Boston Center for Older Americans for long. As a result, in early 1973 the group found and rented the basement of a small building, "a defunct antique shop," on Haviland Street in the heart of the Fenway neighborhood to house a new community clinic. The basement on Haviland Street was a far cry from a clinic at the time Scondras rented it. As one activist reminisced in an interview, "They got my brother-in-law to be their pro bono lawyer who got them their lease for a dollar a year." Community members cleaned the abandoned basement and painted it and constructed makeshift exam rooms, a filing area, a waiting room, and a lab. One remembered, "I helped with some of the physical stuff when they were building, putting some of the flooring down and things like that which was all done by probably some people who knew what they were doing and most people who didn't and were just helping." They furnished the clinic with a hodgepodge of secondhand and donated furniture, including movie seats from a defunct movie theater on Boylston Street that served as waiting room chairs and medical equipment from a retired Back Bay doctor, and opened their doors to the surrounding community in August 1973. Medical supplies were often "acquired" by volunteers who were also physician's assistants, nurses, doctors, or medical students dedicated to providing free health care. A longtime volunteer physician at the Fenway clinic remembered, "I'd filch stuff from the hospital and bring it over." Nearly everything in the clinic was borrowed, used, or homemade, but from its opening it was busy serving the Fenway residents who oftentimes had limited or no access to other health care.
The Fenway Community Health Center, both in its nascent stage at the Boston Center for Older Americans and in its first official home in the basement on Haviland, reflected and served, according to its patient demographics, the diverse neighborhood residents. A third of the Fenway neighborhood lived below the poverty level, scraping by with a median annual income of $2,027. One reporter writing in 1977 described the area as a "low-income, low-rent neighborhood, its population of 4,000 is somewhat transient, consisting mainly of students, welfare families, young working people, and elderly people. It has long had a reputation for street crime, drugs, and prostitution and was once one of Boston's more notorious red-light districts." In a city infamous for its racial segregation and tension during the 1970s, Fenway was a rare example of integration not only of blacks and whites but also a considerable immigrant, mostly Latino, population. Responding to the neighborhood's needs, the clinic treated almost all nonemergency medical needs ranging from child immunizations, blood pressure tests, and cases of strep throat and the flu to testing and treating VD, pre- and postoperative care for most surgeries, and gynecological care. A longtime volunteer physician described the clinic services as a "basically primary care model. If you had high blood pressure, you'd come in. If you had diabetes, you'd come in. If you needed an annual physical, you'd come in." While at the Boston Center for Older Americans, the clinic served a small but diverse population that included the elderly, women, children, and gays. After the move to the Haviland basement in 1973 there was more physical space, and there were also more volunteers to reach out to each of these groups specifically. In addition to its regular daytime operating hours during which anyone could schedule an appointment or drop by, the clinic opened its doors to specific populations in the evening and on the weekends. Among these evening programs was a gay health clinic on Wednesday nights. While these evening programs took a few months to formalize, the services and outreach to these specific populations existed at the Fenway clinic from its opening on Haviland Street, reflected the diversity of the neighborhood, and illuminated the deficiencies in the existing health care system of the early 1970s.
In an attempt to include and galvanize as many residents as possible, the clinic often opened its doors after hours to socials and weekend film screenings for kids, and board meetings looked more like town hall meetings. Board meetings easily lasted a number of hours, a fact that undoubtedly made them inaccessible for some in the community with limited time. One described how meetings would last "anywhere from three to five hours; yeah, they were long. Most of us on the board with some exceptions didn't have experience in health care or the management of clinics or human resources—we were the blind leading the blind." In the early years, anyone who was at all associated with the clinic (founders, volunteers, patients, or even just neighbors) was welcome to attend these meetings, create agenda items on the spot, engage in debate, and vote on any and all decisions. This democratic structure reflected the political approach of many young New Left-affiliated organizations of the period and, like the clinic itself, was meant to foster personal investment and enthusiasm in the clinic and the larger Fenway community in the face of the encroaching redevelopment. Both the board meetings' structure and the use of the space for social off-hours events successfully nurtured investment in the notion of Fenway as a neighborhood and strengthened resistance to gentrification efforts.
With the clinic's open organizational structure and its dedication to serving the entire Fenway community (of which gay men were a small part), creating and maintaining a gay health collective to formalize the clinic's already established treatment of gay men was relatively easy. A doctor at Boston's Homophile Community Health Center, which provided gay-friendly counseling to gays from around the city, asked clinic cofounder, David Scondras, if the Fenway clinic could provide medical backup to his patients. Taking advantage of the open town hall-style board meetings, Scondras pitched the idea in April 1974 and received a warm reception. The Gay Health Collective of the Fenway Community Health Center began offering Wednesday night sessions on May 22, 1974.
Neither the inclusion of gay services from the start at the Fenway clinic nor their formalization in the Gay Health Collective's weekly sessions should be mistaken for gay liberation activism. While a handful of the Fenway activists were gay, Scondras among them, few were explicitly out or active in gay liberation organizations, focusing instead on the antiwar movement or the struggle with the BRA, but they "wanted supportive health care for ourselves and others, so we decided that the health center should provide it." In fact, those who had insisted on the inclusion of gay health services at the clinic's founding were often not out to one another or the Fenway clinic community: "it was sort of an unspoken thing. No one ever got up and said 'hey, I'm gay.'" Shedding more light on the political affiliations of the Fenway clinic during this period, one activist recalled, "It never really became a gay anything; it was just a place where gay people came. . . . You advocated for anybody who needed help—we never thought of ourselves as gay, straight, white, black." From this vantage point, Fenway residents never thought that the Fenway Community Health Clinic directly related to gay liberation, and neither did the clinic itself. Rather, the clinic was an embodiment of New Left politics that challenged oppression in all forms, including homophobia. The clinic and many of its activists appear as more strong gay allies rather than actually gay. However, the existence and success of gay health services at the clinic from its inception did make it unique.
While Scondras, who could not remember ever specifically disclosing his own gay identity to the Fenway clinic community, was central in creating the Gay Health Collective, Ron Vachon perhaps more than anyone was the "gay face" of the Fenway clinic. Vachon was "the backbone of the thing—big, tall, strong, French Canadian, very gentle but six foot three, bearded, probably could have been a professional wrestler if he didn't go into medicine. He was working full-time at the Fenway clinic as a physician's assistant and was gay." While finishing up his degree as a physician's assistant at Northeastern University in 1975, Vachon "wandered into the Wednesday night clinic for the first time because the man he was dating came in to pick up some files. There, he met then-medical director Sandy Reder, who on learning that Vachon was a physician's assistant, put him to work on the spot. Vachon stayed to become part of the collective, and ultimately, the center's first paid staff person." He quickly became a leader at the clinic, even being considered for the executive director's position in the late 1970s and always making sure that the clinic considered and met the medical needs of the gay community. In short, because they "were already part of the we," already part of the Fenway community, a few activists who were gay were able to use the clinic's organizational structure and mission to shape the services of the clinic and meet the medical needs of the gay community specifically without appearing to be outspoken gay activists. Gay health services emerged at the Fenway clinic because they were needed in the community, not because of any specific gay organizing. In this way, both the activists and the clinic itself have a very different relationship with the closet—they were more in the closet or at least downplaying their gay affiliations—than appears typical in the existing history of out and proudly vocal gay institutions of this period.
Boston's gay population, including those beyond the bounds of the Fenway neighborhood, welcomed the opening of the Gay Health Collective at the Fenway Community Health Clinic for a number of reasons. Fenway offered the only local, free, gay-friendly health services, allowing gay men to avoid the ridicule faced in many public clinics, the price gouging in private doctor's offices, and the inherent risks of using medical insurance. Furthermore, the clinic was within less than a five-minute walk from the eastern border of the Fens Park cruising grounds, making it an ideal location for gay men to stop in and get tested on their way either to or from the park. A volunteer doctor of the Gay Health Collective, himself a gay man, described his patients as "college kids, young adults, the bartenders—just the panoply of gay people as gay people were defined in the '70s. There definitely would be a mix of a stock broker or lawyer, but not so many." Another volunteer remembered, "I think we were caught off guard by the deluge of students and young folks that came for sexually transmitted diseases." Word of the Fenway clinic's gay-friendly services quickly spread throughout the city's gay community via word of mouth, flyers in bars, and ads in Gay Community News. Shortly after its opening, the Fenway Community Health Clinic's Wednesday night Gay Health Collective saw gay patients from all across the city and the region. The clinic and its staff viewed and presented its gay services as an incidental subsidiary to the larger mission of serving the neighborhood and providing low-cost, high-quality care, allowing it to remain a strong gay ally but not actually gay. Regardless, they secured the Fenway clinic's position as a new Boston gay institution among the city's gay community.
During the battle with the BRA, the Fenway Community Health Center's relationship with the state was fairly simple. At the municipal level, the state proved largely antagonistic through redevelopment plans as well as licensure requirements and limited funding opportunities. Access to federal funds through direct grants and match grants with area hospitals counteracted many of these municipal hindrances and allowed the clinic to open and survive its early years. However, after the battle with the BRA ended victoriously for neighborhood activists in 1973 with a legal ruling that demanded a neighborhood-elected board approve and aid in designing all development projects, the Fenway clinic's relationship with the state grew increasingly complex. On one hand, the Fenway clinic was dependent on the state, both federal and municipal, for funding, licensure, and inspection approvals to provide health services to its quickly growing number of patients. Both the federal and municipal governments began to more regularly and strictly enforce compliance with existing and newly created regulations before granting more funding and licensure. On the other hand, the policies and culture of the Fenway Community Health Clinic, which emanated from a distrust and dislike of the government's instigating and antagonizing role in the neighborhood's battle against redevelopment, focused more on providing services and creating community than on complying with government regulations. The defeat of the BRA gave Fenway activists greater certainty that the political backlash of attacking a community health clinic insulated the clinic from any real governmental threat. David Scondras described their rationale: "they didn't want to kick us out, they didn't want to look like bad guys." However, new regulations under Richard Nixon's second administration requiring that clinics receiving federal funding meet building and licensure codes, use only trained and certified medical professionals, and comply with standard bookkeeping practices for billing and payroll called for massive changes in culture and protocol in some volunteer-run community clinics such as the Fenway Community Health Center. In short, the politics of the Fenway clinic grew progressively out of sync with the government's increasingly regulatory policies for community health clinics as the decade progressed.
While offensive to the culture of the clinic and its volunteers, Nixon's new approach to federal health programs and regulation enforcement initially had little impact on the quotidian activities in the busy Fenway clinic. The everyday work of the clinic overshadowed the threat of increased enforcement of local, state, and federal regulations for the clinic's volunteers. Within months of its opening on Haviland Street, the clinic saw a steady flow of people displaying both the diversity and energy of the neighborhood residents. The clinic was open five days a week, seeing everything from cases of the flu and child immunizations to blood pressure checks and postoperative care. Within two years of the opening of the Haviland Street space, the Fenway clinic logged over 5,000 patient visits. To care for the ever-growing number of patients, the Fenway clinic drew from the ranks of nearby Harvard Medical School, the New England Deaconess Hospital, and the Brigham Women's Hospital. The clinic became a hot spot for medical students and residents. Excited to hone their medical skills while also serving the surrounding community, "they were getting really good experience." This constantly changing cast of characters gave the space a vibrancy that illustrated the clinic's central role in shaping the Fenway neighborhood, but it also made complying with government regulations both difficult and seemingly unimportant.
The volunteers at the Fenway Community Health Clinic were there because they were passionate about the neighborhood or about providing free health care to those who needed it. Just as community members literally built the clinic, despite their ignorance of building construction, they also ran it, despite limited community health know-how. In both instances, the enthusiasm of the Fenway volunteers did not always make up for lack of experience. As one volunteer recalled, the clinic flooded with sewage "whenever it rained. . . . There was no central heat, ventilation or air conditioning. Privacy for patients was limited to three unsound-proofed exam rooms and one unisex bathroom." The Fenway clinic volunteers focused on providing care and building community among Fenway residents, caring less if a volunteer met outside standards for professional qualification, which were often set by the state or medical profession, that the clinic critiqued. Placing greater value on volunteers' passion than on their qualifications translated into having "some physicians on staff . . . who had not completed their training, . . . nurses who had backgrounds that were not relevant, . . . laboratory personnel who were chemistry majors in college but never had taken any chemical laboratory training." The volunteers responsible for billing often had some bookkeeping experience but often "didn't know the first thing about really setting up medical billing and grant writing and the like." Compounding these issues was a situation whereby numerous volunteers were responsible for single tasks within the clinic because most volunteers only worked a handful of hours per week. Scondras remembered that "we had no particular group of people running the place; it was just a collective—if you showed up, you ran it." Consequently, the more detailed and ongoing tasks such as billing and building management fell between the cracks.
When not lost amid the bustle of the clinic, the Fenway clinic met the state's increased enforcement of regulations with resistance. In the eyes of Fenway residents, government policies at the federal, state, and municipal levels had contributed to the neighborhood's decline into poverty and eventually encouraged an army of wrecking balls. The resulting cynicism among Fenway residents was deep and lasting, so much so that the government's plan to better enforce regulations and impose professional standards at the community clinic engendered both frustration and renewed hostility toward the state. Scondras recalled getting a notice from the state regarding the clinic's noncompliance with licensure and inspection code: "The state tried to clamp down on us because we didn't have a license to operate as a clinic. . . . I remember getting the letter and ripping it up. . . . They told us to stop and we said, no. . . . It was politically impossible to touch us." Many believed that the neighborhood's engagement and successful defeat of the BRA in court meant that the clinic was above reproach or consequence from the state. During the BRA struggle, the clinic had played a central role in successful political and publicity strategies to gain sympathy and support for the Fenway residents. Certainly, few local politicians publicly criticized the thriving clinic, just as few took issue with the Black Panther Clinic blocking another major city redevelopment project that had inspired Scondras and Beane to open the Fenway clinic. In fact, the clinic welcomed Boston mayor Kevin White and many other local government officials to its official opening in 1973, even as the clinic was a clear and intentional threat to the city's redevelopment plans. As a result of their perceived unassailable political position, the Fenway activists who knew of the regulations and requirements often chose to ignore them or work around them. The clinic operated for seven years without obtaining its full licensure from the Massachusetts Department of Public Health; full licensure was granted in 1978.
While the "thankfully slow-moving state bureaucracy" edged the Fenway clinic to its inevitable day of reckoning with regulators, inspectors, and state licensing boards, a more immediate problem challenged the culture of the clinic: money. Before moving into the Haviland Street basement, Scondras and Beane had secured federal funding in the form of a seed grant for the Fenway clinic, most of which had been spent on transforming the space from an abandoned antique shop into a suitable clinic space. Additionally, Deaconess Hospital provided the Fenway clinic with a small medical staff and grants for medical supplies as part of a federal fund-matching program. Beyond these limited funds, "something like $30,000," the clinic had no other immediate sources of income, and by refusing to make any significant changes to comply with government regulations for licensure, it faced a shrinking pool of possible grants for which to apply. Scondras remarked that "we would steal equipment and medicines for the health center because we didn't have a way to buy them, and that couldn't go on forever." Though existing in legal incompliance and financial precariousness was not unprecedented among similar community clinics of the era, Fenway clinic's commitment to do so as an act of protest was unique and clearly not sustainable.
In 1973 just a few months after opening the clinic, some volunteers broached the topic of charging for services in one of the town hall-style board meetings. While charging for services seemed a likely and obvious source of badly needed revenue for the struggling clinic, the idea was in direct opposition to the founding ideals of the clinic, and the resulting debate was both long and contentious. Providing free health care, a political goal reignited by the missed opportunity during President Johnson's push for Medicare and Medicaid in 1965, had been as much an organizing principle for the clinic as preserving the Fenway neighborhood had been. To be sure, no one liked the thought of charging for services, and those who brought it up only did so due to a lack of other options. However, factions quickly developed between those who felt it a necessity to sustain the clinic and those who felt that it so clashed with the founding ideals that it was tantamount to destroying the clinic. Scondras described the debate: "There were the people who felt, like myself, like if you charged anything that it would violate a principle that health care should be free for everyone. Then there were the people who said, yeah, but in real life nothing is free and we have to find a way to get money to pay for it." Another volunteer remembered, "In our minds, the 50 cent fee would lead to corruption and bureaucracy!" However, after more than twenty-four hours of debate spread over several board meetings, idealism bent under the weight of the harsh fiscal reality that the clinic faced. The Fenway volunteers and community members settled on a compromise agreement whereby the clinic would charge fifty cents per visit, with the caveat that patients who either could not or did not want to pay the fee could either volunteer in return for services or pay whatever they could afford. This deal preserved the clinic's identity as a free clinic while also placing it on a slightly better financial footing.
Just as the clinic community crafted an acceptable compromise for one financially rooted ideological challenge, another surfaced. Toward the end of 1973, a fight over whether to hire its first paid staff dominated the board meetings. The battle with the BRA had hinged on the political belief that all Fenway residents should have the same rights and political value to the state as the wealthy residents whom the redevelopment plan hoped to attract. This sentiment filtered into the ethos of the clinic. Volunteers were uncomfortable paying some for work that others did for free, as this could easily be interpreted as the Fenway community placing greater value on one volunteer over another or valuing one form of qualifications or training above another. Paying staff seemed to many at the board meetings to be a slippery slope where judgments over who to hire and for how much pay could easily clash with the ideals of the clinic. Again, after numerous hours of debate the board settled on a compromise in which staff could be paid, but "everyone made the same hourly wage, no matter what you did." The first paid Fenway clinic staff member was physician's assistant Ron Vachon, who also helped coordinate volunteers. Within a year, the clinic had ten paid staff members: some doctors, some physician's assistants, and other former volunteers who assisted with clerical work. Longtime volunteer physician Lenny Alberts recalled, "It was a big deal when we started getting $10 a session, though, of course, we were encouraged to donate it all back into the pot." Board members endorsed this unconventional pay scale as an attempt to preserve the ideal that every person regardless of education, job, or experience had the same worth and value to the greater community.
The compromises struck in the debates over charging for services and paying staff show Fenway volunteers' struggle to remain true to their founding ideals in the face of a changing fiscal and political reality. One activist and board member recalled that "there was just a lot of figuring it out as we were becoming more of an institution and less of a group of people that came together to do something." Despite these changes in its policies, the clinic thrived, seeing its patient numbers rise exponentially throughout the decade. The Gay Health Collective, by far the fastest growing of the clinic's services, expanded to two nights a week. The clinic developed more services and new relationships, teaming in 1976 with the Department of Public Health to educate various communities, including gay men, about VD prevention and treatment. These and similar relatively small and low-cost projects allowed the clinic access to more grants, but none were of the size or magnitude that the clinic needed to avoid deficits. Government grants that did not require major changes at the clinic became scarcer and less lucrative as regulations became more common and more strictly enforced over the decade. Instead, the clinic focused on programs and grants for which it could easily qualify without licensure as a clinic, such as family planning grants through Title IX programming, rat-prevention grants through the city, and university-funded health research and outreach programs. In 1978, a Tufts-based researcher offered to pay for Giardia testing for gay clients at the Fenway clinic who were willing to answer a medical questionnaire, thus allowing the clinic to offer the test to its clients. These smaller grants, in addition to Deaconess Hospital's match grant that paid for some medical supplies and provided staffing, permitted the Fenway clinic to continue operating without significantly changing its political or organizational culture but did little to relieve its growing financial instability or put it more in step with the larger social and political trends of the decade.
In late 1979, facing patient numbers far outpacing revenue, the board hired a new executive director for the struggling Fenway clinic with the hope that the leadership change would bring about greater financial stability. With a history of health care management and community projects, Sally Deane started her tenure as the executive director in January 1980, only to realize that the organization was on the brink of collapse. In addition to "no written standards for employment, personnel policies, quality assurance standards, or management reports," the clinic required significant renovations before its inspection for licensure renewal, which was due to take place just three months after her arrival. However, the clinic's financial situation quickly became her greatest concern, especially after "finding . . . signed checks made out to the . . . government for withholding taxes that had never been mailed because the checks would have bounced. . . . Even though they alleged that they were operating on a $200,000 budget with 7,000 patient visits, maybe 2,000 patients, they were technically in bankruptcy." On her tenth day as the executive director, Deane learned that the clinic had not paid payroll taxes for quite some time and that the Internal Revenue Service (IRS) was on the verge of closing it down. The clinic's avoidance of professionalization and regulatory compliance had left it in great danger of losing its license and its funding and shutting down completely.
Seeing no other option, Deane looked to Deaconess Hospital to give Fenway clinic a loan to pay for the back taxes. The decision marked the moment when clinic's trajectory changed. Before lending the needed money, Deaconess Hospital required assurances of better business practices on the part of the clinic. For Deane, promises to reform the more slapdash aspects of the clinic were easy, as she already had plans to put into practice new professional standards, implement billing practices, and streamline the decision-making process. One longtime volunteer remembered how she felt when the Fenway board agreed to accept the loan from Deaconess Hospital: "I thought it was a necessary thing to do, but I thought it was a sad necessary thing to do." For many of the Fenway clinic community at large, the loan from Deaconess Hospital, along with the professionalization it demanded, was bittersweet, allowing the clinic to remain open but also demanding an end of the political culture and structure that defined the clinic.
In a vote that formally marked the end of the consensus and democratic days of the Fenway clinic, the board granted Deane much more oversight and control of policies and procedures at the clinic in an effort to expedite all the necessary changes demanded by the loan and required for the upcoming licensure inspection. With this new power, the immediate threat of closure behind her, and the IRS paid, Deane focused her attention on transforming the clinic into a more professional organization. First, she "took a stand that the medical staff had to be qualified to do the work that they were doing." Under these new policies, physicians had to be eligible for board certification in order to volunteer or work at the clinic, which meant "no more med students." Nurses and laboratory technicians also had to have proper training and licensure. However, personnel were not the only issue as Deane struggled to bring the clinic up to code. She faced an inspection by the Massachusetts Department of Public Health in order to renew the clinic's license. While the previous generation of Fenway clinic staff had avoided licensure for many years, Deane saw maintaining the clinic's license as crucial to its future. After numerous renovations, paid for with money from Deaconess Hospital, the clinic passed government inspection and renewed its license in 1981. Going beyond the physical structure and the personnel within it, Deane, along with newly hired staff, instituted a new accounting system that "allowed for third party billing, including Medicaid and private insurers, making the financial base . . . more solid." As a result of these major institutional changes, the Fenway Community Health Clinic went from evading and circumnavigating any form of organizational hierarchy and professionalization to embracing and epitomizing both—all within a year of Deane's hiring.
While internecine battles had not caused the Fenway clinic's change, internal schisms certainly resulted from it. When the clinic finally succumbed to the pressure to professionalize in the interest of becoming a financially and medically strong institution, Fenway neighborhood activists and the free health care movement that had been at the clinic's core parted ways. Many neighborhood activists left the Fenway clinic shortly after the acceptance of the loan, falling victim to Deane's insistence on standards for employment. Volunteering and community involvement had been at the very core of the clinic and were crucial ingredients in making the clinic so interwoven with the Fenway neighborhood as it battled against the BRA. However, as a result of many of Deane's new policies, many staff and longtime volunteers were suddenly "unqualified" to do the jobs they had been doing, in some cases for years. One community member recalled how the transition influenced her decision to leave the board: "I quit the board because I didn't think I could make a contribution. . . . There was nothing left for an ordinary citizen to do. I wasn't the right match for that board anymore." Many volunteers and community members no longer felt welcome in the clinic that many had come to think of as a community center, a home away from home. While the neighborhood had proven itself to be a sustainable political entity with the victory over the BRA, the Fenway clinic, on the other hand, was on the brink of collapse. With its survival taking precedence, the clinic's definition of community and its role in building that community began to shift.
By the end of 1980, Deane's changes at the Fenway clinic filtered into its every aspect. Its new structures and policies made for faster decision making, although more hierarchical and excluding of community members. Billing Medicare, Medicaid, and insurance companies was more consistent and reliable than ever before, and the clinic's financial situation slowly became more stable, shoring up its sliding fee scale. With its new professionalization, the clinic saw the number of grants for which it was eligible increase and had trained volunteers and staff applying for them.
In agreeing to work with the Fenway clinic, both the IRS and local funding partners insisted that the clinic plot a clear financial path forward. Thus, with an eye for building a long-lasting institution, the clinic also underwent a strategic planning process in the early 1980s that focused on how the clinic could have the largest and most stabilizing and sustained impact as a clinic while cutting unused or underused services that other area clinics made redundant. As part of the four-month strategic planning, the clinic collected information on the services of other clinics, surveyed their patients, and assessed each of their programs. The final strategic planning report was over one hundred pages long and included multiple appendixes detailing the redundancies with other nearby clinics and the willingness of the Fenway clinic's clients to visit other clinics when more convenient and charting the strengths and weaknesses of each program down to the hours of operation and the number of patients seen. The main recommendation of the strategic planning process was clear: the Fenway Community Health Clinic needed to become a clinic focused predominantly on serving Boston's gay and lesbian community. The strategic plan's recommendation grew as much out of supply-and-demand market forces as it did the insistence of the clinic's funders and the state to ensure future solvency and longevity. Thus, while the recommendation appears market-driven, the state's professionalizing hand was merely one small step removed.
The Fenway clinic's indifference to gay liberation politics made the recommendation of the strategic planning process unexpected. With few other providers of quality health services for gays and lesbians available throughout the 1970s, little doubt existed among the gay community that the Fenway clinic was the clinic for them, "a gay institution" as one 1978 article in the Gay Community News described. However, there was no confusion among clinic founders, volunteers, and staff that the clinic was a neighborhood clinic, not a gay one. This distinction informed not only the diverse services of the clinic but also the experiences of the gays and lesbians who worked there, giving insight into a closeted or gay ally organization rather than a fully out gay organization of the period. Sally Deane remembered that in preparation for her interview for the executive director position at the clinic in late 1979, "friends had advised me not to share with the search committee of the board that I was gay, even though several members of the board were gay. . . . These people were on the board because they cared about the services but not because they were gay political activists." Those volunteers who maintained the Gay Health Collective were more likely to be out and politically active in the gay community, as in the case of Ron Vachon, yet their work within the clinic focused on the politics of health care rather than gay liberation. Clearly, their work in providing gay health services was at some level an outgrowth of gay liberation in that gay liberation allowed for the clinic to publicize its services in gay newspapers, attract out gay doctors and medical professionals to volunteer their time, and, of course, serve patients who benefited from, if not identified with, gay liberation. However, few of the staff and volunteers at the Fenway clinic saw themselves as gay liberation activists even as the larger gay community saw the clinic as providing vital services for the burgeoning gay community.
Though the strategic plan's recommendation for the Fenway clinic to focus on gay and lesbian health care surprised both the gay community and the clinic, the advice made sense when framed within the larger community health and political context of the city. As the 1970s progressed, coalitions between movements and diverse groups gave way to identity-based services. Just as Boston's gay community flourished and became more insular and concentrated in the area around Boston Common over the decade, other groups began to separate themselves both physically and politically, with feminists rallying in Cambridge and blacks in Roxbury. As these groups created their own health organizations, community clinics such as the Fenway clinic saw their services become increasingly redundant. In short, the abundance of identity-based services forced the Fenway clinic to specialize its services as well. This speaks to a shift in the Fenway neighborhood community as well as to a change in the way that the Fenway clinic defined community. The clinic's moment as a political rallying point or community organizing entity for a struggling neighborhood had passed. Initially, the clinic services were both useful and convenient health care as well as part of a larger struggle to save residents' homes. In this new era the battle for the neighborhood's survival had ended, and residents simply needed the services and did not mind getting them elsewhere if more convenient. Both the clinic and the neighborhood residents seemed to be altering their definitions of community. This shift in political context along with the clinic's structural changes that alienated some of the more committed volunteers and clients made the clinic's neighborhood patient base unreliable. As the Fenway clinic's strategic planning process sought ways to ensure the clinic's sustainability, its services to the gay community emerged as its strongest option for growth for three reasons. First, the gay community was growing quickly and steadily in this identity-based political atmosphere. Second, the Fenway clinic was the only area clinic to offer gay-friendly physical health services. Third, the number of clients at Gay Health Nights grew consistently throughout the second half of the 1970s. In this way, the expansion of identity-based politics and identity-based services forced the clinic to abandon its broad service offerings and simultaneously created a community with little access to identity-specific services.
Even as this reasoning was convincing, the recommendation to become a predominantly gay and lesbian clinic raised concerns for the board. Some, Deane among them, saw the proposed change as necessary not because of an allegiance to the gay community or to gay liberation politics but rather in the hope of ensuring the clinic's survival. Yet before accepting the decision, other board members raised a number of questions, again revealing some of the divisions within the Fenway clinic community that resulted from the recent changes. While the changes at the Fenway clinic in the wake of the IRS back taxes and the loan from Deaconess Hospital had upended many of the founding ideals, policies, and structures of the clinic, it still remained a community health clinic that served the diverse Fenway neighborhood residents. Many of the board members feared that becoming a gay and lesbian-focused clinic would mean abandoning this last remaining aspect of the original clinic and potentially alienating existing heterosexual clients.
There was also great concern about creating tension with the neighborhood that the clinic had been so influential in building, especially as the gay clientele of the Fenway clinic were much more white and middle class than many of the neighborhood residents. One Gay Community News piece highlighted the whiteness of the clinic's gay clients when it asked, "the gay night at Fenway Health Center . . . where are the black faggots and lesbians, the Hispanics and other minorities?" While the clinic at large offered its services to everyone and had a racially and economically diverse clientele generally, white and middle-class men made up an increasing percentage of the patients seen specifically by the Gay Health Collective in the late 1970s. This homogenization of gay health consumers reflects two compounding problems: the social and political conflation of gay identity as a white (and male) identity in the 1970s and the Fenway clinic's failure to specifically target gay communities of color with its outreach and services, making it complicit in the construction of gay as inherently white.
Beyond concern for the neighbors, critical board members were also concerned for the clinic and for themselves. Over the 1970s, many of Boston's gay organizations had been targets of violence and vandalism ranging from a fire at the Other Side bar to repeated break-ins at the Gay Community News offices. Combined with the regular acts of violence against gays in the nearby Fens Park, the fears of violence and vandalism against a gay-identified clinic were legitimate. Some individual board members also had worries over being personally affiliated with an explicitly gay organization: "a lot of people on the board had corporate jobs and things and were just not fully out."
Ultimately, the board's commitment to the clinic's growth and sustainability, rather than to gay liberation, drove its decision to focus on gay health services. The board adopted the recommendation to focus its services on the gay and lesbian communities in the summer of 1980. In an effort to avoid tension with existing clients or the larger Fenway neighborhood, the board insisted that services be given to anyone who came to the clinic, regardless of their sexuality, and that the clinic attempt to reach out to gay minorities.
While business and the clinic's survival prompted the decision to focus on gay and lesbian health, the Fenway clinic and its board proved fully committed to serving gays and lesbians even as their health needs expanded exponentially in the early 1980s. AIDS emerged on the Boston landscape in late 1981, with Fenway clinic's Dr. Lenny Alberts diagnosing the first case of the disease in New England. Dr. Kenneth Mayer, who joined the staff and immediately initiated research and community education programs in 1980, quickly became a researcher and clinician on the forefront of the disease. Within a year of the first Boston AIDS case, the basement clinic hosted experts from the Centers for Disease Control, the National Institutes of Health, and Harvard Medical School hoping to learn from the clinic's response to the epidemic. The Fenway clinic became a national leader in terms of community-based research, experimental treatments, hospice care, and support groups for patients, community members, and the staff who faced death and trauma to an extent previously unseen in American community health clinics.
At the same, the Fenway clinic blazed a trail for lesbians seeking to become mothers through alternative insemination (AI). Though initially hesitant to divert any attention and resources away from the AIDS crisis or draw more critique from the public at a time when AIDS-inspired homophobia peaked, in 1983 the Fenway board approved a proposal, two years in the making, from the Fenway AI Task Force to offer education and insemination services for lesbians wanting to conceive. Among the first in the nation, the AI program at the clinic became a model for similar services across the country that granted lesbians easier access to fertility services than ever before. While the clinic downplayed its affiliation with the gay and lesbian community in the 1970s, it emerged as a gay and lesbian health gladiator after coming out in 1980.
Over a dozen gay and lesbian-focused health clinics emerged over the course of the 1970s in the United States, with the majority closing within two years. Local politics shaped each clinic's structure and relationship to the state more so than any universal notion of gay liberation during the 1970s. Consequently, each clinic, even the clinics that failed to thrive, offers a window into the politics of the closet in the age of gay liberation, Reagan, and AIDS. The Fenway clinic was unique in many ways, most notably in its adversarial positioning to the state for nearly a decade that inspired its creation, impacted its funding, and informed its structure. Of those clinics that remained open for many years, the Fenway clinic's resistance to state involvement proved to be the most sustained and permeating. In fact, most other long-lasting gay and lesbian-focused clinics linked their survival and success to the support and approval of the state through licensure, funding, and tax status from the outset. The clinic's battle with the state makes it an ideal case to examine the driving role of the state in shaping and nurturing a gay institution in the 1970s and 1980s, first by galvanizing residents through encouraging the redevelopment of the neighborhood and then by demanding professionalization and regulation of community health clinics. Similarly, the Fenway clinic's tangential relationship to gay liberation at its inception sets it apart from other organizations offering services explicitly for gay and lesbian patients, providing a glimpse into an institutional coming-out process during the gay liberation and early AIDS periods. The clinic's initial reluctance to embrace its new identity as a gay clinic and its emergence as a national leader in the early AIDS response speak to the limits of gay liberation and the realities of the early epidemic that have scholarly implications far beyond the small basement clinic.