It’s too late to arm yourself with a copy of the September issue of The Blue & White. Here, Senior Editor Anna Bahr explores the history of women and gay health at Columbia.
In the fall of 1983, women graced Columbia’s undergraduate class for the first time. The same year, the HIV/AIDS crisis rose to global prominence. It marked a remarkable confluence of both triumph and tragedy, each of which was navigated by groups of ambitious individuals whose activism determined the future attitudes of the University toward marginalized groups. They endowed an institution with empathy.
Health care, as evidenced by every stump speech of this summer’s presidential campaigns, is a specifically political issue. Who gets sick and how quickly they are treated reveals their socioeconomic status, sex, and sexuality. Being the disadvantaged party in any of those categories can mean the difference between life and death. However, in contrast to the current vitriolic climate, Columbia’s historic health care reforms eluded overt controversy. Likewise, they lacked the antagonistic explosiveness of the hallowed ‘68 protests, so often held up as the standard of Columbia counterculture. Medical care that addressed the needs of women and queer men was espoused as an obvious course of action. Advocates shaped policy not because they were violently critical of existing structures, but because they were explicitly self-righteous and stood up for their beliefs without interrupting the overall pace of life.
After lagging behind peer institutions, once Columbia integrated undergraduate women into its student body, it did so unequivocally. The university threw generous support behind building a Women’s Health Center at a time when explicit discussion of reproductive health was “marginalized and not acceptable at most university settings,” says Dr. Martha Katz, the Center’s first director. Open for its first full year in 1984, the clinic introduced a new model of care that not only offered superior sexual health services—an unprecedented investment in women’s well-being—but also worked with Columbia security to manage cases of rape. Counselors would accompany victims to the hospital, and advise women dealing with sexual harassment before the term had a functional meaning; Columbia’s care providers professionalized emotional as well as physical support.
Almost contemporaneously, another remarkable development took place within the campus medical establishment. In 1985, the University became the first academic institution in the country to offer free HIV testing to its queer student and faculty community through the Gay Health Advocacy Project (GHAP)—much to the chagrin of its notoriously image-conscious administration. Racing ahead of nationwide recognition of the disease, GHAP reached out to researchers at St. Luke’s for trials with HIV-positive students and encouraged testing at Columbia before AZT (an antiretroviral used to treat the virus) had been officially approved by the FDA. Still, Columbia’s administrative leadership was concerned with the liabilities of the virus, going so far as to form an HIV Advisory Committee that sought to distance the University’s image from associations with the disease scourging New York. The committee discussed the realities of HIV as a handicap in admission to law and medical schools based on applicants’ HIV status: will they live long enough to survive graduate school?
The Women’s Health Center
Robert Pollack, then the Dean of Columbia College, described the faculty vote to admit women as the obvious step forward: “Opening the College to women was by any measure fair, generous, creative, democratic and open-minded.” Yet the decision was infamously delayed. Though the university saved face through its relationship with next-door Barnard and ever-present female graduate students, Columbia’s academic rivals were reaping the benefits of coeducation long before Columbia, and the University needed more than speeches to catch up. John Jay lacked bathroom facilities with the requisite “Women” sign on the door. Panty raids at Barnard were Friday fraternity fun. Medical care did not include gynecological services.
But Columbia readied itself for the inclusion of the fairer sex with enthusiasm, recognizing that, “If the university wanted to serve its women students, it needed to meet their needs,” says Rebecca Weiker, CC ’88, one of the first women admitted as an undergraduate. “Not just as an afterthought, but as a priority. If Columbia was really going to be coed, it had to treat women well.” With the support of both Richard Carlson, the director of Health Services, and the Dean, the Women’s Health Center did just that.
This was ten years after Roe v. Wade, when stories of back alley abortions and plane flights for overnight procedures in willing clinics were still fresh in the minds of American women. To organize health care around the unique demands of women was a phenomenon born of the pro-choice movement—an ambitious tenet of the feminist agenda. But the University, though progressive, proceeded cautiously. Still recovering from its 1960s adventures in controversial politics, throwing immediate weight behind a mission statement with a resounding feminist ring was unlikely. Candid conversation about birth control, STIs and eating disorders was still rare between mother and daughter, let alone in school-sanctioned forums. For the American public, such forthright dialogues were freely associated with bra-burning and Gloria Steinem’s rhetoric.
To reassure the administration that its goals were focused on public health, not public policy, the clinic’s visionaries had to temper the program’s radical connotations by clearly delineating between women’s care and women’s liberation. “The people who developed Our Bodies, Ourselves [an early iteration of women’s health advocacy publications, radical for its frank discussions of abortion and pregnancy] were alienated. They didn’t fit into the academic setting. Columbia trusted us because we mainstreamed the image of women’s health. It wasn’t fringe anymore,” says Dr. Katz.
Thanks to a $300,000 grant from the New York State Dormitory Authority (the project was funded independently of university investment) to build and buy equipment, a bright, modern space was renovated, complete with three examining rooms and a counseling room. The clinic abandoned the expensive care of specialists and primary physicians, instead using nurse practitioners who could spend more time with young women, helping them to assess potential risks to their health. While the renovation was aided by state funding, the clinic operated under the budgetary oversight of Columbia Health Services. This arrangement gave the University administration some distance from the program while sanctioning it.
Care surpassed the basic annual in-and-out physical. It was a safe space. Even faculty experiencing sexual harassment sought counseling at the clinic. in an era when date rape and sexual coercion were absent from collo- quial vocabulary and rarely publicly acknowledged, the clinic prioritized assault issues and took initia- tive in cases of student rape. The clinic even devel- oped some of the first crude rape kits, sterilized and pre-packaged versions of which later became standard hospital gear. dr. Katz went as far as to perform a vaginal smear for a violently assaulted undergraduate student at St. Luke’s—a hospital at which she was not formally employed. “The spirit of the women who worked at the clinic was amazing. i haven’t seen anything like it since. it was more a move- ment than a clinic. The level of commitment transmitted to the nature of the care,” she remembers.
The example of personal investment in the program investment in the program set by its leaders was emulated by dedicated undergraduate students. A peer counseling program trained students to help their classmates understand their health care choices. After undergoing extensive training, student facilitators would roam through dorm halls singing “sex raps” that explained basic principles of safe sex and STI transmission, answered classmates’ questions and practiced basic pregnancy counseling. Shockingly recent, even in the 80s, “[young women] had really little knowledge about their bodies or their choic- es,” says Weiker, who went on to work for the clinic after graduation. “Having that kind of control over your sexuality and your reproduction meant basic empowerment.”
The Gay Health Advocacy Project
A similar combination of stigma and silence surrounded health care for gay men. “Two things were important when we talked about AIDS in the ’80s: One, a diagnosis was recognized as a death sentence; without treatment you had, max, 10 years before you died. Two, anonymity. There was a lot of discrimination against those with HIV. People would sometimes use pseudonyms when they went to our conferences,” says Dr. Laura Pinsky, who began working with Columbia Health in 1985 and co-founded GHAP. By the end of 1983, half of the nearly 1,400 people infected had died. Centers for Disease Control (CDC) estimates at the time, men who had sex with men comprised 71% of diagnoses. Dr. Pinsky remembered that figure being closer to 100 percent at Columbia. For a time, Pinsky kept a running list of the Columbia students and faculty killed by the disease–nearly all of those were gay men. After hitting 127, she stopped updating it. The city was recognized as the epicenter of the disease, a reputation administrators were all too conscious of.
But New York also has a distinguished history of LGBTQ activism. It was the site of the first openly LGBTQ weekly newspaper in America, Gaysweek; it made legal history as the first state to reduce sodomy to a misdemeanor. The increasingly visible gay social scene and acceptability of students openly identifying as homosexual took root on campus. Columbia boasted one of the most vocal queer communities in the country; as early as 1967, Columbia had became home to the first LGBTQ student organization in the world—the Student Homophile League. Its presence on campus was well-organized and passionate.
Still, discrimination at Columbia and in the city ran rampant. Dr. Katz described attitudes toward the unrelenting HIV virus as nothing short of hysterical. “There was a frenzy on campus,” she says. “The administration didn’t want a gay man [who worked at the University] as a receptionist because they were afraid he would get a paper cut and bleed on the phone… We simply didn’t understand the disease.” This was the standard fare for the day. Hospital employees making their rounds at St. Luke’s served infected patients by leaving dinner trays outside hospital doors for fear of contraction on contact. This substantial stigma was pervasive, the fear, contagious, and, to a degree, justifiable.
To navigate the potential legal hazards of an at-risk student population, the University created an HIV Advisory Committee composed of the senior vice president for planning and budget activities, Joseph Mllinix; representatives of Health Services; Dr. Laura Pinsky and Dr. Richard Carlson; Kendall Thomas, a professor specializing in law and sexuality; legal counsel for the University; and a handful of human resource affiliates. Though Health Services was “always supportive of GHAP,” says Dr. Pinsky, the administration was less concerned with public health than avoid- ing potential legal complications. The committee (described as “egregiously unaware” and “looking to cover its legal ass” by a source close to the situation) sought to chisel out a uniform policy on such issues as allowing students with an HIV-positive diagnoses to live with their uninfected classmates and hot infected staff could be medically treated.
With Dr. Pinsky and co-founder Paul Harding Douglas, an AIDS researcher who died of AIDS-related complications in 1995, GHAP became a model for testing programs across the country. Though initially much more poorly funded than the Women’s Health Center, and without a publicity apparatus (the program couldn’t afford to take out ads in the Spectator), it remains one of the most respected groups at Columbia, offering better care and support than any comparably city-sponsored program. Over 250 student advocates have devoted countless hours as peer counsellors through its 27-year history.
Movements advocating equal and specialized health for all represent a quieter political revolu- tion. Health advocacy at Columbia proved that political gestures can dissociate from rhetorical causes and abstain from strict variations on moral- ity. Despite day-to-day discriminations and sys- temic social inequality, these movements were most revolutionary for their inclusion, rather than their specificity. Feminist health care? Advocacy for LGBTQ patients? Sure. But the qualifiers matter less than the fundamental obviousness of promoting health for everyone. That was was in the interest of the University. And yet, such foresight, nearly 30 ago, has yet to extend to a national audience.
There has been some progress. This summer, the legitimacy of the Affordable Care Act, both affectionately and disparagingly—depending on your loyalties—dubbed “Obamacare,” and fought tooth and nail by its more virulent opponents, was upheld in the Supreme Court. It requires all insur- ance providers to offer women access to free birth control and abortion services. And yet, this month, the GOP announced its revised platform, which now enshrines official support for “a human life amendment to the Constitution that would make abortion illegal without specific exemptions for cases of rape or incest.”
Earlier this year, President Barack Obama announced explicit support for same-sex marriage. While his statement was for many both revolutionary and radical, it had little impact on the Defense of Marriage Act, under which married gay couples are not granted equal health care rights to their heterosexual friends.
Here we are at a historical moment during which dialogue surrounding the rights of women, gays, lesbians, transexuals, and people of every color is constant, ubiquitous and persistent. The Internet feeds us a slow drip of outrage at the smallest injustices. High-profile gestures toward change seem at once reactionary and reductive. Where Occupations and marches certainly draw much-needed attention to national issues, their overall impact is difficult to measure. Important, yes, but decidedly distant from concrete change. Perhaps the lesson here is to narrow our focus. National reform is necessary. But GHAP, a project started by two concerned Columbia affili- ates, still offers some of the best care for those infected with HIV in the country. The Women’s Health Clinic proved so successful that it was even- tually absorbed by Health Services and in so hap- pening, was recognized of its work as a key player in making Columbia a more welcoming social envi- ronment for women. Maybe we should go back and start building small.