The AIDS crisis erupted so quickly and with such devastation that gay communities of care and medical infrastructures seemingly developed from nothing, appearing as rapid responses to an epidemic that could be narrativized only through images of a plague or an explosion. AIDS destroyed (and still destroys) so much, not only human lives but also historical memory, and much was lost that may never be recovered. Katie Batza's Before AIDS resists this historical erasure by recovering gay health politics of the 1970s, which set in place crucial institutional networks that played important roles in mitigating some of the ravages of HIV/AIDS in the United States.

AIDS provides the inescapable marker of periodization, but much of Batza's analytical focus shrewdly falls on questions of institutionalizing the nebulous “gay liberation” ethos of the 1970s into medical establishments, as heightened political rhetoric began sounding somewhat different in its concrete bureaucratic manifestation. As such, Before AIDS offers an important assessment of gay politics more broadly and the always vexing question of what the conditions of possibility for “liberation” are within existing structures of power.

At the core of the book are three case studies of gay health organizations: the Community Health Clinic in Boston, Gay Community Services Center in Los Angeles, and Howard Brown Memorial Clinic in Chicago. All established in the first half of the 1970s, they emerged from the era's various strands of left activism. In Boston, anti-gentrification work spurred the push for community-based health care, with gay activism initially “tangential” (18). Chicago and Los Angeles were driven by more specifically gay mobilizations, but in different ways. Howard Brown, named after a New York City health administrator driven out of his job by a reporter's threat of outing, was built within a professional network headed by gay doctor David Ostrow. The Gay Community Services Center, in contrast, was spearheaded by radical activists and challenged normative medical approaches, theorizing “oppression sickness” as a malady linking personal illness to social injustice. All three reflected gay liberation in some sense, but, as Batza notes, to simply invoke that phrase “oversimplifies their origins and misrepresents gay liberation” (39).

A “general ignorance of gay health issues among medical professionals” fostered distrust and even misdiagnosis, necessitating independent organizing (4). Batza shows how gay health politics drew sustenance from Black Panther Party precedents, feminist challenges to patriarchal medicine, and anticapitalist critiques that “proved a driving force in gay health activism” (40). But implementation meant grant funding, labor relations, hierarchy – in short, professionalization, of a sort that coexisted uneasily, or perhaps impossibly, with more egalitarian aspirations. At its best, this helped Howard Brown become a central clearinghouse for gay medical research and even led to the first ever vaccine for a sexually transmitted disease, after a major hepatitis B study identified its sexual transmission. Other times, it led to abandonment of radical ideals. In Los Angeles, a male-dominated center management already guilty of sexist approaches to lesbian health set off a long, antagonistic labor dispute with its own feminist staffers, who picketed and deemed its leaders “male-identified bourgeois capitalist sexist lackey pigs” (83). The genuinely radical idea of oppression sickness faded, superseded by “more rigid and narrow definitions of health” (84).

Much of this disciplinary pressure came from the state, and Batza weaves a subtle but compelling analysis of how the “state can overlook, and at times even nurture, homosexuality as long as it also results in submission to state power,” operating “less as a straight state than an antiqueer state” as it hails gay subjects through its normalizing bureaucracies (5, 67). This is generative in thinking about the foundational moments of neoliberalism and what came to be called homonormativity.

Navigating these straits proved daunting, and even breakthroughs could be marred by their limitations. Howard Brown's mobile “VD van,” for instance, was an innovation that could only come from the gay community itself: destigmatizing both sex and infections, it enlisted drag queen Wanda Lust – now Nurse Lust – on a poster campaign that integrated health, entertainment, and gay-affirmative values to encourage testing and safer sex practices. But which gay community did it serve? In residentially segregated Chicago, the van's itineraries generally followed routes that imagined “gay” as white, leaving a fully intersectional gay health politics still out of reach.

Batza hews close to the central organizational case studies; lesbian health work, she notes, was generally subsumed under broader women's health efforts (highlighting the gendered ways men frequently assumed ownership of gay politics). An affective lens on men's pre-AIDS struggles with sex and illness, seen in gay novels of the decade, is absent but somewhat missed. Still, with a deep research base in organizational archives and nuanced analysis with several claims to historical significance, Before AIDS offers a crucial intervention into histories of gay liberation, health and medicine, and the 1970s more broadly.