The first decade of the AIDS epidemic in Washington was a time of intense debate, uncertainty, and social change. Initially most cases and resources were focused within King County, where the state's first recorded case was reported in Seattle in 1982. AIDS wasn't identified in Snohomish County until 1984, and the county continued to trail slowly but inexorably behind the curve in case numbers. Efforts to educate the public and put preventative measures in place were generally considered to be successful, but Snohomish County consistently lacked sufficient resources to provide medical care and home care for AIDS patients. Too often, residents were forced to seek care or even relocate to Seattle to meet their growing needs as their condition progressed.
Public Health Responses
In September 1984 the Washington State Board of Health ruled that doctors needed to report known or suspected cases of AIDS to their local health districts. At the time of this ruling AIDS was still more of an observable collection of symptoms than a confirmed diagnosis due to a lack of available testing, so this process was initially complicated and spotty. Later the county health department would be able to engage in contact tracing and contacting partners of those who tested positive for HIV or AIDS to inform them of possible exposure, but medical privacy laws prevented disclosing more than dates and locations.
The first blood tests for HIV (the virus that causes AIDS) reached the Seattle area to be used to test blood bank donations in March 1985. On May 20, 1985, the Snohomish Health District began offering free testing to anyone who requested it. This program was launched simultaneously with the Sno-Isle Blood Bank testing all of its donations with a policy of not informing any donors if their donations turned up positive. It was believed that some might use the blood banks as a discrete method of receiving AIDS testing, so the Health Department program was aimed at preventing any burden on the blood bank’s resources. Those who received a positive result from the Snohomish Health Department would be referred to a private physician for treatment.
In February 1987 the Snohomish County AIDS Task Force was formed. This organization comprised of public health officials, government officials, and AIDS education advocates worked closely with the Snohomish Health District and other agencies to shape policies and educational initiatives throughout the initial years of AIDS response. It was around this time that Dr. M. Ward Hinds also began to emerge as a very visible leader in AIDS education and prevention within Snohomish County. In March 1987 he issued a warning as health officer for the Snohomish Health district that the county needed to act swiftly to avoid disaster. Grant funding was sought for an increase in screening, education, and counseling programs. Outreach programs would begin offering AIDS classes, individual counseling, and screening at drug treatment centers and STD clinics. The initiatives would amplify efforts underway at a popular Everett gay bar, the Stage Stop, which was already offering AIDS testing on-site.
In April 1987 Everett formed its own AIDS task force to further analyze local policies and practices, and in May the county received its first round of federal funding to fight AIDS ($12,400). Reports released by the Everett Daily Herald in July 1987 cited a lack of home nurses for people with AIDS in the county, as well as any nursing home facilities able to care for people with AIDS, as some of the reasons why AIDS patients were forced to move into Seattle and away from friends and families. In a November 1987 interview with The Seattle Times, Dr. Hinds said that in an informal survey of doctors in Snohomish County, he was able to locate only two who were willing to work with AIDS patients. The same article outlined a program recently initiated by the University of Washington to develop 20 regional Centers of Competence to train physicians to work with AIDS patients, but Everett was not selected as a location. According to Susan Kaetz, director of the initiative, "Everett is just too close to Seattle” ("Suburbs Not Ready ..."). Snohomish County was stuck in the unenviable position of being too close to a major urban center with a high case volume and high resource needs and the inability to successfully advocate for an adequate portion of available funds to meet its growing needs. The other nearest training center was placed in Bellingham.
The issue of mandatory testing was debated in many different spheres at the national and local level. Some parents wanted all school children tested. Some members of the public wanted all food handlers tested, still misunderstanding how AIDS was transmitted. An Edmonds obstetrician refused to treat high-risk women or women on welfare without first testing them for AIDS. The issue remained controversial because of patient privacy rights and rights to bodily and medical autonomy, but also because widespread screening was cost prohibitive. Correctional officers were frequently in the news threatening to picket over fears of AIDS transmission. In 1987, after a prison guard in Monroe was bitten in an altercation with a prisoner who later was identified as having AIDS, the debate heated up. On March 24, 1988, Governor Booth Gardner (1936-2013) passed a sweeping AIDS bill that put the matter to rest, at least in the matter of testing those who were incarcerated. Inmates who were violent could be tested at the request of the prison with the approval of the local health officer; there would be no large-scale inmate testing. This and other provisions were backed by $5 million in funding. Also early in 1988, Snohomish County began testing all newborns for AIDS.
In February 1988 Snohomish County gained a new and much-needed ally in the fight against AIDS. Kathleen Compton, a former AIDS hospice nurse from Seattle, became the first case worker hired by the Snohomish Health District. "Really my job description is to coordinate services, but what I’m doing is facilitating development" ("County Begins ..."). More than half of her clients needed to go to Seattle for medical care, as there were few doctors in the county who would treat them and no dentists; all of her clients had been referred to the city for emotional and practical support. Compton credited the county’s task force for its educational and preventative efforts but said that many of the participating agencies had not done much to assist her clients.
In April 1988 Snohomish County received $477,000 in funding, its portion of the state’s new omnibus AIDS bill. Over the next few months, a plan emerged for an increase in public education, screening, and services. The Snohomish Health District planned to hire two educators projected to give 175 presentations to 3,500 people by the end of 1989, and 792 presentations to 23,760 people by the end of 1991. Funding allowed for HIV counselors to begin working with the Snohomish Health District in September 1988, and AIDS testing was expanded to three sites: the AIDS Program Office and district’s main office, and the South County Clinic in Lynnwood.
In 1989 AIDS cases had reached 48 since 1984, more than half of whom had died. Dr. Hinds pointed to the lack of methadone clinics, drug treatment slots, and the lack of ‘bleach and teach programs’ to instruct drug users how to safely clean and reuse needles as major hurdles to preventing the spread among drug users. Because no additional funds would be arriving before 1990, there would be no ability to address these issues; there was also community backlash when these kinds of programs were discussed. In August the Snohomish County HIV/AIDS Housing Coalition petitioned the Everett Housing Authority and the board of health to secure 24 federally subsidized housing units for patients in the late stages of AIDS. There was a year's wait for subsidized housing, which was not realistic at a time when people who were terminally ill with AIDS did not have long to live. Twenty-six patients were living in Snohomish County at the time, but not all were in Everett; six were in South County, six were in East County, and four were in North County. Mercifully some patients in Snohomish County had begun to see positive effects in slowing the progress of their symptoms by taking azidothymidine (AZT). Despite side effects and high cost, this drug proved to be a lifeline that pulled many individuals into an era of more effective treatments to come.
In September 1990 members of the HIV/AIDS Continuum of Care Task Force released the results of a six-month study on AIDS response in Snohomish County. The recommendations included setting up a resource library on AIDS information; developing a referral list of supportive clergy in the area; lobbying for more in-patient AIDS treatment slots locally; creating an education program for local physicians; and publishing price lists for local pharmacies for drugs frequently used by AIDS patients. According to the report, 96 people in the county had tested positive for AIDS since 1984, including 87 males, six females, and three children under the age of 12. The report closed, repeating the common criticism that more than half of Snohomish County residents with AIDS needed to go to King County for medical treatment, support groups, and other services. In October, the 100th case of AIDS was reported in Snohomish County.
In March 1991, Snohomish County received part of a $1 million federal grant to become a test site for the treatment of substance-abusing pregnant women. Intensive counseling would be provided to help them address their addiction issues. According to the Everett Daily Herald’s coverage, treatment of a single baby born addicted to drugs and alcohol because of prenatal use by its mother cost $40,000 in the first week of its life; a baby who contracts AIDS from its mother required $1 million worth of care in its lifetime. In May the Herald covered the fierce debate between Dr. Hinds and Sarah France, the director of Everett’s Office of Neighborhoods, over the prospect of bringing methadone clinics to the county to treat pregnant drug users. On the public health side, Hinds believed that the methadone clinics would prevent the transmission of AIDS from parent to fetus; on the Office of Neighborhoods side, it was believed that the methadone clinics would bring a large influx of addicts, dealers, and crime to Everett.
In June 1991 the Herald published a Decade of AIDS retrospective, reiterating how much had changed nationally and locally in terms of what was known. Some inroads had been made in terms of sourcing subsidized apartments for AIDS patients within the county, but more were still needed. There was still a desperate need to establish an in-county long-term nursing facility that could work with AIDS patients. Snohomish County schools were watching the debate in Seattle about handing out condoms but were not preparing just yet to make it an official conversation.
Public Education Efforts
The Everett Daily Herald did an admirable job reporting on the realities of the epidemic, particularly bringing to light the hidden complexities of life with AIDS in rural and suburban Snohomish County. It is arguable that consistent and accurate news coverage may have reached more eyes than many coordinated public health campaigns simply because newspapers had the luxury of a dedicated readership. This section highlights some of the bigger Herald features, as well as some of the coordinated public awareness campaigns created by other entities.
On April 14, 1984, the Herald published a story announcing that the first two cases of AIDS had been detected in Snohomish County. At that time, AIDS needed to be diagnosed via a collection of symptoms due to a lack of any adequate means of testing for the virus that caused AIDS. State health officials were alarmed because there had been 14 new cases identified since January. "We had expected the number to increase, as it has in other cities, but we’re surprised about the dramatic increase" ("Two Snohomish ..."). The piece concluded by stating that the at-risk groups included gay men with multiple partners, intravenous drug users, and hemophiliacs; it also briefly discussed the believed manner of transmission was through contact with body secretions and blood, somewhat vague language that would become more specific as accuracy in public education became increasingly important.
On January 13, 1985, the Herald covered a regional conference on AIDS that was attended by medical professionals from the Puget Sound region. The numbers and predictions were stark. "The disease is almost uniformly fatal, and those who contract it usually die within two years" ("Area Health Workers ..."). Despite this grim prognosis, vital information was shared to calm hysteria and misinformation about casual contact transmission. "AIDS is caused by a blood-borne, sexually-transmitted virus that is readily killed by soap, common disinfectants and probably by drying, you do not get it from non-sexual personal contact in the work place, in the home or in public places" ("Area Health Workers ..."). Getting people to believe this message was an uphill battle for public health officials, volunteers, AIDS patients, and those who loved them for the foreseeable future.
On July 5-6 of 1987 the Herald published a lengthy report on the state of AIDS, locally and nationally. Through multiple articles, the paper went into details about how the disease was transmitted, progressed, and how people eventually died, usually of AIDS-related illnesses. Through straightforward explanations the writers attempted to dispel myths about casual contact transmission, and humanized the lives of those who were impacted by AIDS by outlining the ways in which they struggled to access housing, daily care, and medical care within the county.
In the first week of August 1987, Gary Beaman, AIDS activist and founder of the M. A. K. AIDS Foundation, worked with local politicians and the Snohomish Health District to launch an AIDS awareness week. Despite efforts to drum up support, Beaman was frustrated by the low attendance at the kickoff rally. Fearing hostile acts, health officials had avoided printing the locations of screenings and fundraisers during the week, so outreach efforts remained word of mouth among those already within targeted groups. "The gay population is still a high-risk group, but people are not realizing that this is becoming a disease of the heterosexual population," Beaman told The Seattle Times ("Activist Deplores ...").
Other non-profits arose to do outreach in more rural areas of the county. In March 1989, Beverly Carter and Mary Floyd, workers for Pacific Treatment Services, were profiled by The Seattle Times as they did their rounds at bars and hotels in downtown Snohomish. They spoke about how finding and engaging with drug users and sex workers was much harder in rural and suburban areas, not because they did not exist, but because they lived much more covert lifestyles. "Our job is definitely more difficult, we have to drag them out,” said Floyd ("AIDS is Small Town ...). They still counted their efforts as successful; the kits with condoms and needle cleaning supplies that they left in restrooms disappeared and were not found discarded nearby unused. A large part of their work was sitting and having conversations with people; one woman interviewed learned that she could get AIDS through oral sex, a bit of information she admitted she would not have gone out of her way to learn. Still, misinformation persisted and people doubled down on personal beliefs. One man refused to believe that AIDS could not be contracted by mosquito bite or sitting on a toilet seat. "Lady, I’m not going to argue with you, how many times has research been wrong?” ("AIDS is Small Town ...").
On December 1, 1990, 65 participants took part in a candlelight walk through downtown Everett in honor of World AIDS Day. Those involved asked for better awareness and understanding for those impacted by AIDS and HIV. One parent, Tom Mansker Sr., who had lost his son Tom Mansker Jr. the previous year, stated that it had been his job to help his son experience the best of life while he still had time left, and now his role was, "to get the message out about this terrible disease so it can be stopped and other families don’t have to go through what we did" ("65 March ..."). Ron Gipson of the Boeing Good Neighbor Fund, also present, said he did not understand how some families could abandon their loved ones. "They bear these children, clothe and feed them, but once they find out they have AIDS they leave them alone to die" ("65 March ..."). Gary Beaman said that Snohomish County had come a long way in the support it had shown for those with AIDS; the community raised more than $2,000 for Thanksgiving baskets for AIDS patients and hoped to do something similar for Christmas.
Sometimes national events pushed the public conversation forward. Perhaps the biggest leap in awareness outside of the gay community came on November 7, 1991, when Earvin "Magic" Johnson Jr. (b. 1959), a player for the Los Angeles Lakers basketball franchise, announced that he had AIDS and would be retiring. Prior to this announcement AIDS had largely forced closeted gay celebrities to disclose their sexuality when their diagnosis became known, but having a straight celebrity disclose his status was a wake-up call to some. Herald reporter Eric L. Zoeckler went to local sports bar Sport’s Beef and Brew to interview patrons as Johnson announced his retirement. "It hasn’t been this quiet in here since the start of the Persian Gulf War, but then again what we’re seeing is amazing, just amazing,” said Susan Clark, a cook at the bar ("AIDS Revelation ..."). Some patrons thought it was a prank and were waiting for a punch line until reality set in. "That this could happen to someone like Magic Johnson drives home the point that no matter how much money you have, how good-looking you are, how much you have going for you, that you can still get AIDS,” said patron Gregg Ortega ("AIDS Revelation ..."). This kind of sentiment was echoed by other clientele. Despite a decade of public education, there were still deeply-held misconceptions regarding who could or could not get AIDS.
