that occurred earlier that summer (Chambre, 1991). As the number of ill and dying rose, it was clear that the community could not, by itself, care for them and that there was a serious need for governmental intervention. From 1981 to 1983 there was increasing community pressure on local and state governments to respond to what was beginning to be recognized as a profound health crisis.

In comparison with the rapid mobilization of public resources in San Francisco, where the gay community was a powerful political voice, the New York public health system moved slowly in response to the epidemic. In contrast to San Francisco, the New York gay community was a much smaller political constituency (San Francisco has a population of approximately 750,000, New York City, approximately 11 million) and had a much more complex political structure. GMHC and other volunteer agencies helped fill an institutional vacuum, focusing on the epidemic among gay men that was happening in their own community. The openly active gay community was willing to recognize it as their own. This contrasted with other similarly afflicted communities. As late as 1987 the major institutions of the African American and Hispanic communities had made only minimal formal responses and there was little evidence of AIDS-related organizations.

Substantial behavioral changes in sexual practices were documented in the gay community—the reduction of unsafe sex, particularly anal intercourse, and numbers of sexual partners. These changes antedated the initiation of formal educational programs to promote behavior change. Studies both in San Francisco and New York indicated that changes in behavior had begun by 1982-1983. By 1986 there had been dramatic declines in risky behavior in all age groups among gay white men (Hansfield, 1986). In New York, studies of the rectal gonorrhea rate (a proxy for risk of HIV transmission) showed about a 10 percent drop between 1981 and 1983 and a drop of close to 80 percent between 1983 and 1986. Similar declines are believed to have occurred among African American and Hispanic men, although lagging behind changes among white men). Martin, Garcia, and Beatrice (1989) reported that the gay-identified men in a nonrandom sample of 745 individuals had reduced their numbers of partners and incidents of anal intercourse by three-quarters (see also Siegel and Glassman). This change appears to have occurred as a result of informal feedback into the community from community-based organizations rather than from formal education programs sponsored by specific health agencies.

Evolution and Role of Volunteer Organizations

By the late 1980s the rate of new HIV infections among gay-identified men began to fall—partly because those at highest risk had already been



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