Interviewed by former GHAP Advocate, Will Hughes — August 18, 2012
Q: Can you talk maybe like what you do remember about like either the beginning, like people coming down with AIDS at Columbia, or like the first responses to that, if you remember, or anything like that?
Dowling: I can just tell you my story.
Q: Yeah, of course.
Dowling: I came to Columbia for graduate school from the Midwest. And I was in the medical anthropology program in the anthropology department. So I was living near Columbia and studying at the downtown campus, and I had actually started a gay and lesbian support group in college, at Dennison University. So when I came to Columbia I wanted to do the same thing. And I also, I guess I got involved with the gay student union at the time, and they had monthly dances. And that’s where I guess a lot of us met each other and wanted to do some kind of education around AIDS because there wasn’t anything at the campus. And we wanted to make sure that all the gay students knew as much as we knew at the time about stopping transmission and how to protect themselves. And I forget exactly how we all got together, but I’m pretty sure it was through the gay student union and the dances and some of the social activities. I also, after my first semester, transferred to the school of public health and got a research assistant job with John Martin. John Martin was a public health and psychology researcher. He had just finished his Ph.D. And he and an anthropology professor named Carol Vance secured the first federal funding to study the impact of HIV on the mental health of gay men. And it was research coming out of the National Institutes of Health and it was a multimillion dollar, multiyear project. And it was groundbreaking at the time. And I was working on that. So I was heavily involved in HIV research and education and training. And my under—my graduate thesis was also on HIV and AIDS and the treatment of gay men in the American healthcare system at the time.
Q: When you guys first got together, like what was that like? Were you involved in like the starting to the counseling program through GHAP? What do you guys do?
Dowling: My recollection is we wanted to do something to educate the gay student population about HIV because there was nothing on campus. And I forget a lot of the details, but the dean at the time didn’t want us to do anything, because they didn’t want to have discussions of HIV on the Columbia campus, because they were afraid of the public relations aspect of it. So rather than doing proactive education they choose to do nothing. And there was a lot of us at the time who were very politically active. It was in the middle of the Reagan years, a very conservative mood of the country. And all of us were, you know, just coming out and there was, you know, ACT UP had been formed, the Gay Men’s Health Crisis had been formed, and we were trying to do something along those same lines for the students at Columbia, primarily the undergrads, because the graduate students tended to have access to other means of education and condoms, and you know, we were kind of living outside the campus, but the undergrads were confined within the campus and didn’t have access to a lot of information. We got together to write a pamphlet that Laura and Paul, you know, eventually took into publication, and that was used around campus at the time. I forget how we got connected with Laura, but there was a need or a requirement that we have some kind of faculty sponsor for what we were trying to do and starting a gay health advocacy program. And it naturally ended up in the student health service. And Laura had an interest in doing it. I forget exactly how we got connected to her.
Q: Cool. And in doing the research for what would eventually turn into the pamphlet, you come from a public health background?
Dowling: Yeah. My undergraduate degree, it was a self-designed major, but it was basically a double major of biology and sociology and anthropology. And then I transitioned into public health. And I had actually done a lot of AIDS education while I was in college. My undergraduate thesis was on a similar subject where I was comparing the treatment of gay men to the treatment of syphilitic prostitutes in Victorian America; there were sexual minorities, sexually transmitted diseases, and how they were treated by the U.S. health system of their era. And I did, the first semester of my senior year I was in Chicago doing the research on the Victorian American health system, and I worked as a volunteer at Howard Brown, which was the Chicago gay health clinic at the time that was moving into HIV. And then I was able to secure an unpaid internship in Boston at the … oh … it was an AIDS program that was an offshoot of the Fenway clinic, and I’m forgetting the name of it right now, but I was their first intern at the – oh, Boston AIDS Action, that’s what it was. It was the Boston counterpart to the GMHC. So I came into graduate school with a lot of firsthand knowledge in having done public health education and research in HIV. Which was fairly new at the time, you know, because AIDS had only been identified for, it wasn’t even AIDS at the time, for like four years at that point. You know, because the first cases were written up in 1981.
Q: At the risk of digressing, do you mind talking a little bit about like your undergrad thesis? It just seems interesting. Were there similar responses from the government?
Dowling: It was not only the government, it was the actual healthcare system itself. I actually have the thesis somewhere buried here, I haven’t looked at it in a long time, but it … I was interested in doing something around gay men and their treatment in the American healthcare system because it was cutting edge at the time. And nobody actually knew how AIDS was transmitted back then. And we were, when I was in college there wasn’t even safer sex, because they haven’t even identified that it was transmitted through sex. And by the time; I started college in ’81 and graduated in ’85, so over those four years is when they figured out that condoms worked and that it was sexually transmitted, it wasn’t transmitted through saliva, through tears, that kind of stuff. But before they knew that, when people got really sick and went to the hospital they were put in isolation. They were treated like piranhas. Often times healthcare personnel refused to treat them, not only because they were gay, but the fear of transmitting the disease because they didn’t know how it was spread. And back then were getting Kaposi’s sarcoma, and pneumocystis pneumonia. And if people were even getting treatment in the hospital it was, you know, not necessarily the best. And I forget exactly how I stumbled on to the comparison, but there was a real epidemic of syphilis in the late 1800s in the U.S. and into the early 1900s because it was before antibiotics. And prostitutes were blamed for the spread, even though it was really the men who were giving it to the prostitutes because they were the ones spreading it around. And the justice system was involved at the time, and prostitutes were put in jail and not treated well in the healthcare system at the time. So I was able to draw comparisons between being sexual minorities and sex workers, even though the concept didn’t really exist back in Victorian America, being oppressed minorities the justice system was involved a little bit, and the healthcare system wasn’t responding and treating people well. And it was interesting. And it was, you know, at the time, you know, I had professors who would arch their eyebrows; do you really want to do this? People thought that it would potentially ruin a career by going into something that was considered so taboo.
Q: And were there scholarly resources on like AIDS, since it was so current at the time? You must’ve had to do so much of your own research.
Dowling: The only thing that was available was the medical research and the public health research. So I was doing, I was using pretty current material.
Q: Yeah, it seems in 1985 it would be all MMWR and stuff like that.
Dowling: Exactly. It was the MMWR, it was newspaper articles, and I was in Popular Press, and I was able to glean a lot of stuff from those. So it wasn’t really historical research, it was contemporary, because my degree was sociology anthropology. So I was looking at a culture, and how people were writing about and responding to AIDS at the time.
Q: That’s so interesting.
Dowling: And at the time there was a specter of death. You know, we didn’t know if we were going to live five more years.
Q: Could you go into maybe more specifically of like Columbia. Was that this present fear?
Dowling: Absolutely. Oh, yeah. I happen to have a lot of friends who were older at the time. So, you know, when I was in graduate school I was 22, 23 and 24, and I lived off campus and I was able to make friends, and not only my friends on campus, you know, who you mentioned: Paul [Douglas] and Bruce [Francis], and David and a bunch of other people. But I had friends who were in their late ‘20s and early ‘30s and don’t forget I was doing the research at the public health school. So I was going out and doing interviews of gay men. We had 700 of them who had signed up for the study. And it was, you know, back then we didn’t have computers. We had two inch thick interview booklets that we had to take out.
Q: Oh, boy.
Dowling: With pencils. We weren’t allowed to use pen. And we had to circle their responses as we did this two hour structured interview about the impact AIDS was having in their life. And then we’d take these filled out books back, and in addition to doing the interviews I was also the quality assurance coordinator, so I had to read every single one of them and make sure that the team of interviewers had asked the questions properly and had, you know, done all the psychological testing charts the right way. So I read 700 peoples’ story several times because I worked on the project for probably two and a half years.
Q: And that was the one through Carol Vance and …
Dowling: Carol Vance and John Martin.
Q: John Martin.
Dowling: Carol Vance actually dropped off of it after a year and a half and it became John Martin’s project. He actually gained a little bit of fame in the public health world at the time, in the mental health world, because it was groundbreaking to even consider studying gay men, much less the, you know, mental health impact that HIV was having on the community. And he ended up living, I guess he was 33 at the time, he probably lived another five years. He moved to San Francisco, continued some research and he actually ended up killing himself rather than dying of HIV.
Q: Wow. What were people like in interviews? What were the findings from that in talking about the mental health impact?
Dowling: We were doing, it was mental health and social networks, it was a really fascinating study. You can probably read some stuff if you look up John Martin or Laura Dean, who’s another person, she was the administrative coordinator on the project. She may still be at Columbia, I don’t know. It was, you know, in retrospect I could call it a warzone and there was a lot of post-traumatic stress syndrome. But the people that we were interviewing, who were anywhere from 25 to 50 years old at the time, were literally losing 20, 30, 40 friends in their networks. And, for me, the strange impact is an entire generation of people who were in their ‘30s and ‘40s back in 1985 into the mid ‘90s died. So, you go out to – have you been to Fire Island?
Q: I never have.
Dowling: So out on Fire Island there was a lot of, you know, people sick out there, there was this gap for about 15 years where there was nobody who was 40 to 55 and aging into old age. I mean there were some, but there were so many people killed that just now we’re starting to get people who are 65 and 70 and gay.
Dowling: It was a weird time because we literally weren’t sure that safer sex was going to work, but we were promoting it as the best option. And this was before the test came out, so we had no idea if it was working.
Q: Thank you.
Dowling: Sure. And, you know, every time we had, you had sex, or you kissed somebody, you didn’t know if you were going to get the virus, because we weren’t sure, we didn’t know how it was transmitted.
Q: So was it really the advent of the test that kind of proved safer sex measures could work? When did that become more certain? That’s just really interesting to hear, like given the content of the pamphlet and stuff like that.
Dowling: It wasn’t the advent of the test when they isolated the virus. And over time they were able to determine that it was body fluids that transmitted it. And then they were able to, it wasn’t an overnight thing, it was a gradual thing over time, probably over two to three years, where they were able to identify that it wasn’t in tears, that it wasn’t in saliva, that it wasn’t in sweat. And then they were able to identify that it was in semen and in blood. And one of the biggest things was the impact on lesbians. Have you ever heard of dental dams?
Dowling: That was being promoted a lot just in case lesbians could potentially pass it back through oral sex. And then just over time as people figured out, you know, how it was transmitted, even before we had the test, that they had isolated the virus in people, then people started to know that safer sex was working. There were still a lot of unknowns, and it’s now people like me who have lived for 30 years without getting the virus, I’m negative, we now know that it works.
Dowling: We were all – in addition to doing GHAP, and being very politically active on campus, all of us were also pretty active in groups like ACT UP and sometimes working at the GMHC, which was called the Gay Men’s Health Crisis, they used the full name back then, they didn’t abbreviate it until much later. And we would take trips down to Washington, I remember the whole group went to Washington, I think twice. And we were able to see the AIDS Quilt a couple of times. And we did a lot of protests here in New York, you know, 72nd and Broadway, or maybe 96th and Broadway, we’d stop traffic all the time. It was a lot of fun.
Dowling: And there was one thing that we did, it was out – I can’t remember if it was an ACT UP rally, or a separate protest against the Berger Commission. And Warren Berger on the Supreme Court.
Q: Oh, yes.
Dowling: To be honest I forget what the spark was, whether it was a Supreme Court decision that happened or if it was tied to the Berger Commission report that came out. But there was a Bar Association dinner that was being held in Lincoln Center. And Chief Justice Warren Berger was there, and there was a big protest outside against him. And some of us actually got in to the auditorium and had toilet paper to throw at them. And unbeknownst to us other people came in and had eggs. So it was a formal dinner. And, you know, here were these college and graduate school radicals who had broken in, it was before 9/11, there were not the same security issues, and were able to have a demonstration and an action, you know, inside a very formal event. That’s one of the things that stuck with me. But I almost got arrested and that was the last time I did something like that.
Q: You mentioned before we started, were you involved in the GMHC maybe later on? Could you talk more about that?
Dowling: I volunteer for it. And I’m trying to remember, I’m pretty sure that I was a buddy doing visitation, I don’t know if they still use the word now, but one of the things that a lot of people with AIDS had was a buddy who would help them with shopping, housework, some cooking depending on the amount of time the volunteer could give, help people get to doctor appointments, because the disease was so debilitating at the time that people just couldn’t, you know, at our time, living with the disease. And we did some of that in Columbia too. Over the course of time students began to get diagnosed with HIV while I was still in graduate school and after I was out.
Q: Could you talk a little bit more about that specifically at Columbia?
Dowling: One of the researchers, no – let me back off that. There were several researchers who worked on this project under John Martin. I think there were only two of us over the two and a half year time period who are still alive today.
Dowling: All the other men on the project who were graduate student researchers working on their Ph.D.’s in a variety of subjects or other students, who you know, were just working, you know, for money, the gay ones all died over time, and while they were students. Mostly graduate students, no undergrads. But they were in their ‘20s.
Q: So just moving back to GHAP, Laura’s always telling me that you were very instrumental in setting up the group. Did you ever counsel as part of that program?
Dowling: I’m pretty sure I did. I mean I was so involved in getting it setup, because I had setup a similar group in college, which is still going today in my college in the Midwest. So I wanted to get one started here. And I was very politically active having come from a conservative, Republican family and wanted to get very involved in social issues and politics in school. And I was very much interested then in fighting the establishment; when they said ‘no you can’t’, I was like, ‘yes, we can, and we’re going to and we’re going to get this setup and we’re going to protect our own and we’re going to do the education’. It was very spontaneous and it unfolded over time, but it was something that we saw a need for. And when the university wouldn’t let us do it, that made us want to do it even that much more.
Q: That makes sense.
Q: You graduated from the public health school you said in three years. And then what was next?
Dowling: I transferred to the School of Public Health in January of ’86. And then …
Q: From what school?
Dowling: Arts and Sciences in the department of anthropology. I started out in the Ph.D. program in anthropology and switched a master’s of public health after the first semester. And I was there from ’86, I think I did my coursework two years, because I was working by 1987. So my first job out of graduate school was in the Mayor’s office. Koch was the mayor and I got a job as the Health Policy Analyst. And I used my experience at Columbia, all the GHAP stuff that I did, all the public health, my master’s of public health training, to get a job as a Health Policy Analyst in the Koch Administration with responsibility for the AIDS programs that the city was running at the time. So I was able to move into AIDS work professionally. And then during the course of my first year and a half in city government I worked on AIDS programs and then I oversaw the health department and then did policy oversight for the Health and Hospitals Corporation. And then went on from there to being an Assistant Commissioner in the Health Department in the Dinkins Administration for four years. And then went to work in the Health and Hospitals Corporation after that for two years. And then moved into the private sector.
Q: And what do you do now?
Dowling: Now I work at Montefiore Medical Center in the Bronx. It’s a little hard to describe what I do, but I work at a wholly owned subsidiary of the hospital, and we do, we’re actually responsible for population health. So we have close to 250,000 people who live in the Bronx and lower Westchester get their healthcare through the Montefiore facility. And we’re responsible for managing their insurance products to make sure they can get the healthcare they need with in the insurance budget that we have. And I’m the Chief Administrative Officer at the subsidiary called the Montefiore Care Management Organization.
Q: So it seems like, and maybe not so much with Montefiore, but it seems like HIV and AIDS have definitely like stayed as a part of your career.
Dowling: You know, actually I don’t specifically work on HIV and AIDS issues now. But we have patients who have HIV, obviously, and we have programs to treat them. And I guess after I left city government I went to work at St. Vincent’s Hospital down in the village. And I was there for five and a half years and I’ve been at Montefiore for 12 and a half. And up through my first 18 months at Montefiore I had always been working on HIV/AIDS issues as part of my day to day job. Both at St. Vincent’s and then at Montefiore, one of the projects I worked on was getting an HIV special needs plan started, which is a category of Medicaid HMO that’s designed to treat Medicaid HIV recipients. And I actually worked on getting licensed in both places. We ultimately didn’t do it at either place because the business model showed that the hospitals wouldn’t make money because it was too small of a population. But there are two special needs plans still in existence today. There were two health systems that decided to start them. One was at Columbia as a matter of fact. It ended up being called Select Health. And it was just purchased by the Visiting Nurse Service of New York. And the other one, I forget the name of it, but it was started by the Village Center for Care. And I think it was called BetaCare for a while, but they had to change their name recently, and it’s still in existence as well. And it’s all a direct line back to, you know, all the work that was started in New York City through ACT UP and forcing the hospitals to get HIV care, and to force the state and health department to pay attention to HIV and allocate funding to it. So it’s an interesting continuum over 30 years.
Q: Yeah. Have you stayed involved? You mentioned after the incident at Lincoln Center you didn’t really demonstrate.
Dowling: I didn’t demonstrate as much.
Q: But did you stay involved in ACT UP or GMHC after that?
Dowling: Over time I didn’t. There was a lot of burnout at the time, so after – and I was working professionally in it. And once I went to work at the Mayor’s Office and then working as an Assistant Health Commissioner, even though I was in democratic administrations for two of them, then I worked for the Giuliani Administration for two years I had to be a little bit more cautious with what I did in my free time and not be in so many political activities, because I worked within the administration. And when you move from doing it as a protest and a social activity, and then you’re dealing with it in your day to day work life you kind of want to turn it off when you’re done with work. So over time, as I moved away from being away from HIV work professionally, I then, you know, go back into doing anything. And the world changed, you know, with the introduction of the drugs that people can take and people started to live, but the whole perspective on it changed.
Q: Yeah. It’s interesting. So just one more thing you mentioned a while ago, what did you write your grad school thesis on? Your dissertation?
Dowling: My undergraduate and graduate thesis were very similar. They were continuations of the same thing. And I used elements of the research that I did in undergrad for my graduate. The undergrad was the comparison of the treatment of gay men to syphilitic prostitution in the American health system. And in graduate school I extended that into public health and education and how you use, if I’m remembering it correctly, how you take sociocultural approaches to educating populations. And I did a little bit about the comparison of the education of prostitutes and Victorian Americans about syphilis to how you educate and get prevention activities going in an oppressed minority community at the time. So there were variations on the same theme that I was very anxious to get out of school.
Q: Well, it makes sense if you were writing it from ’85 to ’87, that’s when the education, or ’86 to ’87 rather, that’s when the education campaigns really started. Just how contemporary they both were.
Dowling: At the time it was very provocative to be doing something like that. There was federal funding coming out for scientific research into the causes of AIDS and to identify the virus and to figure out and to find out why it took so long just to isolate the virus and then to find drugs and then to have the test to detect it. There wasn’t a whole lot of focus on education and prevention. And that’s why GMHC started and some of the other programs around the country. And John Martin’s study was so revolutionary and groundbreaking and there wasn’t a whole lot of public health research into it. So it was very contemporary at the time. And even in graduate school people were skeptical about whether, you know, those of us who were doing this kind of research should be doing it, would it hurt our career? Would we be able to get jobs afterwards? Luckily we made the right decisions.
Q: Just the whole idea of knowing what it was going to turn into. The tip of the iceberg, but never knowing, like you said, in retrospect knowing. Did you have any anything else about setting up GHAP? The university response to it?
Dowling: Until we started talking I had forgotten some of that stuff. It was, at the time, it was perilous. That’s how we felt, because we were fighting. There were lots of comparisons that we were making to the protests in the ‘60s against the Vietnam War. There were a lot of parallels in the social (inaudible) at the time, especially of young people. And it was treacherous, we thought dangerous, we were sometimes afraid that we might lose our scholarships, or lose funding. And there was always a push and a pull and a bit of a tug back and forth between the administration and the student groups as to what they would allow us to do and what they wanted out of Columbia. They were very concerned about their reputation. And HIV and AIDS was so new. They were worried that parents wouldn’t send their kids to Columbia if it was known that there was AIDS on campus. And Columbia wasn’t alone. That was a fear across the country. But having active students doing things about it, I think they were worried about what some people would see as a negative message.
Q: Yeah. I found this memo from Mullinix, the head of the committee, not President Sovern, but some other big wig saying basically that the AIDS committees were in this pamphlet, and there’s this line; even though we’ve discussed how the university does not want to be associated with this, it would be good if students had this. And that was the lens through which distributing this informational pamphlet was viewed through.
Dowling: Oh, yeah. Anything else?
Q: Not that I can think of.
Dowling: Brought back a lot of memories.