Selma DritzBMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a2192 (Published 22 October 2008) Cite this as: BMJ 2008;337:a2192
- Bob Roehr
Selma Dritz is a name that could have been ripped from the pages of a hardboiled detective novel by Dashiell Hammett. But hers was a true story reflecting the noir grit of a more recent time: the early days of the AIDS epidemic in San Francisco.
Selma Dritz was in her 50s when she joined the San Francisco Department of Public Health in 1968 as an infectious disease epidemiologist. Her introduction to the city’s gay community, then one of the largest and most open in the world, began with an explosion of amoebic dysentery.
Rates of the parasitic infection had grown to 50 times those of the city as a whole, spread by oral-anal contact known as “rimming.” Her education in the sexual mores of the community was eye opening. She combined that knowledge with non-judgmental professionalism to pioneer educational efforts and pleas for safer sexual practices.
“Pneumocystis Pneumonia—Los Angeles.” This innocuously sounding paper announced the birth of HIV/AIDS on 5 June 1981 in Morbidity and Mortality Weekly Report (MMWR).
Dritz had already reported her own cluster of Pneumocystis carinii pneumonia to the Centers for Disease Control and Prevention. Soon she would also be tracking Kaposi’s sarcoma and cytomegalovirus. The three were rare, frightening, deadly diseases previously seen only in elderly and severely immunocompromised patients; now they were striking and killing seemingly healthy single young men. The epicentre was the Castro district, the heart of San Francisco’s gay community.
Dritz scrounged a blackboard from the department and began to record cases of the surprising diseases. She used techniques first devised by John Snow in the 1854 Broad Street cholera outbreak, and shoe leather that would have done Dashiell Hammett’s detective Sam Spade proud. But her most valuable assets were her knowledge of the gay community and its sexual practices, and the trust they had in her.
Slowly those interviews allowed her to draw the sexual networks of the dying patients. Within a year she traced the connections between 44 cases in New York, San Francisco, southern California, and Canada of what was then known as gay related immunodeficiency disease (GRID). It was the foundation of an epidemiological understanding of the disease.
She was the first to identify Burkitt’s lymphoma as an AIDS defining condition, and led the way in linking transmission of the virus through blood donations. Her view of gay bathhouses as “cesspools of infection” was instrumental in having them closed in San Francisco.
“I tried to make it clear that my job was to stop this disease, and I didn’t care what they did in bed, in the bushes, or anywhere else. My job was simply to see that they didn’t get sick,” she later told the San Francisco Chronicle.
She retired from the health department in April 1984, just as the viral cause of the epidemic was being announced.
The early days of the epidemic were captured by Randy Shilts in his book And the Band Played On. In 1993 it was turned into a film, shown on American television as a mini-series and in cinemas worldwide. Comedienne and actress Lily Tomlin played Dritz.
“On first glance, Selma seemed to be a character actress from a 1940s movie. She was quintessentially San Francisco,” recalls Donald Abrams, who was a young oncologist at the University of California San Francisco (UCSF) Kaposi’s sarcoma clinic, and a founding member of what would become the Gay and Lesbian Medical Association, when the epidemic broke.
“It became clear very soon that she was a competent and compassionate woman who really cared about each patient, not as a number but as a human being. She was a charter member of the Community Consortium [a UCSF effort to improve the care of patients with HIV infection] and continued to support our activities long after she left her role in the city government.”
Martin Delaney, founder of the HIV patient education charity Project Inform, said Dritz’s “work was critical in those early years, and we all listened carefully to anything she said or did about the suddenly growing caseload of people with the new disease.
“She was one of the very few people that was trusted by everyone: physicians, researchers, activists, and the media alike. It was unusual in those days for any of us in the gay community to trust what we were hearing from the public health department, but even those who saw the department as a threat viewed her as a friend.”
One flash point was the decision by the health department to close the gay bathhouses. “That created hostility toward the department but Dr Dritz was still trusted and respected. It was clear to everyone that she had no motive other than caring about the sick,” said Delaney.
Dritz was born in Chicago and was passionately devoted to music. She was a concert pianist before attending medical school at the University of Illinois, later, in 1967, earning a masters degree in public health at the University of California Berkeley. She is survived by a son, two daughters, and two grandchildren.
Cite this as: BMJ 2008;337:a2192
Selma Dritz, infectious disease epidemiologist, San Francisco Department of Public Health (b Chicago 1917; q Illinois, MPH), d 3 September 2008.