The AIDS Ward at San Francisco General: Where Medicine Changed

On January first, nineteen eighty-three, San Francisco General Hospital opened Ward eighty-six on the sixth floor of Building eighty. It was the first dedicated outpatient HIV and AIDS clinic in the United States. The founding physicians were Paul Volberding, Donald Abrams, and Constance Wofsy. They had been watching their patients die without a medical system equipped to treat them, and they built the system themselves.

Ward eighty-six was followed that same year by Ward five-B, the first dedicated inpatient AIDS ward in the country, organized by a nurse named Cliff Morrison. Morrison designed Ward five-B around a principle that was, in the context of nineteen eighty-three, a radical act: the staff would touch the patients. They would sit with them. They would not leave them alone to die with no one present. At a moment when hospital workers across the country were refusing to enter the rooms of AIDS patients without double gloves and masks, the staff of Ward five-B held their patients' hands.

The San Francisco model integrated what other hospitals kept separate: physicians, nurses, social workers, case managers, psychiatrists, addiction specialists, and nutritionists working in the same clinical space, sharing the same patients. The model emphasized the connection between medical care and the community organizations outside the hospital walls. The San Francisco Department of Public Health funded those organizations.

The Castro neighborhood, where most of the patients came from, was losing people at a pace that had no precedent in a peacetime American city. Ward eighty-six saw those patients. Ward five-B was where many of them died.

The model San Francisco built in those two wards became the international standard for AIDS care. Medical teams from Europe, Africa, and Asia came to study it. It is still operating today.