The killer was dubbed the "Doodler" after he told a person who later became a victim and survived that he was a cartoonist. Police say the attacker was doodling while he and the man talked at a late-night diner.
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The Doodler is believed to have killed at least five men and as many as 14 between January 1974 and September 1975.
The killer targeted men he met at after-hours gay clubs and restaurants in San Francisco. He usually sketched them before having sex and stabbing them.
The bodies of four men were found along the beach. Another stabbing victim was found in Golden Gate Park.
A witness was able to give investigators a description of the attacker, leading to a man being detained in 1976. But he was never charged.
An Associated Press story from 1977 quotes police saying they needed testimony from victims in order to charge the suspect. However, three survivors, including a "well-known entertainer" and a diplomat, were reluctant to "come out of the closet" to testify against him, the AP reported.
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AP interviewed gay rights advocate Harvey Milk at the time about the victims' refusal to testify.
"I can understand their position," Milk said. "I respect the pressure society has put on them."
The interview with AP came just over a year before Milk, the first openly gay man elected to public office in the U.S., was assassinated.
Police also intend to offer a $100,000 reward Wednesday for information leading to the arrest and conviction of the killer and release audio from a 1974 phone call to police reporting a body found along Ocean Beach.
Last year, CNN reported that SFPD had sent DNA samples to be tested. If alive, the suspect would be in his early 60's.