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The AIDS Response Owes a Great Debt to LGBT Communities

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As we prepare for the XIX International AIDS Conference in Washington D.C., I reflect with profound admiration and gratitude on the leadership against AIDS by the lesbian, gay, bisexual and transgender (LGBT) communities in the United States and across the globe. The global AIDS response would never have reached where it is today without their courageous, inspiring and consistent action and activism over the last 30 years.

In the early 1980s, when few dared to touch people with AIDS, gay men united to create the first organizations to care for and support lovers and friends who were dying of unknown and terrifying new illnesses.

In the mid-1980s, when governments and the media were denying the mounting deaths caused by the "gay plague," LGBT communities launched their own media campaigns to warn others of the unfolding tragedy and demand answers and action from politicians and scientists.

When people living with HIV were fired from their jobs, evicted from their apartments, denied medical care and barred from schools and public places, LGBT communities fought for and won legal protection against discrimination. They understood from the start that human rights and public health were not in conflict, but went hand in hand.

When people living with HIV were being treated as pariahs, a group of gay men wrote the seminal "Denver Principles" -- a statement of rights for empowering and protecting people living with HIV. They demanded they be called people Living With (not dying of) AIDS. They refused to be passive "victims;" they insisted on being active agents in control of their own destinies, managing their own health and developing HIV policies and programs as equal partners with others. This manifesto ultimately led to a global "Patient's Bill of Rights" and "GIPA"-- the Greater Involvement of People Living with AIDS, securing the human rights principles of inclusion and participation not only for themselves but for all people living with HIV in the world.

Their activism continues to ripple across the globe. Thanks to the LGBT community's early demands for the accelerated approval of medicines and universal access to treatment, today eight million people in low- and middle-income countries are alive and on HIV treatment. They have secured the right to health for millions.

The historic impact of ACT-UP -- the AIDS Coalition to Unleash Power -- cannot be underestimated. Across America and around the world, ACT-UP was among the first organizations to unite the LGBT community with social justice movements to demand political and economic action against AIDS. To this day, I am inspired by the words of ACT-UP co-founder Larry Kramer: "Unless we fight for our lives, we shall die."

From New York to Berlin, to Paris, to Sydney, LGBT brothers and sisters engaged in bold acts of civil disobedience -- often culminating in arrest -- to force the political and medical establishments, and the public at large, to wake up to AIDS.

Today's treatment success sprang from this bold and "outside the box" grassroots leadership of the LGBT community in the 1980s and '90s. In 1988, at the headquarters of the US Food and Drug Administration, activists called for a change of rules on experimental drugs. They were arrested for civil disobedience but their victory was to open the pathway for promising medicines to reach seriously ill patients earlier in the drug approval process. This extraordinary policy change is still saving lives around the world and across the spectrum of human disease.

But this profound legacy is bittersweet, with the epidemic coming full circle. After 30 years of the world's strongest HIV programs led by the LGBT community, the AIDS epidemic is still taking a tragic and disproportionate toll on LGBT communities all over the world. In the United States, gay and bisexual men comprise less than two percent of the population, yet they have accounted for at least half of new HIV infections and cumulative HIV cases since the first cases were reported in the 1980s. Today, HIV infections in America are growing again only among gay and bisexual men.

In spite of the proud history of LGBT activism and leadership, LGBT people continue to face harassment, discrimination, violence and even murder for being who they are and who they love. It is a travesty that 78 countries still criminalize homosexuality. When governments fail to acknowledge their existence and refuse to provide them with essential HIV services, they face state-sponsored discrimination. Ironically, some of the very countries whose populations have benefited the most from bold LGBT leadership on HIV are the ones who still engage in denial, discrimination and criminalization.

The world owes the LGBT community a great debt. Now it is time to repay our debt of thanks. Those of us in positions of global leadership must stand by LGBT people all over the world and say, "You are not alone. We are in this together." We will work with you to ensure the new generation of young LGBT people are empowered with knowledge and activism to ensure their own protection against HIV and live with dignity and respect. We will work with you to overcome the discrimination, violence and criminalization that you face. We will reach out to the most marginalized among you. And most of all, we will work with, and look to the leaders among you -- in your continued determination to end AIDS -- for your own communities, for the world, for all of us.