On June 5, 1981, the US Center for Disease Control (CDC) published an article in its Morbidity and Mortality Weekly Report that spoke of five young, previously healthy gay men who presented with rare cases of a lung infection called pneumocystis carinii pneumonia (PCP). Two were already dead, and the other three had developed unusual infections. This article marked the first official record of what would later be known as Acquired Immunodeficiency Syndrome, or AIDS. By the end of 1981, there were over 1,600 deaths from the illness only in the US.
On January 20, 2025, almost 44 years after the first reported case of AIDS, President Donald Trump issued an executive order pausing US assistance to foreign countries. This foreign aid freeze has severely restricted the funding of HIV relief and protection groups, jeopardizing the health of more than 20 million patients around the world, including highly vulnerable groups such as queer and trans communities. These developments reflect a similar prejudice-driven government negligence that led to millions of deaths when AIDS first emerged domestically.
Since the original victims of AIDS were primarily queer men, trans women, sex workers, and injection drug users, social stigma infiltrated the treatment of these already marginalized communities. Fueled by these sentiments, the government and existing public interest institutions failed to adequately intervene in the growing epidemic. Many gay men feared that participating in reporting and screening would inevitably breach their privacy at a time when their identities were highly persecuted. Public agencies were reluctant to provide drug users with disposable needles during the ongoing ‘War on Drugs.’ Meanwhile, the creation of separate hospital units for AIDS patients evoked similar segregation as the creation of leper colonies—quarantine centers for those infected with leprosy. Due to societal judgments about AIDS patients’ personal responsibility for their illness, victims were vilified.
It was not until September 1985, four years after the disease was first discovered and the death rate had more than doubled, that President Ronald Reagan first mentioned AIDS in public. Although Reagan finally acknowledged the importance of combating the epidemic in the speech, when confronted with the fact that scientists in the National Cancer Institute had deemed his federal budget insufficient to combat the issue, he defended the government’s current level of funding. Despite the mass deaths resulting from his administration’s neglectful handling of this epidemic, Reagan remained steadfast against further support. For example, the administration withheld US payments to the World Health Organization (WHO) at the height of the global spread of HIV/AIDS. Reagan prioritized maintaining the support of his right-wing followers over the health and safety of marginalized communities around the world.
As a response to this government neglect, nongovernmental routes were forged out of necessity to protect vulnerable populations. As an immediate response to the absence of research funding, 80 queer men assembled in an apartment in June 1981 to raise money, creating Gay Men’s Health Crisis, now the GMHC. This organization continues to fill an important gap in the government’s flawed efforts to protect queer rights. While the government ignored the mass fatality of AIDS, within a year of its founding, GMHC effectively created the first HIV/AIDS hotline, produced and distributed 50,000 copies of its newsletter to doctors and clinics, and launched a program to assist people with AIDS in their daily lives. To this day, nongovernmental organizations play a major role in protecting the rights of marginalized communities and managing public health crises.
As the threat of AIDS spread globally, NGOs became integral not only in the domestic fight against the illness but also in the fight in developing countries. However, as they took on roles of larger scales, their dependence on federal funds increased. In 2003, to provide HIV/AIDS initiatives around the world with the funding necessary, President George W. Bush created the President’s Emergency Plan for AIDS Relief (PEPFAR). Since its creation, PEPFAR has invested over $110 billion in the global HIV/AIDS response and has saved up to 26 million lives through its own initiatives and through funding various local groups around the world. For instance, after Uganda passed a law criminalizing same-sex intercourse and categorizing same-sex relations while having HIV as punishable by death, nonprofit organizations focused on protecting queer rights have depended on foreign funding to continue their operations. One such organization, the Uganda Key Populations Consortium, used an $8 million grant from PEPFAR to house and employ those most vulnerable to HIV/AIDS in the country. However, under the Trump administration, these lifesaving initiatives have been gutted. Despite Uganda currently being home to approximately 1.5 million AIDS patients, the Uganda Key Populations Consortium was forced to shut down in compliance with Trump’s January 20, 2025 Executive Order against diversity, equity, and inclusion. The story is the same for NGOs across the Global South.
The foreign aid freeze also halted the government-funded distribution of pre-exposure prophylaxis, or PrEP, specifically to members of the LGBTQ+ community. This antiretroviral drug prevents the transmission of HIV and has been distributed through PEPFAR to over 20 million people in 2024 alone, including 2.5 million new PrEP users. With this pause, the Trump administration has endangered the lives of every one of these users. In the first week since the administration’s aid freeze, 3,000 new cases of HIV have already been reported worldwide. On February 6, the State Department issued a waiver allowing PEPFAR-funded PrEP to again be given to pregnant and breastfeeding women—glaringly restricting the LGBTQ+ community, who are most at risk of HIV/AIDS, from lifesaving care. This exclusivity in distribution is direct evidence of the continued prejudice against queer people enforced by the governmental response to AIDS.
As was apparent during the Reagan administration over 40 years ago, prejudice and stigma continue to infect the public health sphere. Elected officials continue to prioritize a grasp of their conservative electorates over the safety of those who are most vulnerable. Government negligence, fueled by a resurgence of anti-LGBTQ+ sentiment, threatens the lives of millions of people who, until now, were protected by both NGOs and the government. So much progress has been made since AIDS first arose as a public health threat: Nonprofit organizations have created community-oriented programs on local levels, four consecutive presidencies (both Democratic and Republican) have supported PEPFAR, and highly effective medications have been developed to prevent the transmission of HIV. With Trump in office, the world risks reversing decades of bipartisan progress.
Since the start of the AIDS epidemic in 1981, only four decades ago, over 40 million people have lost their lives to HIV-related causes. In 2023, another 40 million people continued to live with this fatal illness. Unless the Trump administration reverses course, these numbers will only continue to rise.