ACT UP–the grassroots organization that shut down the New York Stock Exchange and picketed St. Patrick’s Cathedral–is back, and it’s gone global. Over a decade ago, ACT UP (AIDS Coalition To Unleash Power) pioneered many of the direct action tactics currently used by antiglobalization protesters, including activist video, corporate- and government-office takeovers, and high-profile media demonstrations. Today, ACT UP signs at demonstrations bearing such slogans as Stop Medical Apartheid: From Botswana to the Bronx are reminiscent of earlier protests calling for development and fast-track approval of AIDS medications.

When ACT UP was first formed in New York in the late 1980s, its weekly meetings regularly attracted up to a thousand members–largely drawn from white, middle-class gay and lesbian communities. But during the mid-1990s many chapters faced extinction. With the introduction of life-extending triple-therapy antiretroviral cocktails to the US market in 1996, what had been a devastating disease suddenly appeared to be a manageable illness–at least to a certain population of white, middle-class gay men. Media outlets like the New York Times proclaimed the “end” of the plague, and AIDS activism no longer occupied a central place in gay and lesbian politics, which, following national trends, drifted to the right. Asia Russell of ACT UP Philadelphia says the success and availability of these AIDS drugs were only part of the picture. When asked for an explanation, she puts it bluntly: “death and neoliberalism.”

But as the demographics of AIDS in the United States changed, so too did ACT UP’s constituency. While ACT UP had always been attentive to issues of racism and poverty–working, for example, to diversify clinical drug trials and forcing homelessness and intravenous drug use onto the AIDS agenda–it has now rededicated itself to these causes, both in local and global contexts, and is part of an international antiglobalization alliance that concentrates on access to healthcare.

This is particularly true for ACT UP Philadelphia, half of whose current members are people of color and people with AIDS. ACT UP Philadelphia rarely does outreach to traditional gay and lesbian communities, instead using teach-ins at drug treatment clinics, housing organizations and needle exchange programs. Its tactics still draw from a queer consciousness, and many of its members are queer, but they’re also from minority and low-income communities.

ACT UP’s redrawn constituency has also led to a shift in priorities. While it continues to work on domestic AIDS issues, particularly housing needs, medical care in prisons and such privacy issues as names reporting, ACT UP has come to focus on the global AIDS epidemic, applying constant pressure on the US government and pharmaceutical companies to facilitate generic drug manufacturing, and on international policy-makers to enact immediate debt relief for developing nations. As Julie Davids of ACT UP Philadelphia says, “Our members feel passionate about these issues because they realize that it’s the same life-threatening forms of racism and economic injustice that impact their lives here in the United States.”

Both ACT UP Philadelphia and ACT UP New York are part of the Health GAP Coalition, a network of AIDS and trade activists formed in 1999 when its members realized that no organization existed within the United States focusing exclusively on the global AIDS epidemic. Health GAP’s first direct actions included a disruption of the Gore campaign kickoff in Carthage, Tennessee, to protest Gore’s position against compulsory licensing and his threats of trade sanctions against South Africa. Within a month, Gore shifted his stance, endorsing the use of compulsory licensing and parallel imports of drugs to South Africa. After the International AIDS Conference in Durban last year, Health GAP banded together with South Africa’s Treatment Access Campaign to form GTAC (Global Treatment Action Campaign), an international collective of AIDS activists that share information on treatment, and craft policy papers on international trade and drug development.

Through Health GAP and GTAC, ACT UP has built alliances within the antiglobalization movement. For example, ACT UP Philadelphia brought hundreds of demonstrators, mostly people of color, to Washington, DC, in April 2000, joining other groups demanding debt relief from the World Bank and IMF. As Sharonann Lynch of Health GAP says, “At A16 there were meetings between debt relief activists and AIDS activists, and we realized just how closely linked our issues were, how debt has a crippling effect on developing nations and their healthcare infrastructure.”

As the twentieth anniversary of AIDS passes, and as the UN General Assembly holds a special session on HIV/AIDS, international policy-makers and US government officials have made some disturbing statements that bode ill for the fight against global AIDS. Since South African NGOs won a decisive legal victory against Big Pharma, granting them the right to import and manufacture generic drugs, these officials have begun painting treatment as a hopeless cause in Africa, insisting rather on policies that focus on prevention.

Although these statements now come with a racist vision of Africa as the dark continent, in a sense they’re nothing new to ACT UP members, many of whom recall similar statements made years ago when official AIDS policy was to hammer home the message of safe sex while ignoring treatment. “Early ACT UP activists struggled to shake off the ‘victim’ label. They refused to let AIDS become just a matter left up to social services or one informed by a sense of pity. They demanded information, dignity and power,” says Russell. ACT UP members know that treatment and prevention can go hand in hand, and they’ve seen it work in their own communities. That’s why ACT UP members are working to insure that treatment is part of the discussion on global AIDS.

When New York’s Gay and Lesbian Pride march kicks off on June 24, the anniversary of the Stonewall riots, ACT UP New York will not be marching. Instead, ACT UP has committed itself to being a major sponsor of the Stop Global AIDS Now rally in New York on June 23, before the June 25 opening of the UN Special Session on HIV/AIDS. Its demands are debt relief, international humanitarian investment and generic drug licensing. Undoubtedly people at that rally will be chanting, “Act Up! Fight Back!”–but this time they’ll be joined by allies from around the world.