AIDS activists change their act

ACT-UP first began to focus on the epidemic in sub-Saharan Africa and other regions in the late '90s, when intellectual property disputes over AIDS-related drugs first came into serious public play. Jamie Love of the Ralph Nader-funded Consumer Project on Technology, who has been a behind-the-scenes player throughout the international AIDS crisis, went to the group in 1998 and alerted it about then-presumed presidential candidate Al Gore's role in tightening the screws on the South African government. In a Feb. 17, 1999, meeting with South African President Thabo Mbeki, Gore told him, "I'm concerned that, without significant progress toward a resolution, a single trade issue could overshadow our bilateral relationship." He was referring to South African legislation that would make it easier to distribute inexpensive drugs in the AIDS-ravaged country. The legislation was unpopular with the American pharmaceutical industry, a deep-pocketed friend of Washington politicians and lobbyists. And there was growing pressure in Congress and the White House for trade sanctions against South Africa.

ACT-UP took on the veep, initiating "Gore zaps" at his campaign appearances from the day he announced his candidacy for president in Carthage, Tenn. In one of the best examples of the newly reinvigorated ACT-UP, an activist unfurled a banner just feet behind Gore onstage during a nationally televised prime-time town hall meeting in New Hampshire, chanting "Gore's greed kills." In the end, then President Clinton issued an executive order pledging not to impose trade sanctions against South Africa or other African nations related to pharmaceutical disputes as long as they adhered to the requirements set forth for intellectual property protection by the World Trade Organization. Under the TRIPS provision of the WTO, countries can issue compulsory licenses for the generic production of drugs if they declare a national health emergency.

But Gore wasn't the only subject of ACT-UP's zaps. Mark Milano, a 45-year-old HIV-positive ACT-UP member since 1989, said he crashed a $500-a-plate George W. Bush fundraiser outside Philadelphia, where he unfurled a poster he had hidden in his T-shirt and screamed: "Bush is a drug company puppet." The Secret Service escorted Milano out of the dining room to question him, but ultimately let him go. ACT-UP also stormed the offices of President Clinton's U.S. trade representative, Charlene Barshefsky, when she pressured developing nations to strengthen patent protections for pharmaceutical companies.

According to Love, the Gore zaps staged by ACT-UP were crucial in drawing media, and thus public, attention to the AIDS crisis in Africa and how intellectual property protections and drug patents are keeping essential medicines out of the hands of millions who are infected with HIV or dying of AIDS.

Though the primary focus of ACT-UP became international only during the last presidential campaign, it has always been a part of the global movement. "ACT-UP started the Global Aids Action Committee in 1990, 11 years ago," said co-founder Sawyer. "We started doing demonstrations at the U.N. on World AIDS Day to call for access to AZT and Bactrum for pneumonia. We've done major demonstrations at every international AIDS conference and many regional conferences and a lot of press and advocacy work on global AIDS issues ever since. It became the primary focus when people here started living longer and [having] a better quality of life because of protease inhibitors and when we finally got the world's attention to the extent of the global AIDS crisis during the Gore campaign."

Nonetheless, the Philadelphia chapter has continued its involvement with local AIDS initiatives. It works with intravenous-drug users, prisoners and other groups at high risk for infection. "Our idea has always been to follow the epidemic wherever it goes," said Katie Krause, a longtime ACT-UP activist in Philadelphia and San Francisco. " If AIDS were decimating Alaskans, that's where we would be. But if we need to talk to the U.S. trade representative or the Brazilian health minister, we're there too," Krause said.

Different places, Krause said, require different approaches. "AIDS is demolishing a number of African and Asian countries. And if our aim is to support people with AIDS in those countries, and they tell us they need treatment, then we try to get access to top U.S. officials. But when we're trying to get more AIDS drugs for low-income people in Philadelphia, we need to talk to the health commissioner and local drug companies. The goals are always the same; we just use different tools to get there." The Philadelphia chapter is also well-known for its laborlike ability to bus in hundreds of activists to protests on the East Coast.

Krause doesn't make much of ACT-UP's transformation to an international organization. She says much of the inspiration comes from AIDS activists who attended conferences in Paris, Geneva or Durbin, South Africa, where one might sit next to someone who is dying because they don't have access to AIDS drugs. "Could you please give me a Bactrum or something I can bring back to my clinic?" he might ask. "That's a searing experience for any person with feeling. It's not much of a jump from caring about your local community which is being ravaged by AIDS to caring about a neighboring community."

In Philadelphia, where the ACT-UP membership is extraordinarily diverse, Krause says there is tremendous sympathy for the suffering of sub-Saharan Africans. "We have hundreds of African-Americans participating from Philly who have very strong empathy for people with AIDS in Africa, who are also personally connected."

I talked to one of those women during the march. Donna, who would not reveal her last name or age, rode a Trailways bus from Baltimore to participate in the protest. Donna has been trying to kick her drug habit through Philadelphia's Stop and Surrender program, which encouraged its members to join in the march. "AIDS doesn't just affect gays," said Donna. "It affects everyone -- in Africa and in the United States."

ACT-UP thinks it can make a bigger difference through coalition building with like-minded constituencies. Says Milano of ACT-UP New York: "We haven't given up our direct actions. We will still have demonstrations and are arrested." Of Saturday's fairly subdued march, he said: "Normally, we'd do this without a police permit; we'd be taking arrests. That was 10 years ago, when we had a thousand white gay men doing it. But nowadays it's a coalition building. It's people of color, it's labor leaders, it's religious groups, it's drop-the debt-people. It's a different type of activism."

But in these days of political apathy, when the major industrialized nations have teamed up against proposals to provide treatment for the HIV and AIDS infected in Africa with very little dissent, some must yearn for the outrageous ACT-UP of yore. And there is a hint of frustration and exasperation in some ACT-UP members.

"After the Gore zaps and the South African lawsuit, there was a real momentum toward treatment," says Milano. "We were on the verge of getting treatment to people in Africa. I thought, 'My God, the efforts of a few core activists really may have made a difference.' But, suddenly, everything has switched. Bush is talking about prevention only, no treatment; the dollars are incredibly small. Did you know Pfizer is on the official U.S. committee? It became very clear that the drug companies were calling Bush's shots. We're on the verge of losing all of our momentum now. But we're not going to give up."

The question is how ACT-UP can make the biggest dent. Should it rekindle the outrage and angst that fueled its effective protests of the '80s and '90s, or should it try to achieve strength in numbers by building powerful coalitions? The divided thinking about which way to go is clear from conversations with ACT-UP members, and is an inevitable outcome for a maturing political organization -- which has to create a more mainstream message to access political leaders and not alienate coalition partners.

In a telephone conversation last week, ACT-UP Philadelphia's Krause compared the current international AIDS crisis to the Holocaust. Then she backed away from her comments, saying she felt uncomfortable using the comparison to quantify political goals. But two days later, in New York, the organization distributed a press packet with the following quote from New York ACT-UP member Peter Roberts: "It's like living through World War II and hearing [that] U.S. groups [spoke] out against bombing the trains to Auschwitz but did not attempt to bomb the crematoriums."

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