The successes of community-based research notwithstanding, those who cared about the overall progress of AIDS research could hardly afford to ignore the federal agencies that coordinated the bulk of the effort. In early 1987, deep concerns about NIAID's clinical trials and the FDA's regulatory requirements—not to mention the drug companies' obedience to the profit motive, the religious right's intolerance, and the Reagan administration's general indifference—combined to push AIDS activism into a new level of energy and organization. On the East Coast, the gay playwright and all-around rabblerouser Larry Kramer, who had helped found the Gay Men's Health Crisis at an earlier juncture in the epidemic, was one of the initiators of a new group in New York City, a radical activist organization called the AIDS Coalition to Unleash Power—better known by its acronym, "ACT UP." On the West Coast, a group of San Franciscans who called themselves the Citizens for Medical Justice began organizing a series of demonstrations against Burroughs Wellcome at its Bay Area offices, protesting the price of AZT. Citizens for Medical Justice then transformed itself into the AIDS Action Pledge, which in turn became the San Francisco chapter of ACT UP.
Soon there was an ACT UP/Chicago and an ACT UP/Houston, an ACT UP/New Orleans and an ACT UP/Seattle. Although AIDS activism has remained significantly stronger in the United States than elsewhere, most likely due to the greater strength of the gay and lesbian movement and the greater salience of identity politics in general in the United States, ACT UP eventually developed international dimensions. By the early 1990s there were also ACT UP chapters in Sydney, London, Paris, Berlin, Amsterdam, and Montreal. Each chapter was autonomous, though informal links connected them.
A magnet for radical, young gay men and women, ACT UP practiced an in-your-face politics of "no business as usual." Adopting
styles of political and cultural practice deriving from sources as diverse as anarchism, the peace movement, the punk subculture, the feminist health movement, and gay liberation "zaps" of the 1970s, ACT UP became famous for its imaginative street theater, its skill at attracting news cameras, and its well-communicated sense of urgency. "Silence = Death" read its characteristic slogan, set against the pink-triangle symbol of gay liberation (itself a symbolic appropriation of the patch worn by homosexuals in the Nazi death camps). ACT UP chapters typically had no formal leaders; in many cities, meetings operated by the consensus process.
As Joshua Gamson described in a participant-observation study of the San Francisco chapter, ACT UP shared the basic characteristics of so-called new social movements—"a (broadly) middle-class membership and a mix of instrumental, expressive, and identity-oriented activities." By "staging events and by carefully constructing and publicizing symbols," ACT UP "attacks the dominant representations of AIDS and of people with AIDS and makes attempts to replace them with alternative representations." Though the New Yorkers were particularly well connected to the art world and the communications media, ACT UP in general quickly perfected a highly dramaturgical style of activism and an abiding concern with techniques of expression.
On the national scene, the New York City chapter dominated, with more than 150 members at regular weekly meetings and a three hundred thousand-dollar budget by the end of 1988. But chapters in San Francisco, Los Angeles, and Boston were also prominent within the movement. Activists came from all walks of life. Yet as results from a survey of ACT UP/New York members conducted by Gilbert Elbaz suggest, "the group was predominantly gay, white male [with ages] between 26 and 35." Members were also "predominantly sero-negative, highly educated, and part of the new middle class." In Elbaz's sample of 413 activists, 80 percent were men and 78 percent were white. Thirty-five percent had done at least some postgraduate study. It was also a highly politicized group: More than half of Elbaz's respondents had participated in demonstrations before joining ACT UP; a good number had been involved in movements such as the peace movement and the feminist movement. Many of the women, in particular, had had experience with civil disobedience leading to arrest.
For some, radical AIDS activism provided a "home" within the gay and lesbian movement. Commented New York activist David Barr, a lawyer by training: "I can't tell you how many gay men … that I
know who said, 'ACT UP was the first time I've ever felt a part of a gay community.' That was certainly the case for me. I mean, the 'gay community' before that was always more alienating to me than anything else…." For others, like Michelle Roland, whose father had been jailed with Martin Luther King and who grew up reading United Farmworkers literature in her Berkeley home, joining the San Francisco chapter of ACT UP was a natural outgrowth of radical politics. But many, including Roland, have pointed to the deaths of close friends as the immediate, mobilizing incidents that provoked them to become involved. And they have recalled their frustration with the prevalent notion that since AIDS was inevitably fatal, all that could be done for people with AIDS was to provide palliative care.