9 minute read by Jonathan Neale.

 Since 2003, a US government program (PEPFAR) has provided free drugs that are presently keeping 20.5 million people with HIV alive. All these people are in poorer countries, and most of them in Africa. And now, President Trump has suspended the PEPFAR program for 90 days, and it looks like the closure will be made permanent. This is a death sentence for millions of people. It seems Trump is happy to let these people die.

The PEPFAR website has gone dark. The staff are not working and expect to be fired. The cruelty, racism and homophobia behind this shutdown should shock all descent people. 

This is an emergency, and we need to act now, locally, nationally and globally. Humanity has contained HIV for 20 years because people organized two mass movements, and fought and won. We need to remember and learn from these earlier victories. It can be done again.

 MASS MOVEMENTS

In 2003, in his State of the Union Address, President Bush announced the PEPFAR program (President’s Emergency Plan for AIDS Relief) with a grant for the first five years of $15 billion dollars. It has been going ever since. And one lesson from this time is important – the breadth of the support he had for the program. 

From 1990 to 1994, I worked as a counsellor in an HIV testing clinic in London. And I have written about HIV/AIDS since.[1]  I gave people their test results, but we had no cure. HIV is a virus that is passed from person to person through unprotected sex, blood transfusions, sharing needles and childbirth. Back then there was no medicine. The virus gradually destroyed a person’s immune system, and they died from any one of hundreds of infectious diseases.

It broke my heart. Globally, it broke the hearts of hundreds of millions of other people too.

But by 1990 there was ACTUP, a militant campaign of mostly HIV positive men in the United States. They demonstrated, rallied and took direct action to force the US government to develop as quickly as possible the combination of drugs which could turn HIV from a death sentence into something people could live with. That was won by 1995.

In London too, people with HIV were suddenly surviving and flourishing. But you had to take the drugs for life, and they were expensive. In rich countries, health services or insurance companies could afford that. Everyone understood that people in poor countries would not be able to afford the drugs. So they would die.

That was awful, but just how it was. However, the Treatment Action Campaign in South Africa didn’t accept this was inevitable. They thought African lives were worth as much as American lives.

So they organized tens of thousands of people, mostly Black, mostly working class, mostly HIV positive, the majority of them women, to march down the street singing and yelling and dancing and wearing T shirts that said in enormous thick letters, HIV POSITIVE.

That mass movement fought the South African government, the American government, the WTO and all the global corporations of Big Pharma. And they won the right for the South African government to import cheap copies of Big Pharma’s HIV drugs from India.

And the victory had a strange and wonderful result back in the US. Many white evangelical churches there had close ties with churches in Africa. A network of young, affluent white Evangelical Republicans persuaded President George Bush to set up PEPFAR, a program to fund drugs for people with HIV all over the world.

And as a bonus for the corporations, PEPFAR bought the drugs from Big Pharma at high prices.

You have probably never heard of PEPFAR. The Democrats didn’t mention it because they were ashamed they hadn’t done it. The Republicans were quiet because they were ashamed of HIV, except for Bush, who was proud of what he had been able to do.

But don’t kid yourself. PEPFAR was only there because ACTUP and the Treatment Action Campaign had persuaded the world that gay men and working class Black Africans deserved medical care that would save their lives.

And until last week PEPFAR was still there, spending $4.4 billion a year to treat 20.5 million people.

SO HERE WE STAND again needing a global campaign which will make sure that everyone who needs the drugs gets the drugs.

At the moment many, many people and governments are allowing Trump to overwhelm them. Their sycophancy, kowtowing and capitulation is spreading and reinforces a feeling that Trump cannot be stopped.

Certainly, if we are to stop him, we’ll have to fight on three fronts at once. We need to campaign to reverse American policy. We need to campaign to make other governments and public institutions, all over the world, fund the drugs for now. And we campaign to make sure that governments in poor countries can import far cheap “generic” copies of the patented drugs made by Big Pharma.

Fighting on each of these fronts will make it easier to fight on the others. We don’t have to beat Trump to win. We just have to unite enough people in the world to save the sick and shame Trump. Maybe we can force him to change direction, and maybe we can’t, but we can certainly aim to make other governments step up.

SO WHO CAN WE MOBILIZE?

Everyone, but some groups will probably be particularly important.

One place to start with is health and hospital workers and staff. One way to organize them is through the local branches of unions and professional associations. Another is local meetings inside and vigils outside every possible hospital.

Another is in schools, and in university departments of medicine, social sciences and international relations. Again, the way to get started is with a meeting in a classroom, or a vigil outside the school.

A third is in the churches, particularly in the United States. After all, PEPFAR was founded by white evangelicals. But shutting it down will kill millions of Black Africans.  And Black churches are at the moral heart of Black communities in the US. And then there are the Unitarians, the Church of England, the Catholics, the mosques and synagogues and all the rest.

Fourth, LGBT people. Trump’s action is homophobic. He is also saying only straight lives matter. And in Britain in the United States, there are so many veterans, so many survivors who built ACTUP, the Terrence Higgins Trust, Lesbians and Gays Support the Miners, and hundreds more organizations. People who once knew how to care for others and how to fight and win.

Fifth, the people with HIV. Those are the people who built ACTUP and the Treatment Action Campaign.

Those are only five kinds of people. And there will be a lot of overlap between those groups. And I know you can think, offhand, easily, of other groups of people we could mobilize.

Trump’s cuts to HIV drugs are part of a far larger project, including suspending all US foreign aid projects, closing down most of them, withdrawing all funding from the World Health Organization, closing down many domestic programs, and a raft of attacks on LGBT people in the United States. There will be times and places where larger joint protests make sense. And protests and vigils about HIV drugs can also inspire wider action.

WHAT DO WE DO TO MOBILIZE?

When people work to build a mass movement, the question they have to figure out is how to get people moving. If you are new to this kind of thing, here’s a preliminary answer.

You need lots of small meetings. If you can find five people in your town or city who want to do this, get them together for a meeting to talk about who to talk to next. Build a vigil with candles in the early evening, or a rally in a medium sized room.

It is the small, local organizing meetings that really matter. In a hospital you probably start with a vigil, with candles. But to do that, first you start with a meeting of you and three other people you know in the hospital to begin organizing the vigil. Not the most important people, just three people you know. Then go to the union committee, or the union steward. Fan out and talk to the other groups of workers. Remember, always, student nurses are gold dust.

You will want to organize other meetings too, to explain the issues, mostly informally after the shift or in the common room, but maybe in a bigger meeting too.

The same process can work in a school, a university, in a community and in the churches. For example, get together a few ministers and lay people across the city. And have little meetings of a few people in each church. Build towards a potluck supper at the church, or a vigil outside, and then at many churches, and then ring every church bell in the city.

Same process in a school, or a university, or in the communities.

Then you build towards a city demonstration, or in countries like the UK, national demonstrations. And back to the local to build and back again to the city and the national. Don’ get lost in an argument about local, or global. Each strengthens the other.

NEVER THINK LIKE A MINORITY

Don’t think you are building a political movement of individuals. This is a big fight. We are up against enormous power. We need a movement that shows the majority of nurses and doctors and health workers in this hospital want poor people to get the anti-viral drugs. And we need the majority of patients and their relatives who hear about a meeting, or sees the lights of a vigil, to want poor people to get the anti-viral drugs. And, with luck, the movement takes off.

SOUTH AFRICA AND THE WORLD

South Africa will be particularly important to any global movement. Out of 60 million South Africans, eight million are living with HIV. Six million of them are getting the drugs, many with help from PEPFAR.

Over the last fifty years, South Africa has seen enormous social movements. They are combative, angry and brave people. That’s why the Treatment Action Campaign won last time. And those people have not gone away. There will be a strong movement in South Africa.

But just how strong will depend on whether South Africans think they can win. And there will be many people at the top of South African society saying that Donald Trump and Big Pharma are too big to fight. They are there now because there are a lot of people like that in elites all over the world. We can see them compromising and crawling to Trump right now.

If we have a global movement, in South Africa and the United States, that will make all the difference in each local and national campaign.

Think of people with HIV speaking in meetings at union branches, universities and churches all over the United States.  Think of a protest march to the American Embassy in South Africa big enough to be seen on every television screen in Africa and the United States.

The containment of HIV is the one great global victory of social movements over the last fifty years. It is the arena where, after much grief, humanity came together to care for each other. Trump’s cruelty, his racism and his homophobia must not stand.

JONATHAN NEALE is the author of Fight the Fire: Green New Deals and Global Climate Jobs, and with Nancy Lindisfarne, Why Men: A Global History of Violence and Inequality.

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[1] ‘The Politics of AIDS’, International Socialism, 1991, 53:  1-28; ‘Emotional Aspects of HIV’, Physiotherapy, 1993, 79 (3): 173-177; The Laughter of Heroes (a novel), Serpents Tail, 1993; Chapter 4 in You are G8, We Are 6 Billion, Vision, 2002, 73-88; and a chapter with Nancy Lindisfarne in our book on The Sexual Politics of Capitalism, to come out with The New Press in Autumn 2025.