An aura of pent-up anticipation permeates this year’s Pride as millions of LGBT Americans eagerly resume Sunday morning brunch, travel to Instagrammable locations and re-download Grindr and Scruff. Pride — now a month-long celebration — is an apt time to reopen from pandemic-related closures and restrictions.
These discrepancies reflect deeper inequities that are more visible when we consider the pattern set by another epidemic. Like covid-19, HIV/AIDS has and continues to exploit social stratifications of race, class, gender and sexuality. And it also continues to ravage vulnerable communities, even as some commentators have deemed the epidemic “over.”
Puerto Rico’s experience makes clear the social determinants of health that play a role in heightened risk to HIV. At the same time, the responses by LGBT Puerto Ricans and their allies provide us with a model of health activism that is queer and feminist oriented.
Members of the Latina/o Caucus and ACT UP/Puerto Rico understood the structural vulnerability to HIV experienced by Puerto Ricans as a product of the island’s colonial status. They confronted the larger power structures of state neglect, corporate greed and religious dogma that determined who was worthy of public sympathy and, thus, resources. Such activism widens our understanding of Pride to account for collective health and well-being as central in the fight against homophobia and transphobia.
From the onset of the AIDS epidemic, Latinas/os have been disproportionately exposed to HIV. Although people designated as “Hispanics” comprised only 9 percent of the nation’s nearly 250 million people in 1990, they accounted for about 17 percent of all AIDS cases nationally. Unlike other Latina/o subgroups whose primary mode of HIV transmission consisted of male-to-male sexual contact, for Puerto Ricans, both on the island and in the continental United States, the primary mode of HIV transmission consisted of intravenous (IV) drug use.
Members of the Latina/o Caucus of the AIDS Coalition to Unleash Power (ACT UP) in New York understood the geographic distribution of HIV among Puerto Ricans as being intimately tied to the island’s status as an “unincorporated territory” of the United States — that is, a colony. That the Puerto Rican AIDS epidemic was overwhelmingly caused by IV drug use was no coincidence. Since there are no customs inspections on flights from the island to the continental United States, Puerto Rico emerged as a principal entry point for narcotics shipments in the 1980s.
But drug use alone didn’t explain why Puerto Ricans disproportionately acquired HIV. U.S. health policy was also a factor. While U.S. states received open-ended federal Medicaid funds based on per capita income, Puerto Rico (like other U.S. territories) received a fixed block of grant funding per year. As a result, Medicaid on the island restricted eligibility, covered fewer services and lowered the size of payments to providers. This discrepancy meant that Puerto Ricans with HIV/AIDS were less able to access life-sustaining medications, like AZT and aerosolized pentamidine, which were — ironically enough — manufactured on the island as a result of corporate tax breaks.
Although the U.S. Food and Drug Administration approved AZT in 1987 and aerosolized pentamidine in 1989 for the treatment of AIDS, it would not be until the early 1990s that such pharmaceuticals would become widely available in Puerto Rico.
In addition to colonial policies and corporate greed, the AIDS epidemic in Puerto Rico was shaped by the moral conservatism of the Catholic church and commonwealth officials. The cardinal had previously stated that using condoms was a greater sin than contracting HIV. His position, in turn, influenced government policy as the governor and health secretary were both devout Catholics who rejected any mention of condoms in government-funded HIV-prevention campaigns.
By 1990, ACT UP had a Latina/o Caucus consisting of Puerto Rican-born members who moved to the continental United States to continue their studies or access better health care and social services after being diagnosed with HIV. That summer, when they heard that the National Commission on AIDS was scheduled to host a series of conferences in San Juan, they decided to return to Puerto Rico to help organize a local chapter of the activist organization. They partnered with local activists and residents, hosting a number of high-profile demonstrations, teach-ins and exchanges.
In August 1990, the newly founded ACT UP/Puerto Rico held a mock funeral in front of the Condado Plaza Hotel where the U.S. secretary of Health and Human Services spoke. Protesters bathed themselves in fake blood and demonstrated outside the Hotel Caribe Hilton. They marched from La Fortaleza, the governor’s mansion, in Old San Juan to El Capitolio. They interrupted mass at the San Juan Cathedral, distributing condoms to mortified parishioners.
But beyond these theatrics, the campaign in San Juan was a rousing success in part because LGBT Puerto Ricans expanded their outreach to include a diverse array of allies across race, class, gender and sexuality. When grandmothers had lain alongside intravenous-drug users during a staged die-in on the steps of the cathedral, they not only refused the silence espoused by church and commonwealth officials, but they also reinforced the value of the lives of those relegated to the margins. In addition to helping establish ACT UP/Puerto Rico, the Latina/o Caucus proved invaluable in the establishment of clinical trials, pharmaceutical therapies, housing provisions, needle-exchange programs and public education campaigns on the island.
These demonstrations marked the largest public display of LGBT visibility on the island up to then. Participants were so inspired by the marches that the following summer, on June 13, 1991, they hosted the first LGBT Pride Parade in Puerto Rico. The parade, consisting of more than a hundred people, was headed by Puerto Rican transgender activist Christina Hayworth, a participant in the 1969 Stonewall uprising. To this day, the LGBT Pride Parade in Puerto Rico remains one of the largest and most popular ones in the Caribbean.
These activists employed an intersectional approach to health activism that refashioned health not as a marker of personal responsibility but as a collective good in the service of gender and sexual liberation. This approach was on display in Puerto Rico during the 2019 protests against Gov. Ricardo Rosselló, who was accused of corruption. In a series of leaked group chats, Rosselló and members of his cabinet spewed misogynist and homophobic attacks against other politicians, journalists and local celebrities. The comments came amid financial and environmental crises for the island after the previous governor had declared its $72 billion debt unpayable and after Hurricane Maria had torn through the island, resulting in the deaths of 2,975 Puerto Ricans.
Present throughout the unprecedented 2019 marches was the Puerto Rico rainbow flag as a clear indication that gender and sexual minority populations were stewards of the nation’s past, present and future.
In June 2021, San Juan and New York City are expected to host their yearly Pride marches — albeit with covid-19 restrictions in place. (As of June 4, only about 37 percent of Puerto Ricans were fully vaccinated.) Once again the Puerto Rican rainbow flag will fly high.
It is a flag that reminds us now more than ever of the importance of continuously reassessing the parameters of Pride to account not only for the collective freedom to erotic and gendered expression but the right to live lives free from disease and ill health.