The emergence of AIDS in the 1980s precipitated a shift in global gay activism and the perception of the LGBT community – although outside the west it was not experienced or seen as almost exclusively a problem for gays, it was a focus for gay activism (for example in South Africa). Within this shift there was a re-emergence of direct action groups and a move towards support volunteerism. The impact of the AIDS crisis and the rise of fear affected all and mobilized those who had not previously identified with gay activism. The most notable of the support volunteerism groups was Gay Men’s Health Crisis (GMHC) formed in 1981 in the USA in response to the impact on the gay community, which provided a model for support groups elsewhere. GMHC created an AIDS hotline in 1982, as did the People with AIDS foundation (PWA) in 1983. Moreover in the process of providing this support network and opening up a dialogue, the gay community initiated a process of education and self-identity , which had a lasting impact on the gay community and culture.
However, a significant proportion of the US gay community believed that support volunteerism promoted by GMHC and PWA could not enact genuine change. Consequently in 1987 the AIDS Coalition to Unleash Power (ACT UP) was formed in New York, and led to other ACT UP groups in the US and other countries (for example in the UK, Australia and France). Comprising a variety of different protest and pressure groups ACT UP sought to affect public opinion and government policy directly through both political protests and civil disobedience. Perhaps their most famous campaign was Silence=Death, which responded to the media blackout of HIV/AIDS in the gay community. This campaign combined political protest and civil disobedience to place AIDS more centrally in the minds of Americans. Civil disobedience was, for example, directed against the pharmaceutical companies, attempting to get them to invest in alternatives to the drug AZT .
These two distinct approaches – support volunteerism promoting awareness and self help within the community, and direct pressure on the political system through protest and direct action – are still reflected in gay culture today.