From the earliest days of its recognition in the United States, the condition that came to be known as acquired immunodeficiency syndrome (AIDS) has been associated with the gay community. In fact, when the U.S. Centers for Disease Control and Prevention (CDC) first made written notice of the syndrome in 1981, the acronym GRID (gay-related immune disease) was commonly, although not officially, used to describe it. In the five years that followed, the causal agent, human immunodeficiency virus (HIV), was discovered, specific demographic groups were identified as at heightened risk of infection, and transmission routes—including sexual activity, intravenous drug use, and transfusion of blood and blood products—were determined. Identification of HIV with the gay community as a major risk group had important ramifications for prevention and treatment policy, as the community mobilized a rights-based approach that advocated harm reduction over abstinence and access and affordability of treatment over the interests of the private market. These concepts carried into later debates as the world recognized the global severity of HIV and grappled for the first time ever with a goal of universal treatment access in the world’s poorest countries where the pandemic is most severe. Identification of HIV with values, conceptual structures, leadership, and mobilization drawn from the gay community also had ramifications on the social and political contexts of AIDS treatment and prevention globally, as governments and cultures that had ignored or demonized their gay populations have increased their interactions with them as “risk groups” and as political actors. Despite the remarkable inroads made into accessibility of treatment, the world remains without a vaccine, a cure, or the political will to fully implement universal treatment access, which means that eradication of the global pandemic remains elusive.