Employing an anticolonial and anticapitalist approach to HIV/AIDS, the activists of the Latina/o Caucus of ACT UP/NY pushed beyond a biomedical framework of “drugs into bodies” that tended to dominate the larger organization. As US queer racialized/colonial subjects, Latinx AIDS activists enacted a queer and feminist decolonial activism that looked past the continental United States to the global South. In Puerto Rico, Latinx AIDS activists helped establish the first chapter of ACT UP in a Spanish-speaking country. Together, the Latina/o Caucus and ACT UP/Puerto Rico spearheaded a campaign against the colonial policies of the United States, the corporate greed of island-based pharmaceutical firms, and the heteropatriarchal investments of church and commonwealth officials—conditions that exacerbated the disproportionate rates of HIV/AIDS among Puerto Rican island and diasporic communities. Through these efforts, Latinx AIDS activists transformed the domestic and global fight against AIDS into a queer, feminist, and decolonial endeavor.
On August 22, 1990, members of the Latina/o Caucus of New York’s AIDS Coalition to Unleash Power (ACT UP/NY) and of the newly established ACT UP/Puerto Rico (ACT UP/PR) demonstrated outside the Caribe Hilton in San Juan, Puerto Rico. Set on a secluded peninsula with seventeen acres of lush foliage, this swanky San Juan resort hosted the Second Think Tank AIDS Forum on the “air bridge” linking AIDS on the island to the continental United States. The resident commissioner of Puerto Rico (the island’s only, and nonvoting, member of Congress) attended along with personnel from AIDS service organizations. Although the forum was part of a series of AIDS-related conferences scheduled by the commonwealth government during the summer of 1990, for the Latina/o Caucus of ACT UP/NY and ACT UP/PR, these interventions overlooked the political and economic conditions of colonialism and neoliberalism that underpinned the epidemic among Puerto Rican island and diasporic communities.
In addition to demanding increased Medicaid funds to treat Puerto Ricans with HIV/AIDS, protesters denounced the governor’s then-recently released AIDS program, “El plan de acción de gobierno para el SIDA.” The plan omitted the role of the island’s profitable pharmaceutical industry, which produced life-sustaining HIV medications largely unavailable to residents. Activists charged the commonwealth government with minimizing AIDS in order to safeguard Puerto Rico’s booming tourist economy. To shed light on these colonial asymmetries, about thirty demonstrators, holding crosses meant to symbolize those dead of AIDS-related complications, bathed themselves in fake blood and laid their bodies on the pavement outside the Caribe Hilton. Chanting against the commonwealth government of Governor Rafael Hernández Colón, activists held signs in Spanish that translated to “The governor has blood on his hands” and “There is no AIDS education without the condom.”1 This demonstration and others hosted throughout Puerto Rico that summer illuminate a central feature of the Latina/o Caucus of ACT UP/NY: its anticolonial, anticapitalist, and transnational approach to the AIDS epidemic.
The activists of the Latina/o Caucus and ACT UP/PR harnessed their outlier status as US queer racialized/colonial subjects to enact a distinctly queer and feminist decolonial AIDS activism, one that pushed activists beyond the existing strategies of ACT UP/NY and beyond the borders of the continental United States.2 Given their experience of marginality, Latinx AIDS activists embraced a transnational worldview that expanded their advocacy to the global South. This same diasporic worldview afforded them an understanding of the virus as a product of overlapping “structural vulnerabilities” anchored in colonial subjugation and predatory economics.3 In Puerto Rico, members of the Latina/o Caucus and ACT UP/PR simultaneously critiqued the colonial policies of the United States, the corporate greed of multinational pharmaceutical firms, and the heteropatriarchal investments of church and commonwealth officials. In addition to mobilizing LGBT constituencies, activists widened their outreach to encompass heterosexual men, women, and children, deploying family as a critical site of collective resistance. Through these strategies, Latinx AIDS activists pressed ACT UP’s message into forms of engagement that were most resonant to Latinx and Latin Americans at home and abroad.
Since 1898 Puerto Rico has remained an “unincorporated territory” of the United States—that is, a colony. Puerto Rico’s 1952 designation by Congress as a “commonwealth” in English or free-associated state (estado libre asociado) was orchestrated by Luis Muñoz Marín, Puerto Rico’s first democratically elected governor, in response to pressure from the United Nations for world decolonization and the risk posed by a militant Puerto Rican independence movement. Though the commonwealth designation granted local politicians a greater degree of autonomy over local affairs, it maintained US military and capitalist interests through tax breaks for US corporations and policies that ensured cheap labor, tax holidays, economic subsidies, low-interest loans, and duty-free trade.4 Between the 1940s and the 1960s, a series of industrialization policies known as Operation Bootstrap (Operación manos a la obra) turned Puerto Rico into a Caribbean showcase for American-led industrial capitalism.5 This model of development did not produce a self-sustaining economy; instead, it codified a system of extractive capitalism in which tax-free profits were transferred to the continental United States rather than being reinvested in Puerto Rico. The Latinx AIDS activists of ACT UP/NY linked this system of trickle-down-economics to the island’s high rate of HIV/AIDS. By the end of the 1980s, AIDS had become the leading cause of death in Puerto Rico for men between the ages of twenty-five and forty-four and for women between twenty-five and thirty-four.6
Since the start of the US AIDS epidemic in the early 1980s, Latinx people have been disproportionately impacted. In 1989, for every 100,000 Latinx people, 58.2 had AIDS, compared to 21.5 AIDS cases per 100,000 non-Hispanic whites. The cumulative incidence of AIDS at the time was 2.8 times higher among Latinx people than among non-Hispanic whites.7 Latinx women also experienced some of the highest rates of disease, accounting for 20 percent of all AIDS cases among women by the end of 1989.8 Although people designated as “Hispanics” made up only 9 percent of the nation’s nearly 250 million people in 1990, they accounted for about 17 percent of all AIDS cases nationally.9 But, even among Latinx people, the risk of exposure was unevenly distributed. The incidence of AIDS among Latinx people was largely concentrated in people born in Puerto Rico and those who traced their ancestry there.10 In New York City, where by the end of 1989 about 21 percent of the country’s AIDS cases had been registered, 26 percent were reported in Latinx people, the overwhelming majority being of Puerto Rican heritage. The AIDS mortality rates among Puerto Rican–born males in New York were 36 percent higher than those of Black people and twice as high as those of whites.11 Unlike other Latinx subgroups whose primary mode of HIV transmission consisted of male-to-male sexual contact, for Puerto Ricans, both on the island and the continental United States, the primary mode of HIV transmission consisted of intravenous (IV) drug use. By the late 1980s, Puerto Ricans experienced a rate of drug-related AIDS cases that was five times greater than that of other Latinx subgroups.12
Injection drug use was an epidemic in and of itself in 1980s New York City. Out of an estimated two hundred thousand IV drug users, authorities estimated that 50 to 60 percent of them were infected with HIV.13 Seventy-five percent of these HIV-positive IV drug users were male, and about 85 percent were either Latino or African American.14 By August 1988, for the first time in the epidemic, newly reported cases of AIDS among IV drug users and their sexual partners in New York City outnumbered those of homosexual/bisexual men.15 Because the virus traveled along existing lines of structural inequality, AIDS-related cases of IV drug use were largely confined to specific inner-city neighborhoods. In 1988 in the South Bronx, between 10 and 20 percent of the entire twenty-five- to forty-five-year-old population of males was infected with HIV, as was 5 to 8 percent of the female population in the same age group.16 In the South Bronx, Harlem, and Newark area, over 25 percent of people with AIDS were female in 1990, compared with less than 10 percent for the United States as a whole.17
The high prevalence of HIV among Puerto Ricans born in the continental United States was likewise reflected in the high prevalence of HIV among Puerto Ricans born on the island. In 1990 Puerto Rico, with a population of 3.3 million, had a per capita rate of new AIDS cases that was more than three times the US national average.18 Of all cases on the island, IV drug use accounted for 60 percent—a rate greater than among Latinx residents of New York City (53 percent) and among New York City Black people (48 percent) or, for that matter, all US Latinx (39 percent) and all US Black people (35 percent).19
ACT UP/NY, founded in 1987, employed direct-action methods that elicited widespread media attention, challenged the public’s willful ignorance on AIDS, and compelled the federal government to respond to the crisis through new research and health care programs. But for some in the movement—particularly women and queers of color—the biomedical “drugs-into-bodies” focus that frequently dominated ACT UP deflected attention from the racism, injustice, and poverty that structured the crisis.20 Consequently, in late 1989 members of ACT UP/NY’s Spanish Communications Committee, including Moisés Agosto-Rosario, Carlos Maldonado, and Luis Santiago, convened a meeting in the hopes of establishing a group with a more autonomous identity and agenda. The Spanish Communications Committee mostly translated government publications, medical information, and outreach materials already produced by ACT UP/NY. As such, it did not enjoy the same level of autonomy as other committees. As Fernando Mariscal recalls, “We didn’t want to just be the translators.” Instead, they wanted to be “the one[s] participating in the decision-making.”21 However, some Latinx “ACT UPers” did not feel comfortable speaking at the Monday night meetings of ACT UP/NY. They were conscious of their accent, of not being taken seriously. In short, they felt invisible.
For this reason, Latinx queers decided to form their own committee in ACT UP/NY. As Agosto-Rosario explains, they wanted “to address . . . concerns about how the unique issues facing our communities were falling through the cracks, not only within the institutional responses but also within the same coalition of people of color.”22 The Latino Caucus was thus born as a closed group focused specifically on issues impacting Latinx communities, including inadequate health care, immigration restriction, and the criminalization of drug use.23 In addition to Agosto-Rosario, Maldonado, and Santiago, members present at the first meeting included Joe Franco, Robert García, Aldo Hernández, Luis López-Detrés, Juan Méndez, and Robert Vázquez-Pacheco.
Because the caucus was open only to Latinx ACT UPers, others—especially those who dated caucus members—perceived it as “exclusive.” (The caucus was jokingly referred to as “the boyfriend club.”) The caucus, however, was anything but exclusive in terms of the issues around which it organized and the organizations with which it collaborated. As Candido Negrón recalls, “We reached out. We left the Village.”24 The caucus addressed concerns involving women, immigrants, IV drug users, and colonized peoples, as members understood these populations were not mutually exclusive. Speaking to this politicized interconnectedness, Jesús Aguais recalls feeling that “the well-being of all [was] bigger than my own.”25 The caucus eventually became the Latina/o Caucus, welcoming into ACT UP/NY women from Brooklyn and the South Bronx. These women, some of whom were former IV drug users or their partners, came into the caucus as members of their own respective organizations. Rita Córdova-Padron, a leader in the national liberation movement of Puerto Rico, worked at the South Bronx organization Health Force: Women against AIDS. The organization was the first project in the South Bronx to empower HIV-positive women as peer educators. Through Health Force, Marina Álvarez, a single mother of three sons, joined the Latina/o Caucus. As peer educator, Álvarez, who learned she was HIV-positive while in prison, distributed condoms and Spanish pamphlets at locations ranging from laundromats to Riker’s Island. Lydia Awadallah, from Life Force: Women Fighting AIDS, Inc., in Brooklyn, was a mother of two sons, one of whom was also HIV-positive. A strong advocate for the inclusion of children in clinical trials, Awadallah helped establish Iris House, a nonprofit organization for HIV-positive women of color and their children in East Harlem.26
Fighting against the lack of access to health care, needle-exchange programs, and HIV-prevention education, the Latina/o Caucus engendered a space that countered the power dynamics of the larger ACT UP/NY group, diversifying it from the inside out to better reflect the epidemic’s demographics. The caucus also critiqued the unexamined heterosexual mandates of Latinx AIDS service organizations and nurtured Latinx sociality across ethnic, gender, and sexual lines.
While the Latina/o Caucus shared many of ACT UP/NY’s aims and strategies, caucus members also viewed the AIDS epidemic in transnational terms, looking beyond the US Northeast to the global South. More specifically, they theorized the health crisis from a position of colonial alterity. Alfredo González, a surviving caucus member, explains that Latinx queers, because of their outsider status, brought into ACT UP/NY an understanding of “the global and historical dimensions of the pandemic.” He elaborates: “Even if many of us were HIV-positive or recovering drug users, struggled with English, or were undocumented and cleaned apartments to make ends meet, the disparities we witnessed between the United States and Latin America demanded solidarity.” For González and the rest of the caucus, “the call to action went beyond the borders of the United States” (fig. 1).27
The caucus melded an activist style born of the Latin American left with an American tradition of civil disobedience, resulting in a uniquely Latinx hybrid. Although founding members included Chicano and Nuyorican men, a sizable number of caucus members were immigrants from Latin America and the Caribbean, bringing with them significant political experience. Gonzalo Aburto was a founding member of the Worker’s Revolutionary Party in 1976 Mexico City. This Trotskyist political party fought, among other things, for the release of Puerto Rican political prisoners, including Lolita Lebrón.28 Other caucus members had witnessed labor and student uprisings in Chile and Argentina, as well as their repression by US-backed military dictatorships. Whether or not they were HIV-positive, most caucus members already understood what it meant for a government to disregard the well-being of a segment of the country’s population. Although a life-threatening illness brought these men and women together, US foreign policy in Latin America and the Caribbean fortified the nature of those bonds.
The Latina/o Caucus gained a reputation in ACT UP/NY as being leftist and Marxist, a designation that perhaps resulted in dismissals from some and that even alienated some of its own founders, but which caucus members defended as warranted, given the nature of the crisis. Among Chicano and Nuyorican men, as Gilbert Martinez attests, the caucus provided a venue for them to reflect on the cultural and linguistic dimensions associated with being gay and Latino in the United States.29 Members’ distinct yet interrelated experiences coalesced into the political platform of the Latina/o Caucus: mobilizing against the devastation of AIDS in Latinx communities by simultaneously confronting the underlying political, economic, and social parameters of colonialism and neoliberalism.
As both racial and sexual minoritarian subjects, Latinx queers harbored what Chicana feminist scholar Gloria Anzaldúa calls la facultad, or the capacity “to see in surface phenomena the meaning of deeper realities.”30 Chela Sandoval further elaborates on la facultad through her theory of an “oppositional consciousness,” a strategy of survival enacted by oppressed peoples that relies on “the ability to read the current situation of power and of self-consciously choosing and adopting the ideological form best suited to push against its configurations.”31 Such consciousness sees the world from the location of alterity. Individuals who are attuned to this oppositional consciousness are able to recognize one another’s shared marginalization and thus forge links of solidarity not along neatly contained identity categories but rather across and through difference. As racial minorities within an organization of mostly white, middle-class, college-educated gay men, members of the Latina/o Caucus tapped into their own facultades, theorizing from an oppositional consciousness that alerted them that the AIDS epidemic was not divorced from discussions of the political economy of colonialism and neoliberalism but instead central to those discussions.
From 1990 to 1994, through a series of audacious campaigns that embodied the collective’s transnational outlook, the Latina/o Caucus galvanized the public’s attention to AIDS in Latinx communities. In 1990 members disrupted the Puerto Rican Day Parade in Manhattan, distributing thousands of condoms and flyers and staging a “die-in” that shocked spectators. The following year, caucus members demonstrated against former Argentine president Carlos Menem as he spoke at Columbia University. Members condemned Menem’s unwillingness to legally recognize Comunidad Homosexual de Argentina (CHA), then the only LGBT organization and one of the few that conducted HIV outreach in Argentina. Members also participated in HIV-education outreach in churches, schools, and prisons; contributed to needle-exchange programs in Brooklyn and the South Bronx; and stood front and center in actions demanding that the Centers for Disease Control and Prevention (CDC) alter its definition of AIDS to account for opportunistic infections most common among women.
Beyond the continental United States, the Latina/o Caucus established networks with LGBT rights groups and AIDS service organizations throughout the hemisphere. The caucus created ACT UP-Ámericas, an open-membership committee dedicated to AIDS activism across national borders. Together, members from both groups delivered discarded, unexpired HIV medicine to South America, Central America, and the Caribbean. They published the Boletin de ACT UP Ámericas, a Spanish-language newsletter offering HIV-related scientific, social, and political news, which they sent to nongovernmental organizations throughout Latin America. Latinx AIDS activists hosted women activists from the Sandinista party in Nicaragua who shared with Latinx AIDS activists their experiences with that country’s low HIV rates. And, in the Caribbean, they rallied the largest activist response to AIDS in Puerto Rico, through a historic five-week series of actions and events, culminating in the first chapter of ACT UP in a Spanish-speaking country.
Macarena Gómez-Barris has theorized “cuir politics” as a method of analysis that conjoins queer and decolonial thinking, pulling away from the normative structures of the nation-state toward what Gómez-Barris describes as the “sexual underground,” a textured tapestry of complex sexual identities, practices, and experiences that proffer non-normative worlds of political being and interpersonal sociality.32 Like women of color feminism and queer of color critique, cuir politics exalts a focus on embodied forms of relationality, valorizing non-normative gender and sexual formations as reservoirs of knowledge and models of anticolonial resistance. Read through a cuir political framework, the archival records and oral histories of the Latina/o Caucus and ACT UP/PR reveal a decolonial queer praxis in action, centered in grounded, local responses to the health crisis.
Both the Latina/o Caucus and ACT UP/PR employed an anticolonial and anticapitalist praxis that enabled their members to confront the logics of dehumanization and extractive capitalism that proved endemic to American colonial statecraft and, by extension, the proliferation of HIV/AIDS. Refusing to see from a singular frame of reference, the Latina/o Caucus and ACT UP/PR prioritized non-normative modes of engaging the social world. They widened the scope of AIDS politics well beyond the individual treatment and prevention model named “drugs into bodies,” and they located value and purpose in the lives of those relegated to the margins—not just queers but women, immigrants, and IV drug users as well.
The Air Bridge
The Latinx AIDS activists of ACT UP/NY interpreted the geographic diffusion of HIV into Puerto Rico from New York and vice versa as reflecting and capitalizing on the colonial dynamics that shaped migration patterns and social and family networks. Less keen to articulate anticolonial critiques, health officials attributed the heightened incidence of HIV/AIDS on the island to the lower availability of syringe exchanges, drug abuse treatments, and antiretroviral therapies for IV drug users. These factors certainly contributed to the island’s health crisis but did not operate in a political vacuum. As Latinx AIDS activists emphasized, they were manifestations of the island’s territorial status, which buoyed the “air bridge” linking distinct sites of the diaspora. As US citizens, Puerto Ricans are free to travel to and from the continental United States. With three-hour flights at low prices, nonexistent immigration barriers, and no customs inspections, frequent air travel between Puerto Rico and hard-hit cities in the US Northeast like Newark, Philadelphia, and New York City exacerbated an already-dire medical emergency on the island.
That the Puerto Rican AIDS epidemic was and remains overwhelmingly caused by IV drug use is also no coincidence. No other jurisdiction in the country, not even New York, New Jersey, or any other state with a sizeable Puerto Rican population, had a higher proportion of IV drug users among its AIDS caseload than Puerto Rico—two out of every three.33 In the 1980s, Puerto Rico emerged as one of the largest centers of drug use and addiction in the Western Hemisphere.34 By the time AIDS struck the island, Puerto Rico’s midcentury modernization program and subsequent economic boom had all but collapsed. Chronic poverty and high levels of unemployment fueled a growing drug-based, informal economy, which was abetted by Puerto Rico’s commonwealth status.35 Since there were and remain no customs inspections on flights from the island to the continental United States, Puerto Rico emerged as a key transit zone for drugs originating in the Andean source countries of South America.36 Anecdotal evidence also suggests that a significant portion of the more than forty-seven thousand Puerto Rican men who served in the Vietnam War returned to New York and Puerto Rico addicted to heroin.37
Rigid antidrug laws, part of the commonwealth’s turn toward punitive governance, further amplified Puerto Rico’s twin epidemics of AIDS and IV drug use. In a 1991 story published by the San Juan Star, Dr. John Rullán, head of Puerto Rico’s Central Office of AIDS Affairs, argued that the islandwide ban on the purchase of syringes without a prescription encouraged the sharing of contaminated needles.38 However, because both the anti-addiction secretary and the assistant secretary of drug addiction treatment insisted that needle-exchange programs only encouraged the further use of drugs, the commonwealth government responded with mass arrests of drug users. In 1991 the Corrections Administration in Puerto Rico housed about 10,900 inmates, with about another 13,000 people on parole or probation. The Anti-Addiction Services Department estimated that altogether about 83 percent of the system’s inmates experienced some form of drug-related problem.39 The year prior, nearly 70 percent of the sixty-one deaths reported in Puerto Rico’s prisons were associated with AIDS.40
Air travel likewise shaped Puerto Rican experiences with HIV/AIDS care, as many traveled to New York City or other US urban centers desperate for medical treatment unavailable on the island.41 In a 1992 New York Times article, “Puerto Ricans Fighting AIDS with Plane Fare,” Dr. Gabriel Torres, medical director of the AIDS center at St. Vincent’s Hospital in Manhattan’s Greenwich Village, reported treating about thirty visiting Puerto Ricans at any given time.42 Many in the terminal stages of the disease returned home to Puerto Rico to die in the company of their families and be buried in their native land.43 Such travel could also flow north, as residents on the island traveled to New York City to visit relatives who were dying of AIDS.44 The air bridge, in short, mediated access to health care and nursed intimate connections among loved ones.
Further, the air bridge fostered the formation of activist communities linking US- and island-based AIDS advocates.45 The activist networks established between the Latina/o Caucus and ACT UP/PR exemplify the multidimensional nature of the air bridge: as a metaphorical borderland where Puerto Ricans could negotiate and reconceptualize their identities between two geographical spaces, cultures, languages, and histories, and as a politically generative site where Latinx AIDS activists could articulate a decolonial queer critique of US imperialism, multinational corporate interests, and racialized investments in heterosexuality.
The diasporic perspective of the Latina/o Caucus shaped its analysis of the AIDS epidemic as an injury wrought of colonialism and neoliberalism. Some of the founding members were Puerto Rican born or raised, having moved to the continental United States to continue their studies or access better health care and social services after being diagnosed with HIV. The island was marred by a lack of services for people with HIV/AIDS, and federal and local AIDS policy proved indifferent to the needs of Puerto Ricans. Although Puerto Rico ranked sixth among the fifty-seven states and territories in the total number of AIDS cases in 1990, it ranked twentieth in funding for AIDS-related programs per capita from the US Public Health Service and fifty-fifth in total funding per reported case.46 Meanwhile, Medicaid was virtually unavailable on the island. These factors propelled a delegation of Latinx AIDS activists to the island in the summer of 1990, an event that caucus members coined “Hurricane SIDA.” The historic five-week series of actions and workshops catalyzed one of the fiercest showdowns between Puerto Rican island and diasporic communities and the seemingly immovable infrastructure of colonial domination.
During the 1990 International AIDS Conference in San Francisco, members of the Latina/o Caucus met with officials from Puerto Rico, who disclosed a series of upcoming AIDS-related forums and conferences scheduled by the commonwealth government for that summer. Caucus members sprang into action, seeing this moment as an opportune time to expose the service inefficiencies of the commonwealth government and help organize a Puerto Rican chapter of ACT UP. Yet when the caucus requested about $30,000 dollars for the action from the General Assembly of ACT UP/NY, the response was tepid, as some prominent members did not understand why the campaign was necessary or how it fit into the mission of ACT UP/NY. (In 1990 ACT UP/NY generated $1,021,866 in income, half of which came from an art auction featuring the work of Keith Haring.)47 Luis Santiago remembers that ACT UP/NY approved the campaign and provided funding but only after “a long discussion and a heated debate over whether this was an appropriate action for ACT UP/NY.”48 That July, members of the Latina/o Caucus and the Spanish Communications Committee of ACT UP/NY created the Puerto Rico Working Group of ACT UP. The working group established contacts with Puerto Ricans involved in island-based AIDS activism and discussed logistical groundwork, including travel and lodging for thirty activists. At the end of July 1990, the first group of Latinx AIDS activists—Moisés Agosto-Rosario, Carlos Cordero, and José Santini—traveled to Puerto Rico to meet with their island counterparts and plan accordingly.49
In preparation for the visit, the Latina/o Caucus issued a letter addressed to residents of San Juan who were interested in learning more about the group’s efforts. This invitation, addressed to their “compañeras/os,” was also an indictment of the commonwealth government of Governor Rafael Hernández Colón, whom caucus members equated with Presidents Ronald Reagan and George H. W. Bush as “a criminal and murderer who, with his game of politics, puts the health of the people at stake by fostering ignorance, fear and death.”50 Caucus members reaffirmed this tone in their “Silencio = Muerte” (“Silence = Death”) pamphlet. In explaining their visit to Puerto Rico, caucus members declared: “We are here, because AIDS is the leading cause of death for Latinas and Latinos, between 24–44 years of age in New York City. If this is the situation in the so-called capital of the world, we can certainly affirm that the situation of AIDS in Latin America is: CATASTROPHIC.”51 In both pieces of literature, the Latina/o Caucus situated its efforts beyond the continental United States, linking rates of HIV infection on the “mainland” to those in Latin America. Moreover, by using the pronoun we, the Latina/o Caucus communicated a political camaraderie between US Latinx people and Latin Americans in the global South.
Among the most pressing accusations leveled against Governor Hernández Colón was that he had failed to demand that the US federal government allocate more Medicaid funding to the island. While US states received open-ended federal funds based on per capita income, Puerto Rico (like other US territories) received a fixed block of grant funding per year. As such, Medicaid in Puerto Rico limited eligibility, covered fewer services, and reduced the size of payments to providers.52 Despite the fact that 65 percent of Puerto Ricans on the island lived at or below the poverty line, making them eligible for Medicaid, the federal government capped Medicaid spending on the island to $79 million a year.53 Whereas some US states received up to 80 percent of their health budget from the federal government, Puerto Rico received only about 20 percent. In 1990 the island’s average Medicaid benefit per patient was $86. In Mississippi, the poorest US state, the average was $816 per patient.54
This dearth in Medicaid funding prevented most Puerto Ricans with HIV/AIDS from accessing life-sustaining medications like AZT, then the only FDA-approved drug against HIV, and aerosolized pentamidine, which were—ironically enough—manufactured on the island by pharmaceutical giants Burroughs-Wellcome and Lyphomed.55 At $3,000 to $4,000 a year per patient, AZT alone would have cost $60 million of the $79 million in federal aid for health care.56 However, the island’s only funding source for AZT and other such drugs was a paltry $900,000 federal grant.57 Thus only about two hundred people in San Juan received AZT in the summer of 1990, even as Dr. John Rullán, the head of Puerto Rico’s Central Office of AIDS Affairs, estimated that at least twenty thousand Puerto Ricans had immune-system failure advanced enough to qualify them for the drug.58 As a result, many Puerto Ricans with AIDS moved to the continental United States where they were eligible for Medicaid as US citizens but even then, only after thirty days of residency.
When HIV hit the island, Puerto Rico had already ascended as the most sophisticated manufacturer of pharmaceuticals for both the US and global markets. The island had long been a site for medical research and experimentation.59 Due to federal tax exemptions, by the time residents started to grow ill with AIDS-related opportunistic infections, Puerto Rico was already subject to the extractive capitalism of pharmaceutical companies and hundreds of other US-based multinational corporations. As a result of the economic recession of the 1970s and the relocation of US firms from US territories to countries with even cheaper wages, in 1976 the US Congress created Section 936 of the Internal Revenue Tax Code. Pharmaceuticals and other high-tech industries were able to exploit a loophole in Section 936, exempting corporations from federal taxes if they resided in US territories, into an economic boon. By the 1980s, Puerto Rico became the number one source of profit for US firms, and in 1986 Puerto Rico surpassed industrial giants like Germany, Canada, Japan, and the United Kingdom. That same year, US companies earned $5.8 billion from Puerto Rico investments.60
Many US drug companies found the tax climate in Puerto Rico especially hospitable. The pharmaceutical industry received a relatively large share of the tax benefits from Section 936 compared to the number of jobs it created and the amount of employee compensation it provided. Pharmaceutical companies provided just 15 to 18 percent of Section 936–related jobs on the island, but they received about half the policy’s total tax benefits. According to an investigation by the US General Accounting Office, drug companies saved an average of $70,000 in taxes for every Puerto Rican worker they employed in 1987. From 1980 through 1990, the industry’s tax savings topped $10 billion.61
One of the companies that took advantage of this loophole was the pharmaceutical juggernaut Burroughs-Wellcome, which produced and sold AZT. In the early 1990s, the president of the Association of Puerto Rican Industrialists, Daniel LeBrón, was quoted in El nuevo día marveling at the omnipresence of the pharmaceutical industry on the island, which he called the “Capital of the Pharmaceutical Industry.”62 Indeed, as the magazine Drug Topics later confirmed in 1991, eight of the ten most popular medicines in the continental United States were manufactured in Puerto Rico.63 However, the benefits of Section 936, to the extent they helped grow Puerto Rico’s economy, were primarily felt by investors, not by residents of the island and certainly not Puerto Ricans with HIV/AIDS.
Even as the 1980s saw US multinational corporations hit record profits in Puerto Rico, the island’s population suffered economically. Close to two-thirds of island residents lived below poverty levels. About 59 percent depended on food stamps.64 In 1985 unemployment was roughly 22 percent, and 1.8 million Puerto Ricans lacked access to private health care.65 Puerto Rico’s per capita income was only 40 percent of that of Mississippi, the poorest US state. The island was unequipped to handle the basic health care needs of its residents, much less the needs of those exposed to the virus. People with AIDS in Puerto Rico received $32 dollars through Social Security and an additional $52 dollars through the island’s food stamp program, “El programa de asistencia nutricional,” an allowance that did not cover AIDS-related medications.66 These conditions of abject poverty, which promoted the exodus of Puerto Ricans from the island (the estimated net out-migration from 1980 to 1988 was 280,000, almost 9 percent of the 1980 population), were the same conditions that enhanced the transmission of HIV—like a hurricane dependent on warm waters to strengthen.67
Latinx AIDS activists were duly aware of Puerto Rico’s status as an offshore tax haven for pharmaceutical companies. In “El manifiesto de Puerto Rico de ACT UP,” Latinx AIDS activists insisted that no one on the island should have been dying of pneumocystis pneumonia (PCP), an AIDS-related opportunistic infection, when aerosolized pentamidine, the drug used to treat PCP, was manufactured there. The activists declared: “It is positively unacceptable to delay or neglect desperately needed clinical research any further with the excuse of lack of availability of such anti-PCP agents, since Lyphomed, manufacturer of pentamidine, is in Puerto Rico, and twenty miles away from a hospice where a PWA lay dying of PCP.”68 As caucus members emphasized, the political-economic arrangement of colonialism subsidized billions in profits for US drug companies but kept the treatments those companies produced out of the hands of Puerto Ricans who were sick or dying from AIDS.
Confronting the AIDS epidemic in Puerto Rico thus demanded that commonwealth officials challenge the island’s status as an unincorporated territory of the United States. The Latina/o Caucus of ACT UP/NY blamed Governor Hernández Colón for refusing to take this step. In addition to losing out on the revenue that such US firms ostensibly provided, the governor was allegedly concerned about the health crisis alienating potential tourists, given the highly competitive global tourist industry. In one of its leaflets, the caucus chastened the commonwealth government: “The so called ‘Shining Star of the Caribbean,’ slogan used to attract tourism to the island, has a very dark spot to show the visitors: a ravaging AIDS epidemic.”69 Tourism, admittedly, was one of Puerto Rico’s economic mainstays. When a local television report on AIDS aired, the official response came not from the island’s medical experts but from the tourism department.70
Governor Hernández Colón worked to dispel the association of Puerto Rico with disease, likely fearing that it would tarnish the island’s reputation as an escapist getaway for European and North American travelers. Since assuming the governorship in 1985, Hernández Colón had endeavored to make the island amenable to tourist-related businesses, restoring hotels to a whopping 90 percent industrial tax exemption.71 From 1984 to 1987, the number of visitors arriving by air rose 23.4 percent, to 2.1 million, and visitors on cruise ships increased by more than 30 percent.72 By 1987 tourism accounted for 5 percent of the island’s gross national product.73 But these new tax incentives, like those afforded to pharmaceutical companies, did not prove equally beneficial to employees of the sector. A massive fire on New Year’s Eve in 1986 at the 420-room Dupont Plaza Hotel in San Juan killed ninety-seven guests and hotel workers and injured scores of others. Investigators would later reveal that three employees set fire to the hotel in retaliation against deteriorating labor-management relations. In response, Governor Hernández Colón collaborated with private tourist businesses—hotels, restaurants, suppliers, and airlines—on a massive public relations campaign designed to reaffirm the island’s image as an exotic paradise.74
By presenting a disjuncture between fantasy and reality, Latinx AIDS activists shattered the image of Puerto Rico that the Hernández Colón administration concocted in collaboration with the tourism sector. These same activists likewise refused to abide by the disparate power relations that governed the pharmaceutical industry’s presence on the island. Instead, Latinx AIDS activists within ACT UP/NY centered the role of colonialism and neoliberal capitalism, arguing that the island’s colonial status accelerated HIV infection rates among Puerto Ricans. From this theorizing of the political-economic relationship between Puerto Rico and the United States, the Latina/o Caucus and ACT UP/PR built a decolonial queer praxis that pushed beyond the strategies of ACT UP/NY.
Decolonial Queer Praxis
The AIDS epidemic in Puerto Rico necessitated a grounded response that attended to the political, economic, and social forces underlying local disease patterns as well as a response that considered the meanings of gender and sexuality within regional cultural systems. Because the majority of AIDS cases on the island involved IV drug use, any AIDS movement there had to encompass heterosexuals. Latinx AIDS activists mobilized family as a mechanism of political dissent, moving beyond a discrete LGBT constituency. At the same time, caucus members collaborated with local LGBT activists, including Christina Hayworth, a transgender Puerto Rican activist who had participated in the Stonewall uprising. Simply put, the grassroots movement that Latinx AIDS activists spearheaded that summer of 1990 was unlike any prior political mobilization in Puerto Rico.
To establish a Puerto Rican chapter of ACT UP, members of the Latina/o Caucus needed to enlist a local and diverse constituency, especially if they wanted island residents to play active roles in the decision making and agenda setting of the marches planned for the summer of Hurricane SIDA. In the streets and on television, at universities, shopping centers, bars and nightclubs, Latinx AIDS activists distributed pamphlets and discussed direct-action AIDS activism. In a letter to ACT UP/NY, Andrew Vélez, one of the visiting caucus members, described an encounter he shared with a Dominican woman working behind the counter at the diner where the caucus enjoyed breakfast. The woman pointed to the member’s “Silencio = Muerte” button and asked for its meaning. Vélez explained that they were “AIDS activists” and that the button was the symbol for their group. He recalled: “That familiar tension was there as I wondered what her response would be. I needn’t have worried. She excitedly called her fellow workers over and told them what I had said. I went to my briefcase and got stickers for them which they immediately put on.” The following morning when the activists came in for breakfast, the woman and all her coworkers, including the cooks in the kitchen, were wearing the buttons. According to Vélez, the response by the Dominican woman was typical of others throughout the trip. When “people noticed our buttons and T-shirts or overheard our conversations or recognized us—the response was interested, respectful and enthusiastic about what we had to say and what we were doing.”75
Island-born and -raised Puerto Ricans in the Latina/o Caucus relied on existing island networks to further publicize ACT UP. Through these linkages, caucus members convinced local reporters from the Associated Press to cover the series of planned actions. They also adapted their recruitment strategies to account for localized expressions of gender and sexuality. Because there were few formal LGBT establishments other than bars and nightclubs, Latinx AIDS activists looked elsewhere to recruit gay men. They visited public parks and other cruising sites, where they would distribute “Silencio = Muerte” stickers to cruisers and invite them to upcoming ACT UP meetings, many of which were held in the bustling gay bars and nightclubs of San Juan.76
Throughout the 1970s and into the early 1980s, Puerto Rico was one of the centers of gay nightlife in the Caribbean, welcoming tourists from Europe and North America. There was a vast infrastructure of gay tourism, including bars and nightclubs but also hotels and beaches. Early in the pandemic, business owners and employees transformed bars and nightclubs into some of the earliest sites of AIDS activism in Puerto Rico. They distributed information, hosted support groups, and organized fund-raisers.77 The Latina/o Caucus made use of this existing infrastructure, hosting its first meeting that summer at a gay bar. Fernando Sosa, a self-described “Afro-Boricua” activist and prominent member of ACT UP/PR, was working at a restaurant when he was approached by members of the Latina/o Caucus, who invited him to the inaugural meeting of ACT UP.78 Sosa remembers a “huge crowd” of gay men showed up at the designated gay bar, thinking they were going to a party. Once the crowd realized the meeting was political in nature, about half of them left. Sosa assumes these men were not “out” to their families and could not afford the public visibility that AIDS activism might have entailed or were unable to navigate the stigma associated with AIDS. Drag queens who performed at several of the gay nightclubs also became members of the recruitment process, enlisting others through their extensive networks.
Through these recruitment practices, Latinx AIDS activists enlisted a sizeable group of local residents, both LGBT and heterosexual, young and old. Over two hundred people attended a teach-in held by the Latinx AIDS activists. In an interview with the San Juan Star, members of the Latina/o Caucus reiterated that the response on the island had been positive, attracting a coalition of groups and people, including men, women, and children who were infected with HIV themselves or whose loved ones were (fig. 2).79 As Luis Santiago recalls, about 15 to 20 percent of participants in the summer marches hailed from ACT UP/NY, caucus members included. The rest were Puerto Rican residents.80
The welcoming response in San Juan might have also been a result of how the caucus framed “civil disobedience.” Caucus members and Puerto Rican activists alike worried over the appropriateness of the ACT UP/NY model of direct-action street activism for Puerto Rico. With 1980s economic stagnation, the commonwealth government had increasingly relied on punitive strategies and carceral logics. Despite the decades-long independence movement, Puerto Rico had not extensively witnessed the confrontational, direct-action street strategies espoused by AIDS activists. Part of the reason was the crushing repression against political dissent.81
Puerto Rico had been a key site in the FBI’s counter-intelligence program known as COINTELPRO, which monitored and suppressed antiwar, leftist, and other political dissent groups. From 1936 to 1995, the FBI, working alongside the Police Department of Puerto Rico and an extensive network of Puerto Rican confidential informants, compiled carpetas (secret files)—about 1.5 million to 1.8 million—on more than one hundred thousand Puerto Ricans who were involved in or sympathetic with Puerto Rico’s independista movement, or anyone who participated in events that potentially undermined American corporate and political interests.82 “Homosexuals” were also surveilled as political subversives.83 Those who were blacklisted were harassed, imprisoned, and permanently discredited as “terrorists.” Given the chilling effect such practices had on the political culture of Puerto Rico, the challenge before the Latina/o Caucus lay in reauthorizing anger and legitimizing confrontational street protest.
To convince people to engage in activism that defied authority and transgressed norms of public decorum, the Latinx AIDS activists of ACT UP/NY linked their direct action to previous campaigns waged by colonized peoples. During their summer trip, caucus members distributed literature that placed ACT UP’s direct-action AIDS activism within the lineage of the US civil rights movement of the 1950s and 1960s, which the caucus pointed out had, in turn, taken as its model the “pacifist movement for Indian independence by Gandhi.”84 The caucus also tied its efforts to liberation theology fomented in Central America. It noted that in the 1980s, religious groups had carried out “most of the acts of civil disobedience, focusing on their protests mainly on their opposition to nuclear weapons and the intervention of the United States in Central America.”85 Liberation theology, through which nuns, priests, and laypeople worked to empower the poor through communal political action, grew throughout Latin America in response to US-backed “dirty wars” in the region.86
With a large and informed constituency in tow, the newly established ACT UP/PR was ready to galvanize the public into action. In the summer of 1990, ACT UP/PR planned a series of direct actions to coincide with the conferences and forums taking place on the island. On July 31, 1990, about fifty protesters held a baquiné, a funeral of a child in the Afro-Borinquen tradition, in front of the Condado Plaza Hotel where US Secretary of Health and Human Services Louis W. Sullivan addressed the New York Commission on Civil Rights Conference.87 As Luis Santiago explains, activists purposely employed “Puerto Rican symbology to give [the demonstrations] a local Puerto Rican character—that [AIDS] is not a thing from over there in the United States nor from Haitians [but] that this is our problem as well” (emphasis added).88 In short, the caucus situated culture as a locus of HIV awareness and prevention. One of the more memorable chants by Latinx AIDS activists that summer consisted of rewriting the lyrics to “Qué bonita mi tierra” to “Qué bonita mi tierra. Qué bonita mi tierra. Mas bonita ni seria si de SIDA no se muriera” (How beautiful my country. How beautiful my country. How much more beautiful if it wasn’t dying of AIDS).89
A week later, on August 7, 1990, activists infiltrated the official presentation of the governor’s then-recently released AIDS program, “El plan de acción de gobierno para el SIDA.” Activists criticized the plan, presented by Dr. John Rullán at the Caribe Hilton, for overlooking medical treatment and clinical trials, which could prolong the lives of HIV-positive people. The plan likewise failed to enlist Puerto Ricans with HIV/AIDS in important decision making. Activists vehemently opposed the plan’s provisions for “contact tracing” and partner notification, which, they argued, intruded on people’s civil liberties. After gaining access to the conference room, demonstrators stood next to Rullán while holding Spanish-language signs that translate to “He is lying” and “Where are the $900,000 in AZT?” (The latter sign was in reference to information received by ACT UP/PR that a shipment of AZT, with an expiration date of 1991, was being stored and not dispensed.)
The protesters also distributed copies of their manifesto, “El manifiesto de Puerto Rico de ACT UP,” which encompassed a searing critique of the commonwealth government’s plan along with recommendations for more effective measures.90 In addition to the greater availability of AZT and aerosolized pentamidine and more clinical trials of experimental AIDS drugs, Latinx AIDS activists demanded more community-based AIDS hospices and increased Medicaid funding for local AIDS treatment.91 Finally, they called for an island-wide needle-exchange program and an HIV-prevention campaign specifically designed for IV drug users, along with the inclusion of drug users in clinical trials of HIV treatments.
By the end of August 1990, an additional thirty members of ACT UP/NY had flown in to San Juan for the main marches. (Not all caucus members traveled; some were undocumented and could not risk arrest, while others simply could not afford the cost or the time off work.) On August 25, 1990, in the largest action yet that summer, activists from the Latina/o Caucus and ACT UP/PR along with their allies marched from El Capitolio through the colonial buildings of Old San Juan to La Fortaleza, the governor’s mansion (fig. 3). About two hundred protesters participated. Along the cobblestone path, activists distributed flyers to hundreds of onlookers and pressed their red-painted palms onto Spanish colonial edifices (figs. 4–6). They chanted, “In the government plan, women go to hell,” “Condoms, yes; biases, no!,” and “If Cuchin [a nickname for the governor] had AIDS, there would be pentamidine!” In an act of civil disobedience, some of the protesters stormed the gates of La Fortaleza, which the police had blocked. These events coincided with solidarity actions held in front of the offices of the Commonwealth of Puerto Rico in Chicago and New York City.92
Finally, on August 26, 1990, in the most contentious action yet, ACT UP/PR targeted the historic San Juan Cathedral, where mass was taking place. Cardinal Luis Aponte Martínez had previously stated that using condoms was a greater sin than contracting HIV. His position, in turn, shaped government policy. Governor Hernández Colón and former Health Secretary Luis Izquierdo Mora, both devout Catholics, rejected any mention of condoms in government-funded HIV-prevention campaigns.93 During the protest, ACT UP members staged a die-in on the steps of the church. Protesters outlined their bodies in chalk to denote those who had died of the disease and to visually remind the clergy of their complicity in these deaths. They plastered flyers that identified Aponte Martínez as an “AIDS criminal” throughout the area surrounding the cathedral. Woody Enoicaras, a member of ACT UP/NY, and Christina Hayworth “dressed as a straight couple” and entered the cathedral where they distributed condoms to mortified parishioners.94
The campaign in San Juan was a rousing success. It was successful in part because Latinx AIDS activists adapted the direct-action strategies of ACT UP/NY for the context of the island, facilitating the broad incorporation of Afro-Boricua, working-class, transgender, and female participants. In addition to helping establish ACT UP/PR, the Latina/o Caucus proved invaluable in a number of developments, including clinical trials, access to pharmaceutical therapy, complementary health services, case management, housing provisions, patient participation on policy boards and institutions, public education campaigns, and other social services for Puerto Ricans with HIV/AIDS.95 Members of ACT UP also hosted a needle-exchange program in the impoverished barrio of La Perla in Old San Juan after brokering an agreement with the owner of La Perla’s shooting gallery. They also held workshops on cleaning needles and practicing safer sex.96
The demonstrations served as an important catalyst for a new political mobilization in Puerto Rico that cut across race, class, gender, and sexuality. Like their counterparts in the continental United States, Latinx AIDS activists demanded essential services and treatment amid government neglect and religious indifference. However, activists from the Latina/o Caucus and ACT UP/PR proceeded from an understanding that HIV exposure was part of a continuum of imperial violences expressed against the people of Puerto Rico, both on the island and in the diaspora. Instead of relying on a model that privileged identity politics, Latinx AIDS activists inaugurated a coalitional praxis structured around shared proximities to colonial subjugation. As Joey Pons of the Latina/o Caucus recalled, this approach garnered support not just from LGBT people but from “straights, children, and grandmothers” as well.97
In a predominantly Catholic milieu where religious leaders refused to so much as acknowledge condoms, it was remarkable that the family members of Puerto Ricans with HIV/AIDS marched that August. An Outweek story on the action at the San Juan Cathedral quoted an unnamed member of ACT UP/NY saying that the march was unusual because of the number of heterosexuals who participated. In a response letter to Outweek, members of the Latina/o Caucus angrily corrected the newsmagazine, emphasizing that those heterosexuals who joined the activists at the cathedral were the parents and family members of activists.98 Underscoring the participation of parents and family members at the then-largest AIDS protest and LGBT demonstration in Puerto Rico was crucial. When the parents and family members of Puerto Ricans with HIV/AIDS marched alongside their loved ones, they publicly refused the silence and avoidance espoused by the Catholic Church and enshrined by the commonwealth government. A few weeks after the demonstrations, a Puerto Rican father whose son or daughter had presumably died of AIDS-related complications sent a series of letters to members of the Latina/o Caucus, thanking them for the demonstrations and asking them for leads on local families in San Juan willing to establish a local chapter of P-FLAG (Parents and Friends of Lesbians and Gays).99 These examples illustrate the importance of familial and extended kinship networks to the vision of social justice that the Latina/o Caucus and ACT UP/PR imagined and aspired to implement.
Furthermore, according to media scholar Julián de Mayo’s 2019 exhibit, (ES)tatus: Reclaiming the Legacy of the Latina/o Caucus of ACT UP NY, the visibility of the marches marked a turning point in the island’s LGBT movement, which “had never claimed public space in such a bold manner.”100 The visit by the Latina/o Caucus built on the early 1970s LGBT activism of La Comunidad de Orgullo Gay (The Community of Gay Pride) against the Penal Code of 1974, which criminalized consensual same-sex sexual relationships.101 Soon after the marches, Christina Hayworth sent a letter to the Latina/o Caucus thanking its members for their visit to Puerto Rico. Like others, she acknowledged the coalitional nature of the actions: “The march was the first for us—the cross representation of straight, gay, Catholic, lesbian, etc. in itself was a first.” She described the caucus as providing an “example” for Puerto Ricans, reminding them that “we must struggle for everything we deserve!” Although there had been efforts in the 1970s to host an LGBT pride parade with automobiles, Hayworth was so inspired by the marches that she announced plans to host the first LGBT pride parade in Puerto Rico the following summer.102 On June 23, 1991, Hayworth and ACT UP/PR, with the participation of several visiting caucus members, led a one-hundred-plus contingent through the San Juan streets of the Condado neighborhood.
Inasmuch as AIDS and drug use traveled along well-established patterns of social inequality, Latinx AIDS activists understood that any effort to combat the AIDS epidemic necessitated a simultaneous engagement with racism, capitalism, and imperialism. Their integrated analyses provide us with an ideological mooring for thinking through the biopolitical consequences of US domination in the global South. Radical and diasporic rather than reformist and nationalist, their decolonial queer praxis stretched beyond bodies and borders, focusing on the social determinants of health that went beyond “drugs into bodies.”
Moreover, that the Latina/o Caucus mobilized on behalf of queers and IV drug users—devalued racialized subjects—illuminates another central feature of a decolonial queer praxis: its disavowal of heteronormative rubrics of social value as a precondition for personhood. This decidedly cuir politics enabled Latinx AIDS activists to resist the Catholic Church’s imposition of a heterosexual identity onto the island’s national character. In addition to demanding the right to public, non-normative sexual identities and practices, activists expanded citizenship rights to encompass access to health care. By employing a decolonial queer praxis in their grassroots organizing, these Latinx AIDS activists summoned what M. Jacqui Alexander calls an “erotic autonomy,” an emancipatory politics that undermines heteropatriarchy as the organizing episteme of the neocolonial state.103 As a politics of decolonization, erotic autonomy displaces nationalist attempts at recolonization by enacting an autonomous eroticism outside the logics of heterosexual reproduction. Erotic autonomy, rather, nurtures affinities with other dissident subjects in the hopes of transforming the nation toward greater self-determination.
The localized, grounded response to the health crisis in Puerto Rico reflects how a coalitional alliance of men, women, and children across race, class, gender, and sexuality could rattle the foundations of colonial and neoliberal structures. The stakes were certainly high. By 1990 AIDS was already the number one killer of Latinx people aged one to four and twenty-five to forty-four in New York City.104 Meanwhile, Puerto Rico had an infection rate of forty-seven new cases per one hundred thousand in population, ranking second in the nation only after Washington, DC.105 However, while the vision of social justice that Latinx AIDS activists imagined proved successful in Puerto Rico, it proved more challenging to actualize in New York City where activists had to contend with internal power differentials and shifting strategies amid the professionalization of AIDS activism.
“Money for AIDS, Not for Bureaucrats”
Feeling empowered, Latinx AIDS activists returned from Puerto Rico to New York City ready to confront what some of them perceived as the growing bureaucratization of AIDS service organizations. Established in 1985, the Hispanic AIDS Forum (HAF) was New York City’s first and largest Latinx AIDS service organization. With an operating budget close to $1 million dollars in 1990, HAF advertised a number of services to Latinx communities, including risk reduction, and educational and support services. Several caucus members worked or volunteered at HAF, including Joe Franco. They had firsthand knowledge that convinced them HAF was not providing the services it touted. On January 9, 1991, the Latina/o Caucus met with HAF’s board of directors and its executive director, Miguelina Maldonado. The caucus accused the nonprofit of reaping millions in funds while failing to provide sufficient HIV education; condemned the organization’s unwillingness to explicitly discuss sex between men or openly endorse needle-exchange programs; and criticized HAF for having no publicly identified people with AIDS, LGBT people, or people with a history of chemical dependency on its seventeen-member board. Caucus members also decried the physical location of HAF’s headquarters in the trendy and fashionable area of SoHo in Lower Manhattan, far from the Latinx clientele HAF claimed to serve.106 Because the meeting proved unsuccessful in reaching a consensus, the caucus went public with its demands.
On January 23, 1991, during ACT UP/NY’s “Day of Desperation,” the Latina/o Caucus visited the offices of the borough president of the Bronx, Fernando Ferrer, where Marina Álvarez awarded him a “Diploma of Negligence.” The caucus also visited HAF’s offices, where members stormed into Miguelina Maldonado’s office as she was on the phone. Members laid cemetery wreaths with the inscription “Hispanic AIDS Forum” on the desk of a speechless Maldonado.107 A week later, on January 31, 1991, the president of HAF, Pablo Ruiz-Salomón, sent a letter to the Latina/o Caucus in response to its demands. Ruiz-Salomón countered that HAF’s board of directors already comprised people with AIDS, LGBT people, and people in recovery, but that it was not HAF’s policy to “require public disclosure of a [board] member’s sexual orientation or HIV status [which] would, in our view, violate a person’s fundamental right to privacy” (emphasis in original). The president of HAF went on to denounce the “relentless, vile, and abusive attacks” of the Latina/o Caucus against HAF’s board members as well as the caucus’ “scurrilous attacks on HAF’s record of achievement and accomplishments.”108
While the Latina/o Caucus emerged partly in response to the inaction of Latinx elected officials and community leaders, not all caucus members endorsed the campaign against HAF or approved of its adversarial tone. Caucus members who opposed the campaign against HAF or called for a more pragmatic approach held backgrounds in the nonprofit sector and understood the precarious nature of funding; they adamantly disagreed with publicly targeting another Latinx group. Moisés Agosto-Rosario, who was also a member of the Treatment and Data Committee, explains that HAF was the only community-based organization (CBO) in New York City providing services to Latinx people. It competed for funding with larger organizations like Gay Men’s Health Crisis, which had an extensive fund-raising and grant-writing infrastructure. Hispanic AIDS Forum did not. Agosto-Rosario agreed it was necessary to hold agencies accountable but “thought it was not correct to attack the small CBO that was trying to reach out to the Latino community.”109
Internal deliberations over whether to confront HAF culminated in a heated General Assembly meeting of ACT UP/NY on February 25, 1991, the night before a second HAF action. Caucus participants Lydia Awadallah, a peer educator from Life Force, and Manny Maldonado, a heterosexual former IV drug user and founder of Música against Drugs, revealed they had only very recently heard of HAF while working at their own respective organizations. They wondered what precisely the nonprofit had accomplished in Latinx communities.110 Later in the meeting, the vice president of HAF and director of ADAPT (Association for Drug Abuse Prevention and Treatment), Yolanda Serrano, implored ACT UP/NY to deauthorize the action, insisting it was “wrong for Latinos to fight Latinos.”111 She read a statement from Maldonado, HAF’s executive director, who called the actions of the caucus “divisive.”112 When Serrano refused to answer questions, the crowd booed and hissed. Noncaucus members came to Serrano’s defense, warning that targeting an AIDS service organization was “new ground” for ACT UP/NY. Nonetheless, by a close vote, the action against HAF scheduled for the following morning was approved.
At 8:00 a.m., members of the Latina/o Caucus proceeded with their planned event. They had prepared placards demanding the resignation of HAF’s executive director and readied their protest chants: “Hispanic AIDS forum, stop your lying. You do nothing while Latinos are dying” and “Money for AIDS, not for bureaucrats.”113 They had expected a sizable contingent of ACT UPers from outside the caucus, since caucus members were always present at the larger group’s actions. However, only a few ACT UP/NY members showed up. These were the regular allies of the caucus; many of those ACT UPers who voted to approve the action were absent. By the time protesters arrived, a significant police force had already established barricades, preventing caucus members from unfurling their large banners from the building’s roof. The twenty-five or so activists marched around for a couple of hours and then went home. No arrests were made.114
The decision to publicly target another Latinx group through direct action resulted in internal ruptures even as it exposed ideological disagreements between the caucus and the larger organization. As César Carrasco reminisces, the lack of support from the larger organization confirmed that the Latina/o Caucus was, in fact, a “very small group . . . that we did not have the support of the majority of the people of ACT UP.”115 Noncaucus members opposed the action out of a credo that “one never went after one’s own.” Because the HAF campaign was voted as an official ACT UP/NY action and not strictly a Latina/o Caucus action, there was the added dimension of a predominantly white gay male organization publicly targeting a Latinx AIDS service organization. While there was initial opposition to the Puerto Rico campaign—in which Latinx ACT UPers targeted other Latinx people, albeit people in positions of power—those actions primarily took place thousands of miles away. The campaign against HAF threatened ACT UP/NY’s relationship with the bourgeoning AIDS service network. As AIDS activism became institutionalized through the nonprofit model, activists may have deemed it necessary to maintain legitimacy and insider status. Rod Sorge of the Needle Exchange Committee sent a letter to Yolanda Serrano lamenting the caucus’ treatment of her: “I know that other members of ACT UP are equally upset about what happened. . . . Although I’m sure your relationship with ACT UP will now be very different from the way it was in the past, I hope you and I can continue working together.”116 Although the Latina/o Caucus survived this volatile time, the HAF campaign marked the Latina/o Caucus as “unpopular” and its members as “troublemakers” within ACT UP/NY.
Eventually the Latina/o Caucus splintered, with some members venturing to other ACT UP/NY committees and still others joining nonprofit AIDS service organizations. Others experienced the burnout of conducting AIDS activism in the face of persistent rates of infection. Prominent members of the caucus had begun to pass away, including Joe Franco, Luis Salazar, and Lydia Awadallah. By the mid-1990s, the Latina/o Caucus and the ACT UP-Ámericas committee were no more.117 According to Latina/o Caucus member Alfredo González, “Members of both groups had grown disenchanted with HIV activism under the aegis of ACT UP/NY, were very sick, or had died of AIDS.”118
Whatever course their lives took—academia, journalism, psychiatry, social work, or treatment advocacy—the pursuit of social justice figured prominently in the lives of the men and women who composed the Latina/o Caucus. Alfredo González and Jairo Pedraza founded Immigrants Fighting AIDS. Gonzalo Aburto and Candido Negrón established HomoVisiones, a highly influential cable television program for the New York City Latinx LGBT community, broadcast from 1994 to 2004. Jesús Aguais founded Aid for AIDS International, the largest HIV medication redistribution program in the world, having served more than twenty thousand clients in close to sixty countries. Core members of the caucus maintained close contact, nurturing a kinship-like system of care and support. Rita Córdova-Padron explains that in addition to direct action and political advocacy, “we were taking care of people, looking after the well-being of our ‘compañeros.’”119 They shared meals together. When one became sick, everyone was by their bedside. In short, they were one another’s safety net. As José Santini fondly recalls, “A way for us to survive the HIV epidemic was being in the caucus.”120
Writing about the decline of ACT UP/NY, Deborah Gould contends that the demise of the larger group can be partly attributed to a changing context made possible by the legal and social openings afforded to LGBT people.121 These real and perceived political, cultural, and social openings for white gay men and lesbians, however, were certainly not available to Latinx AIDS activists who weathered too many battles without the benefit or privilege of whiteness. While the story of ACT UP/NY has become one of triumphalism, the same cannot be said for the story of the Latina/o Caucus. While some of the more egregious forms of US-sanctioned homophobia have been curtailed, colonialism and neoliberalism in Latin America and the Caribbean—along with structural racism and economic disenfranchisement in the United States—have not.
ACT UP/PR outlived the Latina/o Caucus and remained active until 1996. Cofounder Jorge Irizarry recounts that ACT UP/PR proved instrumental in spearheading a coalition of small organizations conducting HIV outreach on the island. Together, this network secured funds from federal HIV programs like the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, providing Puerto Ricans with resources previously unavailable on the island.122 Like the Latina/o Caucus, the ascendancy of the nonprofit model of AIDS activism coupled with burnout marked the end of ACT UP/PR.
In their actions, meetings, and political ephemera, members of the Latina/o Caucus and ACT UP/PR united to address the broader oppressive social conditions that facilitated the dissemination of HIV, proposing strategies that accounted for patterns of colonial and neoliberal domination inasmuch as these contributed to the proliferation of the virus. Activists strove to politically empower and mobilize men, women, and children—variously queer, IV drug users, women, immigrants, and colonized peoples—as the first step toward delivering a message of HIV prevention. Many members had male privilege, some had class privilege, and most were college educated, but they channeled that privilege in the service of collective survival at home and abroad. In Puerto Rico they pursued this effort by building alliances with existing LGBT and AIDS activists and by treating Puerto Ricans as key social actors who possessed considerable agency in determining the future of their lives and nation. In doing so, members of the Latina/o Caucus and ACT UP/PR anchored their decolonial maneuvers within a feminist and queer theoretical and methodological domain. As Frances Negrón-Muntaner, Ramón Grosfoguel, and Chloé S. Georas contend: “A decolonization project in the Caribbean cannot be understood only as a process of self-determination at a formal political level, but must be seen as a process of radical transformation of the old colonial hierarchies, that is, the eradication of the racial, gender, sexual, and class hierarchies built throughout a long colonial history.”123 In their various campaigns, Latinx AIDS activists strove for more than greater access to HIV medicines; they organized for racial, economic, gender, and sexual liberation in the hopes of abolishing the forces that created and reproduced colonial and neoliberal forms of systemic violence.
The activists of ACT UP/NY’s Latina/o Caucus were attuned to how the US AIDS epidemic among Latinx people was inherently tied to the transnational—an awareness born of their oppositional consciousness. While ACT UP/NY primarily focused on a domestic agenda, Latinx AIDS activists both in New York City and San Juan were already framing a transnational critique of AIDS care and treatment. That is, before mainstream AIDS service organizations in the United States truly acknowledged the global dimensions of the AIDS pandemic in the late 1990s, Latinx AIDS activists, given the specificity of their multiple subject positions, were already alerted to how HIV was not merely a virus but a structural condition triggered by racial subjection, colonial dispossession, and extractive capitalism. Exercising their experiential knowledge as racialized/colonial subjects, Latinx AIDS activists transformed the domestic and global fight against AIDS into a queer, feminist, and decolonial endeavor.
These decolonial maneuvers proved resilient. The same direct-action strategies employed by the Latina/o Caucus and ACT UP/PR paved the way for the 1999 island-wide mobilization against the US naval bombing range in Vieques. Through nonviolent civil disobedience, the people of Puerto Rico successfully forced the Navy to withdraw from the island on May 2003.124 And, in 2019, Puerto Ricans mobilized direct-action strategies to expose the failures of the federal and commonwealth governments in relation to Hurricane Maria as well as to demand the ouster of embattled Governor Ricardo Rosselló.
Today we are at a troubling time in the AIDS pandemic. With the advent of life-sustaining protease inhibitors in 1996, a wave of triumphalist sentiment spread throughout the United States. The funding and political energy surrounding AIDS activism in the United States lost momentum even as the epidemic’s global and racial dimensions became increasingly clear. According to the CDC, in 2016 Latino males accounted for 26 percent of the 40,324 new HIV diagnoses in the United States and six dependent areas. Of these, 85 percent were attributed to male-to-male sexual contact.125 This pattern clearly demonstrates that the epidemic is both ongoing and, at present, endangering the lives of Latinx communities. As Horacio Roque Ramírez notes, post-AIDS discourse obscures not only the devastation of AIDS in the present but also “the earlier histories of AIDS, especially those that are barely beginning to find documentation and analysis.”126 It is key to compile the dismembered history of Latinx AIDS activism, to trace the continuities between the past and present so that we can transform the future through a practice of interconnectedness rooted in anticapitalist, decolonial resistance.
Puerto Rico’s colonial status has also come to an impasse. While substance abuse remains relatively high on the island, the few available drug treatment options are caught in the crosshairs of debt-related cuts. Today, as a result of the continued abundance of illicit drugs in Puerto Rico, drug addiction remains as rampant as ever, with an estimated 60,000 IV drug users on an island of 3 million. In 2010 injection-drug use accounted for 8.6 percent of new HIV infections across the United States, but the proportion in Puerto Rico was more than twice as high at 20.4 percent.127 As addiction has deepened on the island, health care, affordable housing, and drug treatment services continue to vanish. Aside from state-administered drug treatment options operating on shoestring budgets, drug treatment options for Puerto Ricans are mainly provided through faith-based programs, which consist of relocating drug users to the continental United States—a more sinister take on the air bridge.128 With the fiscal austerity measures implemented in the wake of the 2015 Puerto Rican debt crisis and the 2017 destruction and displacement spurred by Hurricanes Irma and Maria, access to what little substance abuse and HIV prevention remains has been heavily curtailed.
These unsettling developments confirm the continued importance of a praxis of decolonial queer criticism in propelling us forward to radical social change. By blurring the boundaries of what counts as effective political mobilization, a decolonial queer praxis questions rights-based political mobilizations tethered to the nation-state. Centering those on the margins, a decolonial queer praxis presents us with a reading practice to invalidate the norms through which the lives of the most marginalized and resource poor among us are rendered unintelligible and, thus, unworthy of life. It is an analysis that speaks to what political scientist Cathy J. Cohen calls a “transformative coalitional politics,” one that attends to racial formation, the intersecting nature of lived experiences, and the interlocking nature of systems of oppression.129 Such an analysis, in turn, might yield a hybrid model of AIDS activism—both driven by direct action and oriented to service care, but always intersectional and transnational—in the continued pursuit of mitigating the colonial, political, and economic inequalities that sustain the contemporary racial profile of the AIDS epidemic, both domestically and globally.
I would like to thank all my colleagues for their generous feedback throughout the writing of the article. Thank you to the guest editors of this special issue along with the anonymous readers for their invaluable insights. Special thanks to Julián de Mayo, Moisés Agosto-Rosario, Alfredo González, and Javier Laureano for their archival assistance. To the men and women of the Latina/o Caucus and ACT UP/PR, I express my immense gratitude for sharing with me your experiences and for illuminating all our path toward a more caring and equitable future.
Juan Mendez, “Puerto Rico ACTs UP,” ACT UP Reports, Agosto-Rosario’s private archival collection; Capo, “Clinical Drug Trials for AIDS Patients to Start Here;” Ferre Rangel, “Urgen mayor ayuda de Medicaid contra el SIDA.”
I use queer not as an identity signifier for lesbian, gay, bisexual, or transgender people but to pinpoint a structural location relative to normativity, as expounded by Cathy J. Cohen. Under this formulation, queerness can describe the heterosexual female sex partners of male intravenous-drug users with AIDS. Cohen, “Punks, Bulldaggers, and Welfare Queens.”
Puerto Rico Department of Health, Informe anual de estadísticas vitales, Division of Statistics and Information, San Juan, Puerto Rico, 1989.
Centers for Disease Control, “HIV/AIDS Surveillance Report,” January 1990, 1–22.
Centers for Disease Control, “HIV and AIDS—United States, 1981–2000,” Morbidity and Mortality Weekly Report 50, no. 21 (2001): 430–34; Centers for Disease Control, HIV/AIDS Surveillance Report, January 1991, 1–22.
Centers for Disease Control, “Update: Acquired Immunodeficiency Syndrome—United States, 1981–1990,” Morbidity Mortality Weekly Report 40 (1991): 358, 363, 369; New York City Department of Health, AIDS Surveillance Update, October 25, 1989.
NYC Mayor’s Commission on Hispanic Concerns, Report of the Mayor’s Commission on Hispanic Concerns, December 10, 1986, 129; “Health Chief: Latinos Lax over AIDS,” New York Newsday; “Informe: SIDA es común entre puertorriqueños,” El diario/La prensa.
NYC Department of Health, AIDS Surveillance Update, February 28, 1990.
NYC Department of Health, AIDS Surveillance Update, February 28, 1990.
NYC Department of Health, AIDS Surveillance Update, February 28, 1990; Centers for Disease Control, HIV/AIDS Surveillance Report, Atlanta, February 1990.
Centers for Disease Control, “Update: Acquired Immunodeficiency Syndrome—United States, 1981–1990,” Morbidity Mortality Weekly Report 40 (1991): 358, 363, 369; Lambert, “AIDS Travels New York-Puerto Rico ‘Air Bridge.’”
Negrón-Muntaner, “Surviving Cultures,” 123; “(ES)tatus” wall text, (ES)tatus: Reclaiming the Legacy of the Latina/o Caucus of ACT UP NY, Brooklyn Community Pride Center, NY.
Fernando Mariscal, “Thirty Years of ACT UP: Hidden Histories and Voices, Lessons Learned,” conference, LGBT Community Center, New York, June 18, 2017.
Members of the Caucus disavowed the term Hispanic for its colonialist underpinnings. Throughout this article, I use Latina/o when speaking of the Latina/o Caucus, and otherwise I employ Latinx.
Candido Negrón (member of the Latina/o Caucus), interview with author, June 2020.
Jesús Aguais (member of the Latina/o Caucus), interview with author, July 2020.
Rita Córdova-Padron (member of the Latina/o Caucus), interview with author, June 2020.
Gonzalo Aburto (member of the Latina/o Caucus), interview with author, June 2020.
Gilbert Martinez (member of the Latina/o Caucus), interview with author, June 2020.
National AIDS Program Office, Compilation of Public Health Service Activities in Puerto Rico, US Department of Health and Human Services, Washington, DC, 1990.
“ACT UP Income Statement,” ACT UP/NY Minutes, December 1990, box 5, folder 5, AIDS Coalition to Unleash Power records (hereafter, ACT UP Records), Manuscripts and Archives Division, New York Public Library.
Luis Santiago, “Thirty Years of ACT UP: Hidden Histories and Voices, Lessons Learned,” conference, LGBT Community Center, New York, June 18, 2017.
Mendez, “Puerto Rico ACTs UP.”
“Declaración de ACT UP/San Juan,” 1990–91, box 184, folder 17, Gay Men’s Health Crisis records (hereafter, GMHC Records), Manuscripts and Archives Division, The New York Public Library.
“Silencio = Muerte.” 1990–91, box 184, folder 17, GMHC Records.
Judith Solomon, “Puerto Rico’s Medicaid Program Needs an Ongoing Commitment of Federal Funds,” Center on Budget and Policy Priorities, April 22, 2019.
“REAL State of the Union,” 1990–91, box 184, folder 17, GMHC Records.
Joey Pons (member of the Latina/o Caucus), interview with author, June 2020; Rangel, “Urgen mayor ayuda de Medicaid contra el SIDA,” El nuevo día.
US General Accounting Office, Pharmaceutical Industry: Tax Benefits of Operating in Puerto Rico, Washington, DC, 1992.
As quoted in Carmen Millán Pabón, “Botiquín abierto al mundo,” El nuevo día, March 8, 1992.
As quoted in “Hecho en Puerto Rico,” El nuevo día, March 8, 1992.
Centro de Datos Censales de Puerto Rico, “Tabulaciones censales, Puerto Rico 1980,” Universidad de Puerto Rico, 1980, 3.
Senado de Puerto Rico, “Estadísticas sobre aspectos demográficos, la economía, el sistema de salud y la utilización y los gastos de hospitales generals en Puerto Rico,” 1985, 22; US Bureau of Labor Statistics, “Data, Tables, and Calculators by Subject: Puerto Rico Unemployment Statistics.” https://data.bls.gov/timeseries/LASST720000000000004?amp%253bdata_tool=XGtable&output_view=data&include_graphs=true (accessed July 20, 2020).
US General Accounting Office, Pharmaceutical Industry: Tax Benefits of Operating in Puerto Rico, Washington, DC, 1992.
“El manifiesto de Puerto Rico de ACT UP,” 1990, box 30, folder 2, ACT UP Records.
“REAL State of the Union,” 1990–91, box 184, folder 17, GMHC Records.
“For inclusion in Puerto Rican Actions report to ACT UP, Aug. 8, 1990,” 1990–91, box 184, folder 17, GMHC Records.
Moisés Agosto-Rosario (member of the Latina/o Caucus of ACT UP/NY), interview with author, July 2019.
Fernando Sosa (member of ACT UP/PR), interview with author, June 2020.
Luis Santiago (member of the Latina/o Caucus), interview with author, June 2020.
“Tácticas de ACT UP,” 1990–91, box 184, folder 17, GMHC Records.
“Tácticas de ACT UP.”
“REAL State of the Union,” 1990–91, box 184, folder 17, GMHC Records.
Luis Santiago (member of the Latina/o Caucus), interview with author, June 2020.
“We had a variety of chants,” 1990–91, box 184, folder 17, GMHC records.
Mendez, “Puerto Rico ACTs UP.”
Rex Wockner and Janis Astor, “ACT UP Hands out Condoms at Mass in Puerto Rico,” Outweek, September 12, 1990, 12–13.
Joshua Mohenban, “ACT UP de Puerto Rico Manifesto,” ACT UP Reports.
Carlos Cordero (member of the Latina/o Caucus), interview with author, July 2020; Fernando Sosa (member of ACT UP/PR), interview with author, June 2020.
Joey Pons (member of the Latina/o Caucus), interview with author, May 2020; Joey Pons, “Making History in Puerto Rico,” PWA Coalition Newsline 59, October 1990, 9.
“Letter to Gabriel Rotello,” September 10, 1990, 1990–95, box 30, folder 1, ACT UP Records.
“Letter from Boris to Carlos,” 1990, 1990–91, box 184, folder 17, ACT UP Records.
“Hurricane AIDS” wall text, (ES)tatus: Reclaiming the Legacy of the Latina/o Caucus of ACT UP NY, Brooklyn Community Pride Center, NY.
“Letter from Christina Hayworth to the Latina/o Caucus of ACT UP/NY,” 1990–93, box 16, folder 3, ACT UP/LA records, ONE National Archives, University of Southern California; Laureano, San Juan Gay, 197–200.
NYC Department of Health, AIDS Surveillance Report of January 12, 1990.
“The Naked Truth about the Hispanic AIDS Forum,” 1988–92, box 194, folder 11, ACT UP Records.
Candido Negrón (member of the Latina/o Caucus), interview with author, June 2020; Alfredo González (member of the Latina/o Caucus), interview with author, June 2020.
“To the Members of the Latino/Latina Caucus of ACT UP,” 1991, box 30, folder 8, ACT UP Records.
Moisés Agosto-Rosario (member of the Latina/o Caucus), interview with author, July 2019.
“ACT UP/NY Feb. 25, 1991 Meeting Minutes,” February 1991, box 5, folder 5, ACT UP Records.
“ACT UP/NY Feb. 25, 1991 Meeting Minutes.”
“HAF Demo Chants,” 1990, box 30, folder 2, ACT UP Records.
César Carrasco (member of the Latina/o Caucus), interview with author, June 2020.
Gonzalo Aburto (member of the Latina/o Caucus), interview with author, June 2020; Alfredo González (member of the Latina/o Caucus), interview with author, June 2020; Fernando Mariscal (member of the Latina/o Caucus), interview with author, June 2020.
Rita Córdova-Padron (member of the Latina/o Caucus), interview with author, June 2020.
José Santini (member of the Latina/o Caucus), interview with author, June 2020.
Jorge Irizarry (member of ACT UP/PR), interview with author, June 2020.
Centers for Disease Control, “HIV and Hispanics/Latinos,” last updated November 1, 2018. www.cdc.gov/hiv/group/racialethnic/hispaniclatinos/index.html.
Centers for Disease Control, “Geographic Differences in HIV Infection among Hispanics or Latinos—Forty-Six States and Puerto Rico, 2010,” Morbidity Mortality Weekly Report 61, no. 40 (2012): 805–10; Hansen, “Faith-Based Treatment for Addiction.”