30 years ago, in March 1987, the Gay Community appeared to be doomed. 17,000 had become sick from a plague. There wasn’t even much of a treatment for doctors to offer. There wasn’t really any hope.

Then, posters began to be spotted around Lower Manhattan. A small collective of artists had been working on a striking image they hoped would galvanize the Gay Community to action. SILENCE = DEATH started to show up scrawled on walls and sidewalks. Writer/activist Larry Kramer had started a movement. He’d been invited to speak as a last-minute substitute for a lecture series at the Lesbian And Gay Community Center. Kramer:

“If my speech tonight doesn’t scare the shit out of you, we’re in trouble. I sometimes think we have a death wish. I think we must want to die. I have never been able to understand why we have sat back and let ourselves literally be knocked off man by man without fighting back. I have heard of denial, but this is more than denial—it is a death wish. It’s your fault, boys and girls. It’s our fault.”

Within a month, the movement had a name: ACT UP (The AIDS Coalition To Unleash Power).

That was 30 years ago this month. So much has happened since then, all of it starting from that one electric moment. ACT UP revolutionized everything, from the way drugs are researched, to the way doctors interact with patients. ACT UP played a key role in the development of the drugs that have helped people with HIV to live a normal life span. ACT UP also brought a new kind of activism to our media-saturated world, inspiring the Occupy Wall Street  movement 25 years later.

Less than two months into the new administration, Trumpcare brings a new threat to all LGBTQ people. But, those with the most to lose are probably the people living with HIV. The threat of actually losing health insurance because of POTUS’s promise to repeal The Affordable Care Act has millions of Americans terrified.

Before Obamacare, only 15% of people with HIV had private health insurance, and 25% had no coverage at all. The ACA has been saving the lives of US citizens with HIV with its subsidies for private insurance and its expansion of Medicaid in states have increased access to medical treatment. Only half of African-Americans with HIV had access to continuous medical treatment, according to the Centers For Disease Control.

The ACA has also increased funding for organizations that provide prevention services, especially helping to keep the transmission of HIV from doing more harm to the most vulnerable communities: Transgender Women Of Color, and the one in two Black Gay men that the CDC predicts could become HIV-Positive unless action is taken.

SILENCE = DEATH, as the Act Up slogan said, means that we need to do it all one more time. We will need to loudly protest to keep people living with HIV from losing access to their medications.

Uninsured people living with HIV would lose access to the viral-suppression meds which makes HIV nearly impossible to transmit. This means there will be an increase in the transmission of HIV to others. People in prison who are HIV-positive will be released with no access to medication. If Republicans fail to keep the Obamacare provisions that allow people with pre-existing conditions to buy insurance without discrimination, those people will most certainly die.

Remember, in 2015, when creepy Veep Mike Pence was Governor of Indiana, he presided over one of the worst HIV outbreaks in the history of the country. He first turned to prayer before then turning to Obamacare to stop the outbreak. Prayer didn’t work, but coverage through The Affordable Care Act did.

But now, Pence is leading the White Nationalists and the Republican’s effort repeal the ACA. He actually wants to end what he knows works. His homophobia, racism and Christian supremacy is going to kill people living with HIV, with LGBTQ people, minorities and poor people suffering the greatest loses.

The administration is already moving away from providing information on HIV/AIDS and LGBTQ health issues to the public. The White House website page on HIV policy is now blank. A CDC summit to address LGBTQ youth health has been infinitely postponed.

Obamacare remains the most important way for information about HIV to reach people. If it is replaced with Trumpcare, the loss, especially in those states which only have “abstinence only” sex education, will be devastating.

The LGBTQ community, friends, families and supporters are going to have to take a cue from those of us over 50, and relaunch SILENCE = DEATH as a message to the masses, taking a stand on how HIV/AIDS will harm the most vulnerable citizens, and demand protection for the 1.5 million people in the USA already living with HIV. Damn it, I can’t even believe we have to do this again!