The Politics of LGBT Health 5 The rise of the HIV epidemic in the 1980s brought the connection between health and human rights for LGBT people into stark relief. Throughout the decade, as AIDS decimated LGBT communities and killed thousands of gay and bisexual men, the reaction from the federal govern- ment was silence (Shilts, 1987). Faced with official indifference, a coalition of activists founded the AIDS Coalition to Unleash Power, or ACT UP, in 1987. ACT UP quickly became associated with the Silence = Death Project, which declared, “Silence about the oppression and annihilation of gay people . . . must be broken as a matter of our survival” (Crimp & Rolston, 1990). Throughout the remainder of the 1980s and into the 1990s, ACT UP employed a range of advocacy tactics to shatter that silence. These tactics included both “outsider” and “insider” activism: in addition to direct street action against relevant agencies within the U.S. Department of Health and Human Services (HHS), including the National Institutes of Health, the Food and Drug Administration, and the Centers for Disease Control and Prevention (CDC), some activists developed detailed knowledge of the workings of federal health policy and began to approach the issue of a national response to HIV from the perspective of policy advocacy (Crimp & Rolston, 1990). POLICY PARADIGMS IN LGBT HEALTH In order for social movements to advance via policy advocacy, advocates and policy makers must be able to employ a common language to define the terms and goals of the discussion. Peter Hall describes these shared cognitive frameworks as “policy paradigms.” As he explains, Policymakers customarily work within a framework of ideas and standards that specifies not only the goals of policy and the kinds of instruments that can be used to attain them, but also the very nature of the problems they are meant to be addressing. . . . Policymaking in virtually all fields takes place within the context of a particular set of ideas that recognize some social interests as more legitimate than others and privilege some lines of policy over others. (Hall, 1993) In other words, LGBT health policy advocacy is made possible by specific concepts that both facilitate the description of health issues affecting LGBT populations and provide the vocabulary necessary to engage with policy makers in casting these issues as legitimate objects of government concern. Over the last 30 years, two major policy paradigms have formed the backdrop for LGBT health advocacy. The first, which arose in the 1980s, is characterized by a focus on health disparities. The second, which is related