For those LGBTQ people who lived through the worst years of the AIDS epidemic or grew up in its shadow, monkeypox brings a grim sense of deja vu. Once again, an unfamiliar virus is spreading through gay men’s sexual networks, and far too little is being done to stop it. But monkeypox isn’t just a case of history repeating itself. It also shows that, despite remarkable improvements in the prevention and treatment of HIV — the virus that causes AIDS — the vision of health justice that AIDS activists articulated and fought for over the past 40 years remains largely unfulfilled.

Granted, the response to monkeypox shows signs that some doctors, public health officials and political leaders have learned valuable lessons from HIV/AIDS. For example, guidelines on monkeypox from the Centers for Disease and Prevention emphasize “harm reduction,” advising people on how to reduce the risk of transmission during sex. This approach recognizes that abstinence-only messages tend to be ineffective, and harks back to Michael Callen and Richard Berkowitz’s “How to Have Sex in an Epidemic,” which offered gay and bisexual men advice on how to practice a range of sexual activities as safely as possible based on what little information was known about AIDS in 1983.

Public health officials have also shown a genuine desire not to replicate the kind of anti-gay stigma that marred early responses to AIDS. Last week President Biden appointed Demetre Daskalakis, a gay doctor and former assistant health commissioner for HIV prevention in New York City who is well known for offering HIV testing and counseling at the city’s gay sex clubs and bath houses, to be deputy coordinator of the White House Monkeypox Response Team.

Indeed, the U.S. medical system has gotten better at providing care to LGBTQ people, which reflects a greater degree of social acceptance and real political gains in terms of LGBTQ rights and legal protections. That doctors and public health officials have gotten better at talking to and about queer people when it comes to their health is important, and that progress is due in no small part to the work of AIDS activists.

But early AIDS activism was about far more than crafting effective messages about safe sex. AIDS activists also wanted to change health systems to make sure that all people had the care they needed. And monkeypox shows just how much we have failed to deliver on their vision of an equitable health-care system at home and a humanitarian vision of global health abroad.