In 1980, doctors in Africa and large urban areas of the United States began to confront a new and mysterious disease. In sub-Saharan Africa, the disease appeared to be relatively indiscriminate, while in cities such as San Francisco and New York it attacked a disproportionate number of gay men. In the following year, the disease was identified as Acquired Immune Deficiency Syndrome (AIDS), a lethal infection in the immune system. In 1983, researchers isolated human immunodeficiency virus (HIV), which attacks the immune system, constituting the first phase of AIDS. The virus spreads from the initial site through the lymph nodes. Eventually, usually about 10 years later, it moves into its final phase, AIDS. At that point, diseases such as pneumonia, lymphoma, or sarcoma develop. HIV can be contracted in a variety of ways: through semen or female genital secretions, shared use of a hypodermic needle, blood transfusions, or breast milk. Pregnant women can transmit it to their unborn babies. By the year 2001, the international death toll from AIDS had reached 21.8 million, with another 40 million infected with HIV. Although AIDS is now a worldwide pandemic, the most seriously affected area remains sub-Saharan Africa.

One controversial feature of the response to AIDS in America has been the perceived inadequacy of research efforts to fight the disease. As the AIDS historian Randy Shilts aptly summarized the issue, "the federal government viewed AIDS as a budget problem, local public health officials saw it as a political problem, gay leaders considered it a public relations problem, and the news media regarded it as a homosexual problem that wouldn't interest anybody else." Since those early years, research and treatment have benefited the United States and other Western countries, but the condition in Africa and Asia has become increasingly alarming.

In the relatively brief period since its outbreak in the early 1980s, AIDS has resulted in the production of a large body of literature. Most of this work has formed the central theme of contemporary gay literature. As the disease achieves the dimension of a worldwide epidemic, however, a small but increasing proportion of AIDS literature is being written by heterosexuals.

Much of the early AIDS literature was angry, direct, and combative, striving to overcome the hostility, superstition, and fear that greeted the disease. While more recent literature has retained this angry tone, it has been tempered by infusions of comedy and the themes of love, compassion, and remembrance.