This ACT UP poster further indicts New York City’s AIDS response under Health Commissioner Dr. Stephen C. Joseph. Created during Gran Fury’s “Blood on Their Hands” campaign that infiltrated the walls, subways, and outdoor public spaces of Lower Manhattan, it reflects a shift in tactics from general institutional critique to personal accountability. The rhetorical questions on the right of the poster reflect the activists’ frustrations with Joseph’s tenure, one marked by delays in implementing needle-exchange programs, hesitancy around condom distribution, and the exclusion of community organizations from policymaking. He was widely criticized for favoring bureaucratic control over the urgent need to address a public health crisis. The poster’s answer below its litany of questions is scathing: New York was a city lacking “inclusive, culturally-sensitive, coordinated, sane leadership” on AIDS. More than a critique of one man, this poster condemned larger institutional failures that activists believed had cost lives. Like many of ACT UP’s other visual works, this poster demanded individual accountability and reckoning, calling out not just policy gaps but also the power structures and values that allowed them to persist. In doing so, it made public health a public fight. While federal messaging warned individuals, ACT UP warned the public about power: who had it, how they used it, and who paid the price when they failed.