The death of George Bush on the eve of World AIDS Day was a painful reminder of some of the most lethal days of the epidemic, when people — predominantly gay and bisexual — were struck down by an illness that few in the White House seemed to lose sleep over.

For them, the 41st president was a slow-moving leader whose response to the crisis was hard to separate from his public uneasiness with gay men and lesbians.

“If one was being charitable one could say it was a mixed legacy, but in truth it was a bad legacy of leadership,” said Urvashi Vaid, who led the National Gay and Lesbian Task Force from 1989 to 1992. “He did not lead on AIDS.”

Mr. Bush, who died Friday at 94, took two significant steps to address the epidemic, which had killed roughly 59,000 Americans by the end of 1989: He signed the Americans with Disabilities Act of 1990, which forbade discrimination against people living with the disease, and the Ryan White Care Act, which remains the largest federally funded program for H.I.V./AIDS patients.