While Clive Barker’s Sacrament received the Lambda Literary Award in 1997, it nonetheless remains overlooked by both scholars and horror enthusiasts. Encompassing themes such as disease, death, gender and sexual identities, the novel represents the ways characters such as Jacob and Rosa (a demon soul split into two humanlike characters) negotiate their Otherness within heteronormative environments. These two characters, however, are not the only ones who feel marginalized. Will Rabjohns, the protagonist of the novel, undergoes ostracization for being gay and suffers loneliness as one of the last to survive among his friends during the AIDS crisis. As a child, Will encounters Jacob/Rosa once and, from there, spends his whole life trying to recreate that moment. Through Will’s investigation of Jacob/Rosa’s mysterious origin, two opposing responses to the existential crisis of the AIDS epidemic emerge. Jacob (whose destructive personality finds pleasure in killing) can be read as embodying Lee Edelman’s theory of the death drive while Rosa (whose lustful drive fuels her desire to procreate) can be read as embodying José Esteban Muñoz’s theory of queer futurity. Will’s journey to understanding Jacob/Rosa ultimately implies that a future for queer individuals during the AIDS epidemic requires envisioning Muñoz’s theory of queer futurity. Through this examination, I therefore argue that novels such as Sacrament should be central to the canon of queer literature, for they wrestle with significant historical challenges to queer identities.