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The state of HIV in Washington: 29 years later

From fear and despair to promising new treatments and hope

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On April 4, 1983, AIDS entered the public arena of the District of Columbia.

On a Monday evening 29 years ago, Whitman-Walker held the first public forum on AIDS in D.C. At that time, Cabbage Patch dolls were a hit, people were watching M*A*S*H, and AIDS was destroying the gay male community. A panel of public health experts and advocates spoke to a full house at Lisner Auditorium of The George Washington University. The audience of predominantly gay men was driven to the forum after watching friends, lovers and colleagues die quickly and horribly from AIDS. And they were in a state of fear bordering on panic.

The forum that night probably did little to calm that fear. Think about what was happening in 1983. AIDS had only been recently named. The HIV virus had not been discovered yet. There was no test to see if someone was infected and there was no treatment. In fact, people were unsure if you could catch AIDS from a simple kiss. In short, there was almost no good news that night; only fear and despair for the future.

Today, on the eve of the 2012 International AIDS Conference, there is far more good news in the world of HIV/AIDS.

Since that forum in 1983, HIV testing has become standard operating procedure for many Americans, particularly those in groups at high risk for HIV, like gay or bisexual men. Successful treatments are keeping people with HIV healthy and alive for many years. And people are more knowledgeable about condom use and other safer sex practices.

Over the last few years, even more developments have brought new hope and optimism in the fight against HIV/AIDS, including the idea of using HIV medications to prevent HIV transmission, also known as “Treatment as Prevention.”

One of the best ways to reduce new HIV transmissions is by diagnosing people with HIV, getting them into care and on medications. These HIV medications can suppress the amount of virus in the person’s blood to very low levels, which make it much less likely for that person to transmit the virus. In fact, studies have shown successful treatment to reduce the risk of transmission by up to 96 percent. This same strategy is used to prevent the mother’s HIV from transmitting to the baby.

Another way HIV medications are used to reduce transmission is through HIV “post-exposure prophylaxis” or “PEP.” If a person has a needle stick at work or an unsafe sexual encounter they can take HIV medications for a month to prevent infection. This method is at least 80 percent effective if used within 72 hours of the potential exposure.

Recently, studies have shown HIV medications can be taken by individuals at high risk for HIV before they are exposed to the virus to protect them from infection. “Pre-exposure prophylaxis” or “PREP” is still undergoing clinical trials but seems to be very effective for certain populations at high risk for HIV, such as men who have sex with men and serodiscordant couples (where one partner has HIV and the other is HIV-negative).

All of these new “Treatment as Prevention” tools add to weapons in the fight against new HIV transmissions, but none are a magic bullet. Currently, in the District of Columbia, 70 percent of people diagnosed with HIV do not have a suppressed viral load. Why is this number so high? A large number of people in D.C. have HIV and do not know it. Others have been diagnosed with HIV but have not seen a doctor yet (often due to denial, stigma, etc.). And lastly, a good percentage of HIV-positive people on medication do not have a suppressed HIV viral load due to poor adherence to their medication regimen (often due to depression, addiction issues or competing priorities). We are lucky at Whitman-Walker to have comprehensive health care on site, including care teams, mental health practitioners, a pharmacy, and nurses that focus on patients’ barriers to care. Through this team model, 85 percent of our HIV patients on medications have a suppressed viral load.

Now that the health care community has more options in our fight against HIV, we have to figure out a comprehensive way to prevent new HIV transmissions from occurring. But the good news is that we are more knowledgeable about HIV transmission and there are more prevention options with known effectiveness.

So come join us in a Return to Lisner Auditorium on Tuesday, July 24, at 7 p.m. You will hear from leaders in the field that reducing the number of new HIV infections in Washington, D.C. is possible. You will learn about “Treatment as Prevention.” And we will all reflect on how far we have come in the past 29 years.

Dr. Ray Martins is chief medical officer of Whitman-Walker Health.

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Border to border: modern slavery and human trafficking in refugee movements across East Africa

LGBTQ people disproportionately targeted for sexual exploitation

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U.S. Ambassador to South Sudan Michael Adler visits the Gorom Refugee Settlement on Oct. 25, 2023. LGBTQ refugees in the country and elsewhere in East Africa remain susceptible to modern slavery and human trafficking. (Photo courtesy of the U.S. Embassy in South Sudan)

I did not choose to become a refugee. I did not choose to become a victim of trafficking. I only chose to live as myself. Yet in the world I come from, choosing to live as myself was enough to make me a target. As a transgender woman from Uganda, my identity alone placed me in danger. What followed was not just displacement, it was a journey through systems of exploitation that closely resemble modern slavery, hidden in plain sight along the borders and pathways that refugees are forced to travel.

People often imagine modern slavery as something that happens in secret: in locked rooms, in distant brothels, in hidden factories. Human trafficking is portrayed as a dark underworld run by organized criminals. But for many refugees in East Africa, exploitation does not hide in the shadows. It exists in the open, woven into the very routes of survival. It is present at border checkpoints, in refugee camps, in the hands of smugglers, and even in the institutions meant to protect us. It is not always marked by chains or cages. Sometimes it looks like a bus ticket, a border crossing, a promise of safety, or a demand for money that you cannot refuse.

My journey across borders is only one example of how these systems operate. But it is a story shared by many LGBTQI+ refugees whose lives are shaped by violence, silence, and the constant negotiation of safety.

In Uganda, being transgender is not simply misunderstood, it is dangerous. My family, deeply rooted in conservative religious beliefs, saw my identity as a disgrace. I was threatened, rejected, and made to feel that my life had no value. Outside the home, communities policed identity through violence. The legal environment offered no protection. Instead, it reinforced fear. Laws targeting LGBTQI+ people made it impossible to seek help from authorities. Reporting abuse often meant risking arrest. Every day became a calculation of risk: where to walk, who to trust, how to hide. Eventually, the threats became too real to ignore. Leaving was not a choice, it was survival.

My journey out of Uganda began through unofficial routes. Like many refugees fleeing persecution, I could not rely on safe or legal pathways. Instead, I was forced into networks of smugglers and traffickers operating along border regions. From Uganda through border points like Maraba, and later through movements connected to Kakuma Refugee Camp and into South Sudan, each step came with a cost financial, emotional, and physical. At border crossings, money speaks louder than rights. Payments were demanded at checkpoints. There was no transparency, no accountability. You either paid, or you risked being turned back or worse.

For LGBTQI+ refugees, these journeys are even more dangerous. Visibility can mean exposure. Exposure can mean violence. There is constant fear of being outed, harassed, or assaulted not only by traffickers but sometimes by those meant to enforce the law. This is how modern trafficking operates not always through chains, but through systems of dependency, coercion, and fear.

Human trafficking is often imagined as a distant or extreme phenomenon. But for many refugees, especially LGBTQI+ individuals, it exists in subtle and systemic ways. It is in the forced payments demanded at every step of the journey. It is in the exploitation of vulnerability by those offering “help.” It is in the silence of systems that fail to protect. Many LGBTQI+ refugees face extortion by smugglers and intermediaries, threats of violence or exposure, sexual exploitation and abuse, and discrimination by officials and communities. These experiences are rarely documented. Fear prevents reporting. Lack of access prevents justice. What remains is a hidden crisis, one that continues across borders.

Reaching South Sudan did not bring safety. I now live in Gorom Refugee Settlement Camp, where the reality for LGBTQI+ refugees remains harsh and dangerous. Discrimination is part of daily life. Access to food, water, and healthcare is often affected by stigma. Moving freely within the camp can be risky. Violence and threats are constant. As a transgender woman, I am highly visible. This visibility increases my vulnerability. I have faced harassment, intimidation, and threats from both host communities and other refugees. Some blame LGBTQI+ refugees for misfortunes accusing us of bringing curses or problems. These beliefs, rooted in stigma and misinformation, fuel violence and exclusion. Safety, even in a refugee camp, is not guaranteed.

Despite these challenges, I have chosen not to remain silent. In Gorom, I serve as a leader and representative of an LGBTQI+ Refugees and Asylum Seekers Network. Our community includes individuals who are traumatized, isolated, and often unable to advocate for themselves. Many cannot read or write. Some are dealing with serious medical conditions. Others are too afraid to speak. I support them by helping fill out applications and forms, writing emails to organizations, connecting them with protection pathways, and providing peer support and coordination. Through this work, several members of our community have managed to access opportunities for relocation and protection. Some have received case numbers and are progressing through international processes. While I am proud of this work, it comes with a cost. My visibility as a leader makes me a target. The more I help others, the more I am exposed.

The systems I have experienced reflect a form of modern slavery that is not always recognized. It is not defined by ownership, but by control. It is not enforced by chains, but by fear and dependency. When refugees are forced to rely on informal and unsafe systems to survive, exploitation becomes inevitable. International frameworks like the Palermo Protocol recognize trafficking as involving coercion, exploitation, and abuse of vulnerability. By these definitions, what many refugees experience during displacement falls within this reality. Yet, these experiences are rarely acknowledged in policy or response.

My story is one thread in a much larger tapestry of exploitation. Across East Africa, displacement has created informal systems where movement is controlled not by law, but by power, money, and vulnerability. Within these systems, trafficking and modern slavery are not isolated crimes; they are embedded in the everyday experiences of refugees. The blurred line between smuggling and trafficking becomes clear when a voluntary agreement turns into coercion. Payments increase unexpectedly. Conditions worsen. Threats emerge. At this point, smuggling begins to resemble trafficking. People are forced to pay additional fees under threat, detained or abandoned if they cannot pay, and subjected to coercion, intimidation, or violence. The journey becomes one of survival under control, rather than movement by choice.

Checkpoints are one of the most visible forms of exploitation. Across multiple borders, movement is regulated not only by official policies but by informal practices. Travelers are often required to make payments to pass through, regardless of their legal status. These payments are rarely documented. They are negotiated at the moment, often under pressure. Failure to comply can result in detention, forced return, physical intimidation, or exposure to further risks. For those already vulnerable, checkpoints become sites of control and exploitation. This system benefits from a lack of accountability. It thrives in environments where oversight is weak and corruption is normalized.

Modern slavery is not always about physical confinement. It can also take the form of economic exploitation. During transit, individuals may be required to pay escalating fees at each stage of the journey, surrender money or belongings, or depend entirely on intermediaries for movement. In some cases, individuals are left stranded if they cannot meet financial demands. This creates a cycle of dependency: you rely on the network to move, the network controls the cost, and the cost determines your safety. Such systems exploit vulnerability in a way that aligns closely with definitions of modern slavery particularly the abuse of power and the extraction of value through coercion.

Reaching a destination, such as a refugee settlement, does not necessarily end exposure to exploitation. In many camp settings, individuals continue to face restricted access to resources, dependency on aid systems, and informal economies that can be exploitative. Where formal support systems are overstretched or under-resourced, informal structures emerge again. These structures may involve gatekeeping access to services, manipulation of aid distribution, or continued financial or social exploitation. The conditions that enable trafficking do not disappear; they evolve.

Beyond East Africa, modern slavery takes other forms that mirror the same patterns of vulnerability and exploitation. Labor trafficking to the Gulf has become a major issue for migrants from Uganda, Kenya, and Tanzania. 

A beach in Dubai, United Arab Emirates, on Oct. 3, 2024. Labor trafficking to the United Arab Emirates and other Gulf counties has become a major issue for migrants from East Africa. (Washington Blade photo by Michael K. Lavers)

Recruitment agencies promise good jobs, but many migrants end up in forced domestic labour, with confiscated passports, unpaid wages, and conditions amounting to slavery. Some never return home. Organ trafficking has also been documented, with victims from Africa ending up in countries such as Thailand, Malaysia, Russia, and China. Kidneys are the most commonly trafficked organs. Some victims are coerced; others are deceived; some are killed. Women, girls, and LGBTQI+ individuals are disproportionately targeted for sexual exploitation. For refugees, “survival sex” becomes a coping mechanism in the absence of protection and resources. Modern slavery thrives because the global economy rewards cheap labour. Migrants from East Africa are used in construction, domestic work, agriculture, and manufacturing. Their exploitation is hidden behind the products the world consumes.

From a humanist perspective, the existence of such systems raises urgent ethical questions. If all human beings have equal dignity, why are some forced to risk exploitation to survive? If rights are universal, why are they not accessible in practice? Human trafficking and modern slavery in refugee movements are not only criminal issues, they are moral failures. They reflect a gap between principles and reality. They expose the distance between what we claim to value and what we allow to happen.

Addressing these issues requires more than isolated interventions. Safe and legal migration pathways must be expanded. Border accountability must be strengthened. Anti-trafficking measures must be integrated into refugee protection. Refugee-led initiatives must be supported. Those with lived experience are best positioned to identify risks and solutions.

Modern slavery and human trafficking are not always visible in chains or confinement. In many cases, they exist within systems that appear as ordinary border crossings, transit routes, and refugee settlements. Recognizing these systems is the first step toward change. The movement of people across borders should not come at the cost of their dignity, safety, or freedom. Yet, for many, it does. Until safe alternatives exist, and accountability is enforced, these hidden systems of exploitation will continue.

The question is not whether they exist.  

The question is whether we are willing to confront them.

Aby lives in the Gorom Refugee Settlement Camp in South Sudan.

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A surtax would end this war quickly

We fought a king once before and won

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President Donald Trump (Washington Blade photo by Michael Key)

Today nearly 99% of us watch wars on television. We see news reports, and watch bombs exploding and people dying, somewhere else. The only people actually involved are those who volunteered to serve in the military, and the national guard. I am sure most of them didn’t join to fight illegal wars like the one the felon in the White House is waging in Iran. But I respect them, and their willingness to serve our country.

But we are in Iran, and the felon is now asking Congress for $200 billion more for this war. We have been spending over a billion dollars a day. Who is paying for this? Right now, no one. We are simply adding it to the national debt, for our children to worry about. I propose a 5 or 10% surtax on every person, to cover the cost of this illegal war. Just have it added to your tax bill. If Congress passed such a surtax, I am sure we would already be out of Iran, as people would rise up to stop this illegal and unnecessary war very quickly. 

I am old enough to remember the Vietnam War, and what we did to try to end it. It took time, but the people spoke. I did not serve, but unlike the felon in the White House, was willing to. I got my draft notice, along with a subway token, and reported to Whitehall street in NYC. It was as the Arlo Guthrie song, “Alice’s Restaurant,” said it would be. I got there at 7 a.m. and at 3 p.m. was told they wouldn’t take me because of my bad knee, sending me home with my 1Y designation. My friends had given me a going away party the night before, and my mom cried. So, it was a little embarrassing when my friends found I was still home. But my mom was happy and cried again.

I had been to anti-war demonstrations in D.C. in front of the DOJ, and got tear gassed. I demonstrated in London, in Russel Square, in front of the American embassy. While so many more were involved in that war because of the draft, we knew then if a 5% surtax had been levied, it would have ended much faster. Seems we never learn. 

Today there is no draft, and no surtax. It is taking a while for people to recognize the felon who opposes any help for people to pay for their healthcare, easily asks for the $200 billion in funds for a totally unnecessary war. He closed USAID, which showed the United States in a positive light, helping people around the world, and that agency’s budget was only $25 billion.  On top of not asking Americans to pay for this illegal war, he is giving tax breaks to millionaires, billionaires, and corporations, adding more to the national debt. What is the definition of insanity? Today it is clearly having voted for, and still supporting, the felon in the White House. 

To make things worse and give us even less chance to stop his destruction of our democracy, the felon is trying to make it harder to vote. Millions of women who changed their names for marriage will not have a birth certificate with their current name on it, or a passport with their current name, allowing them to vote if the felon has his way. Reality is less than 50% of Americans even have a passport. The fact the Constitution gives states the right to set voting procedures, isn’t deterring the felon and his fascist cohorts, from trying to do it. He is doing it while we are losing American lives, the lives of heroes, who he has fighting a war he would have never signed up to fight himself. He is running it from the gold-leaf painted Oval Office, and from Mar-a-Lago, where he is golfing. He is a racist, sexist, homophobic, POS, working with the war criminal in Israel, causing a renewed spate of antisemitism and Islamophobia, and possibly creating World War III. 

If you care about the future of the United States, you must stand up and speak out. We must defeat every Republican sycophant of his in the midterms — it’s the only way to let the felon know that we will not put up with his shit anymore. His grifting, and that of his family and appointees, must end. We the people, must not let him destroy 250 years of democracy, because he thinks he is a king. We fought a king once before and won. We will defeat him too. We will not let the felon implement the rest of Project 2025 and will take his name off everything he illegally plastered it on. He will be relegated to the trash heap of history, where he belongs, and we will reclaim our democracy for the next 250 years. 


Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.

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SAVE Act could silence millions of trans voters

New administrative barriers pose threat to voting rights

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Activists hold signs opposing the passage of the SAVE Act outside of the U.S. Capitol on March 18. (Washington Blade photo by Michael Key)

In Washington, debates over voting rights usually arrive loudly — through court rulings, protests, or sweeping legislation that captures national attention. 

The Safeguard American Voter Eligibility (SAVE) Act, now under debate in Congress, may reshape voting access in a quieter way — through paperwork. The bill would require Americans registering to vote in federal elections to present documentary proof of citizenship, such as a passport or birth certificate. Supporters argue the measure would strengthen election integrity and restore public confidence in the voting process. But for millions of eligible voters, particularly transgender Americans, the practical consequences could be far more complicated.

According to Gallup, about 1.3% of U.S. adults identify as transgender, representing roughly 3.3 million Americans. Far from disengaged politically, transgender voters participate in elections at high rates. Data released by Advocates for Trans Equality shows 75% of transgender respondents reported voting in the 2020 election, compared with 67% of the general population. Registration rates are also higher. 

This is a community that shows up for democracy. Yet the SAVE Act could place new administrative barriers directly in its path. Birth certificates, the document many supporters believe should verify citizenship are among the most difficult identity records for transgender Americans to update. According to data released by The Williams Institute at UCLA Law School  and the U.S. Transgender Survey, 44% of transgender adults had updated their name on government identification, but only 18% had successfully updated their birth certificates.

That gap matters.

If birth certificates become a central requirement for voter registration, millions of eligible transgender Americans could face bureaucratic obstacles that other voters rarely encounter. 

History offers a warning. According to the Bipartisan Policy Center, Kansas implemented a similar proof-of-citizenship law that blocked more than 30,000 eligible voters from registering before the Kansas Supreme Court struck it down as unconstitutional.

At the same time, evidence suggests voter fraud remains extraordinarily rare. Research cited by the American Immigration Council estimates fraud at roughly 0.0001% of votes cast. 

The question before lawmakers is not whether election security matters. It clearly does. The question is whether policies designed to solve a rare problem could intentionally disenfranchise legitimate voters.

The broader cultural debate surrounding gender identity often becomes emotionally charged, particularly when conversations turn to pronouns or language. Yet polling suggests the issue remains unfamiliar to many Americans. A 2022 YouGov poll found only 22% of Americans personally know someone who uses gender-neutral pronouns.

Meanwhile, the problems weighing on everyday Americans are far larger: rising grocery prices, health care costs, housing shortages, and economic struggles in both rural towns and urban neighborhoods. Yet, many conservatives choose to focus unnecessary time, energy, and resources litigating the use of pronouns.

A healthy democracy should be able to debate cultural questions without allowing them to become barriers to the ballot box.

So, what should transgender Americans, and allies, do in this moment? First, stay engaged politically. Contact legislators and explain how identification requirements affect real voters. Personal stories often reach policymakers in ways statistics alone cannot.

Second, document the impact. Write letters to local newspapers, share experiences publicly, and ensure the real-world effects of voting policies are visible.

Third, consider running for office. Local school boards, city councils, and state legislatures shape many of the rules governing elections. Finally, protest with discipline and purpose. The most transformative movements in history — from Mahatma Gandhi to Dr. Martin Luther King Jr. — were rooted in peaceful persistence and moral clarity.

The SAVE Act may ultimately pass, fail, or change significantly as Congress debates it. But the larger principle at stake should guide the conversation. America’s democracy has always grown stronger when more citizens can participate, not when the path to the ballot becomes harder to navigate. For transgender voters, and for the country as a whole, that principle remains the quiet foundation of the republic.


James Bridgeforth, Ph.D., is a national columnist on the intersection of politics, morality, and civil rights. His work regularly appears in The Chicago Defender and The Black Wall Street Times.

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