National
‘Fiscal cliff’ brings fears of devastating AIDS cuts
More than 12,000 HIV patients could lose access to care next year
AIDS Institute Deputy Executive Director Carl Schmid estimated that up to 12,000 people in ADAP could lose access to care. (Blade file photo by Michael Key)
Pending across-the-board cuts to federal programs have advocates concerned that up to 12,200 people living with HIV/AIDS in the United States could lose access to drugs and programs unless Congress takes action.
The anticipated cuts, set to take effect on Jan. 2, are the result of the Budget Control Act, legislation President Obama signed last year as part of a compromise to raise the limit on the nation’s debt ceiling. It would reduce continued funding for the U.S. government in 2013 and beyond by cutting an estimated 8.2 percent in the first year from discretionary federal programs — including HIV/AIDS programs.
Carl Schmid, deputy executive director of the AIDS Institute, said unless Congress acts to institute an alternative budget, the level of funding provided would be troublesome because “people wouldn’t be able to get their drugs.”
“The sequestration wasn’t ever to occur and within three months from now, it’s going to take place unless Congress acts,” Schmid said. “It would be devastating to our programs.”
Kimberly Crump, policy officer at HIV Medicine Association, said problems are already emerging because care providers aren’t sure what level of funding will ultimately be provided.
“It really hinders them in hiring staff and making decisions around personnel, around controlling costs of labs and accepting new patients, the hours that they can be open,” Crump said. “It’s going to really start to impact availability of services.”
Estimates for what these cuts would mean for people living with HIV/AIDS have varied widely. In a letter dated Sept. 19 to Congress, the AIDS Institute says the reductions to ADAP funding could mean wait lists for drugs would once again be extended and around 9,400 patients would lose access to medication.
“This would automatically create wait lists again, and extremely long ones,” Schmid told the Blade. “But it could be even more than that, we’re doing some further analysis, so some people are saying it’s like 10,000 to 12,000 people removed from the ADAP program if this sequestration goes through.”
The number is an estimate from the Department of Health & Human Services. In a June 29 letter to Congress, Ellen Murray, HHS assistant secretary for financial resources, writes that “approximately 12,150 fewer patients” would receive benefits from the AIDS Drug Assistance Program.
A July 25 report from the Senate Health, Education, Labor & Pensions Committee similarly estimates that 12,219 people in the United States receiving drugs from ADAP would lose access to medicine. The report details how many individuals would lose access for each jurisdiction in the United States. For example, the committee estimates 199 fewer people in D.C. would have access to drugs.
In the letter to Congress, the AIDS Institute spells out the reductions to four federal HIV/AIDS programs that would result from sequestration, which amounts to a total reduction of $538 million based on calculations from fiscal year 2012 levels:
• funding for HIV prevention at the Centers for Disease Control would be cut by $64 million;
• the Ryan White HIV/AIDS Program, which provides care to low income people with the disease, would be cut by $196 million, including $77 million in cuts from the AIDS Drug Assistance Program;
• AIDS research at the National Institutes of Health would be cut by $251 million;
• and the Housing Opportunities for People with AIDS, or HOPWA, program would be cut by $27 million.
One consolation is that funds for Medicare and Medicaid would largely be immune from cuts. Medicare would only be reduced by 2 percent — and those cuts wouldn’t come from programs for patients, but providers. Medicaid, under which 50 percent of people living with HIV/AIDS receive care, won’t see any cuts.
The Washington Blade reported in August 2011 at the time President Obama signed the Budget Control Act that the legislation could impact HIV/AIDS programs, and again reported on the issue when the congressional supercommittee established by the legislation failed to provide an alternative to across the board cuts, but cost estimates for reductions weren’t previously known.
But the cuts wouldn’t only affect domestic programs aimed at providing care to people with HIV, but global programs as well, including the President’s Emergency Plan for AIDS Relief, or PEPFAR, and U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Chris Collins, director of policy for amfAR, said the sequestration — commonly referred to as the “fiscal cliff” — would have a “devastating impact” on programs aimed at confronting HIV/AIDS overseas.
“It would undercut multiple aspects of the global AIDS response from treating people, which we know has a potential for saving lives, but also to preventing infection, as well as programs to help kids who are vulnerable,” Collins said. “Sequestration sets us up for seriously backtracking in response to global AIDS just at the time when we have the ability to really accelerate progress.”
In a brief published Sept. 25, amfAR provides details on the problems that reductions to global AIDS initiatives would cause. As a result of projected decreases to U.S. government bilateral support, HIV/AIDS treatments for 276,500 people wouldn’t be available, potentially leading to 63,000 more AIDS-related deaths and 124,000 more children becoming orphans. The decrease in U.S. contributions to the Global Fund would result in an additional 100,000 people not being treated for HIV/AIDS.
In addition to HIV/AIDS programs, federal initiatives that more generally serve the LGBT community would also face cuts under the sequester. The U.S. Equal Employment Opportunity Commission, which earlier this year interpreted federal law to allow it to protect transgender workers from discrimination, would face cuts as would the Justice Department’s community relations service to fight hate crimes.
Laurie Young, the National Gay & Lesbian Task Force’s director of aging and economic security, said the sequester could have an impact on local LGBT community centers that rely on funds from the federal government.
“Any programs … that are funded out of the Older Americans Act — community health programs, community health centers — any of the programs that receive any kind of federal support could be affected by it,” Young said.
Young said the cuts could also affect U.S. governmental efforts in research, including data collection efforts for LGBT people on health surveys, which the Department of Health & Human Services began to implement last year upon requests from LGBT advocates.
HIV/AIDS advocates expressed dismay that the pending defense cuts under the sequester — which would reduce the Pentagon’s budget by an estimated $54.7 billion in 2013 — have received attention in the media, but other programs haven’t received significant attention.
Crump said big ticket items like defense and Medicare have greater “political clout” behind them, which makes other programs such as HIV/AIDS more vulnerable to cuts.
“It makes the non-defense discretionary budget more vulnerable to cuts when these other big ticket items have their champions talking about fencing off or protecting them,” Crump said. “That means we’re going to have to cut more steeply into these other annually funded programs.”
Government agencies that operate programs for people with HIV/AIDS referred the Washington Blade to the White House Office of Budget & Management, which issued a report on Sept. 14 detailing the extent of cuts to government programs.
“As the administration has made clear, no amount of planning can mitigate the effect of these cuts,” the report states. “Sequestration is a blunt and indiscriminate instrument. It is not the responsible way for our nation to achieve deficit reduction.”
Amid this fear, observers were generally optimistic that Congress would institute an alternative to the Budget Control Act to avoid the cuts to HIV/AIDS and other programs.
A Senate Democratic aide, who spoke on condition of anonymity, said an agreement to avoid the sequester would likely be reached after campaign season has concluded.
“As much as we like to piss on each other’s boots and do nothing, when there’s a gun to our head, we know it’s time to do something,” the aide said.
The aide predicted a proposal similar to previously proposed bipartisan debt reduction plans — those from the Simpson-Bowles Commission, the Domenici-Rivlin Task Force or the “Gang of Six” — would be enacted.
But even if an agreement is reached, concerns persist that Congress could enact a plan that would cut into HIV/AIDS funds even more so than the Budget Control Act — especially because another agreement on the debt ceiling must be reached in February when the limit will likely be reached.
Schmid said an alternative plan that Congress might come up with could reach into currently protected programs of Medicare and Medicaid to pay for budget reduction.
“We still have to come up with these cuts, and so they are looking at different ways,” Schmid said. “But Medicare and Medicaid will be back on the table again, and we are concerned about that as well.”
Young predicted that any plan Congress would enact for deficit reduction would cut funding for government programs, but it remains to be seen where those cuts would fall.
“There’s going to be some pain somewhere because the whole reason that the sequestration was enacted and passed was because of the rampant fears about the outrageous federal deficit,” Young said. “Now I could get on my soap box with you, but the reason that the deficit is the way it is today is because we’ve had 10 or 12 years of tax cuts, and in order to pay our bills we have to have money coming in.”
And Crump said if the election results in wins for Republicans, they may feel emboldened to pass a plan similar to what House Budget Committee Chair and Republican vice presidential nominee Paul Ryan has proposed, which she said would “cut even more deeply” than sequestration.
“There’s a looming series of threats to the whole health care environment that could very much impact the hope that the Affordable Care Act held for improving HIV care and access to care for people with HIV,” Crump said.
National
Top 10 LGBTQ national news stories of 2025
Trump, Supreme Court mount cruel attacks against trans community
President Trump’s anti-LGBTQ agenda dominated national news in 2025, particularly his cruel attacks on trans Americans. Here are our picks for the top 10 LGBTQ news stories the Blade covered in 2025.
10. Trump grants clemency to George Santos
President Donald Trump granted clemency to disgraced former Long Island Rep. George Santos. Santos was sentenced to 87 months in federal prison after pleading guilty to wire fraud and aggravated identity theft and had served just 84 days of his more than seven-year sentence. He lied to both the DOJ and the House Ethics Committee, including about his work and education history, and committed campaign finance fraud.
9. U.S. Olympics bans trans women athletes
The United States Supreme Court decided in 2025 to take up two cases — Little v. Hecox and West Virginia v. B.P.J.— both of which concern the rights of transgender athletes to participate on sports teams. The cases challenge state laws under the Equal Protection Clause of the 14th Amendment, which prevents states from offering separate boys’ and girls’ sports teams based on biological sex determined at birth. Both cases are set to be heard in January 2026. The developments follow a decision by the United States Olympic & Paralympic Committee to change eligibility rules to prohibit transgender women from competing in women’s sporting events on behalf of the United States, following Trump’s Executive Order 14201, “Keeping Men Out of Women’s Sports.”
8. FDA approves new twice-yearly HIV prevention drug
The U.S. Food and Drug Administration on June 18 approved a newly developed HIV/AIDS prevention drug that needs to be taken only twice a year, with one injection every six months. The new drug, lenacapavir, is being sold under the brand name Yeztugo by pharmaceutical company Gilead Sciences. According to trial data, 99.9 percent of participants who received Yeztugo remained HIV negative. This emerging technology comes amid direct cuts to HIV/AIDS research measures by the Trump–Vance administration, particularly targeting international HIV efforts such as PEPFAR.
7. LGBTQ people ‘erased’ from gov’t reports
Politico reported in March that the Trump–Vance administration is slashing the State Department’s annual human rights report, cutting sections related to the rights of women, people with disabilities, the LGBTQ+ community, and more. Members of Congress objected to the removal of the subsection on “Acts of Violence, Criminalization, and Other Abuses Based on Sexual Orientation, Gender Identity or Expression, or Sex Characteristics (SOGIESC)” from the State Department’s Annual Country Reports on Human Rights Practices.
In a Sept. 9 letter to Secretary of State Marco Rubio, U.S. Reps. Robert Garcia (D-Calif.), Julie Johnson (D-Texas), and Sarah McBride (D-Del.) urged the department to restore the information or ensure it is integrated throughout each report, noting that the reports serve as key evidence for asylum seekers, attorneys, judges, and advocates assessing human rights conditions and protection claims worldwide.
6. Trump admin redefines ‘sex’ in all HHS programs
The Trump administration canceled more than $800 million in research into the health of sexual and gender minority groups. More than half of the National Institutes of Health grants scrapped through early May involved studies of cancers and viruses that disproportionately affect LGBTQ people.
The administration is also pushing to end gender-affirming care for transgender youth, according to a new proposal from the Department of Health and Human Services, NPR reported. The administration is considering blocking all Medicaid and Medicare funding for services at hospitals that provide pediatric gender-affirming care. “These rules would be a significant escalation in the Trump administration’s attack on access to transgender health care,” said Katie Keith, director of the Center for Health Policy and Law at Georgetown University.
5. FBI plans to label trans people as ‘violent extremists’
The Human Rights Campaign, Transgender Law Center, Equality Federation, GLAAD, PFLAG, and the Southern Poverty Law Center condemned reports that the FBI, in coordination with the Heritage Foundation, may be working to designate transgender people as “violent extremists.” The concerns followed a report earlier this month by independent journalist Ken Klippenstein, who cited two anonymous national security officials saying the FBI is considering treating transgender subjects as a subset of a new threat category.
That classification—originally created under the Biden administration as “Anti-Authority and Anti-Government Violent Extremists” (AGAAVE) — was first applied to Jan. 6 rioters and other right-wing extremists. Advocates said the proposal appears to stem from the false claim that the assassination of Charlie Kirk was committed by a transgender person.
4. Pentagon targets LGBTQ service members
Acting in agreement with the growing anti-LGBTQ sentiment from the Trump administration, during a televised speech to U.S. military leaders at Marine Corps Base Quantico in late September, Defense Secretary Pete Hegseth denounced past military leadership for being too “woke,” citing DEI initiatives and LGBTQ inclusion within the Department of Defense. During the 45-minute address, Hegseth criticized inclusive policies and announced forthcoming directives, saying they would ensure combat requirements “return to the highest male standard only.”
Since 2016, a Navy replenishment oiler had borne the name of gay rights icon Harvey Milk, who served in the Navy during the Korean War and was separated from service under other than honorable conditions due to his sexuality before later becoming one of the first openly LGBTQ candidates elected to public office. In June 2025, the ship was renamed USNS Oscar V. Peterson.
The U.S. Air Force also announced that transgender service members who have served between 15 and 18 years would be denied early retirement and instead separated from the military without benefits. Transgender troops will be given the option of accepting a lump-sum payout offered to junior service members or being removed from service.
In February, the Pentagon said it would draft and submit procedures to identify transgender service members and begin discharging them from the military within 30 days.
3. Trump blames Democrats, trans people for gov’t shutdown
Republicans failed to reach an agreement with Democrats and blamed them for the government shutdown, while Democrats pointed to Republicans for cutting health care tax credits, a move they said would result in millions of people paying significantly higher monthly insurance premiums next year. In the White House press briefing room, a video of Democrats discussing past government shutdowns played on a loop as the president continued to blame the Democratic Party and “woke” issues, including transgender people.
“A lot of good can come from shutdowns. We can get rid of a lot of things. They’d be Democrat things,” Trump said the night before the shutdown. “They want open borders. Men playing in women’s sports. They want transgender for everybody.”
2. Supreme Court joins attacks on LGBTQ Americans
The U.S. Supreme Court issued multiple rulings this year affecting LGBTQ people. In Mahmoud v. Taylor (6–3), it ruled that public schools must give parents advance notice and the option to opt children out of lessons on gender or sexuality that conflict with their religious beliefs. The case arose after Montgomery County, Md., schools added LGBTQ-inclusive storybooks to the elementary curriculum.
In June, the court upheld Tennessee’s ban on gender-affirming care for transgender minors, protecting similar laws in more than 20 states. Lawmakers and advocates criticized the ruling, and a coalition of seven medical associations warned it strips families of the right to direct their own health care.
The Court also allowed the Trump administration to enforce a ban on transgender military personnel and to implement a policy blocking passports with “X” gender markers, with the federal government recognizing only male and female designations.
1. Trump inaugurated for second time
President Donald Trump became the 47th president after winning Wisconsin, securing 277 of the 270 electoral votes needed. His guidebook, Project 2025, outlined the Republican Party’s goals under his new leadership, with a particular focus on opposing transgender rights.
Trump nominated openly gay hedge fund executive Scott Bessent as U.S. Treasury Secretary, a role he eventually assumed. Bessent became the highest-ranking openly gay U.S. government official in American history.
Honorable mention: The war on rainbow crosswalks escalates around the country
Florida Gov. Ron DeSantis (R) ordered state transportation officials to remove a rainbow-colored crosswalk in Orlando next to the Pulse gay nightclub, where 49 mostly LGBTQ people were killed in a 2016 mass shooting. The move follows a July 1, 2025, announcement by U.S. Transportation Secretary Sean Duffy that, with support from President Trump, the department adopted a “nationwide roadway safety initiative” that political observers say could be used to require cities and states to remove rainbow street crosswalks.
Federal Government
Holiday week brings setbacks for Trump-Vance trans agenda
Federal courts begin to deliver end-of-year responses to lawsuits involving federal transgender healthcare policy.
While many Americans took the week of Christmas to rest and relax, LGBTQ politics in the U.S. continued to shift. This week’s short recap of federal updates highlights two major blows to the Trump-Vance administration’s efforts to restrict gender-affirming care for minors.
19 states sue RFK Jr. to end gender-affirming care ban
New York Attorney General Letitia James announced on Tuesday that the NYAG’s office, along with 18 other states (and the District of Columbia), filed a lawsuit to stop U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. from restricting gender-affirming care for minors.
In the press release, Attorney General James stressed that the push by the Trump-Vance administration’s crusade against the transgender community — specifically transgender youth — is a “clear overreach by the federal government” and relies on conservative and medically unvalidated practices to “punish providers who adhere to well-established, evidence-based care” that support gender-affirming care.
“At the core of this so-called declaration are real people: young people who need care, parents trying to support their children, and doctors who are simply following the best medical evidence available,” said Attorney General James. “Secretary Kennedy cannot unilaterally change medical standards by posting a document online, and no one should lose access to medically necessary health care because their federal government tried to interfere in decisions that belong in doctors’ offices. My office will always stand up for New Yorkers’ health, dignity, and right to make medical decisions free from intimidation.”
The lawsuit is a direct response to HHS’ Dec. 18 announcement that it will pursue regulatory changes that would make gender-affirming health care for transgender children more difficult, if not impossible, to access. It would also restrict federal funding for any hospital that does not comply with the directive. KFF, an independent source for health policy research, polling, and journalism, found that in 2023 federal funding covered nearly 45% of total spending on hospital care in the U.S.
The HHS directive stems directly from President Donald Trump’s Jan. 28 Executive Order, Protecting Children From Chemical and Surgical Mutilation, which formally establishes U.S. opposition to gender-affirming care and pledges to end federal funding for such treatments.
The American Medical Association, the nation’s largest and most influential physician organization, has repeatedly opposed measures like the one pushed by President Trump’s administration that restrict access to trans health care.
“The AMA supports public and private health insurance coverage for treatment of gender dysphoria and opposes the denial of health insurance based on sexual orientation or gender identity,” a statement on the AMA’s website reads. “Improving access to gender-affirming care is an important means of improving health outcomes for the transgender population.”
The lawsuit also names Oregon, Washington, California, Colorado, Connecticut, Delaware, the District of Columbia, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Mexico, Pennsylvania, Rhode Island, Vermont, and Wisconsin as having joined New York in the push against restricting gender-affirming care.
At the HHS news conference last Thursday, Jim O’Neill, deputy secretary of the department, asserted, “Men are men. Men can never become women. Women are women. Women can never become men.”
DOJ stopped from gaining health care records of trans youth
U.S. District Judge Cathy Bissoon blocked an attempt by the Department of Justice (DOJ) to gain “personally identifiable information about those minor transgender patients” from the University of Pittsburgh Medical Center (UPMC), saying the DOJ’s efforts “fly in the face of the Supreme Court.”
Journalist Chris Geidner originally reported the news on Dec. 25, highlighting that the Western District of Pennsylvania judge’s decision is a major blow to the Trump-Vance administration’s agenda to curtail transgender rights.
“[T]his Court joins the others in finding that the government’s demand for deeply private and personal patient information carries more than a whiff of ill intent,” Bissoon wrote in her ruling. “This is apparent from its rhetoric.”
Bissoon cited the DOJ’s “incendiary characterization” of trans youth care on the DOJ website as proof, which calls the practice politically motivated rather than medically sound and seeks to “…mutilate children in the service of a warped ideology.” This is despite the fact that a majority of gender-affirming care has nothing to do with surgery.
In United States v. Skrmetti, the Supreme Court ruled along party lines that states — namely Tennessee — have the right to pass legislation that can prohibit certain medical treatments for transgender minors, saying the law is not subject to heightened scrutiny under the Equal Protection Clause of the Fourteenth Amendment because it does not involve suspect categories like race, national origin, alienage, and religion, which would require the government to show the law serves a compelling interest and is narrowly tailored, sending decision-making power back to the states.
“The government cannot pick and choose the aspects of Skrmetti to honor, and which to ignore,” Judge Bissoon added.
The government argued unsuccessfully that the parents of the children whose records would have been made available to the DOJ “lacked standing” because the subpoena was directed at UPMC and that they did not respond in a timely manner. Bissoon rejected the timeliness argument in particular as “disingenuous.”
Bissoon, who was nominated to the bench by then-President Obama, is at least the fourth judge to reject the DOJ’s attempted intrusion into the health care of trans youth according to Geidner.
A Wider Bridge on Friday announced it will shut down at the end of the month.
The group that “mobilizes the LGBTQ community to fight antisemitism and support Israel and its LGBTQ community” in a letter to supporters said financial challenges prompted the decision.
“After 15 years of building bridges between LGBTQ communities in North America and Israel, A Wider Bridge has made the difficult decision to wind down operations as of Dec. 31, 2025,” it reads.
“This decision comes after challenging financial realities despite our best efforts to secure sustainable funding. We deeply appreciate our supporters and partners who made this work possible.”
Arthur Slepian founded A Wider Bridge in 2010.
The organization in 2016 organized a reception at the National LGBTQ Task Force’s Creating Change Conference in Chicago that was to have featured to Israeli activists. More than 200 people who protested against A Wider Bridge forced the event’s cancellation.
A Wider Bridge in 2024 urged the Capital Pride Alliance and other Pride organizers to ensure Jewish people can safely participate in their events in response to an increase in antisemitic attacks after Hamas militants attacked Israel on Oct. 7, 2023.
The Jewish Telegraphic Agency reported authorities in Vermont late last year charged Ethan Felson, who was A Wider Bridge’s then-executive director, with lewd and lascivious conduct after alleged sexual misconduct against a museum employee. Rabbi Denise Eger succeeded Felson as A Wider Bridge’s interim executive director.
A Wider Bridge in June honored U.S. Rep. Debbie Wasserman Schultz (D-Fla.) at its Pride event that took place at the Capital Jewish Museum in D.C. The event took place 15 days after a gunman killed two Israeli Embassy employees — Yaron Lischinsky and Sarah Milgrim — as they were leaving an event at the museum.
“Though we are winding down, this is not a time to back down. We recognize the deep importance of our mission and work amid attacks on Jewish people and LGBTQ people – and LGBTQ Jews at the intersection,” said A Wider Bridge in its letter. “Our board members remain committed to showing up in their individual capacities to represent queer Jews across diverse spaces — and we know our partners and supporters will continue to do the same.”
Editor’s note: Washington Blade International News Editor Michael K. Lavers traveled to Israel and Palestine with A Wider Bridge in 2016.
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