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.
U.S. Federal Courts
Judge temporarily blocks executive orders targeting LGBTQ, HIV groups
Lambda Legal filed the lawsuit in federal court
A federal judge on Monday blocked the enforcement of three of President Donald Trump’s executive orders that would have threatened to defund nonprofit organizations providing health care and services for LGBTQ people and those living with HIV.
The preliminary injunction was awarded by Judge Jon Tigar of the U.S. District Court for the Northern District of California in a case, San Francisco AIDS Foundation v. Trump, filed by Lambda Legal and eight other organizations.
Implementation of the executive orders — two aimed at diversity, equity, and inclusion along with one targeting the transgender community — will be halted pending the outcome of the litigation challenging them.
“This is a critical win — not only for the nine organizations we represent, but for LGBTQ communities and people living with HIV across the country,” said Jose Abrigo, Lambda Legal’s HIV Project director and senior counsel on the case.
“The court blocked anti-equity and anti-LGBTQ executive orders that seek to erase transgender people from public life, dismantle DEI efforts, and silence nonprofits delivering life-saving services,” Abrigo said. “Today’s ruling acknowledges the immense harm these policies inflict on these organizations and the people they serve and stops Trump’s orders in their tracks.”
Tigar wrote, in his 52-page decision, “While the Executive requires some degree of freedom to implement its political agenda, it is still bound by the constitution.”
“And even in the context of federal subsidies, it cannot weaponize Congressionally appropriated funds to single out protected communities for disfavored treatment or suppress ideas that it does not like or has deemed dangerous,” he said.
Without the preliminary injunction, the judge wrote, “Plaintiffs face the imminent loss of federal funding critical to their ability to provide lifesaving healthcare and support services to marginalized LGBTQ populations,” a loss that “not only threatens the survival of critical programs but also forces plaintiffs to choose between their constitutional rights and their continued existence.”
The organizations in the lawsuit are located in California (San Francisco AIDS Foundation, Los Angeles LGBT Center, GLBT Historical Society, and San Francisco Community Health Center), Arizona (Prisma Community Care), New York (The NYC LGBT Community Center), Pennsylvania (Bradbury-Sullivan Community Center), Maryland (Baltimore Safe Haven), and Wisconsin (FORGE).
U.S. Supreme Court
Activists rally for Andry Hernández Romero in front of Supreme Court
Gay asylum seeker ‘forcibly deported’ to El Salvador, described as political prisoner
More than 200 people gathered in front of the U.S. Supreme Court on Friday and demanded the Trump-Vance administration return to the U.S. a gay Venezuelan asylum seeker who it “forcibly disappeared” to El Salvador.
Lindsay Toczylowski, president of the Immigrant Defenders Law Center, a Los Angeles-based organization that represents Andry Hernández Romero, is among those who spoke alongside U.S. Rep. Mark Takano (D-Calif.) and Human Rights Campaign Campaigns and Communications Vice President Jonathan Lovitz. Sarah Longwell of the Bulwark, Pod Save America’s Jon Lovett, and Tim Miller are among those who also participated in the rally.
“Andry is a son, a brother. He’s an actor, a makeup artist,” said Toczylowski. “He is a gay man who fled Venezuela because it was not safe for him to live there as his authentic self.”
(Video by Michael K. Lavers)
The White House on Feb. 20 designated Tren de Aragua, a Venezuelan gang, as an “international terrorist organization.”
President Donald Trump on March 15 invoked the Alien Enemies Act of 1798, which the Associated Press notes allows the U.S. to deport “noncitizens without any legal recourse.” The Trump-Vance administration subsequently “forcibly removed” Hernández and hundreds of other Venezuelans to El Salvador.
Toczylowski said she believes Hernández remains at El Salvador’s Terrorism Confinement Center, a maximum-security prison known by the Spanish acronym CECOT. Toczylowski also disputed claims that Hernández is a Tren de Aragua member.
“Andry fled persecution in Venezuela and came to the U.S. to seek protection. He has no criminal history. He is not a member of the Tren de Aragua gang. Yet because of his crown tattoos, we believe at this moment that he sits in a torture prison, a gulag, in El Salvador,” said Toczylowski. “I say we believe because we have not had any proof of life for him since the day he was put on a U.S. government-funded plane and forcibly disappeared to El Salvador.”
“Andry is not alone,” she added.
Takano noted the federal government sent his parents, grandparents, and other Japanese Americans to internment camps during World War II under the Alien Enemies Act. The gay California Democrat also described Hernández as “a political prisoner, denied basic rights under a law that should have stayed in the past.”
“He is not a case number,” said Takano. “He is a person.”
Hernández had been pursuing his asylum case while at the Otay Mesa Detention Center in San Diego.
A hearing had been scheduled to take place on May 30, but an immigration judge the day before dismissed his case. Immigrant Defenders Law Center has said it will appeal the decision to the Board of Immigration Appeals, which the Justice Department oversees.
“We will not stop fighting for Andry, and I know neither will you,” said Toczylowski.
Friday’s rally took place hours after Attorney General Pam Bondi said Kilmar Abrego Garcia, a Maryland man who the Trump-Vance administration wrongfully deported to El Salvador, had returned to the U.S. Abrego will face federal human trafficking charges in Tennessee.
National
A husband’s story: Michael Carroll reflects on life with Edmund White
Iconic author died this week; ‘no sunnier human in the world’
Unlike most gay men of my generation, I’ve only been to Fire Island twice. Even so, the memory of my first visit has never left me. The scenery was lovely, and the boys were sublime — but what stood out wasn’t the beach or the parties. It was a quiet afternoon spent sipping gin and tonics in a mid-century modern cottage tucked away from the sand and sun.
Despite Fire Island’s reputation for hedonism, our meeting was more accident than escapade. Michael Carroll — a Facebook friend I’d chatted with but never met — mentioned that he and his husband, Ed, would be there that weekend, too. We agreed to meet for a drink. On a whim, I checked his profile and froze. Ed was author Edmund White.
I packed a signed copy of Carroll’s “Little Reef” and a dog-eared hardback of “A Boy’s Own Story,” its spine nearly broken from rereads. I was excited to meet both men and talk about writing, even briefly.
Yesterday, I woke to the news that Ed had passed away. Ironically, my first thought was of Michael.
This week, tributes to Edmund White are everywhere — rightly celebrating his towering legacy as a novelist, essayist, and cultural icon. I’ve read all of his books, and I could never do justice to the scope of a career that defined and chronicled queer life for more than half a century. I’ll leave that to better-prepared journalists.
But in those many memorials, I’ve noticed something missing. When Michael Carroll is mentioned, it’s usually just a passing reference: “White’s partner of thirty years, twenty-five years his junior.” And yet, in the brief time I spent with this couple on Fire Island, it was clear to me that Michael was more than a footnote — he was Ed’s anchor, editor, companion, and champion. He was the one who knew his husband best.
They met in 1995 after Michael wrote Ed a fan letter to tell him he was coming to Paris. “He’d lost the great love of his life a year before,” Michael told me. “In one way, I filled a space. Understand, I worshiped this man and still do.”
When I asked whether there was a version of Ed only he knew, Michael answered without hesitation: “No sunnier human in the world, obvious to us and to people who’ve only just or never met him. No dark side. Psychology had helped erase that, I think, or buffed it smooth.”
Despite the age difference and divergent career arcs, their relationship was intellectually and emotionally symbiotic. “He made me want to be elegant and brainy; I didn’t quite reach that, so it led me to a slightly pastel minimalism,” Michael said. “He made me question my received ideas. He set me free to have sex with whoever I wanted. He vouchsafed my moods when they didn’t wobble off axis. Ultimately, I encouraged him to write more minimalistically, keep up the emotional complexity, and sleep with anyone he wanted to — partly because I wanted to do that too.”
Fully open, it was a committed relationship that defied conventional categories. Ed once described it as “probably like an 18th-century marriage in France.” Michael elaborated: “It means marriage with strong emotion — or at least a tolerance for one another — but no sex; sex with others. I think.”
That freedom, though, was always anchored in deep devotion and care — and a mutual understanding that went far beyond art, philosophy, or sex. “He believed in freedom and desire,” Michael said, “and the two’s relationship.”
When I asked what all the essays and articles hadn’t yet captured, Michael paused. “Maybe that his writing was tightly knotted, but that his true personality was vulnerable, and that he had the defense mechanisms of cheer and optimism to conceal that vulnerability. But it was in his eyes.”
The moment that captured who Ed was to him came at the end. “When he was dying, his second-to-last sentence (garbled then repeated) was, ‘Don’t forget to pay Merci,’ the cleaning lady coming the next day. We had had a rough day, and I was popping off like a coach or dad about getting angry at his weakness and pushing through it. He took it almost like a pack mule.”
Edmund White’s work shaped generations — it gave us language for desire, shame, wit, and liberation. But what lingers just as powerfully is the extraordinary life Ed lived with a man who saw him not only as a literary giant but as a real person: sunny, complex, vulnerable, generous.
In the end, Ed’s final words to his husband weren’t about his books or his legacy. They were about care, decency, and love. “You’re good,” he told Michael—a benediction, a farewell, maybe even a thank-you.
And now, as the world celebrates the prolific writer and cultural icon Edmund White, it feels just as important to remember the man and the person who knew him best. Not just the story but the characters who stayed to see it through to the end.
Drag queens protest Trump at the Kennedy Center
Padilla forcibly removed from federal building for questioning DHS secretary
Pride and Progress: Supporting LGBTQ+ Communities in Quitting
Comings & Goings
Indigo Girls coming to Capital One Hall
WorldPride recap: Festival, parade, fireworks, and Doechii
Judge temporarily blocks executive orders targeting LGBTQ, HIV groups
PHOTOS: WorldPride Parade
PHOTOS: WorldPride Street Festival and Closing Concert
