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.
Puerto Rico
The ‘X’ returns to court
1st Circuit hears case over legal recognition of nonbinary Puerto Ricans
Eight months ago, I wrote about this issue at a time when it had not yet reached the judicial level it faces today. Back then, the conversation moved through administrative decisions, public debate, and political resistance. It was unresolved, but it had not yet reached this point.
That has now changed.
Lambda Legal appeared before the 1st U.S. Court of Appeals in Boston, urging the court to uphold a lower court ruling that requires the government of Puerto Rico to issue birth certificates that accurately reflect the identities of nonbinary individuals. The appeal follows a district court decision that found the denial of such recognition to be a violation of the U.S. Constitution.
This marks a turning point. The issue is no longer theoretical. A court has already determined that unequal treatment exists.
The argument presented by the plaintiffs is grounded in Puerto Rico’s own legal framework. Identity birth certificates are not static historical records. They are functional documents used in everyday life. They are required to access employment, education, and essential services. Their purpose is practical, not symbolic.
Within that framework, the exclusion of nonbinary individuals does not stem from a legal limitation. Puerto Rico already allows gender marker corrections on birth certificates for transgender individuals under the precedent established in Arroyo Gonzalez v. Rosselló Nevares. In addition, the current Civil Code recognizes the existence of identity documents that reflect a person’s lived identity beyond the original birth record.
The issue lies in how the law is applied.
Recognition is granted within specific categories, while those who do not identify within that binary structure remain excluded. That exclusion is now at the center of this case.
Lambda Legal’s position is straightforward. Requiring individuals to carry documents that do not reflect who they are forces them into misrepresentation in essential aspects of daily life. This creates practical barriers, exposes them to scrutiny, and places them in a constant state of vulnerability.
The plaintiffs, who were born in Puerto Rico, have made clear that access to accurate identification is not symbolic. It is a basic condition for moving through the world without contradiction imposed by the state.
The fact that this case is now being addressed in the federal court system adds another layer of significance. This is not a pending policy discussion or a legislative proposal. It is a constitutional question. The analysis is not about political preference, but about rights and equal protection under the law.
This case does not exist in isolation.
It unfolds within a broader context in which debates over identity and rights have increasingly been shaped by the growing influence of conservative perspectives in public policy, both in the United States and in Puerto Rico. At the local level, this influence has been reflected in legislative discussions where religious arguments have begun to intersect with decisions that should be grounded in constitutional principles. That intersection creates tension around the separation of church and state and has direct consequences for access to rights.
Recognizing this context is not an attack on faith or religious practice. It is an acknowledgment that when certain perspectives move into the realm of public authority, they can shape outcomes that affect specific communities.
From within Puerto Rico, this is not a distant debate. It is a lived reality. It is present in the difficulty of presenting identification that does not match one’s identity, and in the consequences that follow in workplaces, schools, and government spaces.
The progression of this case introduces the possibility of change within the applicable legal framework. Not because it resolves every tension surrounding the issue, but because it establishes a legal examination of a practice that has long operated under exclusion.
Eight months ago, the conversation centered on ongoing developments. Today, there is already a judicial finding that identifies a violation of rights. What remains is whether that finding will be upheld on appeal.
That process does not guarantee an immediate outcome, but it shifts the ground.
The debate is no longer theoretical.
It is now before the courts.
National
LGBTQ community explores arming up during heated political times
Interest in gun ownership has increased since Donald Trump returned to office
By JOHN-JOHN WILLIAMS IV | As the child of a father who hunted, Vera Snively shied away from firearms, influenced by her mother’s aversion to guns.
Now, the 18-year-old Westminster electrician goes to the shooting range at least once a month. She owns a rifle and a shotgun, and plans to get a handgun when she turns 21.
“I want to be able to defend my community, especially being in political spaces and queer spaces,” said Snively, a trans woman. “It’s just having that extra line of safety, having that extra peace of mind would be important to me.”
Snively is among what some say is a growing number of LGBTQ gun owners across the United States. Gun rights organizations and advocates say interest in gun ownership appears to have increased in that community since President Donald Trump returned to the White House last year.
The rest of this article can be read on the Baltimore Banner’s website.
Tennessee
Tenn. lawmakers pass transgender “watch list” bill
State Senate to consider measure on Wednesday
The Tennessee House of Representatives passed a bill last week to create a transgender “watch list” that also pushes detransition medical treatment. The state Senate will consider it on Wednesday.
House Bill 754/State Bill 676 has been deemed “ugly” by LGBTQ advocates and criticized by healthcare information litigators as a major privacy concern.
The bill would require “gender clinics accepting funds from this state to perform gender transition procedures to also perform detransition procedures; requires insurance entities providing coverage of gender transition procedures to also cover detransition procedures; requires certain gender clinics and insurance entities to report information regarding detransition procedures to the department of health.”
It would require that any gender-affirming care-providing clinics share the date, age, and sex of patients; any drugs prescribed (dosage, frequency, duration, and method administered); the state and county; the name, contact information, and medical specialty of the healthcare professional who prescribed the treatment; and any past medical history related to “neurological, behavioral, or mental health conditions.” It would also mandate additional information if surgical intervention is prescribed, including details on which healthcare professional made a referral and when.
HB 0754 would also require the state to produce a “comprehensive annual statistical report,” with all collected data shared with the heads of the legislature and the legislative librarian, and eventually published online for public access.
The bill also reframes detransitioning as a major focus of gender-affirming healthcare — despite studies showing that the number of trans people who detransition is statistically quite low, around 13 percent, and is often the result of external pressures (such as discrimination or family) rather than an issue with their gender identity.
This legislation stands in sharp contrast to federal protections restricting what healthcare information can be shared. In 1996, Congress passed the Health Insurance Portability and Accountability Act, or HIPAA, requiring protections for all “individually identifiable health information,” including medical records, conversations, billing information, and other patient data.
Margaret Riley, professor of law, public health sciences, and public policy at the University of Virginia, has written about similar efforts at the federal level, noting the Trump-Vance administration’s push to subpoena multiple hospitals’ records of gender-affirming care for trans patients despite no claims — or proof — that a crime was committed.
It has “sown fear and concern, both among people whose information is sought and among the doctors and other providers who offer such care. Some health providers have reportedly decided to no longer provide gender-affirming care to minors as a result of the inquiries, even in states where that care is legal.” She wrote in an article on the Conversation, where she goes further, pointing out that the push, mostly from conservative members of the government, are pushing extracting this private information “while giving no inkling of any alleged crimes that may have been committed.”
State Rep. Jeremy Faison (R-Cosby), the bill’s sponsor, said in a press conference two weeks ago that he has met dozens of individuals who sought to transition genders and ultimately detransitioned. In committee, an individual testified in support of the bill, claiming that while insurance paid for gender-affirming care, detransition care was not covered.
“I believe that we as a society are going to look back on this time that really burst out in 2014 and think, ‘Dear God, What were we thinking? This was as dumb as frontal lobotomies,’” Faison said of gender-affirming care. “I think we’re going to look back on society one day and think that.”
Jennifer Levi, GLAD Law’s senior director of Transgender and Queer Rights, shared with PBS last year that legislation like this changes the entire concept of HIPAA rights for trans Americans in ways that are invasive and unnecessary.
“It turns doctor-patient confidentiality into government surveillance,” Levi said, later emphasizing this will cause fewer people to seek out the care that they need. “It’s chilling.”
The Washington Blade reached out to the American Civil Liberties Union of Tennessee, which shared this statement from Executive Director Miriam Nemeth:
“HB 754/SB 676 continues the ugly legacy of Tennessee legislators’ attacks on the lives of transgender Tennesseans. Most Tennesseans, regardless of political views, oppose government databases tracking medical decisions made between patients and their doctors. The same should be true here. The state does not threaten to end the livelihood of doctors and fine them $150,000 for safeguarding the sensitive information of people with diabetes, depression, cancer, or other conditions. Trans people and intersex people deserve the same safety, privacy, and equal treatment under the law as everyone else.”
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Minimal version of ‘Streetcar Named Desire’ heading to Dupont Underground
Comings & Goings
An effort to increase the number of psychiatrists of color
Calendar: April 10-16
Tenn. lawmakers pass transgender “watch list” bill
Vance speaks at Orbán rally in Hungary
LGBTQ groups condemn Trump’s threat to destroy Iranian civilization
Report: Grenell wants Russian ambassadorship
