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‘Fiscal cliff’ brings fears of devastating AIDS cuts

More than 12,000 HIV patients could lose access to care next year

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Carl Schmid, deputy executive director of the AIDS Institut

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.

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National

Madonna roundup: Reviews, sales, and love for ‘Danceteria’

Pop legend’s new album ‘Confessions II’ earning raves

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Madonna isn’t just back, she’s ubiquitous. 

From a Times Square takeover to Graham Norton’s couch, the pop legend is busy promoting her new album, “Confessions II,” a sequel to 2005’s “Confessions on a Dance Floor,” that is earning rave reviews.

“Madonna’s back in peak form with a fresh and honest dance record that’s not only her best in 20 years, but a genuinely vital addition to her canon,” says Pitchfork.

“Facing grief and loss has made Madonna’s music deeper than it’s been in 20 years, but also more alive,” the Guardian proclaims.

“If everyone in the club is a work of art, as ‘Danceteria’ says, then to live loudly is to make an indelible mark,” according to Vulture.

The album features upbeat dance productions along with some melancholic views on death and loss. On the song “Betrayal,” she reflects on the recent death of her stepmother Joan, singing, “You’ll never take my mother’s place … you betrayed me, you enslaved me.”

On “L.E.S. Girl,” she revisits her early days living on the Lower East Side and struggling to pay the rent. “Bizarre” seems to reference her failed 1980s marriage to actor Sean Penn. “Test” is a duet with daughter Lola Leon, in which she sings, “I wish I knew / The pain I’ve caused / My butterfly / Was always being watched.”

But the emotional high point of the album comes on “Fragile,” which she wrote about the death of her brother Christopher. The two were close early in Madonna’s career and he designed sets for early tours, including “Blonde Ambition.” But they had a falling out after her marriage to Guy Ritchie and he wrote a scathing tell-all book about his sister that led to years of estrangement. The two reconciled after Christopher’s cancer diagnosis and shortly before he died in 2024 at age 63. She sings, “Late last night I was fast asleep/You came to me in a dream/You said, ‘Don’t forget about me/Don’t forget to be happy.’”

Death emerges again but in a much more upbeat context in “Danceteria,” an ode to the iconic New York nightclub that has emerged as a gay favorite single and seems destined to be the song of the summer in queer nightlife. She recounts her pre-fame days trying to convince a DJ to play her first single “Everybody” at the club and name checks Jean-Michel Basquiat, Keith Haring, best friend Debi Mazar, and DJ Mark Kamins on the track. 

Streaming numbers and sales are strong for the new album with projected first week sales of 100,000 ensuring a No.1 debut in the U.S. 

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U.S. Federal Courts

Three overlooked court rulings limited White House anti-trans policies

Supreme Court narrowed trans rights, advocates saw victories in other decisions

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(Bigstock photo)

While the U.S. Supreme Court’s decision in West Virginia v. B.P.J. continues to dominate headlines about transgender rights, three recent federal court cases produced significant rulings that limited or temporarily blocked Trump-Vance administration policies attacking trans Americans.

Talbott v. USA

Trump issued Executive Order 14183, “Prioritizing Military Excellence and Readiness,” on Jan. 27, 2025, banning trans people from serving in the military. The following day, GLAD Law and the National Center for LGBTQ Rights filed a federal lawsuit in the U.S. District Court for the District of Columbia challenging the ban on behalf of six active-duty service members and two individuals seeking to enlist. The organizations argue the policy violates the Fifth Amendment’s guarantee of equal protection under the law.

The plaintiffs sought a nationwide preliminary injunction — a temporary block on enforcement of the executive order while the litigation continued. The district court granted that injunction and later rejected the Trump-Vance administration’s request to dissolve it, temporarily protecting trans service members from being discharged solely because of their gender identity.

That protection, however, was short-lived. In Shilling v. Trump, the Supreme Court stayed the lower court’s injunction, allowing the military to begin enforcing the trans service ban while litigation continued. The U.S. Air Force subsequently required trans service members facing involuntary separation proceedings to appear in uniforms and grooming standards corresponding to their sex assigned at birth and, in some cases, used their deadnames during those proceedings.

Despite that setback, the plaintiffs secured two significant legal victories during Pride month.

On June 1, a federal appeals court blocked the discharge of the trans service members involved in Talbott. Then, on June 30, a federal district court certified the case as a class action on behalf of all currently serving trans service members. That means future rulings in the case will apply not only to the original six plaintiffs but to all active-duty trans military personnel covered by the class.

The case remains ongoing, but class certification significantly strengthens the ability to protect trans service members as the litigation continues. Currently, there are 28 plaintiffs in total, including the two still attempting to enlist.

Z.A. v. Blanche

In Z.A. v. Blanche (formerly Z.A. v. Lucile Salter Packard Children’s Hospital at Stanford), the U.S. District Court for the Northern District of California issued an emergency order one day before a federal grand jury subpoena was set to be enforced on July 2. The order blocked the Department of Justice from obtaining confidential medical records belonging to California families whose children receive gender-affirming care.

The ruling relied in part on protections established under the Health Insurance Portability and Accountability Act (HIPAA), the 1996 federal law governing the privacy and security of medical records.

The decision represented a significant check on the administration’s efforts to obtain sensitive patient information, protecting the privacy of trans patients and their families while the legal challenge proceeds.

Doe v. Blanche

Doe v. Blanche, which remains ongoing, challenges Trump’s executive order, Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government. Under policies implementing that order, many trans women in federal custody would be housed in men’s prisons.

A federal district court in D.C. granted a preliminary injunction blocking enforcement of a Bureau of Prisons policy that would require incarcerated trans women to be housed in men’s facilities regardless of individualized safety assessments or the risk of sexual assault.

The Bureau of Prisons policy also conflicts with the goals of the Prison Rape Elimination Act (PREA), enacted by Congress in 2003 to address sexual abuse in correctional facilities through standards, research, funding, and prevention measures. Federal data has consistently shown that trans people in custody experience sexual assault at dramatically higher rates than the general prison population.

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Commentary

When a church fears the rainbow

Puerto Rico pastor objected to Pride symbols outside congregation

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(Washington Blade photo by Michael Key)

There are moments when an incident stops being merely a local story and begins to reveal something much deeper. What happened on June 28 outside One Church, in Comerío, Puerto Rico, belongs in that category.

I do not know who painted the rainbow colors on the asphalt and on a roadside guardrail. I do not know what motivated them, and it is not my place to justify their actions. If someone believes a law was broken, there are authorities and legal mechanisms to address that. That is not the point of this reflection.

The point is the words that followed.

Hours after those colors appeared, Pastor Jorge J. Santiago Reyes went live on social media. He said he felt threatened. He described what happened as a physical attack against his church. He appeared angry and disappointed. He called those who painted the rainbow “cowards” and “charlatans.” He expressed frustration with the support that, according to him, the municipal government of Comerío has shown toward the LGBTQ community, and with those who support posts related to that community. He repeated several times that the people responsible had “crossed the line.” He ended his message by saying, “These charlatans have to be stopped.”

As I listened to his words, I stopped thinking about the paint.

I began thinking about fear.

There is one phrase the pastor repeated again and again: “They crossed the line.” Yet he never explained what that line was. If he was referring to a possible violation of the law, that is for the authorities to determine. If he meant respect for property, there are also procedures to deal with that. But when that line remains undefined and the message begins to associate a rainbow with a threat, the question changes. It is no longer only about a guardrail or a road. It becomes a question about what boundary, in the pastor’s view, was actually crossed.

Paint can be erased.

A brush can cover the asphalt and return a guardrail to its original color.

What does not disappear so easily is the meaning of those colors.

And perhaps that is where the real conflict begins.

It is significant that this happened precisely on June 28, the day when the LGBTQ community remembers a history marked by exclusion, violence, and the struggle for dignity. What represents memory, hope, and the possibility of living without hiding for millions of people was presented by others as a threat.

I do not know why someone painted that rainbow. I do not need to know in order to ask whether those were the words society should expect from a pastor.

A religious leader may feel hurt, frustrated, or angry. What he cannot forget is the responsibility that comes with every public expression. His words do not end when a livestream ends. They move beyond the space of his church, reach people who may never share his faith, and help shape the way others see those who think differently. When a pastor calls other people “charlatans” and “cowards,” says they “have to be stopped,” and turns a rainbow into evidence of an attack, he is no longer speaking only from frustration. He begins to build a discourse that can feed rejection toward a community far larger than the people responsible for that act.

There was another moment in the livestream that caught my attention. The pastor reminded viewers how much he has served Comerío, how much he has accompanied his community, and how much he has worked for it. I have no reason to question that service. I am sure many people can testify to the good he has done.

That is precisely why it was difficult to hear.

Pastoral vocation is not about reminding a town of everything one has done for it when conflict appears. Service does not lose its value when it goes unrecognized; it loses something when it becomes an argument to claim a moral position from which to speak down to others. A person who serves does so because that is the nature of the calling, not because that service grants authority to discredit those who think differently.

As a pastor, that part of the message left me deeply uneasy. Not because I expect ministers of God to be perfect. We are not. But because our words carry weight, we are called to speak with greater responsibility. Some expressions build bridges. Others raise walls. Some words invite encounter. Others end up justifying rejection.

The paint will disappear. A brush will be enough to cover the asphalt and return the guardrail to its original color.

The words will not disappear as easily.

They will remain recorded in a video, shared again and again on social media, and remembered by those who heard them. They will remain long after the last trace of paint has been erased.

When this episode is remembered, it probably will not be because of the rainbow that appeared outside One Church, in Comerío, Puerto Rico.

It will be because of the words a pastor chose to use when speaking about it.

And that difference changes everything.

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