Upwards of 100 HIV/AIDS activists on Monday blocked an intersection near the White House and demanded the Trump-Vance administration fully fund PEPFAR.

Housing Works, Health GAP, Treatment Action Group, AIDS United, ACT UP Philadelphia, and the National Minority AIDS Council organized the protest that took place at the intersection of 16th and I Streets, N.W. The activists then marched to Lafayette Park.

(Washington Blade video by Michael K. Lavers)

(Washington Blade video by Michael K. Lavers)

Activists since the Trump-Vance administration took office in January have demanded full PEPFAR funding.

Secretary of State Marco Rubio Jan. 28 issued a waiver that allowed PEPFAR and other “life-saving humanitarian assistance” programs to continue to operate during the freeze on nearly all U.S. foreign aid spending. HIV/AIDS service providers around the world with whom the Washington Blade has spoken say PEPFAR cuts and the loss of funding from the U.S. Agency for International Development, which officially closed on July 1, has severely impacted their work.

The State Department in September announced PEPFAR will distribute lenacapavir in countries with high prevalence rates. The first doses of the breakthrough HIV prevention drug arrived in Eswatini and Zambia last month.

The New York Times in August reported Office of Management and Budget Director Russell Vought “apportioned” only $2.9 billion of $6 billion that Congress set aside for PEPFAR for fiscal year 2025. (PEPFAR in the coming fiscal year will use funds allocated in fiscal year 2024.)

Bipartisan opposition in the U.S. Senate prompted the Trump-Vance administration in July withdraw a proposal to cut $400 million from PEPFAR’s budget. Vought on Aug. 29 said he would use a “pocket rescission” to cancel $4.9 billion for HIV/AIDS prevention and global health programs and other foreign aid assistance initiatives that Congress had already approved.

“Russell Vought, director of the Office of Management and Budget, has defied the appropriations authority of Congress, slashing the budget for the program despite full funding enacted by lawmakers, stealing $1.6 billion despite the direction of Congress that PEPFAR be fully funded,” notes a press release that detailed Monday’s protest. “As a result, lifesaving treatment and prevention programs have closed across dozens of sub-Saharan African countries, while Vought has refused to release money ringfenced by Congress to save lives.” 

Monday’s protest coincided with World AIDS Day.

The White House has not publicly acknowledged World AIDS Day. A State Department directive the New York Times obtained last week mandated employees and grantees “to refrain from messaging on any commemorative days, including World AIDS Day.”

“Trump thinks by banning commemoration of World AIDS Day, he can hide from the death and destruction that he’s causing around the world,” said Health GAP Executive Director Asia Russell in Lafayette Square. “But we’re here to say, we can see him. We see him stealing medicine, stealing support services, stealing HIV testing, stealing life-saving care from communities all around the world suffering and dying without access.”

The Clinton Health Access Initiative in a report it published last month said more people with HIV or are at risk of contracting the virus because of “HIV treatment and prevention cascades” during the first half of 2025. Specific figures include:

• 3.4 million fewer adults tested for HIV

• 24,000 fewer infants tested for HIV

• A 22 percent decline in new HIV diagnoses due to a reduction in testing among the most vulnerable, highest-risk people

• An 8 percent decline in people living with HIV receiving CD4 tests to diagnose advanced HIV disease

• 2,000 fewer infants and children with HIV started on life-saving medication

• A 37 percent reduction in PrEP initiations for people at risk for HIV

• 26,000 fewer infants and children on antiretroviral medications

• A 5 percent reduction in adults starting antiretroviral medications

• A 10 percent increase in people living with HIV disengaging from treatment

The Clinton Health Access Initiative also said more children around the world will die “due to undiagnosed and un- or under-treated HIV infection” if “these trends persist.”

The Human Rights Campaign Foundation in its 2025 Annual LGBTQ+ Community Survey notes more than 20 percent of adults said “policies the federal government have made accessing HIV prevention and treatment care more difficult in the last year.” The report indicates 30 percent of respondents identify as LGBTQ.

The transgender community has been part of India’s social fabric for centuries, but decades of policy neglect pushed many into poverty and inadequate health care. 

The Supreme Court formally recognized trans people as a third gender in 2014, yet state-level services developed slowly. Telangana opened India’s first dedicated trans clinic, the Mitr Clinic, in 2021 with support from the U.S. Agency for International Development and Johns Hopkins University. Jharkhand State has now ordered all government hospitals and medical colleges to establish dedicated outpatient units for transgender patients.

People for Change, an LGBTQ organization, spent the past year mapping gaps in trans health care across Jharkhand. Its surveys of 100 trans residents in five districts found limited access to gender-affirming care, hormone therapy, dermatology, and mental-health services. The group followed this survey with a May 2025 consultation in Jamshedpur, an industrial town in Jharkhand, that brought together clinicians and community leaders to outline a feasible outpatient model. 

Those findings were presented to Health Minister Irfan Ansari in June, backed by input from allied organizations and more than 50 trans leaders. The process helped inform the state’s decision to introduce dedicated trans outpatient departments in all government hospitals and medical colleges.

People for Change, which played a central role in shaping the policy, noted that government hospitals in Jharkhand still face infrastructure and resource gaps. Even so, the group said the order reflects a clear policy commitment to creating dedicated trans health services.

If Jharkhand’s trans outpatient departments system functions as planned, it could become a regional model for states with comparable gaps in public health access. 

Government data from the 2011 Census — the latest official count to identify an “other” gender category — lists 13,463 trans residents in Jharkhand, alongside sizable populations in neighboring states: 40,827 in Bihar, 30,349 in West Bengal, 22,364 in Odisha, 18,489 in Chhattisgarh, and 137,465 in Uttar Pradesh. Though likely underreported, these figures underscore the scale of need across eastern and central India.

“The decision to start dedicated transgender OPDs (outpatient departments) is not just an administrative step — it is a statement of inclusion, a recognition that the transgender community deserves discrimination-free, dignified, and responsive healthcare. When the government takes such a deliberate step, it sets a tone for systemic change,” said Souvik Saha, founder of People for Change. “It creates an official entry point for transgender healthcare.”

“For the first time, transgender persons will have a recognized and respectful space within the public health system,” added Saha. “That itself is a major shift. It signals to doctors, nurses, and administrators that transgender health is a priority. This leads to sensitization, accountability, and the gradual improvement of attitudes within hospitals.”

Saha told the Washington Blade the policy is likely to trigger broader improvements, noting that once a service is formally notified, budget allocations, training, infrastructure, and staffing typically follow. He said the move could strengthen the system gradually, “step by step.”

“We are realistic: we know improvements won’t happen overnight. But we are also optimistic because the state has already shown genuine leadership and empathy by issuing this order,” said Saha. “And since Jharkhand is celebrating its 25th year of formation, this decision reflects the state’s intention to move towards greater equality and social justice.” 

“For the transgender community, this is not just a service — it is dignity. It is visibility. It is inclusion,” he added. “And with the government, civil society, and community working together, we believe this will lead to meaningful and lasting change in the years ahead.”

Saha told the Blade that the dedicated transgender outpatient will operate within existing government medical colleges and hospitals in Jharkhand and will be staffed by current medical and paramedical teams, with no separate funding required at this stage. He said the policy does not call for separate wards or beds, but for clearly designated outpatient spaces for trans patients. The service, he added, will be run by existing staff who will receive training and orientation as needed.

“At this moment, the specific operational details are still being discussed with the government of Jharkhand. However, what is clear is: the OPD will function as a dedicated space within the hospital, not limited to a specific day,” said Saha. “Transgender individuals will have access to focused, discrimination-free services through this dedicated space. The clinic will run through existing hospital systems, with linkages to psychiatry, dermatology, endocrinology, and other departments when required.”

“This structure allows the government to start services immediately without needing new construction, new staff positions, or separate budget lines,” he added. “It is a practical and efficient first step, making the service accessible while keeping the doors open for: future budget allocations, specialized staffing, expansions into gender-affirming services, and strengthened infrastructure. The government’s intent is very clear: to ensure dignified, equitable, and discrimination-free healthcare for the transgender community. This order is a strong beginning, and operational details will continue to evolve through collaborative discussions between the government, hospitals, and People for Change.”

Saha acknowledged that taboos, misinformation, and stereotypes about the trans community persist in Jharkhand and in many other states. However, Saha said there are encouraging models at which to look. 

He pointed to Kerala and Chhattisgarh, which have introduced sensitization programs and begun integrating trans-inclusive practices into their public health systems. These examples, he noted, show that when health departments invest in training and awareness, attitudes shift and services become more respectful and accessible.

“In Jharkhand, People for Change has proposed a similar approach. We have formally recommended to the government that civil surgeons, chief medical officer, doctors, nurses, and other hospital staff be trained on gender sensitization and transgender health challenges. This includes understanding gender identity, psychological needs, respectful communication, medical protocols, and ways to ensure discrimination-free services,” said Saha. “The encouraging part is that these proposals are already being discussed in detail with the government of Jharkhand. The government has shown strong intent through the issuance of the transgender OPD order, and training health professionals is naturally the next crucial step.”

Saha noted that it remains unclear whether trans people will be recruited into government health roles, saying it is too early to make any definitive statement. He explained that recruitment requires separate processes, policies, and approvals, and the current order does not address new staffing or the creation of government positions.

A recent performance audit by the Comptroller and Auditor General of India, the constitutional authority responsible for auditing government spending and administration, outlined severe human-resource and medicine shortages across Jharkhand’s public health system. 

Tabled in the state assembly in February, the report found that about 61 percent of sanctioned posts for medical officers and specialists were vacant, along with more than half of all staff-nurse positions and roughly four-fifths of paramedic posts. The audit also documented acute shortages of essential drugs in the hospitals it reviewed, with stock gaps ranging from 65 to 95 percent during the 2020-2022 period. The findings highlight the systemic constraints that the new trans outpatients will have to navigate.

Saha acknowledged that drug shortages remain a serious issue in government hospitals and said the concern is valid. Even so, he added that he is approaching the new outpatient policy with hope and confidence.

“The government of Jharkhand has made a historic and intentional decision by opening dedicated transgender OPDs,” said Saha. “When a government takes such a strong step of recognition and inclusion, it also shows the readiness to understand the specific health challenges and medication needs of the transgender community.” 

“As more transgender persons start coming to the OPDs and their health requirements become clearer through proper documentation and reporting, we are confident that the state will make every effort to ensure that essential medicines are available for them,” he added.

Saha said People for Change is also seeking support outside the public system. The organization has begun briefing civic service groups — including Lions Club, Rotary Club and Inner Wheel, international volunteer organizations that run local welfare and health projects — on the outpatient order and the community’s needs. According to Saha, several of these groups have indicated they may help trans patients with medicines and other essentials when prescribed by a doctor.

“So the effort is two-fold: the government is creating an inclusive health system and will be informed of the community’s specific medicinal needs through the OPDs. People for Change and partners are strengthening the safety net to ensure that transgender persons are never left unsupported,” said Saha. “We truly believe that this collaborative approach will ensure that transgender individuals receive the medication and care they deserve — with dignity, consistency, and compassion.”

“Every hospital may take a slightly different amount of time depending on internal readiness, but overall: The foundational work is already underway, Hospitals have started preparing their designated OPD spaces, And coordination is happening at the level of civil surgeons, medical superintendents, and hospital management teams,” he added.

The Comings & Goings column is about sharing the professional successes of our community. We want to recognize those landing new jobs, new clients for their business, joining boards of organizations and other achievements. Please share your successes with us at [email protected]. 

Congratulations to RODRIGO HENG-LEHTINEN on his new role as Trevor Project Senior Vice President of Public Engagement Campaigns. On accepting the position, he said, “My mission has long been to stop LGBTQ, and especially trans, people from being perceived as political footballs and start getting us seen as real people – your friends, your families, your neighbors. Now I get to focus on that 100% at The Trevor Project.”  

Prior to this, he was executive director, Advocates for Trans Equality (A4TE), where he co-led the merger of two national transgender rights organizations, NCTE and TDLEF, to create the new organization. He had served as executive director of the National Center for Transgender Equality, leading that organization through a period of growth, restoring organizational size and stability. He had served as deputy executive director prior to that. Previously he served as vice president of Public Education, Freedom for All Americans, where he led a successful campaign for transgender nondiscrimination protections in New Hampshire.  He oversaw a full range of legislative lobbying, field organizing, and communications strategies and oganized a leadership coalition, established structure, and divided roles for key committees of 17 state and national partner organizations and local activists.   

Heng-Lehtinen conducted English-language interviews with outlets such as The New York Times, CNN, MSNBC, and Politico. He planned a Transgender Leadership Summit for the Transgender Law Center and served as Development & Donor Services Assistant, Liberty Hill Foundation. He earned his bachelor’s degree in Latin American Studies from Brown University.