As the executive directors of LGBTQ+ advocacy orgs in nearby states, we share an unshakeable commitment to the wellbeing of our communities. This commitment drives us and our organizations to advocate for health care affordability and accessibility, whether for gender-affirming health care and HIV treatment, or simple prevention measures and non-discrimination. And, it is why we oppose giving unaccountable advisory boards the power to set prices, and therefore threaten access, to critical, life-saving drugs such as HIV treatment medication. 

The LGBTQ+ community loves acronyms, but there’s one that we wish more people knew about: PDAB. A Prescription Drug Affordability Board is an appointed board that reviews the cost of some prescription drugs and determines if they are affordable. While this sounds good, the reality is that these boards may actually limit access to some important drugs, or even cause new affordability problems for patients. Plus, they have done little to consider patient or community input or demonstrate true accountability to the communities affected by their decisions – like our friends and family members living with HIV. 

Our organizations continue to raise concerns about PDABs and their expansion because of our serious concerns about their potential impact on LGBTQ+ people and people living with HIV and other chronic conditions. In fact, Virginia’s governor recently vetoed a bill that would have created a prescription drug affordability board. In his veto statement, Gov. Youngkin said: “This legislation risks limiting patient access to essential medication by prioritizing costs over medical necessity. Affordability of prescription drugs is a critical issue, but this proposal would instead compromise patient welfare in the Commonwealth of Virginia.”

Maryland’s PDAB was created in 2019 and has yet to bring down costs, even for those in the state health plans. FreeState Justice advocated against expanding the board’s scope to potentially set “upper payment limits” or UPLs for drugs purchased by state and local government health plans. UPLs can easily backfire and decrease access for many patients. We are particularly concerned about the potential unintended consequences of actions by these boards.

Because LGBTQ+ communities are disproportionately affected by HIV, our organizations advocate for the rights, equality, and well-being of people living with HIV. Thanks to significant advancements in science and treatment, HIV is now a manageable chronic illness. But only if we maintain access to the medications that people living with HIV rely on.

Beyond HIV, LGBTQ+ people experience higher needs for health care and steeper barriers to access than other populations. Almost half, or 47 percent, of LGBTQ+ people have a medical condition that requires monitoring or medication. And, LGBTQ+ people are more likely to delay or go without care due to cost issues. That is why PDABs, and in particular, upper payment limits, could exacerbate health disparities for the LGBTQ+ community.

In the handful of states with PDABs, these boards have made decisions that impact patients living with chronic conditions, including HIV– often without considering comments from advocates, patients and providers, or the programs that support patients in accessing and affording these treatments. 

Programs like the AIDS Drug Assistance Program and other supports help make the cost of HIV treatments affordable for patients. These programs were hard-won by advocates, who for years have held fast to the mantra: nothing about us, without us. This principle of HIV advocacy is directly opposite of what PDABs do: empower an appointed board of experts to make decisions about the affordability of HIV medications without any input from people living with HIV. 

In February, the Oregon PDAB heard many stakeholder comments on the importance of preserving access to HIV treatment. Advocates explained how drug assistance programs work and why patients need access to as many treatment options as possible. Despite this strong testimony, the board chose to review an HIV medication, Odesfey, against community recommendations.

Today many communities including people living with HIV are concerned and fearful about the serious impacts of federal funding cuts to health care. State PDABs are a costly tool, and they have not produced the savings they promised. This is a moment to preserve access and stabilize the system, and avoid any changes that could jeopardize the care people need.

There’s so much at stake for our communities when it comes to access to health care. We do need to address the high cost of prescription drugs, but there are better ways to do it that earnestly incorporate community input and take a more comprehensive look at the complex health care system. Our organizations are ready to bring LGBTQ+ people and people living with HIV into the discussion. By bringing patients, healthcare providers, and policymakers to the same table, we can come up with better solutions that truly make medications affordable without sacrificing access. Our north star is clear: a healthcare system that listens to all voices and makes sure everyone gets the care we need to thrive.

Phillip Westry is executive director of FreeState Justice in Maryland and Narissa Rahaman is executive director of Equality Virginia.

It’s an odd dichotomy: President Trump appoints the highest-ranking openly gay government official in history in Treasury Secretary Scott Bessent, yet he launches cruel attacks on transgender Americans. 

Make no mistake: Those attacks are claiming lives. Trans people are killing themselves. I know of one trans person who died by suicide on Election Night, overwhelmed by fear of the incoming administration. Trump’s attacks have driven trans Americans and their families to flee the country and move to Canada, as the Blade has reported. 

None of this is hypothetical or melodramatic. It’s real life and happening everywhere. 

And so when Bessent was confirmed as Treasury Secretary, I wrote an op-ed urging him to educate Trump about the plight of trans Americans and the destructiveness of the attacks on the community. I waited 90 days for some sign that Bessent has a heart or at least a modicum of decency but sadly, I must report that he does not. 

The attacks on the LGBTQ community under Trump keep coming. Last week’s news that the U.S. Department of Health and Human Services is planning to retire the national 988 crisis lifeline for LGBTQ youth on Oct. 1 is just the latest evidence that this administration doesn’t just dislike us — they want us dead.

“Ending the 988 Suicide and Crisis Lifeline’s LGBTQ+ youth specialized services will not just strip away access from millions of LGBTQ+ kids and teens — it will put their lives at risk,” Trevor Project CEO Jaymes Black said in a statement.

The service for LGBTQ youth has received 1.3 million calls, texts, or chats since its debut, with an average of 2,100 contacts per day in February.

Make no mistake: cutting this service will kill young LGBTQ people.

Just a couple of weeks earlier, Trump’s administration announced the Office of Infectious Disease and HIV/AIDS Policy would be gutted. 

“In a matter of just a couple days, we are losing our nation’s ability to prevent HIV,” said HIV+Hepatitis Policy Institute Executive Director Carl Schmid.

And prior to that, Trump issued a series of executive orders targeting the trans community — restricting access to affirming healthcare, banning trans service members from the military, barring trans women and girls from playing sports, eliminating the “X” gender marker on passports, and barring students assigned male at birth from using women’s restrooms.  

Let’s be very clear: When you deny someone the ability to use the bathroom, you deny their humanity.

So back to Scott Bessent, the billionaire hedge fund manager now running our economy into the ground. As many Trump protesters have noted: silence is complicity. And Bessent has been silent on all of these horrific attacks on trans Americans and their basic humanity. He is spineless and a traitor to the LGBTQ community. 

Bessent runs the U.S. Treasury and reportedly has Trump’s ear on all matters related to the economy. He could easily push Trump in a better, more compassionate direction, yet there is no evidence he has done that. 

“The LGBTQ+ community is counting on openly LGBTQ+ nominees like Scott Bessent to step up for the community,” said Human Rights Campaign President Kelley Robinson after the inauguration. Sadly, it’s become clear we cannot count on Bessent. As I wrote in January, Trump likes his queer people gay, white, cis, rich, and obedient. 

Bessent has ignored the Blade’s interview requests. (And after this is published, I have no illusions he will change his mind.) The mainstream media, increasingly cowed by Trump, have failed to ask Bessent even the most basic questions about his views on trans equality and Trump’s attacks. 

As a member of the LGBTQ community, Bessent has a responsibility to at least speak up on behalf of trans people who are suffering. But Republicans today have lost their spines. They genuflect before their Dear Leader, line their own pockets, and leave the rest of us to deal with the consequences. 

The crisis is real. People are dying. Trans people especially are suffering. The rest of us must do what we can to mitigate that suffering and to speak out in defense of our trans friends. 

Kevin Naff is editor of the Washington Blade. Reach him at [email protected].

The Trump administration, by its actions, has already hurt WorldPride. By attacking trans people, they have gotten many nations to suggest to trans citizens they not come to the United States. Canada’s queer group has said it is advising its people not to come. It is sad in so many ways. But despite what the felon in the White House is doing, WorldPride will be a success. It can be a time to not only have fun, but to make a point to the administration and the world. What was the old saying, “We’re here, we’re queer, and we’re not going anywhere, so get used to it.”  The LGBTQ community in the United States has made great strides since Stonewall in 1969, and there is no way we are going back into the closet. 

One way we can make a strong statement is if every member of the Congressional Equality Caucus would come out and join hands with constituents from their state, who are coming to D.C. for WorldPride. Together, they can take a stand for equality. Together, they can make a statement about our country to the world; that the United States values and supports its LGBTQ community. 

This year from May 17-June, we are anticipating huge crowds in Washington, D.C. for WorldPride. Let us together make sure they are all safe and that they have an exciting and fun time while here. But at the same time we should use this gathering to speak out, for our community here, and the LGBTQ community around the world. 

We must show the felon in the White House, and his MAGA acolytes in Congress, and around the nation, all those who would keep us down, we can, and will, stand up for ourselves. We are only willing to move one way, and that is forward toward full equality. Many years ago, during the early fight for recognition of the HIV/AIDS epidemic, there was an event staged by the group ACT UP, called ‘hands around the White House.’ It is time to stage something like that again. 

With all the attacks on the trans community, and as threats to the entire LGBTQ community continue, we need to stand together, and stay strong. We need to join with everyone else who is fighting back against the felon, and his Nazi sympathizing co-president, in the White House. To join in the demonstrations, fight back, and not fall for the distractions meant to take us from our goals. Those goals must include defeating every Republican in elections in 2025, and taking back Congress in 2026. I say every Republican, only because today there is no longer a rational Republican Party. That party has become a MAGA Party, or ‘Cult of Trump.’ That is sad, but it’s true. It is not up to Democrats, or independents, to change the Republican Party; it is up to us to ensure their defeat until they change themselves. 

Until then we must work hard to elect Democrats across the nation. From school board, to county council, from statehouse to Congress. For the LGBTQ community that is the only way we will move forward on equality. It is the only way we can defeat those who want to ban books about our lives, and try to force us back in the closet. We must say a resounding NO to that. 

We must vote for Democrats because history shows us, any other vote, a vote for a third party, helps Republicans win. The reality, like it or not, is today there are only two parties that can win a general election. Yes, in a few rare districts, a third party has won. But this is rare and let’s not take the chance of that happening if there isn’t a history in your state, or district, or community, where it happened in the past. Be smart! While you may not like everything the Democratic Party stands for, it has proven, its members stand for the rights of the LGBTQ community. The incredible progress since Stonewall has been because the Democratic Party has worked with the activists in our midst, to make that progress. Let’s not give up now and move backwards with the MAGA Party. Together, let’s retake our government, and continue to move forward until we have full equality. That must be the goal we join hands for, and pledge to work toward. 

Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.