Opinions
Drug imports endanger patients like me
Are HIV meds from Canada authentic?

I was diagnosed with HIV just shy of my 30th birthday. That day, everything changed. I was apprehensive about my prognosis, my treatment plan, and my ability to live a normal life.
Fortunately, medical advances have turned HIV from a certain death sentence into a manageable condition. Still, like all Americans who depend on complex medications to stay healthy, I worry about high drug prices, and this concern has only intensified amid the COVID-19 pandemic. Especially since some of the proposed “solutions” to high drug prices would put patients’ health at risk.
Just recently, the Trump administration announced that it would allow states to import prescription medications from Canada with the aim of saving money for consumers. Doing so, though, could expose millions of Americans to counterfeit drugs, while achieving little in the way of savings.
I’ve seen firsthand how importation schemes can put patients at risk.
Shortly after learning I was HIV-positive, I ordered my anti-retroviral drugs from an online Canadian pharmacy. For two months, I received medications via mail without ever wondering where they were sourced or whether they contained the active ingredients I needed to keep me alive.
Then my doctor intervened. She told me that drugs purchased through online storefronts are often adulterated or counterfeit—in fact, the global trade in fake medicines is a $30 billion-a-year business. Unknowingly, I had been rolling the dice with my health.
There are two types of counterfeit drugs. The first contains potentially deadly substances— everything from arsenic to antifreeze. The second contains few, if any, active ingredients. Though pills in the latter category don’t contain actual poisons, they can be deadly. Anti-retroviral drugs have to be taken exactly as prescribed; missing even a few doses can allow the virus to reemerge.
There is no mechanism in place to regulate the quality of drugs imported by American patients. A senior official at Health Canada explicitly told the U.S. surgeon general that her agency “does not assure that products being sold to U.S. citizens are safe, effective, and of high quality.” The FDA, meanwhile, plainly states that it “cannot ensure the safety and effectiveness of drugs that it has not approved.”
Moreover, drugs purportedly from Canada could come from anywhere. A 2017 study by the National Association of Boards of Pharmacy found that three quarters of online pharmacies claiming to sell Canadian drugs actually sourced their products from places like India, Singapore, and Hong Kong, all major suppliers of counterfeits. Back in 2005, the FDA reported that only 15 percent of imported drugs marketed as Canadian actually originated in Canada. The other 85 percent came from “27 countries around the globe,” meaning that many likely didn’t go through rigorous quality control.
It’s relatively easy to get hoodwinked by online pharmacies that promise quality drugs at bargain prices. CanadaDrugs.com, for instance, started out in 2001 as a seemingly reputable online pharmacy. But soon it turned to distributors outside of Canada to secure medicines. In 2018, a U.S. court prosecuted and fined the company for selling fake cancer drugs to American doctors.
Counterfeiters have shown they are willing to prey on people living with all kinds of diseases, including HIV. In 2011, a British regulatory agency discovered that two fake HIV medications had infiltrated the market and were circulating among patients.
Opening the door to drug imports would allow that kind of thing to happen here, putting us all at risk. And it’s not even certain that legalizing importation would cut costs. The FDA acknowledges that it is “unable to estimate the cost savings” from President Trump’s new plan. Former FDA Commissioner Scott Gottlieb wrote that “when importation of foreign drugs is done under a regulated scheme, it really wouldn’t save money.”
Right now, Americans are anxious enough about our health. Let’s not add drug imports to our list of things to worry about.
Brandon M. Macsata has been living with HIV since 2002, and serves as CEO of the ADAP Advocacy Association, an organization that promotes the AIDS Drug Assistance Program and works to improve access to care.
Botswana
The rule of law, not the rule of religion
Bonolo Selelo and Tsholofelo Kumile are challenging the Botswana Marriage Act
Botswana was in a whole frenzy as religious and traditional fundamentalists kept mixing religion and constitutional law as if it were harmless. It is not. One is a private matter of belief between you and God, while the other is the framework that protects and governs us all. When these two systems get fused, the result is rarely justice. It results in discrimination.
The ongoing case brought by Bonolo Selelo and Tsholofelo Kumile challenging provisions of the Botswana Marriage Act has reignited a familiar debate in Botswana. Some commentators insist that marriage equality violates religious values and therefore should not be recognized by law. It is a predictable argument. It is also fundamentally incompatible with constitutional governance.
Botswana is not a Christian state. It is a constitutional democracy governed by the Constitution of Botswana. That distinction matters. In a constitutional democracy, laws are interpreted in accordance with constitutional principles such as equality, dignity, protection, inclusion and the rule of law, rather than the doctrinal beliefs of any particular religion.
Religion has no place in constitutional law and democracy
The central problem with religious arguments in constitutional disputes is simple in that they divide, they other, they contest equality and they are personal. Constitutional law by contrast, must apply equally to everyone.
Botswana’s Constitution guarantees fundamental rights and freedoms under Sections 3 and 15, including protection from discrimination and the right to equal protection of the law. These provisions are not conditional on religious approval. They exist precisely to protect minorities from the preferences or prejudices of the majority.
Legal experts, such as Anneke Meerkotter, in her policy brief in Defense of Constitutional Morality, point out that constitutional rights function as a safeguard against majoritarian morality. If rights depended on whether the majority approved of a minority’s identity or relationships, they would not be rights at all. They would merely be privileges.
This principle has already been affirmed in Botswana’s jurisprudence. In the landmark decision of Letsweletse Motshidiemang v Attorney General, the High Court held that criminalizing consensual same-sex relations violated constitutional protections of liberty, dignity, privacy, and equality. This judgment noted that constitutional interpretation must evolve with society and must be guided by human dignity and equality. The court emphasized that the Constitution protects all citizens, including those whose identities, expressions or relationships may be unpopular. That ruling was later upheld by the Court of Appeal of Botswana in 2021, reinforcing the principle that constitutional rights cannot be restricted on grounds of moral disapproval alone. These decisions were not theological pronouncements. They were legal determinations grounded in constitutional principles.
The danger of religious majoritarianism
When religion is used to justify legal restrictions, the result is what constitutional scholars call “majoritarian moralism.” It allows the dominant religious interpretation in society to dictate the rights of everyone else. That approach is fundamentally incompatible with constitutional democracy. Botswana is religiously diverse. While Christianity is the majority faith, there are also Muslims, Hindus, traditional spiritual communities, Sikh and people who practice no religion at all. If the law were to follow the doctrines of one religious group, which interpretation would it adopt? Christianity alone contains dozens of denominations with different views on love, equality, marriage, sexuality, and gender. The moment the state begins to legislate on the basis of religious doctrine, it implicitly privileges one belief system over others. That undermines both religious freedom and constitutional equality. Ironically, keeping religion separate from constitutional law is what protects religious freedom in the first place.
Judicial independence is the cornerstone of Botswana’s governance system
The current case involving Bonolo Selelo and Tsholofelo Kumile is before the judiciary, where it belongs. Courts exist to interpret the Constitution and determine whether legislation complies with constitutional rights. Political and religious lobbying, as well as public outrage, must not influence that process.
Judicial independence is the cornerstone of Botswana’s governance system. According to the International Commission of Jurists, judicial independence ensures that courts can make decisions based on law and evidence rather than political or social pressure.
When governments, political, religious, or traditional actors attempt to interfere in constitutional litigation, they weaken the rule of law. Botswana has historically prided itself on having one of the most stable constitutional systems in Africa. The judiciary has played a critical role in safeguarding rights and maintaining legal certainty. The decriminalization case demonstrated this. Despite strong public debate and political sensitivity, the courts assessed the law according to constitutional principles rather than moral panic. The same standard must apply in the current marriage equality case.
This article was first published in the Botswana Gazette, Midweek Sun, and Botswana Guardian newspapers and has been edited for the Washington Blade.
Bradley Fortuin is a consultant at the Southern Africa Litigation Center and a social justice activist.
My strawberry muumuu was about the ugliest thing I could have picked for our muumuu-themed movie night.
Really, it’s just an excuse to cross-dress while the sun’s still up; these themed movie nights are concocted by a teammate of mine on the Washington Scandals, D.C.’s LGBT and mens-plus rugby club.
The team is hosting an informational event on Saturday, March 21st, for those interested in testing the waters on inclusive rugby. We have a lot of fun with a lot of balls, and then we head out for a drink at Kiki.
Events like these Rugby “101s” are a blast because the joys of queer camaraderie are on full display – no experience is necessary. If you’re interested in learning more, check out our socials for more info in our bio. Back to the muumuu night, because someone will make a good point that bears repeating.
After settling in with some pizza and homemade cream puffs, I asked my friend and teammate, Theo, on my left, what it’s been like in a rugby club.
“Flooded with love,” he told me, him wearing a thin-striped but soft cotton muumuu. Theo often prioritizes comfort in clothing, always dressed for the weather. Eyes as soft and fuzzy as a warm bunny, he recounted his journey here to LGBT rugby as the life of the party shifted from food to entertainment.
Theo and I both prefer the quiet to the crowd, which is odd, given our shared passion for rugby — famously loud, infamously tough on the body.
The details are irrelevant, here; it’s Theo’s passion that caught my eye. Passion, I thought; it wasn’t particularly familiar to me, especially in sport. Profession, yes, but social pursuits? Passion seemed so foreign to me there.
That’s because it’s nurtured through culture, not inherited as a personality trait. This is a familiar place for much of D.C.’s LGBT culture and community; ‘chosen’ or ‘found’ family is the common phrase, but this is too simplistic, is it not? It makes it sound like you washed ashore and stumbled effortlessly into family. It’s not like that, not in real life.
It’s work and work requires passion to keep showing up.
Adult friendships are hard, Mary. It’s not light and airy, like when we were kids. It’s hard enough in adulthood, and to carve a space out for men’s-plus LGBT rugby in a city literally built on compromise is an act of defiance in itself.
Taking a chance on LGBT rugby is not for the casual observer – it’s a tough sport (but safer than football) with some big personalities. But as Theo pointed out, when I asked him about the magnetic draw between the LGBT community and rugby, that all body types are welcome in the sport; anyone can imagine themselves wearing a jersey and still fit in.
If you are to take anything from this, dear reader, it’s that when you show up for rugby, you belong.
The team’s hosting an informational Rugby 101 on Saturday, March 21, at Harry Thomas Rec Center, at 2 p.m. Our home match the next Saturday, March 28, is also at Harry Thomas, at 1 p.m.
Opinions
Protecting D.C.’s promise: why Kenyan McDuffie deserves our support
Former Council member is longtime ally
For generations, LGBTQ+ people have come to DC searching for something simple: the freedom to love who they love. I was one of them.
Washington, D.C., is the gayest city in the world. This didn’t happen by accident; It’s the result of generations of organizing, advocacy, and leadership from elected officials who championed the movement for equality, a movement that drew people like me to this city in search of safety and acceptance.
Now, as we approach the June 16 mayoral primary, the LGBTQ+ community will play a decisive role in shaping the city’s future. I believe the candidate our community should rally behind is Kenyan McDuffie, a longtime ally with a proven track record.
Kenyan’s relationship with the LGBTQ+ community began long before it was politically fashionable. In 2012, when he ran for the Ward 5 D.C. Council seat, he sought and earned the support of the Gertrude Stein Democratic Club, the city’s largest LGBTQ+ political organization. At a time before marriage equality was the law of the land, Kenyan stood with us and went on to support the banning of conversion therapy.
But what has always stood out to me about Kenyan’s leadership is his willingness to tackle issues head-on that deeply impact queer families and young people.
As someone who was recently engaged and is currently navigating pathways to parenthood, I was moved by Kenyan’s leadership to modernize D.C.’s outdated surrogacy laws. For more than two decades, the District criminalized surrogacy agreements, threatening families with fines of up to $10,000 and even jail time. Kenyan helped lead the effort to repeal that law, opening a legal pathway for LGBTQ+ couples and others to build families through surrogacy. Thanks to advances in medicine and policy changes like this one, more LGBTQ+ families are now able to pursue parenthood.
Kenyan has also been a champion for some of the most vulnerable members of our community: LGBTQ+ young people experiencing homelessness. In DC, LGBTQ+ youth represent nearly 40 percent of the city’s homeless youth population. Early in his time on the Council, Kenyan worked with fellow members to dedicate housing beds for LGBTQ+ youth and to strengthen the capacity of the Mayor’s Office of LGBTQ+ Affairs to support community programs. Those investments helped ensure that young people facing rejection or instability had a safer place to turn.
Leadership like this matters, especially as our city faces unprecedented challenges. In addition to being a champion for our community, the next mayor will need to navigate threats from the federal government, a massive reduction of the federal workforce of over 20,000 jobs, an unprecedented wave of restaurant closures, and year-after-year billion-dollar budget shortfalls.
Today, our city needs a leader whose values never waver and who has delivered real results for all our neighbors. Kenyan McDuffie has shown that kind of leadership throughout his public service career.
D.C. has always been a safe haven for the queer and trans community seeking opportunity, safety, and belonging. That promise is worth protecting and ensuring the next generation can find the same refuge and opportunity we have.
As voters prepare to make an important choice about the city’s future, I believe Kenyan McDuffie is the leader best prepared to carry that promise forward.
That’s why I’m proud to join him and countless others in launching the Out for Kenyan coalition this Thursday, March 26, at Number Nine.
Cesar Toledo is a first-generation queer Latino and an Out Magazine Out100 honoree who has spent over a decade advancing LGBTQ+ equality, equity, and social justice.
