Opinions
Cruel court decision makes it harder to prevent AIDS
Disease gets a boost from federal judge in Texas

Just as the disease was on a glide path to extinction thanks to new drugs, HIV/AIDS got a boost from a federal court in Texas.
On Sept. 7, U.S. District Judge Reed O’Connor ruled that the government can’t require an employer-sponsored health care plan to cover a therapy that prevents the spread of a disease that has already killed more than 700,000 Americans. The decision in Braidwood Management Inc. v. Becerra is not just poorly argued; it is flat-out cruel.
Perhaps the best feature of the Affordable Care Act (ACA) of 2010, nicknamed Obamacare, was a requirement that insurance offer coverage of specified preventive care procedures and therapies, such as colon cancer screening and influenza immunizations.
In June 2019, the U.S. Preventive Services Task Force, an advisory panel of experts, issued a “Grade A” recommendation for pre-exposure prophylaxis, or PrEP, a medicine that is 99% effective in preventing HIV transmission during sex. The first PrEP drug, Truvada, had been approved seven years earlier by the Food & Drug Administration. On Jan. 1, 2021, the federal government required plans to cover PrEP with no copay, coinsurance, or deductible.
Even before the mandate, the Centers for Disease Control and Prevention (CDC) credited PrEP with helping reduce new HIV infections in the U.S. by 8% between 2015 and 2019 “after a period of general stability.” The CDC now calls PrEP “a key prevention strategy for ending the HIV epidemic in the U.S.,” a goal for 2030 set by both the Trump and Biden administrations.
The way to end AIDS once and for all is to get PrEP to those who need it most. Researchers are developing intravaginal rings, implants, antibodies, and long-lasting injectables. Although PrEP use has risen by a factor of eight in just five years, three-quarters of those most at risk are not using the therapy.
The success of the lawsuit by a group of self-described Christian business owners and employees will make access even more difficult. The plaintiffs argued that the preventive care mandate for PrEP violated their constitutional right to religious freedom. In the complaint, Dr. Steven Hotze said that he was unwilling to pay for a health plan covering PrEP “because these drugs facilitate or encourage homosexual behavior, which is contrary to [his] sincere religious beliefs.”
Hotze, whose vitamin company ran afoul of the FDA for COVID-19 claims, was indicted in April on aggravated assault charges involving a bizarre search for ballots after the 2020 election.
In the PrEP case, Hotze’s objection went beyond gay sex. He complained that providing coverage of the drugs facilitates and encourages “sexual activity outside of marriage between one man and one woman” as well as illegal drug use.
Judge O’Connor agreed. He went even further, ruling that members of the Preventive Services Task Force were “unconstitutionally appointed.”
In a previous case, O’Connor had ruled that the entire ACA was unconstitutional, but the Supreme Court reversed that decision last year. The current ruling draws on the Religious Freedom Restoration Act (RFRA) of 1993, which was enacted by Congress after the Supreme Court ruled in Employment Division v. Smith that the protection of the free exercise of religion in the First Amendment does not entitle anyone to a religion-based exception from a general law.
In recent years, writes Michael Dorf of the Cornell University Law School, “conservative Christians have increasingly relied on [RFRA] to obtain exceptions from laws involving insurance coverage for contraception and abortion.”
For example, in Burwell v. Hobby Lobby, a 2014 case, the Supreme Court held that a company owned by religious Christians could be excused from an obligation to pay for health insurance that covered “forms of contraception that the owners regarded as tantamount to abortion.”
But the ruling in the Braidwood case is far more sweeping. The Hobby Lobby plaintiffs considered abortion itself immoral. In this case, it’s not PrEP that Braidwood considers immoral; it’s certain kinds of sexual activities. By substantially lowering the risk of contracting HIV/AIDS, this twisted logic goes, PrEP is a facilitator of what Hotze considers immoral. And by offering insurance that covers PrEP, Braidwood says it becomes complicit.
There is a serious cost to this attenuated argument. By decreasing access to PrEP, people will needlessly become ill and, in some cases, die. The economy will also be burdened with the cost of treating a disease that can be prevented.
Modern science has developed therapies that are ending the spread of a dangerous, mortal virus. Easing access to these medicines is clearly a legitimate function of government — undoubtedly, a compelling interest. What can be more selfish and foolish than to erect needless obstacles for those who want to protect themselves and people around them?
James K. Glassman, a former Under Secretary of State in the George W. Bush administration, is an adviser to health care companies and non-profits.
Opinions
USAID’s demise: America’s global betrayal of trust with LGBTQ people
Trump-Vance administration dismantled agency after taking office

The U.S. Agency for International Development — proudly my institutional home for several years of my international development career and an American institutional global fixture since November 1961 — is no more.
How will USAID’s closure impact LGBTQI+ people around the world, especially in poor, struggling countries (“the Global South”)? Time will tell, but “dire,” “appalling,” and “shameful” are appropriate adjectives, given the massive increase in HIV/AIDS deaths that follow the callous, abrupt, and unspeakably cruel cut-off of funding for USAID’s health and humanitarian programming in HIV/AIDS prevention, treatment, and care.
Regarding LGBTQI+ people and issues, USAID worked in a tough neighborhood. In Africa alone, more than 30 countries in which USAID had programming still criminalize same-sex relationships, often to the point of imposing the death penalty. These fiercely anti-LGBTQI+ countries share harsh anti-LGBTQI+ punishments with most countries in the Middle East and North Africa. Other countries where USAID formerly worked retain colonial-era sodomy laws.
Where did USAID fit into all this turbulence? The agency was not allowed to transgress local laws, so how could it support the human rights of local LGBTQI+ people? USAID did so by building close and trusting relationships with local LGBTQI+ civil society, and by “superpower advocacy” for the universal human rights of all people, including those of us in the queer community.
I served at USAID’s Africa Bureau under the Obama administration, becoming the only openly transgender political appointee in USAID’s history. In that role, I was privileged to have a platform that caught the astounded attention of both queer people and of anti-LGBTQI+ governments around the world. If the president of the United States can elevate a transgender woman to such a senior position within the U.S. government, that open declaration of acceptance, inclusion, worth, and recognition set a precedent that many in the LGBTQI+ community worldwide hoped their countries would emulate.
Serving as an openly queer person at USAID also afforded me the opportunity to meet with many fiercely anti-LGBTQI+ senior politicians and government officials from African countries who sought USAID funding. Uganda’s first woman speaker of the parliament, Rebecca Alitwala Kadaga and her whole delegation came to see me at USAID in Washington about such funding. I had some very frank (and USAID-approved) “talking points” to share with her and her team about President Obama’s strong and secular commitment to equal human rights for all people. My tense meeting with her was also an opportunity to educate her as to the nature of the transgender, nonbinary, and intersex community — we who are simply classified and discriminated against as “gay” people in Uganda and in most countries in the Global South. I also had the chance to represent USAID in the “inter-agency” LGBTQI+ human rights task team led by openly gay U.S. Ambassador David Pressman, whose effective leadership of that Obama-era initiative was inspirational.
Working closely with professional, capable, and caring USAID career employees such as Ajit Joshi and Anthony Cotton, and with the strong and open support of the USAID Deputy Administrator Don Steinberg, I helped to craft and promote USAID’s very first LGBTQI+ policy. Under President Obama, USAID also created the LGBT Global Development Partnership, a public-private partnership supporting LGBTQI+ civil society groups throughout the Global South. USAID funding also increased for programs promoting LGBTQI+ inclusion, anti-violence, and relevant human rights protections. This programming expanded further (albeit never adequately funded) during the Biden administration under the able leadership of USAID Senior LGBTQI+ Coordinator Jay Gilliam and his team.
So what did it all mean? Has USAID left a footprint for the global LGBTQI+ community? Will its absence matter?
In my view, that answer is an emphatic yes. International development and humanitarian response go to the heart of recognizing, respecting, and caring about universal human dignity. USAID converted those ethical commitments into tangible and meaningful action, again and again, and modelled for the world what it means to truly include all persons.
My time serving at USAID was a high point of my career, being surrounded by the best of American civil servants and foreign service officers. For me, “USAID Forever” remains my battle cry. Let’s start thinking of how we will rebuild it, beginning in three years.
Chloe Schwenke is a professor at Georgetown University’s McCourt School of Public Policy.
Opinions
Community comes together to repair WorldPride history exhibition
Vandals damaged pictures, timeline walls on June 22

Earlier this month, vandals shouting homophobic slurs damaged the 8-foot hero cubes and timeline walls of the Rainbow History Project’s (RHP) WorldPride exhibition “Pickets, Protests, and Parades: The History of Gay Pride in Washington.” The week’s incident was the fifth homophobic attack on the exhibition chronicling DC’s LGBTQ+ History, the vandalism damage was only made worse by the storms this past week.
In response, RHP posted a call online for volunteers and donations and over a dozen volunteers showed up on Saturday to repair the exhibition in its final stretch.
It took three hours, but the group assembled during a heat advisory to bend the fences back into place, fix the cubes and zip tie all the materials together to keep them safe. Some of those who came out to volunteer, Slatt said, were known RHP volunteers but most were total strangers who had attended an event here or there or just wanted to get involved for the first time, one was even in D.C. as an out-of-town guest and after seeing the Instagram call, decided to spend their day lifting some heavy fencing back into place.
When asked why they showed up, volunteer Abbey said: “especially during Pride month, it’s so important to come together as a community, not just to celebrate, but to support each other. To know that this historic exhibit is even able to exist right now under this administration is really amazing. The fact that we’re just able to help continue it in its last leg of being out here is really important.”
“Rainbow History Project does a lot of work for the community,” another volunteer Ellie said, “they show up in a lot of ways that I think we really need right now, so in terms of being asked to come out and do a couple hours of lifting, that is something that we can easily support and do.”
“We put out a call asking for support from the community, and so we didn’t know what we’d get,” Slatt continued, “but strangers have shown up. We were upset, we were crying. We were trying to come up with a battle plan and more and more people have shown up with open arms and empty hands to do this. It’s 95 degrees, we are melting in the heat. It’s just amazing the number of people who have come here.”
If anything, the anonymous exhibit designer said, the people who vandalized the exhibit made the community stronger and mobilized members passionate about preserving and sharing our histories. Their efforts backfired in a big way — bringing together people who had only attended one or two RHP events or had read about the organization online to actively contribute to the work.
It’s a meaningful representation of the history of D.C.’s LGBTQ+ community, one that often starts with a small group of people who come together to protest but soon mobilize their communities and enact monumental change in the nation’s capital.
“If Pride in D.C. started with 10 people picketing the White House,” Slatt remarked, “you just got 12 more to join the gay history movement.”
This was especially poignant, another volunteer Mattie said, on the week that the Supreme Court issued a decision allowing Tennessee to ban puberty blockers and hormone therapy for minors seeking gender affirming care. It was a devastating moment for the LGBTQ+ community who mobilized once more in front of the Supreme Court this past Friday.
“It’s been actually really important to see this community come together in the face of direct attack on our history in the wake of direct attacks on our rights,” Mattie said, “and we stand up to that. We come together, and we represent. That is so important to maintaining our strength and our community throughout trying times now and ahead.”
When asked about how community members can support RHP’s work and repair the damage long-term to the exhibit, Slatt urged people to donate to RHP, to volunteer as exhibit monitors, and to come visit the exhibit.
“We’ve been doing this for 25 years. This is our 25th anniversary, and if it weren’t for volunteers donating their time and their talents, if it weren’t for small dollar donors, we would never have gotten anything done,” Slatt said. “I’d say to anyone out there that we are on this plaza all through Independence weekend, we are here through the Smithsonian Folklife Festival, people can come on down.”
Slatt and other volunteers will be leading tours each evening at 7 p.m. at Freedom Plaza, and people can pre-order the exhibition catalog right now, which will be delivered in time for LGBTQ+ History Month in October.
Emma Cieslik is a D.C.-based museum worker and public historian.

Independence Day, commonly known as the Fourth of July, is a federal holiday commemorating the ratification of the Declaration of Independence by the Second Continental Congress on July 4, 1776, establishing the United States of America. The delegates of the Second Continental Congress declared the 13 colonies are no longer subject (and subordinate) to the monarch of Britain, King George III and were now united, free, and independent states. The Congress voted to approve independence by passing the Lee resolution on July 2, and adopted the Declaration of Independence two days later, on July 4.
Today we have a felon in the White House, who wants to be a king, and doesn’t know what the Declaration of Independence means. Each day we see more erosion of what our country has fought to stand for over the years. We began with a country run by white men, where slavery was accepted, and where women weren’t included in our constitution, or allowed to vote. We have come far, and next year will celebrate 250 years. Slowly, but surely, we have moved forward. That is until Nov. 5, 2024, when the nation elected the felon who now sits in the Oval Office.
There are some who say they didn’t know what he would do when they voted for him. They are the ones who were either fooled, believing his lies, or just weren’t smart enough to read the blueprint which laid out what he would do, Project 2025. It is there for everyone to see. There should be no surprise at what he is doing to the country, and the world. Last Friday his Supreme Court, and yes, it is his, the three people he had confirmed in his first term, gave him permission to be the king he wants to be. The kind of king our Declaration of Independence said we were renouncing. A man who with the stroke of a pen can ruin thousands of lives, and change the course of America’s future. A man who has set back our country by decades, in just a few months.
So, I understand why many are suggesting there is nothing to celebrate this Fourth of July. How do we have parties, and fireworks, celebrating the 249th year of our independence when so many are being sidelined and harmed by the felon and his MAGA sycophants in the Congress, and on the Supreme Court. Yes, there are those celebrating all he is doing. Those who want to pretend transgender people don’t exist, and put their lives in danger; those who think it’s alright to take away a women’s right to control her body, and her healthcare; those who think parents should be able to interfere on a daily basis with their children’s schooling and wipe out the existence of gay people for them. Those who pretend there was a mandate in the last election, when it was only won by about 1 percent. Those who think disparaging veterans, firing them, and taking away their healthcare, is ok. Those in the LGBTQ community like Log Cabin Republicans, who think supporting a racist, sexist, homophobe is the right thing to do.
So, what do we, as decent caring people, do this Fourth of July. What do we say to those who are being harmed as we celebrate. What do we say to those trans people, those women, those immigrants who came here to escape their own dictators, and are now finding they have come to a country with its own would-be dictator. I say to them, please don’t give up on America. Don’t give up on the possibility decent loving people in our country will finally wake up and say, “enough.” That the majority of Americans will remember we fought a revolution to escape a king, and we fought a civil war to end slavery. That we moved forward and gave women the right to vote, and gave the LGBTQ community the right to marry. Don’t give up on the people that did all that, and think they won’t rise up again, and tell the felon, racist, homophobe, misogynist, found liable for sexual assault, now in the White House, and his sycophants in congress, and his cult, that we will take back our country in the 2026 midterm elections. That we will vote in large numbers, and demand our freedom from the tyranny that he is foisting on our country.
So yes, I will celebrate this Fourth of July not for what is happening in our country today, but rather for what our country actually stands for. Not for birthday parades, and abandonment of the heroes in Ukraine in support of dictators like Putin. But for the belief the decent people in our country will rise up and vote. That is what I will celebrate and pray for this Fourth of July. That is what I think the fireworks will mean this July Fourth. I refuse to accept defeat the same way our revolutionary soldiers wouldn’t, and the way our troops in the civil war wouldn’t till the confederacy was defeated.
I will celebrate this Fourth of July because I refuse to accept we will not defeat those who would destroy our beautiful country, and what it really stands for.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.