Health
EXCLUSIVE: Meet the director of Johns Hopkins Center for Transgender Health
Dr. Fan Liang on politicizing healthcare, fear among patients
The topic of gender affirming healthcare has never attracted more attention or scrutiny, presenting challenges for both patients and providers, including Dr. Fan Liang, medical director of the Johns Hopkins Center for Transgender and Gender Expansive Health and assistant professor of plastic and reconstructive surgery.
Speaking with the Washington Blade by phone last week, Liang shared her perspective on a variety of topics, including her concerns about the ways in which media organizations and others have shaped the discourse about gender affirming care.
Too often, she said, the public is provided incomplete or inaccurate information, framed with politically charged and polarizing language rather than balanced and nuanced reporting for the benefit of audiences who might have little to no familiarity with the topics at hand.
“This is an evolving field that requires input from many different types of specialists,” Liang noted, so one issue comes when providers “start to comment outside of their scope of practice, or extrapolate into everybody’s experience.”
A more intractable and difficult problem, Liang said, is presented by the fact that, “issues with transgender health have really taken center stage with regard to national politics, and as a result of that, the narrative has really been reduced to an unsophisticated representation of what’s going on.”
“I think that is dangerous for patients and for the community that these patients live in and have to work in and survive in because it paints a picture that is really inaccurate,” she said.
Conservative state legislatures across the country have introduced a record number of anti-LGBTQ bills this year, passing dozens, including a slew of anti-trans healthcare restrictions. The Human Rights Campaign reports 35.1 percent of transgender youth now live in states that have passed bans on gender affirming care, many of which carry criminal penalties for providers.
A big part of the Center’s work, Liang told the Blade, involves working closely with trans patients and organizations like Trans Maryland and the Trans Rights Advocacy Coalition “to make sure that the community’s voices are being heard, so that we’re able to represent those interests here.”
She described “a generalized sense of anxiety and fear,” concerns that she said are “pervasive throughout the community,” over “access to surgery and to overall gender healthcare.”
“I get a lot of questions about that,” she said.
While Liang has not yet worked with any patients who traveled to the Center because gender affirming care was banned in the states where they reside, she said, “I do anticipate that will happen in the relatively near future.”
Challenges for clinicians
The political climate “really interferes in physician autonomy and basically using our training and discretion to provide the best therapies that we can,” based on research and evidence-based guidelines from medical organizations on best practices standards of care, Liang said.
“I earnestly believe that people who go into medicine try to do right by their patients and try to provide exceptional care whenever they can,” she said. “When I speak to other providers who are engaged in trans care, the reason they entered the field was because they saw patients that were suffering and had no other providers to go to and they were filling a need that desperately needed to be filled.”
“It is unfortunate that their motives are being misinterpreted, because it is causing significant emotional harm to these providers who are being targeted,” Liang said, noting “there is so much vitriol from the anti-trans side of things,” including “this narrative out there that physicians are providing trans care because of financial reasons or because of some sort of politically motivated, I don’t know, conspiracy.”
The political climate, along with the realities of practicing in this speciality, may threaten to stem the pipeline of new providers whose practice would otherwise include gender affirming care, said Liang, who serves on the interview board for incoming residents who are looking to specialize in plastic surgery.
Many, perhaps even most, she said, are eager to explore transgender care, often because, particularly among young trainees, they are friends with trans and non-binary people. “I don’t know how much of that interest persists as they move through the training pipeline, because — especially if they are at an institution that does provide trans care — they do see a lot of the struggles that physicians encounter in being able to offer these services.”
Liang noted the “significant hurdles from an insurance standpoint” and the “significant prerequisites in order to access surgery,” which require “a tremendous amount of back-end coordination and optimization of the logistics for surgical readiness.”
“And then,” she said, “they see a lot of the backlash in the media against trans providers, and I think that that does discourage residents who otherwise would be interested in the field because physicians, by and large, are a pretty conservative bunch. And having them start their practice where they’re sort of stepping into a political minefield is not ideal.”
Speaking up can be beneficial but risky
“Some physicians feel like they can make the most amount of impact by being advocates for the patient population on a national stage or being more vocal about how anti-trans legislation has been impacting their patients,” Liang said.
“My goal, as the director for the Center for Transgender Health here at Hopkins is really to normalize this care to allow for the open conversation and discussion amongst providers to create a safe space for people to feel comfortable providing this care,” she said.
Destigmatizing gender affirming care and connecting clinicians who practice in this space will help these providers understand they are not “functioning in isolation” and instead are part of “a national effort and a nationally concerted effort toward delivering state-of-the-art health care,” Liang said.
“It’s important,” she said, to “bring the generalized healthcare community to the table in offering these services and have a frank discussion when it comes to education, research and teaching.”
Other providers, however, “do not feel comfortable putting themselves into that place of vulnerability,” Liang said, “and I don’t fault them for it because I personally know people who’ve received death threats and who have been targeted because of what they say to the media,” in many cases because their comments were reported incorrectly or out of context.
In July, Liang participated in an emergency trans rights roundtable on Capitol Hill with representatives from advocacy groups like the Southern Poverty Law Center and the Transgender Law Center, as well as members of Congress including U.S. Reps. Mark Takano (D-Calif.), Barbara Lee (D-Calif.), and Sara Jacobs (D-Calif.).
She told the Blade it was “a really wonderful experience” to “hear the heartfelt stories” of the panelists advocating on behalf of themselves, their friends, and their families, earning the attention of members of Congress.
“I do think advocacy is important,” Liang told the Blade. “I try to make time for it when I can,” she said, “but I have to balance that with all of my other clinical obligations.”
Finding compassion and lowering the temperature
On Aug. 1, The Baltimore Banner reported that the director of the Mayor’s Office of LGBTQ Affairs in Baltimore filed a discrimination complaint with the city’s Office of Equity and Civil Rights against the Hopkins Center for Transgender and Gender Expansive Health. (The story was also published by the Washington Blade, which has a media partnership with the Banner.)
Asked for comment, Liang said “it was an upsetting article to read,” adding, “I was upset that there wasn’t more due diligence done to investigate a little bit further” because instead the article presents “just this one person’s account of things.”
She noted there is “not much I can say from a physician standpoint because everything is contained within HIPAA,” the federal Health Insurance Portability and Accountability Act, which prohibits providers from even acknowledging which patients they may or may not have worked with.
The Banner article underscores the importance of journalists’ obligations to “make sure there is due diligence to confirm sources and make sure things are accurate,” Liang said, including, of course, when covering complicated and politically fraught subjects like gender affirming care.
“On the one hand, it’s really wonderful that there’s a fair amount of press being dedicated to trans issues around the country,” Liang said, but what is “frustrating for me is these conversations always seem to be so loaded and politically charged, and there doesn’t seem to be much space for people to ask earnest and honest questions” without taking heat from either side.
There is “compassion to be offered for patients who are struggling to receive basic health care” as well as for “people who are struggling to understand how this issue is evolving,” those for whom the matter is “uncharted territory” and therefore likely to “cause consternation and fear,” she said.
“Most of the time, the way to overcome” this is to cultivate “relationships with people who do identify as transgender or non-binary” on the grassroots level, she said, while leaving room “for people to ask earnest and honest questions.”
Removing the artificial “us-versus-them” paradigm provides “opportunity for more compassionate interactions,” Liang said.
At the same time, she conceded, amid the heightened polarization and escalation of an anti-trans backlash over the last few years, efforts to fight sensationalization with compassion and understanding have often fallen short, presenting hurdles that have long plagued other areas of science and medicine like abortions and vaccines.
Health
United States Conference on HIV/AIDS grapples with federal budget cuts
Annual gathering is largest of its kind in the country
Advocates, public health experts, and healthcare providers gathered for the United States Conference on HIV/AIDS on Sept. 17 in Anaheim, Calif.
The conference is the largest of its kind in the nation and came amid a wave of new challenges for HIV research and treatment. Since the beginning of the second Trump-Vance administration, federal spending cuts have targeted HIV/AIDS programs, including the gutting of the U.S. Agency for International Development and proposed cuts to PEPFAR, which supports HIV testing and treatment globally, in 2025.
Last year, Congress maintained funding for HIV programs after proposed cuts faced opposition from advocacy groups and bipartisan criticism. Yet, this year Congress has proposed similar cuts to many of the same programs, which would cut nearly one billion dollars in HIV funding. The majority of the cuts would impact HIV prevention and outreach, which includes ending nearly all Centers for Disease Control and Prevention HIV prevention activities.
“If we continue down this path,” said Jeremiah Johnson, the executive director of PrEP4ALL, an advocacy group that supports expanding access to HIV prevention. “We’re going to see more people falling off treatment. We’re going to see more wait lists. That’s going to lead to more people dying from AIDS-related complications.”
Cuts and challenges
The funding cuts loomed over the conference and inspired protest from activists.
On the first day of USCHA, activists with Save HIV Funding organized a mock funeral outside the convention center. Advocates living with HIV wrote eulogies for themselves, meant to show the consequences of diminished access to treatment. Then activists marched through the conference carrying fake coffins.
Johnson, who helped organize the protest, said that “the Trump administration has eviscerated global aid … and the fears that many of us are just talking about hypothetically for ourselves at the moment are already happening [internationally]. And so we wanted to place that front and center at this conference.”
The attacks on funding for HIV research and outreach come at a complicated time for the movement to end the AIDS epidemic. While options for prevention and treatment have never been more accessible, such as PrEP and antiretroviral therapy, there have been some concerning upticks in infections, particularly among communities of color.
Southern states account for the majority of new HIV infections in the country, despite making up only 38 percent of the population. And these infections impact disproportionately Black and Latino communities. According to the CDC, even as overall HIV infections decreased from 2018 to 2022, diagnoses of HIV among Latinos grew by 17 percent, with a majority of this increase happening in the South.
Stigma is still the biggest barrier for people seeking out HIV treatment, said Guillermo Chacón, president of the Latino Commission on AIDS.
“The progress that we [made] in the past two years has been demolished,” he said.
Chacón blames the federal government for stigmatizing HIV treatment by using harmful rhetoric about queer people.
“The level of homophobia and transphobia right now is even higher because it has been used as a political message to create fear and division in our country,” he said.
Chacón believes that research and outreach must be done to reverse the rising HIV infections among Latinos. However, this is exactly the type of research that the Trump-Vance administration is targeting most intensely. Research into “health disparities” — why some health problems impact certain communities more than others — has been heavily criticized by the White House, along with other research that it considers “woke” and claims is not supported by science.
Impact felt at conference
The opening plenary for the conference addressed some of the funding challenges the movement was facing but tried to shift the focus to the victories the movement has seen over the years. Speakers highlighted historic successful activist campaigns like ACT UP, and recent improvements in medical care and access to treatment.
Randevyn Pierre, head of U.S. external affairs at ViiV Healthcare, the sponsor of the plenary, took the stage to celebrate the success of the U = U campaign (undetectable viral load =
untransmittable HIV virus), and ViiV’s investment of $33 million in HIV community organizations across the U.S. This comes as the Trump-Vance administration has made moves to end direct funding of community-based organizations, opting to give the funding to state healthcare agencies.
The speakers at the conference discussed reducing stigma for those living with HIV and the joy of living authentically. They also emphasized the diverse groups of people that are impacted by HIV and how they can come together to fight for a cure. Longtime AIDS activist Rae Lewis Thorton exclaimed, “When they tell me there’s a cure to HIV, I’m gonna take off my 4-inch heels and put on gold slippers,” to applause from the audience.
The opening plenary also featured song and dance from a variety of artists, many of whom spoke about how HIV has impacted their own lives and how advocacy has uplifted their spirits. However, the joyous atmosphere at the conference would not last.
On the final day of USCHA, Geri Donenberg, the associate director of AIDS research at the National Institutes of Health, took the stage to address the conference.
As she spoke, phones began to buzz around the room with breaking news: the Trump-Vance administration was drafting an executive order to create an external board to oversee NIH grants and screen them for political content. NMAC CEO Harold Philips took the stage after Donenberg to address the crowd. “It’s up to us,” Philips said, “to hold NIH accountable.” He added that HIV advocates “have supporters inside NIH who are struggling and working to do the right thing. We have to have their back.”
Chants of “stand up, fight back, fight AIDS” erupted from the crowd as Philips spoke. “We do have to fight back. We do have to continue to fight,” Philips replied.
Caleb Kaufman is a California Local News Fellow placed with the Los Angeles Blade. The California Local News Fellowship is a state-funded initiative to support and strengthen local news reporting. Learn more about it at fellowships.journalism.berkeley.edu/cafellows.
Health
AIDS Healthcare Foundation announces 3 million people globally in its care
Los Angeles-based group lauded ‘historic milestone’
The AIDS Healthcare Foundation, a Los Angeles-based nonprofit group founded in 1987 that has become the world’s largest HIV/AIDS organization, has announced it has three million people in care around the world.
In a statement released on May 26, the organization, known worldwide as AHF, said the latest accomplishment reflects its global commitment to HIV prevention, care, and treatment. It says the accomplishment comes at a time when AHF marks the 25th anniversary of its first global programs launched in South Africa and Uganda in early 2001.
The statement says the three million people in care milestone also comes while the group approaches the 40th anniversary of its founding in 1987.
“Today, AHF provides lifesaving services in 50 countries across Africa, the Americas, Asia, and Europe, supporting millions of people living with HIV through a network of 1,056 global clinics, 79 healthcare centers in the U.S., 67 pharmacies, 96 wellness centers, 26 Out of the Closet thrift stores, outreach programs, and community partnerships,” the statement says.
“This accomplishment is far more than a number — it represents 3 million individuals whose lives have been touched by compassion, commitment, and the belief that healthcare is a human right,” Condessa M. Curley, the AHF board chair, said in a statement. “We extend our deepest gratitude to every member of the AHF team whose dedication made this milestone possible,” Curley said.
The AHF website notes the organization was founded in 1987 in Los Angeles as a network of hospices committed to “fighting for the living and caring for the dying” at a time when there was no effective treatment for HIV/AIDS. A statement on the website says since that time AHF has greatly expanded, converting its hospices into healthcare centers “and building a new paradigm for HIV care both in the United States and around the world.”
The statement adds, “Under the leadership of president and co-founder Michael Weinstein, AHF has grown from a group of friends dedicated to creating dignified hospice care to the largest AIDS organization in the world.” It says Weinstein “has been at the forefront of creating cutting-edge healthcare and advocacy programs and continues to drive the organization forward with the aim of saving more lives around the world.”
The statement announcing the milestone has also come at a time when more than 40 million people worldwide are living with HIV, “while hundreds of thousands continue to die annually from AIDS-related illnesses despite the availability of effective treatment.”
It says AHF’s response has included an expansion of its prevention and public health programs worldwide. In 2025 alone, according to the statement, AHF and its affiliated programs provided nearly five million free HIV tests globally and distributed more than 54 million free condoms, “underscoring the organization’s continued emphasis on both prevention and treatment.”
In D.C. AHF operates health care centers at 1701 K St., N.W., Ste. 400 [202-293-8680], 650 Pennsylvania Ave., S.E., Ste. 310 [202-350-5000], and 1647 Benning Road, N.E., Ste. 300 [202-350-5000].
Cannabis Culture
LGBTQ people, weed, and mental health: what you need to know
Community uses marijuana at much higher rates than general population
Uncloseted Media published this story on May 7.
By SPENCER MACNAUGHTON | In 2025, the global cannabis market size was valued at nearly $103 billion. By 2034, that number is expected to explode by roughly 1,400 percent to more than $1.43 trillion.
In short, as an increasing number of countries legalize marijuana use, everyone is starting to consume a lot more weed. And LGBTQ people tend to use cannabis at much higher rates than the general population. One study found that 55 percent of lesbian and 45 percent of gay young adults use marijuana, compared to about 33 percent and 37 percent, respectively, of their straight counterparts.
As LGBTQ people face a mental health crisis, the mainstream stereotypes that depict weed as an antidote for anxiety, panic and depression aren’t painting the full picture. And that could be exacerbating the mental health struggles so many queer people, and especially youth, face.
Here’s what the research demonstrates about marijuana and its effects on mental health:
- Multiple studies suggest a link between marijuana use and an increased risk of mental health disorders, including schizophrenia, depression and anxiety in individuals who are genetically predisposed.
- One study found that daily marijuana use, especially among younger people, makes some individuals seven times more likely to develop psychosis.
The increase in higher-potency strains of marijuana could pose unknown risks. In 1995, the average content of Tetrahydrocannabinol (THC) in confiscated marijuana was less than 4 percent. In 2022, it was more than 16 percent. Researchers don’t know the full extent of the impact that these higher concentrations can have on mental health and especially on younger people whose brains are still developing.
- A systematic review of studies published between 2013 and 2025 found damning results for the mental health of young cannabis users:
They were 51 percent more likely to experience depression, 58 percent more likely to experience anxiety, between 50 and 65 percent more likely to experience suicidal ideation and 80 to 87 percent more likely to have attempted suicide.
- While the above stats paint a grim picture, there is also some research that suggests benefits of cannabis use:
- A 2025 systematic review found that “medicinal” weed showed some efficacy in relieving withdrawal symptoms of opioid use disorder. THC use has been associated with improvement of post-traumatic stress disorder symptoms, bipolar symptoms and sleep quality.
- Other studies found that THC administered in a controlled setting was associated with a decrease of symptoms and adverse effects for a range of mental health disorders, including schizophrenia, psychotic symptoms, and anorexia nervosa.
Beyond what we pulled from academia, there is an astounding lack of information about the interplay between weed and mental health. As we dive deeper into Mental Health Awareness Month, I hope advocacy organizations, influencers and news outlets ramp up their coverage of this important topic that affects the countless LGBTQ weed smokers, many of whom are already struggling.
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