Opinions
Proposed Medicaid rule may hurt people with HIV
A freeze on drug development would be a crushing blow
We’re fortunate to exist in a world where it’s possible to live for a long time with HIV. Medical science has made astounding progress since the 1980s, when a positive diagnosis was considered a death sentence. Queer activism helped bring about the shifts in policy and attitude that made this success possible.
But our job isn’t over yet.
HIV isn’t spread evenly across the United States. In urban areas with high poverty, it’s as prevalent as it is in low-income countries with generalized HIV epidemics, like Ethiopia and Burundi. This means that almost 40% of Americans with HIV get their health coverage through Medicaid, the government insurance plan for low-income people. And recently proposed changes to the program could halt future progress toward finding a cure.
Under the current Medicaid Drug Rebate Program, Medicaid receives a sizeable manufacturer rebate on brand-name drugs — calculated in part based on either 23.1% off the average price of the drug, or the best price available to another purchaser if that discount is higher.
But now, the Centers for Medicare & Medicaid Services (CMS), the federal agency that runs Medicaid, has proposed a new rule. It would require calculating a medicine’s best price by stacking the rebates and discounts on a single unit of drug that a manufacturer provides to different eligible purchasers.
Due to the interplay with other recent changes to Medicaid, in some cases, the total markdown could exceed 100% of the average price of the drug — meaning manufacturers would be forced to effectively sell the medications at a loss to Medicaid.
This could mean trouble for drugs whose largest market is Medicaid, like those that treat HIV. If manufacturers and their investors decide that it’s no longer financially viable to make drugs that primarily serve disadvantaged patients, then those medications might not be developed at all.
That’s concerning, given that many groundbreaking HIV therapies stemmed from private sector research and development. And with research inching ever closer to a cure, a freeze on HIV drug development would be a crushing blow to those of us living with the disease.
The proposed rule change also threatens the search for a cure with policies that target cell and gene therapies, areas in which scientists have recently made promising HIV-related breakthroughs. When cell and gene therapies come to market after years of research, they can often have high up-front costs — sometimes more than $1 million per patient. That’s in part because the field is so cutting edge and the therapies deliver long-term benefits, and in part because research failures in drug development are far more common than successes.
One CMS policy change would require manufacturers to report their research and development costs for specific high-price medicines to the agency. The government could make such information public, and use it to challenge drug prices. In addition, the rule proposed to specifically target accelerated approval drugs, a pathway that has allowed many patients with HIV/AIDS early access to lifesaving treatments.
The problem is that for every drug candidate in clinical trials that succeeds, nine fail. Sometimes they fail after years of research and hundreds of millions of dollars invested. To keep the research money flowing, that one success needs to make up for the cost of the nine that washed out.
If Medicaid drives drug mandatory rebates so low that companies can’t recoup their investments, it will discourage them from pursuing the most cutting-edge avenues of research — and put some of them out of business. Biotech investors will abandon gene therapy and seek out more stable markets, and HIV research will suffer. Ultimately, patients living with HIV who rely on Medicaid will miss out on potential cures that never get developed. They may also lack access to therapies that do get created, given that the companies behind them could pull out of the Medicaid market altogether.
Forty percent of Americans living with HIV are Black, and 63% are gay and bisexual men.
As a queer Black man with HIV myself, I know all too well how devastating it is to receive that diagnosis, especially when you’re underinsured and living in poverty. But I also know that effective treatment can vastly improve quality of life. Without the sacrifices and the activism of those who came before us, HIV might still be a death sentence.
It’s up to us to continue the fight now. Our community deserves a shot at a cure. CMS officials urgently need to reverse course on this disastrous proposal. And if they fail to do so, it’s incumbent on HIV activists to push for the federal government to adopt policies that support affordable HIV treatments and research funding.
Guy Anthony is the president and CEO of Black, Gifted & Whole.
Opinions
The felon in the White House must be stopped
Are there any decent Republican members of Congress left?
We are up shit’s creek if the felon in the White House actually thinks he has a Nobel Peace Prize. If he believes he deserves one, or Venezuelan opposition leader Maria Corina Machado had any other reason to give him hers, than it was easier, and less degrading, than going on her knees to him, as a number of men already have. I don’t know if she understood how many millions the medal could be worth. Instead, she could have used it for her people, if she didn’t want to keep it.
Machado was awarded the Nobel Prize for her work for the Venezuelan people. She spoke up for them, and fought for them. The felon couldn’t care less about them. He proved that by invading, and then supported Maduro’s vice president as president. He said he, and his fascist cohorts, would run the country, and is now stealing their oil and personally deciding what to do with it. After U.S. troops captured Venezuelan President Nicolás Maduro, Trump said, Venezuelan opposition leader Maria Corina Machado “doesn’t have the support within Venezuela to be its next leader, she was not consulted prior to the operation.” He went on to say, “I think it would be very tough for her to be the leader. She doesn’t have the support within or the respect within the country.” This is the slime bag she gave her Nobel Peace Prize medal to. I hope she is not naïve enough to believe he really cares about her, or her countrymen, and women.
Trump is vile, sick, and mentally deranged. He is threatening foes and allies alike. They see bending a knee to him only works for the moment, but has no long-term impact on his tiny brain. Today, he is threatening Greenland, and our NATO allies are moving their military to Greenland to protect it against the United States. Now he is threatening them with new tariffs. That would have once been unfathomable. He is saber rattling over Iran, Colombia, even Mexico. He is bombing Nigeria and Syria.
If that weren’t enough, he threatens to use the Insurrection Act to send the military into cities here. He has already sent in thousands of ICE agents. ICE is classified as a federal law enforcement agency under the Department of Homeland Security. They have authority to arrest, detain, and investigate immigration violations. However, the law is clear; ICE agents do not have unlimited power. They face significant constitutional restrictions that many people don’t realize, especially when it comes to entering homes and private spaces. But what is clear, in Minneapolis today, some of the agents are acting like the Gestapo. They are smashing car windows, pulling people out of their cars, invading homes, and workplaces, all without first having any proof the people they are going after are guilty of anything. I believe we need fair immigration laws, and they should be enforced. But this is clearly not what the felon is doing. The felon in the White House and his incompetent stooge at Homeland Security, Kristi Noem, who has no idea what the hell she is doing, are acting egregiously, and making a mockery of our democracy.
The president, Noem, Hegseth, Bondi, and the other incompetents in the felon’s Cabinet, simply pretend to forget the history of the United States. They don’t want to accept the truth; we are a nation of immigrants. It is immigrants who built our country, and are still building it. My parents were immigrants escaping from Hitler, and they came here and built a life, and in doing so, added to the greatness of our country. I want every person around the world who needs to escape from dictators, and despots, to be able to do the same as my parents did. We need to build an immigration system that allows them to do that. Instead, because of what this felon is doing, we are seeing American citizens thinking of leaving this country, and looking for asylum in others. That is really sick, but it’s happening.
Sitting in the Oval Office today we have a felon who is reveling in becoming the war president. He is taking the United States down an incredibly dangerous path, threatening our own citizens with violence here at home, and doing the same to our allies around the world. He, and the incompetents and fascists surrounding him, need to be stopped. If there are any decent Republican members of Congress left, they need to join with Democrats, and the voters, to stop him.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.
January arrives with optimism. New year energy. Fresh possibilities. A belief that this could finally be the year things change. And every January, I watch people respond to that optimism the same way. By adding.
More workouts. More structure. More goals. More commitments. More pressure to transform. We add healthier meals. We add more family time. We add more career focus. We add more boundaries. We add more growth. Somewhere along the way, transformation becomes a list instead of a direction.
But what no one talks about enough is this: You can only receive what you actually have space for. You don’t have unlimited energy. You have 100 percent. That’s it. Not 120. Not 200. Not grind harder and magically find more.
Your body knows this even if your calendar ignores it. Your nervous system knows it even if your ambition doesn’t want to admit it. When you try to pour more into a cup that’s already full, something spills. Usually it’s your peace. Or your consistency. Or your health.
What I’ve learned over time is that most people don’t need more motivation. They need clarity. Not more goals, but priority. Not more opportunity, but discernment.
So this January, instead of asking what you’re going to add, I want to offer something different. What if this year becomes a season of no.
No to things that drain you. No to things that distract you. No to things that look good on paper but don’t feel right in your body. And to make this real, here’s how you actually do it.
Identify your one true priority and protect it
Most people struggle with saying no because they haven’t clearly said yes to anything first. When everything matters, nothing actually does. Pick one priority for this season. Not 10. One. Once you identify it, everything else gets filtered through that lens. Does this support my priority, or does it compete with it?
Earlier this year, I had two leases in my hands. One for Shaw and one for National Landing in Virginia. From the outside, the move felt obvious. Growth is celebrated. Expansion is rewarded. More locations look like success. But my gut and my nervous system told me I couldn’t do both.
Saying no felt like failure at first. It felt like I was slowing down when I was supposed to be speeding up. But what I was really doing was choosing alignment over optics.
I knew what I was capable of thriving in. I knew my limits. I knew my personal life mattered. My boyfriend mattered. My family mattered. My physical health mattered. My mental health mattered. Looking back now, saying no was one of the best decisions I could have made for myself and for my team.
If something feels forced, rushed, or misaligned, trust that signal. If it’s meant for you, it will come back when the timing is right.
Look inside before you look outside
So many of us are chasing who we think we’re supposed to be— who the city needs us to be. Who social media rewards. Who our resume says we should become next. But clarity doesn’t come from noise. It comes from stillness. Moments of silence. Moments of gratitude. Moments where your nervous system can settle. Your body already knows who you are long before your ego tries to upgrade you.
One of the most powerful phrases I ever practiced was simple: You are enough.
I said it for years before I believed it. And when I finally did, everything shifted. I stopped chasing growth just to prove something. I stopped adding just to feel worthy. I could maintain. I could breathe. I could be OK where I was.
Gerard from Baltimore was enough. Anything else I added became extra.
Turning 40 made this clearer than ever. My twenties were about finding myself. My thirties were about proving myself. My forties are about being myself.
I wish I knew then what I know now. I hope the 20 year olds catch it early. I hope the 30 year olds don’t wait as long as I did.
Because the only way to truly say yes to yourself is by saying no first.
Remove more than you add
Before you write your resolutions, try this. If you plan to add three things this year, identify six things you’re willing to remove. Habits. Distractions. Commitments. Energy leaks.
Maybe growth doesn’t look like expansion for you this year. Maybe it looks like focus. Maybe it looks like honoring your limits. January isn’t asking you to become superhuman. It’s asking you to become intentional. And sometimes the most powerful word you can say for your future is no.
With love always, Coach G.
Gerard Burley, also known as Coach G, is founder and CEO of Sweat DC.
Greenland
The Greenland lesson for LGBTQ people
Playbook is the same for our community and Europeans
I understand my own geopolitical limits and don’t pretend to know how Europeans should respond to U.S. threats to seize Greenland or retaliate against anyone who opposes them. However, as I mentioned in March, it’s clear that for Europeans and LGBTQ+ people alike, hug-and-kiss diplomacy is over.
In practice, that means responding to the U.S. administration’s provocations with dialogue, human‑rights rhetoric, and reasoning may now be counterproductive. It looks weak. At some point, Europeans will have to draw a line and show how bullying allies and breaking international agreements carry a cost — and that the cost is unpredictable. On the surface, they have few options; like LGBTQ+ communities, they are very behind in raw power and took too long to wake up. But they still have leverage, and they can still inflict harm.
Maybe it is time for them to call the bluff. America has a great deal to lose, not least its reputation and credibility on the world stage. Stephen Miller and Pete Hegseth, with all their bravado, obviously underestimate both the short‑ and long‑term geopolitical price of ridicule. Force the United States to contemplate sending troops into an ally’s territory, and let the consequences play out in international opinion, institutions, and markets.
In the United States, LGBTQ+ communities have already endured a cascade of humiliations and live under constant threat of more. In 2025 our symbols and heroes were systematically erased or defaced: the USNS Harvey Milk was quietly renamed after a straight war hero, Admiral Rachel Levine’s title and image were scrubbed from official materials, Pride flags were banned from public buildings, World AIDS Day events were defunded or stripped of queer content, the Orlando memorial and other sites of mourning were targeted, the U.S. lead a campaign against LGBTQ+ language at the U.N., and rainbow crosswalks were literally ripped up or painted over. We cannot simply register our distress; we must articulate a response.
In practice, that means being intentional and focused. We should select a few unmistakable examples: a company that visibly broke faith with us, a vulnerable political figure whose actions demand consequences, and an institution that depends on constituencies that still need us. The tools matter less than the concentration of force — boycotts, shaming, targeted campaigning all qualify — so long as crossing certain lines produces visible, memorable costs.
A friend suggested we create what he called a “c***t committee.” I liked the discipline it implies: a deliberate, collective decision to carefully select a few targets and follow through. We need a win badly in 2026.
These thoughts are part of a broader reflection on the character of our movement I’d like to explore in the coming months. My friends know that anger and sarcasm carried me for a long time, but eventually delivered diminishing returns. I am incrementally changing these aspects of my character that stand in the way of my goals. The movement is in a similar place: the tactics that served us best are losing effectiveness because the terrain has shifted. The Greenland moment clarifies that we must have a two-pronged approach: building long-term power and, in the short term, punching a few people in the nose.
