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
SAVE Act could silence millions of trans voters
New administrative barriers pose threat to voting rights
In Washington, debates over voting rights usually arrive loudly — through court rulings, protests, or sweeping legislation that captures national attention.
The Safeguard American Voter Eligibility (SAVE) Act, now under debate in Congress, may reshape voting access in a quieter way — through paperwork. The bill would require Americans registering to vote in federal elections to present documentary proof of citizenship, such as a passport or birth certificate. Supporters argue the measure would strengthen election integrity and restore public confidence in the voting process. But for millions of eligible voters, particularly transgender Americans, the practical consequences could be far more complicated.
According to Gallup, about 1.3% of U.S. adults identify as transgender, representing roughly 3.3 million Americans. Far from disengaged politically, transgender voters participate in elections at high rates. Data released by Advocates for Trans Equality shows 75% of transgender respondents reported voting in the 2020 election, compared with 67% of the general population. Registration rates are also higher.
This is a community that shows up for democracy. Yet the SAVE Act could place new administrative barriers directly in its path. Birth certificates, the document many supporters believe should verify citizenship are among the most difficult identity records for transgender Americans to update. According to data released by The Williams Institute at UCLA Law School and the U.S. Transgender Survey, 44% of transgender adults had updated their name on government identification, but only 18% had successfully updated their birth certificates.
That gap matters.
If birth certificates become a central requirement for voter registration, millions of eligible transgender Americans could face bureaucratic obstacles that other voters rarely encounter.
History offers a warning. According to the Bipartisan Policy Center, Kansas implemented a similar proof-of-citizenship law that blocked more than 30,000 eligible voters from registering before the Kansas Supreme Court struck it down as unconstitutional.
At the same time, evidence suggests voter fraud remains extraordinarily rare. Research cited by the American Immigration Council estimates fraud at roughly 0.0001% of votes cast.
The question before lawmakers is not whether election security matters. It clearly does. The question is whether policies designed to solve a rare problem could intentionally disenfranchise legitimate voters.
The broader cultural debate surrounding gender identity often becomes emotionally charged, particularly when conversations turn to pronouns or language. Yet polling suggests the issue remains unfamiliar to many Americans. A 2022 YouGov poll found only 22% of Americans personally know someone who uses gender-neutral pronouns.
Meanwhile, the problems weighing on everyday Americans are far larger: rising grocery prices, health care costs, housing shortages, and economic struggles in both rural towns and urban neighborhoods. Yet, many conservatives choose to focus unnecessary time, energy, and resources litigating the use of pronouns.
A healthy democracy should be able to debate cultural questions without allowing them to become barriers to the ballot box.
So, what should transgender Americans, and allies, do in this moment? First, stay engaged politically. Contact legislators and explain how identification requirements affect real voters. Personal stories often reach policymakers in ways statistics alone cannot.
Second, document the impact. Write letters to local newspapers, share experiences publicly, and ensure the real-world effects of voting policies are visible.
Third, consider running for office. Local school boards, city councils, and state legislatures shape many of the rules governing elections. Finally, protest with discipline and purpose. The most transformative movements in history — from Mahatma Gandhi to Dr. Martin Luther King Jr. — were rooted in peaceful persistence and moral clarity.
The SAVE Act may ultimately pass, fail, or change significantly as Congress debates it. But the larger principle at stake should guide the conversation. America’s democracy has always grown stronger when more citizens can participate, not when the path to the ballot becomes harder to navigate. For transgender voters, and for the country as a whole, that principle remains the quiet foundation of the republic.
James Bridgeforth, Ph.D., is a national columnist on the intersection of politics, morality, and civil rights. His work regularly appears in The Chicago Defender and The Black Wall Street Times.
Opinions
The frightening rise of antisemitism, Islamophobia
Trump, Netanyahu to blame for inflaming tensions
We can lay the rise in antisemitism and Islamophobia directly at the feet of the felon in the White House, and the criminal at the head of the Israeli government. Both Trump and Netanyahu belong in jail, not leading their governments.
I am a proud Jewish, gay man, and the homophobia and antisemitism the felon in the White House is generating are truly frightening. I am assuming my Muslim friends are feeling the same way about the Islamophobia he is causing to rise. While people have always been racist, homophobic, Islamophobic, and antisemitic, Trump has given tacit permission, with his statements, actions, and now his war on Iran, for those feelings to be shouted in the public square, and in the worst-case scenarios, acted on with violent attacks.
We can clearly attribute the rise in antisemitism around the world, to the actions of the right-wing, war criminal, leader of the Israeli government, Benjamin Netanyahu, and what he is doing to destroy Gaza, murdering innocent Palestinians, and now again bombing innocents in Lebanon.
This is all seeping into the politics of our nation. One organization promoting antisemitism and expecting it of the candidates they endorse, is the Democratic Socialists of America (DSA). They went so far as to take away an endorsement at one point, from one of their most ardent supporters, Rep. Alexandria Ocasio-Cortez (D-N.Y.), because she refused to fully support their anti-Zionist platform and their support of BDS. The DSA took issue with “[Ocasio-Cortez’s] votes, including a vote in favor of H.Res.888, conflating opposition to Israel’s ‘right to exist’ with antisemitism,” and a press release in April she co-signed that “support[s] strengthening the Iron Dome and other defense systems.” In their 2025 platform DSA called for a single state from the ‘river to the sea’ as the Palestinian right to resist, thereby eliminating the State of Israel. It goes with their support of BDS and anti-Zionist positions. It is fair to see that as antisemitism.
I am a Zionist, in the sense of the term as coined by Theodor Herzl. I am a believer in, and supporter of, the State of Israel. I am also for a Palestinian state. I am opposed to what Israel’s current government, led by a war criminal, is doing. I had hoped he would have abided by what former President Biden said to him immediately after Oct. 7. “Don’t make the same mistake we did after 9/11. Temper your response.” But instead, Netanyahu has murdered Palestinians by the thousands, destroying Gaza. He was rightfully declared a war criminal and should be brought to justice. He has made things worse both for the people of Israel, and Jews around the world. He has been responsible for antisemitism around the world once again rearing its ugly head. Now, two and a half years after Hamas’s attack on Israel, he is still murdering Palestinians, and now again more people in Lebanon and Iran. He still denies the Palestinian people need a home, a state of their own. He promotes settlements on the West Bank that should be part of a Palestinian state and refuses to prosecute settlers who commit crimes against the Palestinian people there.
My parents and relatives had to flee Hitler. Some came to the United States, and some immigrated to Israel. My father’s parents were killed in Auschwitz. I believed it could never happen again. But the felon in the White House, and criminal in Israel, are abusing me of that notion. Their policies of greed and corruption are leading to danger for all the people of the world. They are leading us into a third world war. The felon is attempting to steal, yes steal, billions through his phony ‘Board of Peace’ where he is screwing the Palestinian people out of their homes in Gaza. It is insanity, and we are all suffering for it; Jews, Muslims, and the rest of the world, as we are thrown into war none of us wants.
Now as I wrote, the DSA, tells people all Zionists are the enemy, without a definition of what a Zionist is. They expect their supporters not to recognize the State of Israel. They create antisemitism, and now in D.C. we have a candidate running for mayor, Janeese Lewis George, asking for, and getting their support. They also have in their platform to defund the police. Those things should frighten all the people of D.C. Any candidate who can run on the DSA platform must be deemed unacceptable to anyone who opposes prejudice and discrimination of any kind. One prejudice leads to others and gives rise to people feeling they can be open about not only their antisemitism, but their Islamophobia, racism, and sexism, as well.
We need all the good voters in the District of Columbia to find these DSA positions unacceptable, and reject any candidate who solicits, and takes their endorsement.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.
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.
