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Previewing LGBTQ public health under new Trump administration

Experts discuss everything from PrEP access to blood donation

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Recent years have seen major inroads in the fight against HIV, including through the development of new preventative medicines that have become more affordable and accessible thanks in part to government interventions like the Affordable Care Act’s federal health insurance coverage and cost-sharing mandates.

Over the past four years under the Biden-Harris administration and U.S. Health and Human Services Secretary Xavier Becerra, health policy has focused to a significant extent on health equity, including for LGB and trans or gender diverse populations.

President-elect Donald Trump’s record from his first administration, plans laid out in the Heritage Foundation’s Project 2025 governing blueprint, and the policies championed by voices closest to him offer a roadmap for how the federal government is likely to approach public health issues important for the LGBTQ community in the second term.

Speaking about these matters with the Washington Blade earlier this month were two experts from the Human Rights Campaign, Torrian Baskerville, who serves as director of HIV and health equity, and Matthew Rose, the organization’s senior public policy advocate.

Appointments  

The discussion happened before Trump’s nomination of Robert F. Kennedy Jr. to serve as HHS secretary, Dave Weldon for director of the Centers for Disease Control and Prevention, and Marty Makary to lead the Food and Drug Administration.

“HHS will be very important for us,” Rose said. “Who they put at the Office of Civil Rights at HHS will be incredibly important for us. The assistant secretary for health has, under Democratic administrations, and in Republican administrations, been a champion for us, sometimes” like Trump 1.0’s Assistant Secretary for Health Admiral Brett Giroir, who “did what he could for us.”

He continued, “This is the first time that CDC requires, will require, a Senate-confirmed person, and so that is going to be something to watch. I’m not as concerned about NIH always, unless they find someone really, really crazy to take over. FDA is a worry because it could change just how we view drugs and drug regulations and how those get approved.”

Rose added that he is “always watching OMB, because the people who make the budget decide how money gets spent” and it remains unclear whether the new administration will see a new director of the Office of National AIDS Policy.

Concerns

“I know a lot of people, particularly LGBTQ folks, who are like, ‘oh, shit. We are in trouble,'” Baskerville told the Blade. “And what does that mean for my care? What does that mean for” people who are saying, “I’m a Black trans woman who’s living with HIV ā€” these proposals that folks are talking about, particularly out of Project 2025 and Trump, and the rhetoric ā€” how does that impact me?”

“While we are desiring and hoping for the best,” Baskerville said, “the reality is that things that we have seen, at least the rhetoric, hasn’t been hopeful. And so we’re just hoping that there are guardrails in place that help to maintain and control as best as possible some of the things that may be going on.”

He added, “As a community, we’re really just thinking like it’s going to be a shit show, but what does that mean for us? How do we persevere through and what do we need to do to hold him accountable, hold his administration accountable, and continue the fight of advocacy?”

Baskerville said his biggest concern is “safety” and the ways in which the “Trump administration is going to challenge folks’ ability to feel safe” whether based on their immigration status or gender or sexual identity.

“Trump, in his rhetoric, has emboldened folks with different ideals and opinions to really lean into some of the hatred and the bigotry and the things that challenge and impose difficulties on folks’ safety,” he said. “If folks aren’t feeling safe at home, if they’re not feeling safe in their communities, they’re not going to access any of the health care, or any of the other things, and feel like they’re empowered to do that.”

In the case Braidwood v. Becerra, the Biden-Harris administration has defended the principle that the U.S. Preventive Services Task Force can make coverage determinations about preventatives like pre-exposure prophylaxis (PrEP), which is taken to reduce the risk of HIV transmission.

Under the next Trump administration, “We’re actually very concerned about the government reversing its role,” Rose said, which could jeopardize coverage mandates for contraceptives, too. “Changing the position on Braidwood is pretty quick and easy for them to do. They can pull out of that pretty fast.”

“It’s a whole sweep,” he said. “Like, the argument is that the U.S. Preventive Services Task Force is not an assigned body and voted on and thus they should not have prescribing authority to set standards, and that whole piece has been sent back to the district court” from the U.S. Court of Appeals for the Fifth Circuit.

“Nobody wants to pay for preventative medicine, is what they are trying to say,” Rose explained. “And that the government doesn’t have a right to tell us what the preventive medicine is. And then they asked [for the court to strike down] the whole ACA, which was just fantastical. But it’s still an active case, and we don’t know what’s going to happen if the U.S. government switches its position on it. I imagine that state attorneys general, who have been tracking the case, would step in, but we’ll have to see what their capacity looks like.”

“Our argument has always been that if you want to have your religion, that’s fine, but you don’t get to use government dollars to discriminate,” Rose said. “And if you want to have the government plan, and you want a government support, you can’t discriminate against people. If you wanted to set up your own private system, that’s on you, but you don’t get to take public dollars and do that with them.”

With respect to PrEP as well as other public health matters, Rose noted some other reasons for concern ā€” including “some things in Project 2025” that indicate there will be “greater deference to all things like religious exemptions and conscience clauses and whatnot,” though he said it is unclear how far the next administration would be able to take this.

Trump 1.0

“Some of their biggest health people aren’t all anti-PrEP,” Rose said. “The HIV community has continuously reminded Republicans that Donald Trump did create the Ending the HIV Epidemic initiative that has helped move the needle. And so there is some promise there. They aren’t all full-on, like, anti-PrEP all the time, but they are wary of it.”

He added that while officials in Trump 1.0 were not “the biggest fans of the CDC,” they were “fighting so many other battles” that they were unable to substantially reorient the public health agency.

“They didn’t go back to some of the regressive years of, like, no promo homo, where you could not talk about gay people or anything that made gay life seem like a good thing,” Rose said.

“There were more Bush people back then,” he said, a lot of whom “still have the legacy of doing PEPFAR with the president,” like Giroir, who “worked on pediatric AIDS as part of his career, and so he was willing to push for some things that we wouldn’t have seen otherwise.”

Rose added that “that’s how he” and longtime National Institute of Allergy and Infectious Diseases Director Anthony Fauci “got together and worked to create, with the Trump people, the Ending the HIV Epidemic initiative.”

“At the same time, those same people who said, ‘wow, these HIV numbers are really bad and we should do something about it’ we’re like, ‘but we hate all these LGBTQ people and their health, and so we’re not going to have any non-discrimination [rules], and we don’t care if we kick them off their health care, and we don’t care if they’re invisible in society,” Rose said.

This is a problem, he said because “given where the epidemic has always been in the community, it’s hard to end the HIV epidemic without talking about LGBTQ people and the resources that we use in the community, and the lives that we live, and the lives that we have.”

“And so, it ends up being this weird place of like, you have these religious, fundamentalist nationalists who want one thing; you have these quasi-public health people who are like, ‘oh, the private sector can help;’ and you have these government people who are like, ‘we’re not spending any new money,'” Rose said.

“I will say that, despite his saying he was supportive, every budget produced by [Trump] when he was in office decimated funding for the CDC and HRSA and HHS in all of the HIV line items,” Rose said. “So, he didn’t wholesale eliminate anything, but he shaved those things down to bare bones.”

Timing

Asked whether the FDA under Trump would be likely to consider rolling back the expanded guidelines on blood donation for men who have sex with men, Rose said no.

“One, it’s very small potatoes for them,” he said. Plus, “because it was done through formal rule making, it would take a lot of effort to roll it back” and the guidelines ā€” while they are substantially better than the categorical ban on blood donation by gay and bisexual men that persisted for decades ā€” are not exactly perfect.

At HRC, Rose said, “we would say [the policy is] still not in a perfect place, because it still requires a level of deferment that is not the same for heterosexuals who engage in the same sexual activity, where data could just tell you and you’re going to test the blood anyway.”

More broadly, Rose said, “I think about what levers can they pull when. Like, dismantling the Affordable Care Act is going to take a while. He has ‘concepts of a plan,’ but until he gets rid of concepts and actually has a plan, no one’s buying that.”

The proposal for “block granting Medicaid” is also unlikely, Rose said. “Medicaid is one of the largest payers of HIV services, both for treatment and prevention, because there’s just a lot of low-income people on Medicaid and the poverty tracks are similar to the HIV tracks. So changes to the Medicaid program, I worry about like things like work requirements, which they’ll try again. That will happen faster than block granting.”

Timing-wise, Rose said, “For health, there’s just a lot of regulation to get through” so, “we’ll have less acute pain than some of the immigration stuff” where the administration will “hit the ground running on day one.”

At the same time, he added, for people living with HIV who are in mixed-status families, or who are undocumented, there will be a “chilling effect” that “will happen really soon, or could happen really soon,” which is “something I worry about the most, right away.”

PrEP

Changes to America’s healthcare governance come as the outgoing administration has pushed to expand access to preventative medicine for reducing the risk of HIV transmission, which follow major advancements in drug discovery.

“There is a new version that Gilead Sciences is putting up, lenacapavir,” Rose said, which is administered twice per year with a subcutaneous self-injector. The drug ” will have a different name when it comes to market, just like cabotegravir became Apretude,” he said.

“The coverage determination that the administration just released last month covers all PrEP products,” Rose said. “It happens to cover all three of them right now. Technically, it’s just a clarification of the existing rule already.”

He continued, “The ACA already required that you provide any Grade-A rated, preventative service at a zero cost sharing. And this clarification just says, ‘Hey, you were supposed to be doing this. We heard some of you aren’t doing this. If you want to sell in the marketplace, you have to do this.’ We saw the same [thing] with contraceptives also had to have this clarification.”

PrEP enjoys the rare distinction of being a drug regimen that is covered along with preventative services like mammograms, Rose added.

“In the early days of PrEP, we made the case to insurance companies that they should cover it,” he said, because “from a financial standpoint, at the time it was $16,000 a year for Truvada, which now has gone down with the generic. It’s around $18,000 for Descovy, but that is still cheaper than the overall cost of [HIV] treatment a year, which is, you’re looking at $62,000 plus additional medical expenses and costs.”

“Without guidance from the government, it was kind of a free range and the insurance companies said, ‘well, we’re going to put in prior authorizations to cost-control this,'” Rose added.

Baskerville detailed how HRC will continue to serve populations impacted by HIV.

“One of our biggest initiatives around wellness and action is our HIV self-testing kit program, understanding that there is a group of communities who will not go into a brick and mortar house and get tested,” he said. “And so providing them with another option” is important, and so on this initiative “we partner with seven community-based organizations across the U.S. mainland, and Puerto Rico, to distribute testing kits throughout the country.”

“In that partnership we have also worked with CVS Health,” Baskerville added. “What’s different with our program than other self-testing kit programs is that all of our partners also work to do a follow-up, so a navigation piece, once they distribute a testing kit, following up with them to see one, have they taken the test? If they have not taken the test, figuring out what barriers are in place, to get them to take the test and addressing those barriers. And then if they have taken the test, figuring out what their result was, and then connecting them to either care, if it was a reactive test, or connecting them to PrEP services if it was non-reactive.”

Baskerville continued, “We also have our leadership development program where we work with different populations over a course of six months to educate them around health equity, HIV, to then empower them to go into their communities, to help them be spokespeople and be advocates for HIV and help their community get the services that they need. This year, we particularly work with Black, sexually minoritized men living with HIV at the intersection of mental health, understanding that post-coming out of COVID, there have been a lot of issues with mental health things and depression and anxiety among populations.”

Additionally, “we have our public education sexual health platform, which is our My Body My Health” portal, Baskerville said, “where we provide all sex-positive, body-positive sexual health education as well as resources.”

“We’re currently developing what we call an HIV service provider index, and that is to assess service providers and their quality of service provision as it relates to providing HIV services to individuals, particularly Black and Latin LGBTQ community folks,” he said. “And so we’re utilizing that because we hear stories all the time around folks going to their providers and being denied PrEP or being told they can only get one particular version of PrEP when they want something different. It should be completed and developed by the end of February 2025, with implementation expected to happen kind around May ā€“ June.”

“We are constantly working with our federal partners to ensure that community’s perspective and the voice of community is is a part of the conversations when they’re thinking through policies and procedures,” Baskerville said.

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Federal Government

Education Department moves to end support for trans students

Mental health services among programs that are in jeopardy

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The U.S. Department of Education headquarters in D.C. (Photo courtesy of the GSA/Education Department)

An email sent to employees at the U.S. Department of Education on Friday explains that “programs, contracts, policies, outward-facing media, regulations, and internal practices” will be reviewed and cut in cases where they ā€œfail to affirm the reality of biological sex.ā€

The move, which is of a piece with President Donald Trump’s executive orders restricting transgender rights, jeopardizes the future of initiatives at the agency like mental health services and support for students experiencing homelessness.

Along with external-facing work at the agency, the directive targets employee programs such as those administered by LGBTQ resource groups, in keeping with the Trump-Vance administration’s rollback of diversity, equity, and inclusion within the federal government.

In recent weeks, federal agencies had begun changing their documents, policies, and websites for purposes of compliance with the new administration’s first executive action targeting the trans community, ā€œDefending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.ā€

For instance, the Education Department had removed a webpage offering tips for schools to better support homeless LGBTQ youth, noted ProPublica, which broke the news of the “sweeping” changes announced in the email to DOE staff.

According to the news service, the directive further explains the administration’s position that ā€œThe deliberate subjugation of women and girls by means of gender ideology ā€” whether in intimate spaces, weaponized language, or American classrooms ā€” negated the civil rights of biological females and fostered distrust of our federal institutions.”

A U.S. Senate committee hearing will be held Thursday for Linda McMahon, Trump’s nominee for education secretary, who has been criticized by LGBTQ advocacy groups. GLAAD, for instance, notes that she helped to launch and currently chairs the board of a conservative think tank that “has campaigned against policies that support transgender rights in education.”

NBC News reported on Tuesday that Trump planned to issue an executive order this week to abolish the Education Department altogether.

While the president and his conservative allies in and outside the administration have repeatedly expressed plans to disband the agency, doing so would require approval from Congress.

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Trump bans transgender service members from U.S. armed forces

Lambda Legal, HRC announce plans to sue

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President Donald Trump (Photo via White House/X)

President Donald Trump on Monday signed a series of executive orders focused on the military, including a directive gutting the Pentagon’s diversity, equity, and inclusion programs along with another banning transgender service members from the U.S. armed forces.

White House officials said new military standards for mental and physical readiness will exclude transgender troops, which would mean the EO goes further than the ban Trump implemented during his first term in 2017.

Among the first actions the president took after his inauguration on Jan. 20 was rescinding the order that former President Joe Biden signed immediately after he took office in 2021 that allowed trans and gender diverse service members to serve openly.

ā€œThe implementation [of the ban] is on the DoD regarding specifics,ā€ a White House official told CNN.

A February 2018 memo by the U.S. Department of Defense contained carveouts to exempt trans service members already in uniform who had joined the military prior to the policy excluding them, along with those who do not require a change in gender or those who have been ā€œstable for 36 consecutive months in their biological sex prior to accession.ā€

DEI practices, meanwhile, will be subject to review by Defense Secretary Pete Hegseth, who was narrowly confirmed by the U.S. Senate on Friday.

Lambda Legal and the Human Rights Campaign on Monday announced plans to sue the Trump-Vance administration “to block implementation of yet another discriminatory and dangerous attempt to bar patriotic transgender military service members from serving openly in the U.S. armed services,” Lambda Legal said in a press release.

ā€œWe have been here before and seven years ago were able to successfully block the earlier administrationā€™s effort to prevent patriotic, talented Americans from serving their country,ā€ said Sasha Buchert, Lambda Legal counsel and director of the Nonbinary and Transgender Rights Project. ā€œNot only is such a move cruel, it compromises the safety and security of our country and is particularly dangerous and wrong. As we promised then, so do we now: we will sue.”

ā€œThousands of current service members are transgender, and many have been serving openly, courageously, and successfully in the U.S. military for more than eight years ā€” not to mention the previous decades when many were forced to serve in silence,” Buchert added. “Once again, as during the first term, the Trump administration is attacking a vulnerable population based on bias, political opportunism, and demonstrably untrue ā€˜alternative facts,ā€™ denying brave men and women the opportunity to serve our country without any legitimate justification whatsoever.ā€ 

Sarah Warbelow, vice president of legal at HRC, said ā€œOur military servicemembers, including thousands of transgender troops, wear the same uniform, take the same oath, and meet the same rigorous standards,” adding, “They are heroes who put their lives on the line to protect our countryā€”and we owe them all a debt of gratitude.ā€

ā€œInstead, this discriminatory ban insults their service and puts our national security at risk. Expelling highly trained members of our military undermines military readiness and wastes years of financial and training investments,” Warbelow said.

“It also needlessly upends the lives of families who have already sacrificed so much,” she said. “The Commander-in-Chief should prioritize our militaryā€™s safety and readiness, not use his position to issue bans on entire groups of people. This order is unconstitutional, and we will see this administration in court.ā€ 

GLBTQ Legal Advocates & Defenders (GLAD) and the National Center for Lesbian Rights also filed a federal lawsuit on Tuesday challenging the ban. The suit,Ā Talbott v. Trump, was filed on equal protection grounds on behalf of six active service members and two individuals actively seeking enlistment, according to a statement from the groups.

ā€œWhen you put on the uniform, differences fall away and what matters is your ability to do the job,ā€Ā said Nicolas Talbott, Second Lieutenant, Army.Ā ā€œEvery individual must meet the same objective and rigorous qualifications in order to serve.”

SPARTA Pride, a nonprofit of transgender people who currently serve or have served in the military, released a statement on Monday:

“Transgender Americans have served openly and honorably in the U.S. Armed Forces for nearly a decade. Thousands of transgender troops are currently serving, and are fully qualified for the positions in which they serve. 

“Transgender service members currently fill critical roles in combat arms, aviation, nuclear engineering, law enforcement, and military intelligence, many requiring years of specialized training and expertise. Transgender troops have deployed to combat zones, served in high-stakes missions, and demonstrated their ability to strengthen unit cohesion and morale. 

“While some transgender troops do have surgery, the recovery time and cost is minimal, and is scheduled so as not to impact deployments or mission readiness (all of which is similar to a non-emergent minor knee surgery). The readiness and physical capabilities of transgender service members is not different from that of other service members.

“SPARTA Pride is standing by to support all transgender service members impacted by this policy.” 

ā€œDonald Trumpā€™s executive orders are not only cruel, discriminatory, and wrapped in disinformation, but they will make all of us less safe. Throughout our militaryā€™s history, thousands of transgender people have served with honor, integrity, and bravery,” said Fatima Goss Graves, president and CEO of the National Womenā€™s Law Center. “Attempting to ban them is an insult to their humanity and the contributions that they have made.”

ā€œAdditionally, Trumpā€™s decision to remove diversity, equity, and inclusion initiatives will lead to further harassment in our ranks, making underrepresented service members a greater target for discrimination,” she said. “Already we are hearing reports of anti-harassment policies being taken down based on the order to end equity and inclusion initiatives, which is appalling, misguided, and a gross insult to those who serve.”

Goss Graves added, “Everyone, regardless of race, gender or sex, should be able to work with dignityā€” including in the military ā€” without fear of discrimination and harassment. We will continue to fight against these harmful abuses of power.ā€ 

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Senate confirms gay Treasury secretary nominee Scott Bessent

Hedge fund manager confirmed by 68-29 vote margin

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Treasury Secretary Scott Bessent (Washington Blade photo by Michael Key)

The U.S. Senate on Monday confirmed President Donald Trump’s pick for Treasury secretary, openly gay hedge fund manager Scott Bessent.

Overcoming opposition from some economically progressive Senate Democrats like Elizabeth Warren (Mass.) and Ron Wyden (Ore.), the nominee was confirmed by vote of 68-29.

Bessent during his hearing said that extending tax cuts that were passed during Trump’s first administration with the 2017 Tax Cuts and Jobs Act but are slated to expire in 2025 will be a top priority.

ā€œThis is pass-fail, that if we do not fix these tax cuts, if we do not renew and extend, then we will be facing an economic calamity,” he told the senators.

“Today, I believe that President Trump has a generational opportunity to unleash a new economic golden age that will create more jobs, wealth and prosperity for all Americans,” Bessent said at his confirmation hearing. 

According to Fortune Magazine, Bessent, who is a billionaire, disclosed assets worth an estimated $521 million.

He will be the second openly gay man to serve in the Cabinet, after Biden-Harris administration Transportation Secretary Pete Buttigieg, and in a Cabinet-level office, after Obama-Biden administration Acting U.S. Trade Representative Demetrios Marantis and Trump-Pence administration Acting Director of National Intelligence Ric Grenell.

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