Health
CMS moves to expand HIV-positive organ transplants
HIV/AIDS activists welcome potential development
The Centers for Medicare and Medicaid Services is pushing forward a proposed rule that would make it not only easier for people with HIV in need to get organ transplants from HIV-positive donors, but also make it a priority where there was often a barrier.
The Washington Blade sat down with people familiar with this topic — from former heads of the Centers for Disease Control and Prevention, to HIV activists and to the first HIV-positive person to donate an organ — about what this proposed change could mean.
HIV is a virus that attacks the body’s immune system, particularly targeting the body’s T-cells, which makes it harder to fight off infection and disease. If left untreated, HIV can become AIDS. Without treatment, AIDS can lead to death within a few months or years. The virus is spread through direct contact with bodily fluids — often through sex, unclean needles, or from mother to baby during pregnancy.
According to HIV.gov, a website managed by the U.S. Department of Health and Human Services, approximately 1.2 million people in the U.S. were living with HIV in 2022. Of those 1.2 million, 13 percent don’t know they have it.
The virus disproportionately impacts men who have sex with men and people of color.
The CDC’s statistics show men are most affected, making up almost 80 percent of diagnoses, with gay and bisexual men accounting for the majority. Racial disparities also are present — Black people make up 38 percent of diagnoses. The World Health Organization estimates that around 44.1 million people have died from AIDS-related illnesses globally as of 2024.
Since the virus was first detected 45 years ago, scientists have been working on ways to treat and prevent its spread. In 1987, the first breakthrough in fighting HIV came as the U.S. approved the first HIV medication, AZT — marking the beginning of antiretroviral therapy. This medicine — and later descendants of it, like today’s widely prescribed Biktarvy — stop the HIV virus from reproducing and allow the body to keep its T-cells.
Then in 2012, another big step toward minimizing the scope of the potentially fatal disease came as the CDC approved the first HIV prevention medication, Truvada, more commonly known as PrEP. As of 2024, nearly 600,000 people in the U.S. are using PrEP, according to AIDSVu, which uses data from Gilead Sciences (manufacturers of Truvada and Biktarvy) and is compiled by researchers at the Rollins School of Public Health at Emory University.
The following year, in 2013, the HIV Organ Policy Equity (HOPE) Act was signed into law, enabling the use of organs from HIV-positive donors for transplants into HIV-positive recipients, overturning a 1988 ban.
There are an estimated 123,000 people waiting for organ transplants in the U.S. The number of HIV-positive people on that list is estimated to be smaller, harder to precisely quantify, but they are still in dire need.
A study from the New England Journal of Medicine, published in 2024, analyzed the outcomes of 198 kidney transplantations to people with HIV at 26 medical centers across the U.S. from 2018 to 2021.
Results from the study showed that for kidney transplants performed using organs from 99 donors with HIV and 99 without HIV, one-year survival rates for HIV-positive recipients were nearly identical (94 percent and 95 percent, respectively). Three-year survival rates were also similar (85 percent and 87 percent). Organ rejection rates were also numerically on par after three years (21 percent and 24 percent). Other measures for surgical outcomes, including the number of side effects that occurred, were also roughly the same for both groups.
This shows that, overall, HIV-positive-to-HIV-positive transplants are nearly identical in outcome to transplants between HIV-negative donors and recipients.
Where we are now
Now in 2026, CMS is pushing past the clinical trial testing phase it has been in, making HIV-positive-to-HIV-positive organ transplants more widespread and more accessible.
Adrian Shanker, the former deputy assistant secretary for health policy and senior advisor on LGBTQ health equity at HHS, explained to the Blade that the HOPE Act was a step in the right direction, but this policy change from CMS will expand the ability to help HIV-positive patients in need.
“The original HOPE Act asked for scientific research,” Shanker explained. “There were 10 years of clinical trials. The Biden administration promulgated a rule that removed clinical trial requirements for kidney and liver transplants between people living with HIV. This proposed rule is further implementation on the CMS side with the organ procurement organizations to ensure they’re carrying out the stated intent of the HOPE Act law. It’s building on consensus that has existed through multiple administrations.”
The proposed change would go into effect on July 1, and, according to Shanker, would help everyone in need of an organ — not just HIV-positive people.
“People living with HIV, their ability to receive organs from other people living with HIV in a more streamlined way means that the overall organ waitlist is sped up as well,” he added. “So it benefits everyone on the waitlist.”
Shanker, who was also a member of the Presidential Advisory Council on HIV/AIDS, spoke about how this is a rare moment of bipartisanship.
“There’s no secret that the Trump administration has been quite adversarial to LGBTQI plus health, and to the health of people living with HIV/HIV prevention resources as well … From destabilizing PEPFAR to shutting down one of the primary implementation partners, which is USAID, to firing almost the entire staff of the Office of Infectious Disease and HIV Policy at HHS … But what this is is a glimmer of hope that we can have bipartisan solutions that improve quality of life for people living with HIV.”
Harold Phillips, the CEO of NMAC, a national HIV/AIDS organization that pushes policy education and public engagement to end the HIV epidemic, and an HIV-positive American, sees this as a huge gain for the HIV-positive community.
“For a number of years, we were excluded from that pool of potential donors,” Phillips said. “Many people living with HIV were excluded from being able to get organ transplants. So this opens up that door. This is a positive step forward that will help save lives.”
That “open door,” Phillips said, does more than just provide life-saving organs to people in the most need. It provides a sense of being able to support their community.
“I remember when I was no longer able to check that box on my driver’s license,” Phillips recalled during his interview with the Blade. “I remember what that meant — that my organs might not be able to save a life. The potential that now they could is really exciting for me.”
“To think about people living with HIV donating their organs to other people living with HIV and helping extend their health and well-being — that’s an exciting moment in our history. It reinforces that HIV is not a death sentence anymore.”
Human Rights Campaign Senior Public Policy Advocate Matt Rose also sat down with the Blade to explain the realities of HIV-positive people in the U.S. right now who are looking for a transplant.
“If you’re HIV positive and on the waitlist for an organ right now, your chance of getting one is slim to nil,” Rose said. “This at least gives you a real shot.”
He went on to explain that while the HOPE Act started to move in the right direction, it hasn’t done enough for HIV-positive people in dire need.
“This bill [HOPE] was supposed to fix that — and it never really has. But every administration, we keep chipping away at the next hurdle,” he said. “This latest move will drastically expand the ability for someone who is HIV positive to donate an organ.”
That slow chipping away, in addition to the non-stop trials being done to prove the efficacy and ability for HIV-positive people’s bodies to accept organ donation, is part of the broader push to normalize this practice and remove outdated restrictions.
Shanker elaborated, explaining all that time was necessary to figure out the efficacy of HIV-positive-to-HIV-positive organ transplants but now that the data has been collected — its time to expand the availability.
“There were over a decade of clinical trials between the original HOPE Act law being signed by President Obama and our rule being promulgated at the end of the Biden administration. It was to allow those clinical trials to run their course,” Shanker said.
Nina Martinez is the first HIV-positive person to donate an organ to another person with HIV.
She explained that the stigma and lack of understanding from the general public is another hurdle that those working to improve the quality of life for people living with HIV have to deal with.
“People don’t generally understand that treatment works,” Martinez said, who became the first person to undergo HIV-positive organ donation in 2019. “When you have access to antiretroviral therapy, it lowers the virus in your bloodstream to levels so low that lab tests can’t detect it. Clinically, that correlates to good health and an inability to transmit HIV sexually. I was healthy enough to pass the same evaluation as any other living donor without HIV.”
She continued explaining:
“Just by having a diagnosis of HIV, they’re labeling donors as medically complex, and that’s not accurate. Every donor with HIV has to pass the same evaluation as donors without HIV,” she said. “If someone passes that evaluation and still isn’t allowed to donate, that’s discrimination. If a patient is willing to accept that organ and you block it because of preconceived notions, you’re denying someone care based on disability. That runs counter to basic fairness.”
When asked about her decision to become a donor and what message she hopes it sends, Martinez emphasized that the choice should remain personal.
“I didn’t undertake this endeavor to say that people with HIV should donate. This is a community that’s been through a lot and has contributed to science — we have served. But for people who wanted a way to leave a legacy, and that is what I wanted, they should be supported in that. There shouldn’t be arcane scientific perceptions and myths getting in the way of that.”
National Donor Day, which raises awareness of organ donation, is on Feb. 14. To become an organ donor, visit registerme.org.
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.
Health
UPDATED: Trans-led HIV clinic in Portsmouth struggles amid funding cuts
As states across the U.S. cut funding for HIV care this small clinic in Va, is still fighting
Two years ago, Nyonna Byers, a transgender woman from Portsmouth, Va., founded Ending Transmission of Sexual Infections (ETSI) Health Clinic to support a community she saw struggling with rising HIV rates. Now, as costs continue to climb and funding for HIV healthcare initiatives is being cut across the United States, Byers says her transgender identity has made it harder to secure the financial support her clinic needs to survive.
Portsmouth, with just under 100,000 people, is right across the Elizabeth River from Norfolk.
“We’re an HIV-led organization here in Portsmouth, providing services throughout the Hampton Roads area,” Byers told the Blade. “As a trans-led organization—with me as the founder and executive director—I’ve received a lot of rejection when it comes to funding. That’s one of the main reasons why we’re struggling to keep the clinic open. Without funding, we can’t provide HIV treatment or care, and then we’re just a theoretical organization—we can’t be impactful in the community we serve.”
She said the data clearly shows a need for increased investment in HIV care in Portsmouth, but the response from leadership has not matched the urgency of the crisis.
“Portsmouth is one of the smallest cities with one of the highest HIV rates, and there are very few HIV-led organizations or clinics here. The need is urgent, but the response doesn’t match it. We’re doing the work on the ground, but we’re not getting the support to sustain it. That disconnect is what’s hurting people the most.”
That need, Byers explained, continues to grow as ETSI struggles to meet the financial demands of the life-saving work it provides.
Portsmouth has one of the highest HIV prevalence rates in Virginia, with roughly 736.9 cases per 100,000 people—a rate that exceeds both state and national averages.
“Leaders like the mayor and city council don’t focus on public health or social health. They focus more on development—building the city up physically—rather than investing in the health of the people. I’ve applied for funding multiple times and been denied. Every time I’ve asked for resources, I’ve been turned away.”
When asked why, Byers said the answer felt clear to her.
“I honestly believe I was denied funding because I’m trans. I told the mayor I was going to go public with it, because it’s not fair. We’re on the ground doing the work to end HIV, and we’re still not getting the support we need. That’s not just frustrating—it’s harmful.”
While she said local support has been lacking, Byers noted that the state has stepped in—though the funding still falls short of what is needed to sustain the clinic long term.
ETSI Health Clinic was included as a recipient of funding in the Virginia 2027–2028 Senate budget, receiving $50,000 per year from the Virginia General Fund. Byers specifically credited State Sen. Lillie Louise Lucas with helping secure that funding, which she said did not come from city leadership.
Byers shared that she has given up a lot to keep ETSI afloat, but the costs just keep coming.
“I’ve worked a lot of contracts—jobs paying $30 to $40 an hour—and poured that money into my clinic. But the downside is that I’m struggling personally. I’ve lost cars, I’ve lost a house—I’ve lost a lot to keep this clinic going. This work has cost me almost everything.”

She added that the impact of federal policy shifts is also being felt locally. As the Trump-Vance administration continues to roll back what it has described as unnecessary “DEI” spending, Byers said those decisions are affecting clinics like hers.
There was a time when the clinic was able to receive funding from Sentara Cares, the philanthropic program of Sentara Health, a not-for-profit healthcare system based in Virginia and North Carolina, but now they can’t.
“We had funding from Sentara Cares for three years, and it helped keep us going. Then when DEI initiatives started getting rolled back, that funding stopped. I was told directly that because of federal policy changes, they couldn’t fund the clinic. I broke down during that meeting, because it felt like they were really saying they couldn’t support us because of who we are.”
That lack of funding is compounded by broader gaps in healthcare access in the region. Portsmouth—the ninth most populous city in Virginia—does not have a hospital.
“There’s very limited access to care in Portsmouth. We don’t even have a hospital—people have to be transported to Norfolk. We’ve had high rates of syphilis, and the health department is only open a few days a week. A lot of people don’t trust it, and that leaves entire communities without care.”
Byers made it clear that this is more than a passion project for her—it is her life’s calling, and she would do nearly anything to keep it going.
“To be honest, I would go back to sex work before I let my clinic close. This is something I built from the ground up. I built this clinic with money I earned myself. I’m not going to let it disappear without a fight.”
She also pointed to gaps in education and outreach, which she says exacerbate HIV rates despite the availability of preventive measures.
“There’s almost no marketing or education about PrEP in the Hampton Roads area. If you go to places like D.C. or Atlanta, you see billboards and campaigns—but here, you don’t see anything. If people don’t see it, they don’t know about it. That lack of awareness is putting people at risk.”
It is also a deeply personal fight, she explained.
“I’ve lost friends to HIV. People say you can’t die from HIV anymore, but you can if you’re not in care. I’ve seen it firsthand, and that’s what motivates me to keep going. HIV doesn’t have to be a death sentence—but without support, it can become one.”
The Blade reached out to Portsmouth Mayor Shannon E. Glover for comment.
Glover disputed Byers’ claims that her clinic was treated unfairly, including her allegation that her transgender identity played a role in funding decisions.
“There’s no issue with Miss—with her and her organization. We have been in discussion, and quite frankly, the claims that she made as it relates to ‘we’re not treating her equitably and fairly because of her [being] transgender’ that is totally untrue,” Glover told the Blade via phone call. “I’ve talked to Miss Nyonna on a number of occasions, and that is categorically not true.”
Glover added that the city provides funding to various organizations and said he had directed Byers to seek support elsewhere.
“So I’m not understanding what her issues are,” he said. “But in any event, you know, we have funding that we provide to organizations. I’ve recommended other organizations to her. I’ve recommended that she go to the state where they have more flexibility with their budget and they could help her. So that’s what I’m prepared to tell you today. I’m not going to answer any questions. I just wanted to respond that her claim that we are mistreating her, not treating her fair, is totally untrue.”
To donate to ETSI, visit their donation page at ESTIhcvas.org/donate
Health
Housewives head to Capitol Hill to promote PrEP coverage
Bravo’s Real Housewives stars to lobby lawmakers for expanded PrEP access.
Stars from Bravo’s hit franchise “The Real Housewives” are heading to Capitol Hill next week to advocate for expanded access to HIV prevention and treatment.
On March 18, several well-known cast members — including NeNe Leakes, Phaedra Parks, Candiace Dillard Bassett, Erika Jayne, Luann de Lesseps, Melissa Gorga, and Marysol Patton — will travel to D.C. to participate in an advocacy event aimed at increasing awareness and coverage for pre-exposure prophylaxis, commonly known as PrEP.
The event, dubbed “Housewives on the Hill,” is being organized by MISTR, the nation’s largest telehealth platform focused on sexual health. The group’s founder and CEO, Tristan Schukraft, will join the reality television stars as they meet with lawmakers and legislative staff to discuss the importance of maintaining and expanding access to HIV prevention tools.
PrEP is a medication regimen that can, if taken properly, reduce the risk of contracting HIV through sex by up to 99 percent according to public health officials. Advocates say wider access to the medication — including through insurance coverage and telehealth services — is critical to reducing new HIV infections across the United States.
During their day on Capitol Hill, the Housewives are expected to meet with members of Congress and participate in conversations about federal policies affecting HIV prevention and treatment. Organizers say the reality stars will also share personal reflections about the continued impact of HIV on communities across the country and the importance of keeping prevention resources accessible.
The “Housewives on the Hill” event aims to use the cultural influence of the Bravo stars to spotlight HIV prevention efforts and encourage lawmakers to protect and expand access to lifesaving medication and treatment options. Organizers say the goal is simple: ensure that more Americans can access the tools they need to prevent HIV and maintain their sexual health.
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