National
‘Fiscal cliff’ brings fears of devastating AIDS cuts
More than 12,000 HIV patients could lose access to care next year
AIDS Institute Deputy Executive Director Carl Schmid estimated that up to 12,000 people in ADAP could lose access to care. (Blade file photo by Michael Key)
Pending across-the-board cuts to federal programs have advocates concerned that up to 12,200 people living with HIV/AIDS in the United States could lose access to drugs and programs unless Congress takes action.
The anticipated cuts, set to take effect on Jan. 2, are the result of the Budget Control Act, legislation President Obama signed last year as part of a compromise to raise the limit on the nation’s debt ceiling. It would reduce continued funding for the U.S. government in 2013 and beyond by cutting an estimated 8.2 percent in the first year from discretionary federal programs — including HIV/AIDS programs.
Carl Schmid, deputy executive director of the AIDS Institute, said unless Congress acts to institute an alternative budget, the level of funding provided would be troublesome because “people wouldn’t be able to get their drugs.”
“The sequestration wasn’t ever to occur and within three months from now, it’s going to take place unless Congress acts,” Schmid said. “It would be devastating to our programs.”
Kimberly Crump, policy officer at HIV Medicine Association, said problems are already emerging because care providers aren’t sure what level of funding will ultimately be provided.
“It really hinders them in hiring staff and making decisions around personnel, around controlling costs of labs and accepting new patients, the hours that they can be open,” Crump said. “It’s going to really start to impact availability of services.”
Estimates for what these cuts would mean for people living with HIV/AIDS have varied widely. In a letter dated Sept. 19 to Congress, the AIDS Institute says the reductions to ADAP funding could mean wait lists for drugs would once again be extended and around 9,400 patients would lose access to medication.
“This would automatically create wait lists again, and extremely long ones,” Schmid told the Blade. “But it could be even more than that, we’re doing some further analysis, so some people are saying it’s like 10,000 to 12,000 people removed from the ADAP program if this sequestration goes through.”
The number is an estimate from the Department of Health & Human Services. In a June 29 letter to Congress, Ellen Murray, HHS assistant secretary for financial resources, writes that “approximately 12,150 fewer patients” would receive benefits from the AIDS Drug Assistance Program.
A July 25 report from the Senate Health, Education, Labor & Pensions Committee similarly estimates that 12,219 people in the United States receiving drugs from ADAP would lose access to medicine. The report details how many individuals would lose access for each jurisdiction in the United States. For example, the committee estimates 199 fewer people in D.C. would have access to drugs.
In the letter to Congress, the AIDS Institute spells out the reductions to four federal HIV/AIDS programs that would result from sequestration, which amounts to a total reduction of $538 million based on calculations from fiscal year 2012 levels:
• funding for HIV prevention at the Centers for Disease Control would be cut by $64 million;
• the Ryan White HIV/AIDS Program, which provides care to low income people with the disease, would be cut by $196 million, including $77 million in cuts from the AIDS Drug Assistance Program;
• AIDS research at the National Institutes of Health would be cut by $251 million;
• and the Housing Opportunities for People with AIDS, or HOPWA, program would be cut by $27 million.
One consolation is that funds for Medicare and Medicaid would largely be immune from cuts. Medicare would only be reduced by 2 percent — and those cuts wouldn’t come from programs for patients, but providers. Medicaid, under which 50 percent of people living with HIV/AIDS receive care, won’t see any cuts.
The Washington Blade reported in August 2011 at the time President Obama signed the Budget Control Act that the legislation could impact HIV/AIDS programs, and again reported on the issue when the congressional supercommittee established by the legislation failed to provide an alternative to across the board cuts, but cost estimates for reductions weren’t previously known.
But the cuts wouldn’t only affect domestic programs aimed at providing care to people with HIV, but global programs as well, including the President’s Emergency Plan for AIDS Relief, or PEPFAR, and U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Chris Collins, director of policy for amfAR, said the sequestration — commonly referred to as the “fiscal cliff” — would have a “devastating impact” on programs aimed at confronting HIV/AIDS overseas.
“It would undercut multiple aspects of the global AIDS response from treating people, which we know has a potential for saving lives, but also to preventing infection, as well as programs to help kids who are vulnerable,” Collins said. “Sequestration sets us up for seriously backtracking in response to global AIDS just at the time when we have the ability to really accelerate progress.”
In a brief published Sept. 25, amfAR provides details on the problems that reductions to global AIDS initiatives would cause. As a result of projected decreases to U.S. government bilateral support, HIV/AIDS treatments for 276,500 people wouldn’t be available, potentially leading to 63,000 more AIDS-related deaths and 124,000 more children becoming orphans. The decrease in U.S. contributions to the Global Fund would result in an additional 100,000 people not being treated for HIV/AIDS.
In addition to HIV/AIDS programs, federal initiatives that more generally serve the LGBT community would also face cuts under the sequester. The U.S. Equal Employment Opportunity Commission, which earlier this year interpreted federal law to allow it to protect transgender workers from discrimination, would face cuts as would the Justice Department’s community relations service to fight hate crimes.
Laurie Young, the National Gay & Lesbian Task Force’s director of aging and economic security, said the sequester could have an impact on local LGBT community centers that rely on funds from the federal government.
“Any programs … that are funded out of the Older Americans Act — community health programs, community health centers — any of the programs that receive any kind of federal support could be affected by it,” Young said.
Young said the cuts could also affect U.S. governmental efforts in research, including data collection efforts for LGBT people on health surveys, which the Department of Health & Human Services began to implement last year upon requests from LGBT advocates.
HIV/AIDS advocates expressed dismay that the pending defense cuts under the sequester — which would reduce the Pentagon’s budget by an estimated $54.7 billion in 2013 — have received attention in the media, but other programs haven’t received significant attention.
Crump said big ticket items like defense and Medicare have greater “political clout” behind them, which makes other programs such as HIV/AIDS more vulnerable to cuts.
“It makes the non-defense discretionary budget more vulnerable to cuts when these other big ticket items have their champions talking about fencing off or protecting them,” Crump said. “That means we’re going to have to cut more steeply into these other annually funded programs.”
Government agencies that operate programs for people with HIV/AIDS referred the Washington Blade to the White House Office of Budget & Management, which issued a report on Sept. 14 detailing the extent of cuts to government programs.
“As the administration has made clear, no amount of planning can mitigate the effect of these cuts,” the report states. “Sequestration is a blunt and indiscriminate instrument. It is not the responsible way for our nation to achieve deficit reduction.”
Amid this fear, observers were generally optimistic that Congress would institute an alternative to the Budget Control Act to avoid the cuts to HIV/AIDS and other programs.
A Senate Democratic aide, who spoke on condition of anonymity, said an agreement to avoid the sequester would likely be reached after campaign season has concluded.
“As much as we like to piss on each other’s boots and do nothing, when there’s a gun to our head, we know it’s time to do something,” the aide said.
The aide predicted a proposal similar to previously proposed bipartisan debt reduction plans — those from the Simpson-Bowles Commission, the Domenici-Rivlin Task Force or the “Gang of Six” — would be enacted.
But even if an agreement is reached, concerns persist that Congress could enact a plan that would cut into HIV/AIDS funds even more so than the Budget Control Act — especially because another agreement on the debt ceiling must be reached in February when the limit will likely be reached.
Schmid said an alternative plan that Congress might come up with could reach into currently protected programs of Medicare and Medicaid to pay for budget reduction.
“We still have to come up with these cuts, and so they are looking at different ways,” Schmid said. “But Medicare and Medicaid will be back on the table again, and we are concerned about that as well.”
Young predicted that any plan Congress would enact for deficit reduction would cut funding for government programs, but it remains to be seen where those cuts would fall.
“There’s going to be some pain somewhere because the whole reason that the sequestration was enacted and passed was because of the rampant fears about the outrageous federal deficit,” Young said. “Now I could get on my soap box with you, but the reason that the deficit is the way it is today is because we’ve had 10 or 12 years of tax cuts, and in order to pay our bills we have to have money coming in.”
And Crump said if the election results in wins for Republicans, they may feel emboldened to pass a plan similar to what House Budget Committee Chair and Republican vice presidential nominee Paul Ryan has proposed, which she said would “cut even more deeply” than sequestration.
“There’s a looming series of threats to the whole health care environment that could very much impact the hope that the Affordable Care Act held for improving HIV care and access to care for people with HIV,” Crump said.
Eswatini
PEPFAR delivers first doses of groundbreaking HIV prevention drug to two African countries
Lenacapavir now available in Eswatini and Zambia.
The State Department on Tuesday announced PEPFAR has delivered the first doses of a groundbreaking HIV prevention drug to two African countries.
The lenacapavir doses arrived in Eswatini and Zambia.
The State Department in September unveiled an initiative with Gilead Sciences to bring lenacapavir “to market in high-burden HIV countries.”
Lenacapavir users inject the drug twice a year.
The State Department in its September announcement noted everyone who participated in Gilead’s clinical trials remained HIV negative. It also said lenacapavir “has the potential to be particularly helpful for pregnant and breastfeeding mothers, as it safely protects them during and after pregnancy to prevent mother-to-child transmission.”
“In our new America First Global Health Strategy, the Department of State is establishing a first-of-its-kind innovation fund to support American-led research, market-shaping, and other dynamic advancements in global health,” said PEPFAR on Tuesday in a press release.
“The arrivals of the first doses of lenacapavir in Eswatini and Zambia mark an important milestone in HIV prevention and reflect our commitment to supporting communities with the greatest need,” added Gilead CEO Daniel O’Day. “For the first time, a new HIV medicine is reaching communities in sub-Saharan Africa in the same year as its U.S. approval.”
The September announcement came against the backdrop of widespread criticism over the Trump-Vance administration’s reported plans to not fully fund PEPFAR and to cut domestic HIV/AIDS funding. The Washington Blade has previously reported PEPFAR-funded programs in Kenya and other African countries have been forced to curtail services or even close because of U.S. funding cuts.
National
213 House members ask Speaker Johnson to condemn anti-trans rhetoric
Letter cites ‘demonizing and dehumanizing’ language
The Congressional Equality Caucus has sent a letter urging Speaker of the House Mike Johnson to condemn the surge in anti-trans rhetoric coming from members of Congress.
The letter, signed by 213 members, criticizes Johnson for permitting some lawmakers to use “demonizing and dehumanizing” language directed at the transgender community.
The first signature on the letter is Rep. Sarah McBride of Delaware, the only transgender member of Congress.
It also includes signatures from Leader Hakeem Jeffries (NY-08), Democratic Whip Katherine Clark (MA-05), House Democratic Caucus Chair Pete Aguilar (CA-33), every member of the Congressional Equality Caucus, and members of every major House Democratic ideological caucus.
Some House Republicans have used slurs to address members of the transgender community during official business, including in committee hearings and on the House floor.
The House has strict rules governing proper language—rules the letter directly cites—while noting that no corrective action was taken by the Chair or Speaker Pro Tempore when these violations occurred.
The letter also calls out members of Congress—though none by name—for inappropriate comments, including calls to institutionalize all transgender people, references to transgender people as mentally ill, and false claims portraying them as inherently violent or as a national security threat.
Citing FBI data, the letter notes that 463 hate crime incidents were reported due to gender identity bias. It also references a 2023 Williams Institute report showing that transgender people are more than four times more likely than cisgender people to experience violent victimization, despite making up less than 2% of the U.S. population.
The letter ends with a renewed plea for Speaker Johnson to take appropriate measures to protect not only the trans member of Congress from harassment, but also transgender people across the country.
“We urge you to condemn the rise in dehumanizing rhetoric targeting the transgender community and to ensure members of your conference are abiding by rules of decorum and not using their platforms to demonize and scapegoat the transgender community, including by ensuring members are not using slurs to refer to the transgender community.”
The full letter, including the complete list of signatories, can be found at equality.house.gov. (https://equality.house.gov/sites/evo-subsites/equality.house.gov/files/evo-media-document/letter-to-speaker-johnson-on-anti-transgender-rhetoric-enforcing-rules-of-decorum.pdf)
The White House
EXCLUSIVE: Garcia, Markey reintroduce bill to require U.S. to promote LGBTQ rights abroad
International Human Rights Defense Act also calls for permanent special envoy
Two lawmakers on Monday have reintroduced a bill that would require the State Department to promote LGBTQ rights abroad.
A press release notes the International Human Rights Defense Act that U.S. Sen. Edward Markey (D-Mass.) and U.S. Rep. Robert Garcia (D-Calif.) introduced would “direct” the State Department “to monitor and respond to violence against LGBTQ+ people worldwide, while creating a comprehensive plan to combat discrimination, criminalization, and hate-motivated attacks against LGBTQ+ communities” and “formally establish a special envoy to coordinate LGBTQ+ policies across the State Department.”
“LGBTQ+ people here at home and around the world continue to face escalating violence, discrimination, and rollbacks of their rights, and we must act now,” said Garcia in the press release. “This bill will stand up for LGBTQ+ communities at home and abroad, and show the world that our nation can be a leader when it comes to protecting dignity and human rights once again.”
Markey, Garcia, and U.S. Rep. Sara Jacobs (D-Calif.) in 2023 introduced the International Human Rights Defense Act. Markey and former California Congressman Alan Lowenthal in 2019 sponsored the same bill.
The promotion of LGBTQ and intersex rights was a cornerstone of the Biden-Harris administration’s overall foreign policy.
The global LGBTQ and intersex rights movement since the Trump-Vance administration froze nearly all U.S. foreign aid has lost more than an estimated $50 million in funding.
The U.S. Agency for International Development, which funded dozens of advocacy groups around the world, officially shut down on July 1. Secretary of State Marco Rubio earlier this year said the State Department would administer the remaining 17 percent of USAID contracts that had not been cancelled.
Then-President Joe Biden in 2021 named Jessica Stern — the former executive director of Outright International — as his administration’s special U.S. envoy for the promotion of LGBTQ and intersex rights.
The Trump-Vance White House has not named anyone to the position.
Stern, who co-founded the Alliance for Diplomacy and Justice after she left the government, is among those who sharply criticized the removal of LGBTQ- and intersex-specific references from the State Department’s 2024 human rights report.
“It is deliberate erasure,” said Stern in August after the State Department released the report.
The Congressional Equality Caucus in a Sept. 9 letter to Rubio urged the State Department to once again include LGBTQ and intersex people in their annual human rights reports. Garcia, U.S. Reps. Julie Johnson (D-Texas), and Sarah McBride (D-Del.), who chair the group’s International LGBTQI+ Rights Task Force, spearheaded the letter.
“We must recommit the United States to the defense of human rights and the promotion of equality and justice around the world,” said Markey in response to the International Human Rights Defense Act that he and Garcia introduced. “It is as important as ever that we stand up and protect LGBTQ+ individuals from the Trump administration’s cruel attempts to further marginalize this community. I will continue to fight alongside LGBTQ+ individuals for a world that recognizes that LGBTQ+ rights are human rights.”
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