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‘Fiscal cliff’ brings fears of devastating AIDS cuts

More than 12,000 HIV patients could lose access to care next year

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Carl Schmid, deputy executive director of the AIDS Institut

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.

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National

At Alliance Defending Freedom’s summit, church and state are one

House Speaker Mike Johnson (R-La.) among speakers

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House Speaker Mike Johnson (R-La.) (Washington Blade photo by Michael Key)

Uncloseted Media published this article on July 23.

By SPENCER MACNAUGHTON | Earlier this month, hundreds of people filled a conference room in San Diego. These included Speaker of the House Mike Johnson, Assistant Secretary of Health Admiral Brian Christine, OpenAI executive Dean Ball, and the attorneys general of West Virginia and Idaho.

They all came together for Alliance Defending Freedom’s 2026 Summit. The Christian legal group, also a Southern Poverty Law Center-designated anti-LGBTQ hate group, described the event as a “gathering of leaders from many different spheres, including law, public policy, media, business, education, and Christian leadership.”

Johnson — who has said that “homosexual relationships are inherently unnatural and … society cannot give its stamp of approval to such a dangerous lifestyle” — was a featured speaker.

In his speech, he seemed unconcerned with the separation of church and state: “It is so encouraging to Kelly and I to be among friends and fellow warriors for this cause and people who understand that God is not done with America yet. … ADF’s on the very tip of the spear, front line, defending those very truths and keeping the door open for the spread of the Gospel. This is our moment. I’m telling you, I believe the next season … is going to be the greatest season of this ministry since its inception.”

That ministry is one that has espoused aggressively anti-LGBTQ views since its inception in the early 1990s. It was co-founded by a group of evangelical men, including Alan Sears, who co-authored a book called “The Homosexual Agenda: Exposing the Principal Threat to Religious Freedom Today.” Since then, ADF has opposed gay marriage and supported bans on gay sex and on gender-affirming care for minors.

After helping overturn Roe v. Wade, ADF lawyers have led key victories at the Supreme Court. In 303 Creative v. Elenis, SCOTUS ruled that a website designer could refuse service to gay weddings. And this year they convinced the Court to overturn Colorado’s ban on conversion therapy and to uphold state laws in West Virginia and Idaho that ban trans girls from playing on girls’ sports teams.

At the summit, ADF President Kristen Waggoner, who has promoted conversion therapists and consistently misgenders trans people, interviewed these states’ attorneys general.

“The lawyers who were defending women’s sports were among the best I’ve ever seen in my entire life,” West Virginia Attorney General JB McCuskey told Waggoner.

Similar to Johnson, Trump’s Assistant Secretary of Health Christine showed his commitment to governing based on conservative Christianity. He gave a Bible-thumping speech against gender transition and trans healthcare, saying that it “contradicts … the deeper moral order that is woven into creation itself. For Genesis 1:27 informs us that God created man in his own image. … Male and female” He also said the “complementary relationship between man and woman is divine” and advocated for youth with gender dysphoria to receive care from a pastor.

All of these remarks from politicians made me think of the interview I published earlier this week with Pete Hegseth’s pastor, Doug Wilson. He wants a Christian theocracy in America and told me that: both the perpetrator and the victim should be disciplined in some cases of marital rape; that transgender people are “sad;” that execution is justifiable for certain homosexual acts; and that gay sex should be illegal.

The ADF Summit is glossy and polished. And while its messaging may be less explicit than Pastor Wilson’s, the track record of the organizations shows they have the exact same desires. They’re just deeply strategic in what they say and when and how they say it.

I believe the political power players who attended this year’s summit know this. They know they are endorsing an organization whose members have essentially called for the illegalization of most — if not all ‚ forms of queer behavior and presentation.

In the last few years, these perspectives have become increasingly embedded in the highest rooms of the federal government and they have been effective in stripping away LGBTQ rights. Wilson, who just installed a full-time pastor in Washington to lead services, says there are 10 to 20 government officials who align with his church’s ideology.

It is vital for Americans to keep their eyes wide open to the ultimate goal of groups like ADF: to create a United States that leaves LGBTQ people without rights and that pushes us back in the closet.

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Puerto Rico

LGBTQ ‘human rights crisis is unfolding in Puerto Rico’

Activist spoke at Congressional Hispanic Caucus briefing in D.C. on July 15

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(Washington Blade photo by Michael K. Lavers)

An activist from Puerto Rico who spoke at a Congressional Hispanic Caucus briefing last week in D.C. said anti-LGBTQ laws and policies have left the LGBTQ community in the U.S. commonwealth even more vulnerable.

“A human rights crisis is unfolding in Puerto Rico — one that disproportionately affects LGBT+ people, particularly transgender and nonbinary Puerto Ricans,” said True Self Foundation Executive Director Miguel Vázquez-Rivera.

The True Self Foundation and LatinoJustice PRLDEF participated in the briefing that took place on July 15.

Vázquez-Rivera during the briefing highlighted several anti-LGBTQ laws and policies that have been implemented since Gov. Jenniffer González took office in January 2025. These include Law 63-2025, which prohibits gender-affirming healthcare for anyone under 21, and Law 26-2026, which prohibits the University of Puerto Rico and other “government facilities” from installing “mixed or gender-neutral multi-occupancy restrooms.”

“The legislation aims to strengthen public safety standards while ensuring that no individual is subjected to unlawful discrimination,” noted the Puerto Rico Federal Affairs Administration on Feb. 25 in a press release after González signed it.

González, a Republican who is a member of the pro-statehood New Progressive Party, was Puerto Rico’s resident commissioner in the U.S. House of Representatives before she became governor. González supports President Donald Trump.

Vázquez-Rivera during the briefing highlighted anti-LGBTQ measures that have been introduced in the Puerto Rico Legislative Assembly. These include House Bill 164, which would prohibit transgender athletes from school sports teams that correspond with their gender identity, and House Bill 131, which would allow faith-based adoption agencies to deny services to same-sex couples.

“The overwhelming scientific evidence is clear: children raised by same-sex parents do just as well as those raised by different-sex parents,” said Vázquez-Rivera. “What matters is not the gender or the sexual orientation of the parents; but the presence of love, stability, and support.”

Trump upon taking office for a second time on Jan. 20, 2025, signed his “Defending Women from Gender Identity Extremism and Restoring Biological Truth to the Federal Government” executive order. Among its provisions is the federal government’s recognition of two genders: male and female.

Vázquez-Rivera noted “other proposals” in Puerto Rico “would recognize only ‘biological sex’ in government documents, prohibit inclusive language throughout public institutions, continue challenging recognition of nonbinary identities, and reverse protections for LGBT+ students previously adopted by the University of Puerto Rico.”

“The challenges facing LGBT+ Puerto Ricans cannot be viewed as isolated debates about healthcare, sports, bathrooms, or language,” said Vázquez-Rivera. “They are part of a much larger picture.”

“Puerto Rico is already confronting poverty, disaster recovery, healthcare shortages, and economic instability,” he added. “When discrimination is added to these realities, existing inequities become even deeper. Mental health worsens. Families are displaced. Communities become more vulnerable.”

Vázquez-Rivera further stressed “these issues are interconnected, and our response must be as well.” He also urged the LGBTQ rights movement to do more to support — and fund — advocacy efforts in Puerto Rico.

“Ultimately, this is not about granting special rights,” said Vázquez-Rivera. “It is about ensuring that more than three million American citizens living in Puerto Rico have the same opportunity to live healthy, safe, and dignified lives as every other American.”

The Puerto Rican government has not responded to the Washington Blade’s request for comment.

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North Carolina

In the middle of the Bible Belt, a summer camp lets trans kids exhale

Adulthood feels possible at Transcending Adolescence

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Ruby during her second year of camp. (Photo by Cornell Watson for Uncloseted Media)

Uncloseted Media published this article on July 18.

By SAM DONNDELINGER | On a June night in rural North Carolina, dozens of campers sat around the fire as a counselor asked them to close their eyes.

“Picture a place where you feel completely safe,” they were told. “Think about what it looks like and how it feels, what you can hear, smell, and taste.”

When they were invited to share what they had imagined, one camper described sitting in a circle with other trans people. It was dark. Trees surrounded them. Mosquitoes buzzed.

“‘That place is here, and this is the place where I feel safe,’” Jacob Hofheimer, one of the camp’s founders, recalled the camper saying. “It got all of us.”

For many of the 8- to 17-year-olds who attend Transcending Adolescence, the weeklong summer camp offers a reprieve from the calculations they have to make in their day-to-day lives: Who knows they are trans? Who can be trusted? Which bathroom can they legally use?

At a time when 40 percent of transgender and nonbinary youth seriously considered attempting suicide in the past year, and 90 percent of LGBTQ youth reported that recent anti-LGBTQ laws, policies, and debates cause them stress or anxiety, those questions never disappear. But at this camp, young people are given space to ask them openly and to a community that understands why they need to.

“It really made me smile knowing that there’s a lot of people out there like me,” Ruby, a 12-year-old camper, told Uncloseted Media. “I’m putting myself out there, I’m being myself and no one judges me.”

Origins

Transcending Adolescence was founded in 2019 by Jacob and his wife Chrissy Hofheimer. The trans married couple wanted to create a camp for queer kids in America’s South, where affirming resources can be difficult to find.

Surrounded by thick woods and the backdrop of the Appalachian Mountains, campers swim, tie-dye shirts, complete ropes courses, roast marshmallows and perform in shows. They also gather for conversations about healthy relationships, medical care, legal rights, bathroom anxiety, coming out, misgendering, depression, substance use, and self-esteem.

“A huge part of it is that every single person there is trans or gender diverse, including the staff,” says Rory Sowers, a 19-year-old junior counselor from Florida. “That’s just something that you don’t get to experience a lot, especially as a young trans person.”

Sowers first attended Transcending Adolescence as a camper during its inaugural year in 2021. He returned three times before becoming a junior counselor.

“There’s so much that trans folks have to worry about just going about their day-to-day lives, especially living in the South,” Sowers says. “I was able to come into myself a lot more when I didn’t have all of those anxieties on my back.”

A place to be ‘just Ruby’

For 12-year-old Ruby, pre-camp anxiety was intense.

When she attended camp in June of last year, it was the first time traveling to another state without her parents.

“I was nervous about having someone there not really understanding me … and not really accepting me,” says Ruby, whose name has been changed to protect her privacy.

Outside camp, Ruby worries about how other people perceive her, according to her mom, Kate, whose name has also been changed. She says her daughter has to consider a litany of questions cis kids don’t have to worry about: “‘What if someone finds out? Are they looking at me? Do I look the part?’ … All these thoughts go through her head every single day.”

Before camp, Ruby had been struggling so intensely that her family had questioned whether it might feel easier for her “not to be who she was,” Kate says. Ruby had faced bullying in school, prompting her family to withdraw her and homeschool her for the remainder of fifth grade.

“I couldn’t really go anywhere without picking [at] myself because I was anxious,” Ruby says.

But when she arrived at camp, a lot of Ruby’s anxiety subsided. She didn’t have to introduce herself through the lens of being trans. She could just be herself: a funny, theatrical, outgoing 12-year-old who likes Beyoncé, improvises rap battles, and wants to be in the center of dance shows.

“She can just go there and just be [Ruby],” Kate says. “[Being trans] is only a little piece of her. There’s so much more to her, and she’s able to do that for the whole week. … It was completely life-changing for her.”

Research suggests that spaces like Transcending Adolescence can have powerful mental health effects.

Young people tend to fare better when they feel they belong and have access to peers and adults who understand them. In one small study from 2021, participants of a six-day LGBTQ summer camp reported increased resilience, self-esteem and quality of life. Focus groups indicated that transgender and nonbinary campers found an affirming environment that offered social opportunities they had been unable to find elsewhere.

Though this environment can be transformative, it’s intimidating at first for some. Jacob remembers asking one camper from Texas his pronouns during medical check-in, and the boy responding that he used “guy pronouns” because he “was a guy.”

Jacob recalled him being closed off and leery of the “hippie-dippy nonsense.”

But on the second-to-last night, Jacob overheard him speaking with a fellow camper.

“‘When I first came here, I thought that I was a disgusting, mutilated pig and an alien, and nobody would ever love me because I’m trans,’” Jacob recalls the camper saying. “‘And now I know that being trans doesn’t make me disgusting. It’s actually a beautiful thing.’”

He later texted Jacob to say the camp had given him confidence during the school year.

“‘Half the time, I forget that I’m trans,’” Jacob remembers him writing. “‘I’m just a guy. I’m just me.’”

“Finding places where you literally see yourself and can be seen by others for who you are is important during adolescence. It’s a human need,” Stephen Russell, professor of social and family dynamics at Arizona State University, told Uncloseted Media. “For trans youth, especially those who may not feel fully accepted at school, at home or in their faith communities, a camp where their identity isn’t something they have to navigate or defend, but is simply centered as part of who they are, can be transformative.”

Filling the gaps

The Hofheimers know that these spaces can transform the mental health of trans youth because they experienced it firsthand when they met while working as lifeguards at a summer camp for young queer people in New Hampshire.

The camp was doing important work, Jacob says, but many of its attendees came from privileged families in New England and other parts of the country where affirming programs were more accessible. Far fewer came from places such as Florida, Georgia, and Texas.

That’s why, for the location of the camp, they intentionally chose North Carolina, a state that has laws on the books that exclude trans girls from participating in sports, restrict the instruction of LGBTQ topics in schools and ban gender-affirming care for trans youth.

“Access is really, really important,” Chrissy says, adding that while the camp costs $1,975 for the week, they offer robust financial aid, including a $1,500 “no questions asked” subsidized rate for families who can’t afford it.

At the camp, the staff educates campers about anti-trans laws, coming out, and how to have conversations with their doctors about gender-affirming care.

“The kids want to talk about this stuff,” Jacob says. “That was the gap that we identified.”

For Chrissy, baking education into the camp’s programming is personal: When she was transitioning as a young adult, accessing informed medical care was difficult. During consultations, doctors either quoted prices she could not afford or refused to treat her. One told her that they did not “put boobs on men.”

Desperate to change her chest, Chrissy turned to a friend who had undergone illegal silicone injections without an apparent complication. She received what she believed were similar injections in Florida.

But the substance wasn’t silicone, she says, and it hardened and became intertwined with her breast tissue. Seventeen years later, Chrissy underwent a double mastectomy to fix the damage.

This experience became one of the driving forces behind the camp’s educational work.

“Accurate information might have changed the course of my life,” Chrissy says.

To provide information that breaks out of the TikTok and Reddit misinformation bubble many campers exist in at home, Chrissy and Jacob bring in experts and host nightly fireside chats.

Each night, campers gather around for structured conversations about the nuances of being trans. They talk about coping with misgendering, managing bathroom anxiety, identifying red and green flags in relationships, asking for help, and caring for their mental health.

Jacob, who is a certified nurse practitioner, helps answer questions about gender-affirming care. A trans attorney explains policies affecting campers in different states and separates the practical effects of those laws from incomplete information and political fearmongering.

“It made me think about the people who I tell I am trans to and what I have to do to make sure I feel comfortable telling them,” Ruby says. “It let me think about all these questions I had but didn’t really know how to ask.”

Building what comes next

Chrissy hopes the results from the camp’s program will eventually be replicated across the country.

For now, roughly 30 campers come together for one week each summer. Some arrive unhappy about being sent to camp. But by the final day, Sowers says, those same campers are often crying because they do not want to leave.

They return home to the same schools, states, and political climates where they have to decide when it is safe to disclose their identities and how to respond when someone does not understand them.

But at camp, Ruby, among the other campers, found a weeklong respite and saw trans adults who were not merely surviving but building careers, relationships, and communities.

“After the camp, I really haven’t been talking about how I feel insecure that I’m trans,” Ruby says. “I can’t wait to go back and see the people I met and [meet] new friends.”

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