A new health agreement between the U.S. and the Philippines has raised questions among HIV/AIDS service providers.

A joint declaration signed by the U.S. and the Philippines on April 7 sets out a plan for closer health cooperation, aimed at transitioning the Philippines toward greater autonomy and “self-reliance” in its health systems, according to a State Department statement released.

In practice, “self-reliance” in health systems refers to a country’s ability to fund, manage, and deliver care without heavy dependence on external donors. In the Philippines, programs serving LGBTQ people — particularly those focused on HIV prevention, testing and treatment — have relied in part on international funding and technical support, including from the U.S., according to UNAIDS. 

The Philippine Department of Health has led the national response to the pandemic.

The joint declaration of intent was signed under the Trump-Vance administration’s “America First Global Health Strategy.” The State Department said the agreement would involve co-funding of mutually agreed global health objectives under bilateral health cooperation between the U.S. and the Philippines in the near future.

The declaration also outlines areas of cooperation beyond financing: workforce development, health information systems, and emergency preparedness. The State Department said the framework is intended to strengthen coordination between U.S. and Philippine institutions while supporting the Philippines’ capacity to manage public health challenges independently over time. The statement does not specifically address LGBTQ health.

Similar agreements in other regions have drawn scrutiny from LGBTQ advocacy groups. 

In Africa, community organizations have warned that a shift from donor-funded, community-led health programs to government-to-government frameworks could affect access for marginalized populations, including LGBTQ people. The Washington Blade found that such changes may reduce reliance on specialized clinics that have historically provided stigma-free care, raising concerns about discrimination, privacy, and continuity of services.

Desi Andrew Ching, president of HIV & AIDS Support House in the Philippines, said the partnership presents a significant opportunity, but added that, like any large-scale international agreement, its success for the LGBTQ community will depend on how it is implemented on the ground.

“On one hand, it’s a positive move. Increased cooperation on health systems can lead to better technical support and potentially more resources for HIV/AIDS prevention and mental health — areas that deeply impact our community,” Ching told the Blade. “If the government and civil society work closely together, we could see some real progress.”

Ching said community concerns often center on where those resources ultimately go. Ching added there is a risk funds could remain within “usual” government-aligned channels or traditional implementers that may not have the trust or reach of grassroots LGBTQ organizations.

The Philippines is facing one of the fastest-growing HIV epidemics in the Asia-Pacific region, with UNAIDS statistics indicating new infections increased by about 543 percent between 2010 and 2023.

The epidemic is concentrated among key populations, particularly men who have sex with men and transgender women who account for a vast majority of new infections. A 2023 analysis found that key populations represented about 92 percent of new HIV cases in the country, underscoring the disproportionate impact on LGBTQ communities. At the same time, stigma, limited access to testing and gaps in healthcare delivery continue to shape outcomes for these groups.

Ching said that for the partnership to be effective, support would need to be closely targeted to reach those most at risk, including individuals who often avoid government facilities because of stigma and fear of judgment. 

“If the partnership prioritizes ‘community-led’ monitoring and direct support to local organizations, it will be a game-changer. If it stays at the top tier of administration, we might just see the same results as before,” Ching said.

Community-led organizations have been central to the Philippines’ HIV response, particularly in reaching LGBTQ populations often underserved by formal healthcare systems. UNAIDS notes groups such as LoveYourself have expanded testing and treatment access through community-based clinics and online outreach, including during the COVID-19 pandemic, when movement restrictions limited access to government facilities.

“To be honest, in these high-level agreements, ‘guarantees’ are hard to come by on paper. The real safeguards lie in the mechanics of implementation,” said Ching. “From the community’s perspective, we believe the best way to prevent services from being diluted is through direct involvement in the planning phase. We would like to see the funding groups and government stakeholders sitting at the same table as the community to game out the specific work plans. It should not be a top-down approach; it needs to be co-designed.”

Ching said oversight would be a critical layer of protection, adding that a dedicated point of contact, such as a U.S Agency for International Development technical lead or a similar monitor, would be needed to track how funds are used.

USAID officially shut down on July 1, 2025, after the Trump-Vance administration dismantled it.

Ching added community-led monitoring would also be necessary in addition to government oversight. He said safety and trust cannot be guaranteed by policy alone but must be built through experience, noting that community-led organizations have consistently reached the most marginalized populations. 

“Safety and trust aren’t things you can just write into a policy; they have to be built through experience,” Ching said, adding that community-based sites are often seen as more accessible and safer because they are “for us, by us.” 

He said the partnership should direct substantial support to grassroots organizations that have demonstrated an ability to overcome stigma, while strengthening coordination with government clinics. The most effective approach, he added, would combine government infrastructure with community-led delivery, allowing trusted local groups to serve as the primary point of access.

’We want a seat at the table’

According to a report by the World Health Organization on the Philippines, prevention efforts account for only about 6 percent of total HIV spending, despite a sharp rise in cases. The report said the gap has been compounded by a recent pause in U.S. funding, which has delayed the development and implementation of prevention programs and community-led responses.

Asked whether community-led LGBTQ organizations would be funded and included in implementation or sidelined under a government-led approach, Ching said that remained the central question for the community, adding that no detailed plan has yet been made public.

“But we have to be realistic about the politics — both within the government and even within civil society — that can sometimes slow things down,” said Ching. “A good baseline to look at is the UNAIDS 30-80-60 targets. These milestones are specifically designed to put community-led responses at the center of the HIV fight. If we’re being honest, as a country, we are still finding our footing in meeting those specific targets. There is a very real risk of being sidelined if the execution defaults to a standard ‘government-only’ approach.”

The UNAIDS set global targets to guide the HIV response, most notably the “95-95-95” goals for 2025. 

The framework calls for 95 percent of people living with HIV to know their status, 95 percent of those diagnosed to receive sustained treatment and 95 percent of those on treatment to achieve viral suppression. The targets were designed to reduce transmission and improve health outcomes, while also highlighting gaps in access to testing, treatment, and prevention services.

“We view this new partnership with the U.S. as a chance to course-correct. If the intention is to end AIDS as a public health threat, the data shows it simply cannot be done without the community in the driver’s seat for service delivery,” said Ching. “Our hope is that the implementation isn’t just government-led, but government-enabled. We want a seat at the table not just for the sake of being there, but to ensure the resources are actually hitting the ground where they matter most. We’re looking for a partnership that honors those 2025 milestones by making community-led organizations formal, funded partners in this roadmap.”

The Sri Lankan government has withdrawn its support for an initiative that encourages LGBTQ tourists to visit the country.

The Sri Lanka Tourism Development Authority last September partnered with Equal Ground, an LGBTQ rights group, on the initiative.

The Daily Mirror, a Sri Lankan newspaper, reported Sri Lanka Development Authority Chair Buddhika Hewawasam in a letter to Equal Ground Executive Director Rosanna Flamer-Caldera said his agency recognizes “the potential of this project to diversify our tourism markets and position Sri Lanka as a safe, inclusive, and welcoming destination for all travelers.”

Cardinal Malcolm Ranjith, the archbishop of Colombo, along other prominent Christian and Buddhist leaders criticized the initiative. Attorney General Parinda Ranasinghe on Feb. 10 indicated the Sri Lanka Tourism Development Authority had rescinded its support for the campaign.

Flamer-Caldera on April 10 acknowledged the criticism over the initiative but added “the fact that the letter has been rescinded doesn’t make any difference.”

“We’re still doing work with the tourism industry who have basically opened up to us and are willing participants in the project,” said Flamer-Caldera. “They realize the potential of the boost to our tourism industry as well as boosting our economy.”

Sections 365 and 365A of Sri Lanka’s colonial-era penal code criminalizes consensual same-sex sexual relations.

The U.N. Committee on the Elimination of Discrimination Against Women in 2022 ruled the criminalization law violated Flamer-Caldera’s rights. The Sri Lankan Supreme Court in 2023 said a bill that would decriminalize homosexuality is constitutional.

Transgender people in Sri Lanka since 2016 have been able to request a Gender Recognition Certificate that allows them to legally change their name and gender on ID cards. Flamer-Caldera noted to the Blade that LGBTQ rights opponents have challenged the Gender Recognition Certificate in the Supreme Court.

India has enacted the Transgender Persons (Protection of Rights) Amendment Act, 2026, that will reshape the country’s legal approach to gender identity. 

Both houses of parliament approved the legislation last month, and it received presidential approval on March 28. 

The Transgender Persons (Protection of Rights) Amendment Act, 2026, narrows the definition of a trans person, removes the provision for self-perceived gender identity, and requires medical certification for legal recognition. These changes mark a shift from the framework established under a 2019 law.

The Transgender Persons (Protection of Rights) Amendment Act, 2026, replaces the earlier definition of a trans person — previously framed as someone whose gender does not align with the gender assigned at birth — with a set of specified categories. It further provides that the term does not include, and is deemed never to have included, people defined solely by their sexual orientation or by self-perceived gender identity.

The bill retains certain categories within its definition, including people with socio-cultural identities such as kinner, hijra, aravani, or jogta. It also includes people with variations in sex characteristics at birth, such as differences in primary sexual characteristics, external genitalia, chromosomes or hormones from the normative standards of male or female bodies.

The Transgender Persons (Protection of Rights) Amendment Act, 2026, removes certain categories from the definition, including a trans man or trans woman, irrespective of whether such a person has undergone sex reassignment surgery, hormone therapy, laser procedures, or other forms of medical intervention. It also excludes genderqueer people — a category that had been recognized under the earlier framework. The Transgender Persons (Protection of Rights) Amendment Act, 2026, however, includes eunuchs, as well as people compelled to assume a trans identity through mutilation, emasculation, castration, or other surgical, chemical or hormonal interventions.

The Transgender Persons (Protection of Rights) Amendment Act, 2026, also revises the process for legal recognition, requiring a trans person to apply to a district magistrate for a certificate of identity, which can now be issued only after the recommendation of a designated medical board. The law specifies that the board will be headed by a senior medical officer and may include other experts. It further provides that individuals issued such a certificate will be entitled to change their first name in official documents, including birth records and other government-issued identification.

The Transgender Persons (Protection of Rights) Amendment Act, 2026, also introduces stricter penalties for certain offences, including cases in which a person is forced to assume a trans identity through kidnapping, coercion or physical harm. Such offenses may attract imprisonment ranging from 10 years to life in prison, along with fines, depending on the severity and whether the victim is an adult or a child. The Transgender Persons (Protection of Rights) Amendment Act, 2026, further requires medical institutions to report gender-affirming surgeries to the district magistrate, and mandates that individuals obtain a revised certificate of identity following such procedures.

India’s 2011 Census recorded 487,803 trans persons, yet only 5.6 percent had applied for a trans identity card, according to the Washington Blade’s previous reporting. These identity cards, required to access government welfare programs, have remained difficult to obtain, with delays and administrative barriers limiting uptake. 

The Transgender Persons (Protection of Rights) Amendment Act, 2026, revised the certification process, which introduces additional requirements for legal recognition. This change is against this backdrop of uneven access to identity documentation.

India’s Election Commission in 2009 directed states to modify voter registration forms to include an “other” category, allowing individuals who did not identify as male or female to register accordingly. The Supreme Court in National Legal Services Authority v. Union of India in 2014 recognized trans persons as a “third gender” and affirmed their right to self-identification. 

Justice Kalavamkodath Sivasankara Radhakrishna Panicker said that “recognition of transgenders as a third gender is not a social or medical issue, but a human rights issue.” Parliament in 2019 approved the Transgender Persons (Protection of Rights) Bill, 2019.

An advisory committee the Supreme Court created that former Delhi High Court Justice Asha Menon has urged the government to withdraw the Transgender Persons (Protection of Rights) Amendment Act, 2026. The panel said the proposal to deny self-identification of gender is inconsistent with theNational Legal Services Authority v. Union of India ruling.

Menon on March 25 wrote to Social Justice Minister Virendra Kumar conveying the panel’s resolution. According to the Hindu newspaper, the committee described the amendment as a “great shock” and a “tremendous setback” to efforts to mainstream trans communities.

The Queer Hindu Alliance, an advocacy group that seeks to uphold the dignity of LGBTQ people within India’s cultural and constitutional framework, expressed concern over the Transgender Persons (Protection of Rights) Amendment Bill, 2026.

“We write not in the spirit of opposition, but in the spirit of samvad — dialogue — and with a sincere call for community consultation before this legislation proceeds further,” the group said in a statement. “The Supreme Court of India recognized the concerns of the transgender community in 2014. The National Legal Services Authority v. Union of India judgment affirmed that a person knows who they are. This bill seeks to reverse that. The Queer Hindu Alliance finds this troubling as a question of basic human dignity.”

The Queer Hindu Alliance added that India “is not a young civilization fumbling for answers on how to understand human identity.”

“This culture has contemplated the nature of the self more deeply, and for longer, than any legal system that has existed. This is not a foreign conversation imported from the West. It is a conversation Bharat (India) has always been capable of having, on its own terms,” the Queer Hindu Alliance said.

Harish Iyer, an LGBTQ rights activist who was among those who fought for marriage equality in the Supreme Court, told the Blade that the amendment is “not just a rollback, but a blatant, arrogant insult” to the Supreme Court. 

“The NALSA judgment gave us the fundamental dignity of self-determination — the right to look in the mirror and say, ‘This is who I am.’ This amendment drags us right back into the dark ages, handing over our bodily autonomy to a bunch of sarkari babus (government officers) and medical boards,” said Iyer. “But here is the most absurd part: you simply cannot define if someone is trans through any physical test. How exactly are you going to diagnose a human mind? Are they only going to regard those who have had gender affirmation surgery as trans? Because that is fundamentally not the definition of being transgender; transition is a choice and a privilege, not a prerequisite for identity. Or are they going to look at someone born with ambiguous genitalia and label them trans? Because that is intersex, which is a completely different reality.” 

“Forcing a trans person to undergo degrading physical scrutiny based on the government’s spectacular ignorance of basic gender science isn’t a legal process; it’s state-sponsored trauma,” he added. “We fought too hard for our dignity to let a bureaucratic tribunal demand that we strip down to prove our humanity.”

Iyer said the Transgender Persons (Protection of Rights) Amendment Act, 2026, goes beyond protection and instead imposes control. 

“You don’t ‘protect’ a community by criminalizing the chosen families and allies who offer safe haven to trans youth fleeing abusive homes,” he said, referring to provisions in the law. “This bill is about regulation, policing and control. By gatekeeping who gets to be trans and punishing those who support us, the government isn’t acting as a guardian — it’s acting as a warden. It is a calculated attack on our existence.”

Iyer said the revised definition could exclude individuals who do not fall within the listed categories. 

“It effectively writes them out of existence,” he said.

Iyer added the Transgender Persons (Protection of Rights) Amendment Act, 2026, could create an administrative “black hole” for gender-fluid individuals and nonbinary people who do not fit into the government’s rigid categories.

“If you are legally invisible, you don’t get access to gender-affirming healthcare, you don’t get legal protection, and you are entirely cut off from participating in society,” said Iyer. “They are trying to legislate us into non-existence because they are too lazy to understand us.”