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Cruel court decision makes it harder to prevent AIDS

Disease gets a boost from federal judge in Texas

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Just as the disease was on a glide path to extinction thanks to new drugs, HIV/AIDS got a boost from a federal court in Texas.

On Sept. 7, U.S. District Judge Reed O’Connor ruled that the government can’t require an employer-sponsored health care plan to cover a therapy that prevents the spread of a disease that has already killed more than 700,000 Americans. The decision in Braidwood Management Inc. v. Becerra is not just poorly argued; it is flat-out cruel.

Perhaps the best feature of the Affordable Care Act (ACA) of 2010, nicknamed Obamacare, was a requirement that insurance offer coverage of specified preventive care procedures and therapies, such as colon cancer screening and influenza immunizations.

In June 2019, the U.S. Preventive Services Task Force, an advisory panel of experts, issued a “Grade A” recommendation for pre-exposure prophylaxis, or PrEP, a medicine that is 99% effective in preventing HIV transmission during sex. The first PrEP drug, Truvada, had been approved seven years earlier by the Food & Drug Administration. On Jan. 1, 2021, the federal government required plans to cover PrEP with no copay, coinsurance, or deductible.

Even before the mandate, the Centers for Disease Control and Prevention (CDC) credited PrEP with helping reduce new HIV infections in the U.S. by 8% between 2015 and 2019 “after a period of general stability.” The CDC now calls PrEP “a key prevention strategy for ending the HIV epidemic in the U.S.,” a goal for 2030 set by both the Trump and Biden administrations.

The way to end AIDS once and for all is to get PrEP to those who need it most. Researchers are developing intravaginal rings, implants, antibodies, and long-lasting injectables. Although PrEP use has risen by a factor of eight in just five years, three-quarters of those most at risk are not using the therapy.

The success of the lawsuit by a group of self-described Christian business owners and employees will make access even more difficult. The plaintiffs argued that the preventive care mandate for PrEP violated their constitutional right to religious freedom. In the complaint, Dr. Steven Hotze said that he was unwilling to pay for a health plan covering PrEP “because these drugs facilitate or encourage homosexual behavior, which is contrary to [his] sincere religious beliefs.”

Hotze, whose vitamin company ran afoul of the FDA for COVID-19 claims, was indicted in April on aggravated assault charges involving a bizarre search for ballots after the 2020 election.

In the PrEP case, Hotze’s objection went beyond gay sex. He complained that providing coverage of the drugs facilitates and encourages “sexual activity outside of marriage between one man and one woman” as well as illegal drug use.

Judge O’Connor agreed. He went even further, ruling that members of the Preventive Services Task Force were “unconstitutionally appointed.”

In a previous case, O’Connor had ruled that the entire ACA was unconstitutional, but the Supreme Court reversed that decision last year. The current ruling draws on the Religious Freedom Restoration Act (RFRA) of 1993, which was enacted by Congress after the Supreme Court ruled in Employment Division v. Smith that the protection of the free exercise of religion in the First Amendment does not entitle anyone to a religion-based exception from a general law.

In recent years, writes Michael Dorf of the Cornell University Law School, “conservative Christians have increasingly relied on [RFRA] to obtain exceptions from laws involving insurance coverage for contraception and abortion.”

For example, in Burwell v. Hobby Lobby, a 2014 case, the Supreme Court held that a company owned by religious Christians could be excused from an obligation to pay for health insurance that covered “forms of contraception that the owners regarded as tantamount to abortion.”

But the ruling in the Braidwood case is far more sweeping. The Hobby Lobby plaintiffs considered abortion itself immoral. In this case, it’s not PrEP that Braidwood considers immoral; it’s certain kinds of sexual activities. By substantially lowering the risk of contracting HIV/AIDS, this twisted logic goes, PrEP is a facilitator of what Hotze considers immoral. And by offering insurance that covers PrEP, Braidwood says it becomes complicit.

There is a serious cost to this attenuated argument. By decreasing access to PrEP, people will needlessly become ill and, in some cases, die. The economy will also be burdened with the cost of treating a disease that can be prevented.

Modern science has developed therapies that are ending the spread of a dangerous, mortal virus. Easing access to these medicines is clearly a legitimate function of government — undoubtedly, a compelling interest. What can be more selfish and foolish than to erect needless obstacles for those who want to protect themselves and people around them?

James K. Glassman, a former Under Secretary of State in the George W. Bush administration, is an adviser to health care companies and non-profits.

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Opinions

The facts about Victory Fund’s investigation and the path forward

Probe did not find legal or policy violations by Evan Low

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Gov. Andy Beshear (D-Ky.) speaks with Victory Fund President and CEO Evan Low at the LGBTQ+ Victory Fund National Champagne Brunch on April 19. (Washington Blade photo by Michael Key)

William Waybourn helped found an organization whose mission has never been more important, but his recent op-ed in the Washington Blade leaves readers with a fundamentally inaccurate impression about how the LGBTQ+ Victory Fund and Institute Boards responded to concerns raised about our organizations, their leadership, and our governance responsibilities. 

The boards did not dismiss or minimize concerns. We did what responsible governing bodies should do: We took them seriously, retained experienced independent legal counsel, and authorized a thorough investigation to establish the facts.

The investigation proceeded without interference from the boards or organizational leadership, and the full boards were briefed on its eventual finding.

The conclusion matters: The investigation did not substantiate any legal or policy violations. After the briefing, the boards voted unanimously to accept the findings and close the investigation.

An independent investigation is meaningful only if we are prepared to respect its conclusions — whatever they may be. In this case, after reviewing the investigation and its findings, the boards continue to have confidence in President and CEO Evan Low.

That does not mean our work as governing bodies is finished or that any organization is beyond improvement. The boards will continue to work with staff strengthening Victory, including reviewing and updating policies to ensure they reflect best practices and support a strong working environment.

We can take matters raised seriously while also being clear about what an independent investigation did and did not find. Those are not contradictory positions. In fact, maintaining both is essential to treating everyone involved fairly.

Victory has endured for more than three decades because its mission is bigger than any one individual — a founder, board member, CEO, staff member, candidate, elected official, or donor. Generations of people have built Victory into an indispensable force for LGBTQ+ political representation, and those entrusted with governing it today take seriously our responsibility to protect that legacy and strengthen Victory for what comes next.

And what comes next could not be more consequential. Election Day is weeks away, LGBTQ+ candidates across the country are facing enormously important races, and our community continues to confront attacks on our rights and representation.

We will continue exercising the oversight expected of us, strengthening the Victory organizations, and focusing on the urgent work Victory was created to do: training and helping elect LGBTQ+ leaders, and ensuring our community has a voice wherever decisions about our lives are made.

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Evan Low is not the leader the Victory Fund needs at this moment

The board must recognize what is at stake and act before org’s legacy is lost

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LGBTQ+ Victory Fund President and CEO Evan Low speaks at the Human Rights Conference at WorldPride 2026 in Amsterdam. (Washington Blade file photo by Michael Key)

As co-founder and the first executive director of the Victory Fund and Victory Institute, I find the ongoing turmoil between a dozen or more employees and the organization’s new president, Evan Low, deeply distressing—particularly during such a critical election year.

The Victory Fund’s mission has always been clear and important: to elect and support qualified LGBTQ candidates for public office and, in doing so, secure a “seat at the table” from which LGBTQ issues can be advanced. That mission is too important to let internal turmoil diminish it.

I applaud the employees for going public with their concerns. When harassment allegations and other serious complaints threaten to derail an organization that was once so effective, where else are employees supposed to turn? The board of directors has a legal and fiduciary responsibility to the organization and to its donors.

I do not know Mr. Low, nor have I ever met him. Given my role as a founder, former executive director, and major donor, I found that somewhat remarkable. I was also surprised by the organization’s lack of contact with me at any level—whether to seek my financial support, ask for help with fundraising, or simply seek the perspective of someone involved in building the organization from its earliest days.

When Mr. Low was hired, members of the press contacted me about reports concerning his involvement in previous election-law matters. I declined to comment beyond saying that the board had hired an outside search firm to conduct the search and that I was in no position to assess any issues in Mr. Low’s past.

In hindsight, however, I have come to believe that Mr. Low is not the leader the Victory Fund needs at this particular moment. Ultimately, though, this is a matter for the board of directors to resolve. The board has an obligation to act decisively and independently before this internal conflict further damages an organization whose stature, effectiveness, and reputation were built over decades. The work of the founding board, subsequent boards of directors, and former leaders David Mixner, Brian Bond, Chuck Wolfe, and Annise Parker should not be so easily undone.

The Victory Fund once commanded the admiration, confidence, and financial support of countless people—including me. I hope the board recognizes what is at stake and acts before that legacy is lost.

(Correction: An earlier version of this op-ed called for the board to conduct an independent investigation of the allegations. The board did conduct such an investigation.)


William Waybourn is co-founder and the first executive director of the Victory Fund and Victory Institute.

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The right to be an ordinary transgender man

And the freedom to become unremarkable

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Perhaps successful visibility should eventually produce another freedom: the freedom to become unremarkable. (Photo by barsik/Bigstock)

For years, transgender Americans have been told that visibility is important. We should tell our stories, educate people, speak publicly about our experiences and show younger transgender people that a future is possible. I understand that argument because I have participated in that kind of visibility myself. Nearly a decade ago, I appeared in National Geographic’s “Gender Revolution,” in 2017, hosted by Katie Couric. I have written publicly about being transgender, participated in LGBTQ politics and spent years thinking about what it means to transition in America. My history is hardly a secret. But as I have gotten older, I have increasingly found myself wanting something considerably less dramatic: I want the right to be an ordinary man.

That does not mean I am ashamed of being transgender, nor does it mean that transgender activists should stop fighting for our rights. Many of the freedoms I enjoy exist because previous generations of LGBTQ people were willing to be conspicuous when visibility carried considerable personal risk. But equality cannot require permanent visibility. There is a strange expectation placed upon members of minority groups that our lives should contain some larger social meaning. A transgender person who overcomes adversity is called “brave.” Someone who talks openly about transition becomes “inspiring.” Someone who succeeds becomes an example of “trans resilience.” Sometimes those descriptions are deserved and sincerely appreciated. But sometimes I do not want to represent resilience. Sometimes I just want to walk my dogs, sit in a coffee shop with my laptop, complain about Northern Virginia traffic, go swimming, write books and figure out what I am having for dinner. I also want to be able to gossip with my friends in meaningless ways and do off kilter things that resemble fun: axe throwing, bowling, and karaoke. 

When I was younger, being transgender occupied an enormous amount of psychological territory. Transition required decisions, explanations and difficult conversations. Other people had questions. My body seemed consequential in a way that other people’s bodies did not. There was always another milestone ahead of me, and for a while it was difficult to imagine reaching a point when gender would no longer dominate my thoughts. Eventually, however, something unexpected happened: life became life again. The questions that occupy me today are increasingly the same mundane questions that occupy millions of other adults. What kind of career do I want? Am I being a good friend? What should I write next? What kind of person do I want to become?

Most strangers who meet me today simply see a man. They do not know my medical history or what I looked like years ago. They don’t know that I looked like a skinny track star, and then was put into the resemblances of a meager nonbinary body. They do not know the chronology of my transition unless I decide to tell them. There is tremendous freedom in that, and I have come to think of it not as deception but as privacy. Nobody introduces himself by providing strangers with a complete inventory of his medical history, childhood insecurities and previous identities. Human beings reveal themselves gradually. Different people know different parts of us, and intimacy develops when we decide that somebody has earned access to more of our story.

Yet transgender people are frequently encouraged to regard disclosure as a measure of authenticity. I no longer believe that it is. There are circumstances in which being transgender matters enormously, and there are others in which it barely matters at all. When I am writing, I want somebody to care about the quality of the sentence. When I am working, I want somebody to care whether I did the job well. When I make a friend, I want that person to discover the complicated human being underneath the surface: my ambitions, flaws, anxieties, ridiculous stories and sense of humor. Being transgender may eventually become part of that conversation, but it does not have to be the first thing somebody knows about me.

That, to me, is one of the least discussed promises of equality. For decades, LGBTQ people fought for the right to be seen because invisibility was often enforced through shame and discrimination. Visibility therefore became a form of liberation. But perhaps successful visibility should eventually produce another freedom: the freedom to become unremarkable. A gay couple should be able to bore their neighbors with complaints about their mortgage. A lesbian should not have to become an ambassador for lesbianism whenever she enters a room. A transgender man should not have to turn his body into a public seminar about gender. He should occasionally be allowed to be some guy. Transgender people, in a sense, should also have the right to be flawed: sometimes we yell at our romantic counterparts, and other times we get fired from jobs for being obnoxious. But we are only human, just like you. 

There are, of course, transgender people who cannot or do not want to disappear into ordinary life, and there are young transgender people desperately searching for evidence that adulthood is possible for them. Visible transgender people can provide that evidence. But there should be another story available to those young people as well: you can grow up, transition and eventually spend less time thinking about transition. You can become preoccupied with your career, fall in love, get divorced, write a terrible first draft and spend three days fixing it, worry about your parents, buy groceries and acquire all the wonderfully tedious problems of adulthood.

That might not sound revolutionary, but perhaps that is precisely what makes it meaningful. The ultimate promise of transgender equality should not be that every transgender person becomes visible, celebrated, courageous, or inspirational. It should include the possibility that a transgender man can walk into a room and nobody finds his gender history particularly interesting. He can simply be a man living his life. Increasingly, I think that ordinary freedom is what I wanted from transition all along.


Isaac Amend is a transgender man and writer based in D.C. In 2017, he starred in National Geographic’s ‘Gender Revolution’ documentary. He sits on the board of the LGBT Democrats of Virginia. His author’s portfolio is available at isaacamend.com, and you can catch him on Instagram at: @isaacamend.

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