Health
Obama AIDS strategy targets gay, bi men
White House plan calls for shifting HIV prevention to high-risk groups

Michael Weinstein, president of the AIDS Healthcare Foundation, called the proposed $30 million AIDS strategy and the $25 million proposed for ADAP grossly inadequate. Other AIDS activists disagreed with that assessment and praised President Obama’s plan. (Washington Blade photo by Michael Key)
A long-awaited National HIV/AIDS Strategy document the White House released this week calls for devoting more funds and attention to HIV prevention programs that target four high-risk population groups, especially gay and bisexual men.
In unusually blunt language, the 45-page strategy document that took 15 months to prepare says state and federal AIDS prevention programs have so far failed to adequately target gay and bisexual men and transgender people.
“Given the starkness and the enduring nature of the disparate impact on gay and bisexual men, it is important to significantly reprioritize resources and attention on this community,” says the document. “The United States cannot reduce the number of HIV infections nationally without better addressing HIV among gay and bisexual men.”
The document adds, “As with gay and bisexual men, transgender individuals are also at high risk for HIV infection. … Yet, historically, efforts targeting this specific population have been minimal.”
Other high-risk groups the strategy calls for targeting are blacks, Latinos and substance abusers.
The National HIV/AIDS Strategy and an accompanying 35-page Federal Implementation Plan call for reducing the overall number of new infections by at least 25 percent over the next five years; increasing access to medical care and “optimizing health outcomes” for people living with HIV; and reducing HIV-related health disparities.
“The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity, or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination,” the implementation plan declares as its goal.
The strategy and implementation document were released Tuesday amid a flurry of activity at the White House, which included a morning briefing on the document for the media and AIDS activists. Among those conducting the briefing were Melody Barnes, director of the White House Domestic Policy Council; Kathleen Sebelius, secretary of the Department of Health & Human Services, and Jeff Crowley, the gay director of the White House Office of National AIDS Policy.
Later in the day, President Obama hosted a reception in the White House East Room for about 150 national and community activists working on HIV/AIDS issues.
“From activists, researchers, community leaders who’ve waged a battle against AIDS for so long, including many of you here in this room, we have learned what we can do to stop the spread of the disease,” Obama told the gathering.
“We’ve learned what we can do to extend the lives of people living with it. And we’ve been reminded of our obligations to one another — obligations that, like the virus itself, transcend barriers of race or station or sexual orientation or faith or nationality,” he said.
“So the question is not whether we know what to do, but whether we will do it, whether we will fulfill those obligations, whether we will marshal our resources and the political will to confront a tragedy that is preventable.”
The president was interrupted briefly during his remarks by a man in the audience who shouted, “Mr. President,” prompting Obama to promise to talk with him after finishing his speech at the reception.
“Let’s hold on, you can talk to me after — we’ll be able to talk after I speak,” Obama said. “That’s why I invited you here, right? So you don’t have to yell.”
The audience member was later identified as Charles King, president and CEO of Housing Works, a New York City-based AIDS group that sometimes organizes AIDS-related protests involving arrests spurred by civil disobedience.
After completing his remarks, the president walked to where King was standing and spoke with him as news photographers hovered over the two.
King could not be immediately reached and it was not clear what he and Obama said to each other. But his brief interruption of Obama’s speech drew attention to concerns raised by some AIDS activists that the National HIV/AIDS Strategy does not include a call for significant new funds to fight the AIDS epidemic.
At the White House briefing earlier in the day, Sebelius and Crowley announced that the Obama administration would allocate $30 million to implement the strategy from a disease prevention fund created by the Affordable Care Act. The act is one of two landmark bills that Congress passed earlier this year to put in place the president’s sweeping health insurance reform proposals.
Sebelius and Crowley also noted that the administration would arrange for a separate emergency supplemental appropriation of $25 million to fund the struggling AIDS Drug Assistance Program, which provides life-prolonging anti-retroviral drugs for low-income people with HIV/AIDS who lack health insurance.
AIDS activists have criticized the administration and Congress for declining so far to appropriate $126 million in emergency funds for ADAP this year, an amount that state AIDS office directors believe is needed to provide drugs for 2,300 people who are on ADAP waiting lists in at least a dozen states.
The AIDS Healthcare Foundation, which bills itself as the largest global AIDS organization providing medical care to people with HIV/AIDS, held a separate news conference in Washington on Tuesday to criticize the AIDS strategy document.
Michael Weinstein, the group’s president, called the proposed $30 million allocation for the National HIV/AIDS Strategy and the $25 million proposed for ADAP grossly inadequate. He also said that the strategy document contained few if any new ideas and would likely “collect dust at the Library of Congress.”
But officials with other national AIDS organizations did not share Weinstein’s assessment of the strategy, calling it an important first step and a first-of-its-kind effort to prioritize federal AIDS programs.
“Today, the Obama administration took a significant step forward in the domestic battle against HIV/AIDS,” said AIDS Action, a national AIDS advocacy group, in a statement.
The statement said that, if properly implemented, the strategy would become “the first truly effective, comprehensive national plan in response to the U.S. HIV/AIDS epidemic, now in its 30th year.”
Michael Ruppal, executive director of the AIDS Institute, another national advocacy group, praised the strategy as an “ambitious” effort to curtail the domestic U.S. AIDS epidemic.
“The strategy will serve as a meaningful roadmap to reduce the number of HIV infections in the U.S., provide care to those who need it, and help reduce the stigma and disparities often associated with HIV/AIDS,” Ruppal said.
But he added, “Now we must turn our collective energies to implementing it with the necessary leadership and resources to achieve its goals and provide results for people who are currently living with HIV/AIDS or may be affected in the future.”
Cornelius Baker, former executive director of D.C.’s Whitman-Walker Clinic and a member of Obama’s Presidential Advisory Council on HIV/AIDS, issued a statement in his role as an official with the National Black Gay Men’s Advocacy Coalition.
He said the coalition considers the National HIV/AIDS Strategy and its accompanying implementation plan “significant steps forward in our nation’s effort to end the HIV epidemic.”
“Black gay men represent one of the most highly impacted populations and suffer the greatest disproportionate burden of the disease,” Baker said. “The National HIV/AIDS Strategy represents a major advance in its recognition that black gay men must be a focal point of attention if the United States is to make progress in reversing the trends of the HIV epidemic.”
In addition to the strategy and implementation documents, Obama issued a separate presidential memorandum to the heads of more than a dozen executive branch departments and agencies, establishing goals and timetables for carrying out the strategy.
The Obama memorandum designates six departments and agencies as “lead agencies” for implementing the strategy. They include the Department of Health & Human Services; Department of Justice; Department of Labor; Department of Housing & Urban Development; Department of Veterans Affairs; and the Social Security Administration.
The White House Office of National AIDS Policy, in consultation with the Office of Management & Budget, is assigned the task of monitoring the progress of the strategy’s implementation and setting the administration’s priorities for the project, the memo says.
At the White House briefing Tuesday, Crowley acknowledged that the National HIV/AIDS Strategy doesn’t initially call for providing significant new funds in the fight against AIDS, although he and Sebelius noted that the administration is committed to continue its existing proposals for increases in the federal AIDS budget in fiscal year 2011 and future years. The two also said the expansion of health insurance coverage for people who currently can’t afford it under the Obama health care legislation passed by Congress will greatly boost treatment and care for people with HIV/AIDS between now and 2014.
Crowley said the economic downturn and other competing spending needs made it important for the strategy to focus on ways to better use existing resources.
“Gay and bisexual men have comprised the largest proportion of the HIV epidemic in the United States since the first cases were reported in the 1980s, and that has not changed,” says the strategy document. “They still comprise the greatest proportion of infections nationally.”
To further show why greater resources must immediately be shifted to HIV prevention programs aimed at gay and bisexual men, the strategy document lists these facts:
• gay and bisexual men of all races are the only group in the United States where the estimated number of new HIV infections is rising annually;
• they are 44 to 86 times more likely to become infected with HIV than other men, and 40 to 77 times more likely to become infected than women;
• approximately one-half of the 1.1 million persons living with HIV in the United States are gay and bisexual men, and they account for the majority (53 percent) of new HIV infections each year;
• and high rates of HIV among gay men are found not only in large urban areas. More than half of all AIDS cases diagnosed in the United States are among gay and bisexual men irrespective of town or city size.
Jose Zuniga, president of the International Association of Physicians in AIDS Care, praised the strategy document’s call for participation by non-government entities and individuals to help implement the strategy, saying more than 13,000 members of his group worldwide and more than 5,000 U.S. members “stand ready” join in the effort.
“[W]e have a ready army of seasoned advocates — public health experts, clinicians and allied healthcare and laypeople providers, AIDS service organizations, community and faith-based organizations, academic institutions, and professional associations — that can help to accelerate implementation and thus allow for more quickly achieving many of the National HIV/AIDS Strategy’s objectives,” he said.
Health
Developing countries to receive breakthrough HIV prevention drug at low cost
Announcement coincided with UN General Assembly
Philanthropic organizations on Wednesday announced two agreements with Indian pharmaceutical companies that will allow a breakthrough HIV prevention drug to become available in developing countries for $40 a year per patient.
The New York Times notes Unitaid, the Clinton Health Access Initiative, and Wits RHI reached an agreement with Dr. Reddy’s Laboratories to distribute lenacapavir. The Gates Foundation and Hetero brokered a separate deal.
Unitaid, the Clinton Health Access Initiative, Wits RHI, and the Gates Foundation announced their respective agreements against the backdrop of the U.N. General Assembly.
Lenacapavir users inject the drug twice a year.
UNAIDS in a press release notes lenacapavir in the U.S. currently costs $28,000 a year per person.
“This is a watershed moment,” said UNAIDS Executive Director Winnie Byanyima in a statement. “A price of USD 40 per person per year is a leap forward that will help to unlock the revolutionary potential of long-acting HIV medicines.”
The State Department earlier this month announced PEPFAR will distribute lenacapavir in countries with high HIV prevalence rates. A press release notes Gilead Sciences, which manufactures the drug, is “offering this product to PEPFAR and the Global Fund at cost and without profit.”
Health
Don’t just observe this Suicide Prevention Month
Crucial mental health are being defunded across the country
September is Suicide Prevention Month, a time to address often-ignored painful truths and readdress what proactivity looks like. For those of us who have lost someone they love to suicide, prevention is not just another campaign. It is a constant pang that stays.
To lose someone you love to suicide is to have the color in your life dimmed. It is beyond language. Nothing one can type, nothing one can say to a therapist, no words can ever convey this new brand of hurting we never imagined before. It is an open cut so deep that it never truly, fully heals.
Nothing in this world is comparable to witnessing someone you love making the decision to end their life because they would rather not be than to be here. Whether “here” means here in this time, here in this place, or here in a life that has come to feel utterly devoid of other options, of hope, or of help, the decision to leave often comes from a place of staggering pain and a resounding need to be heard. The sense of having no autonomy, of being trapped inside pressure so immense it compresses the will to live, is no rarity. It is a very real struggle that so many adolescents and young adults carry the weight of every day.
Many folks in our country claim to uphold the sanctity of human life. But if that claim holds any validity or moral grounding, it would have to start with protecting the lives of our youth. Not only preventing their deaths but affirming and improving the quality of their lives. We need to recognize and respond to the reality that for too many adolescents and teenagers, especially those who are marginalized and chronically underserved, life does not feel so sacred. It feels damn near impossible.
Today, suicide is the second leading cause of death for Americans ages 10 to 24. That rate has almost doubled since 2007. Among queer-identifying youth, the statistics are crushing. Nearly 42 percent have seriously considered suicide in the past year, and almost 1 in 4 have attempted it. These are not just numbers. These are the children and teens we claim to care for and protect. These are kids full of potential and possibility who come to believe that their lives are too painful or meaningless to go on.
For our youth who identify as both queer and BIPOC, the numbers soar to even more devastating heights. Discrimination, housing insecurity, trauma (complex, generational, or otherwise), and isolation pile on the already stacked mental health risks. Transitional times like puberty, continuing education, coming out, or even being outed can all become crisis points. And yet, the resources available to support these youth remain far too limited, particularly in rural and underfunded communities.
We must also call out a disheartening truth. Suicide is not just a mental health issue but also a political one. Despite years of advocacy and an undeniable increase in youth mental health crises, funding for prevention is barely pocket change in regard to national budgets. In 2023, the federal government spent an underwhelming $617 million on suicide prevention efforts. To provide some perspective, that’s less than what we spend each year defending the border wall.
Meanwhile, school-based mental health services, one of the most effective means of reaching children and teens early, are being decimated. A $1 billion mental health grant program, which began after the Uvalde school shooting aiming to increase school counseling services, was recently pulled from hundreds of school districts. In some places, that left over 1,000 students for every one mental health provider. And in others, it left entire counties with zero youth therapists.
This rollback is not an isolated agenda. It operates in tandem with a cultural and legislative attack on the LGBTQ community and our access to affirming education, healthcare, and visibility. Programs that create safe spaces and lifelines are being wiped away. The LGBTQ line of the 988 suicide hotline, created to offer identity-affirming, culturally competent crisis support, was recently defunded, despite having provided help to over 1.3 million callers. The political message here is unmistakable. Only some lives, some pain, and some needs of a select group are worth the money and care.
I can’t help but contrast this with how our country controls the process of childbirth. Over the last decade, particularly following growing awareness and resulting concern around maternal mortality rates, the U.S. has consistently increased investment in maternal health. Federal funds now support initiatives like Healthy Start, safety improvements in birthing facilities, and dedicated maternal mental health hotlines. In 2022, the Into the Light Act was passed, allocating $170 million over six years for screening and treatment of postpartum mental health conditions. These are great and necessary efforts. But even here, we fall short. A study published in “JAMA Psychiatry” in November 2023 examined drug overdose deaths among pregnant and postpartum women in the U.S. from 2018 to 2021. The findings revealed that suicide and overdose were the leading causes of death during this period.
Yet even this limited progress for new parents shows us an undeniable contradiction. As a nation, we have shown we are capable of legislating support for life when we are politically and morally motivated to. We can pass bills, allocate funds, and create crisis hotlines. What’s missing is the motivation to extend that same urgency to the mental health and well-being of young people before they become statistics.
At the same time, astonishing amounts of public money have been directed toward restricting reproductive freedom. Since the overturning of Roe v. Wade in 2022, states have collectively spent hundreds of millions of dollars enforcing abortion bans, funding legal battles, surveillance infrastructure, and crisis pregnancy centers that often provide misleading information.
In 2023 alone, Texas allocated over $140 million to the Alternatives to Abortion program, while at the same time slashing funding to health providers that offered comprehensive reproductive care. Nationwide, anti-abortion lobbying and litigation have received sustained state and federal backing, often at the expense of preventive care, contraception access, and the very maternal health supports that claim to be prioritized. Only the willful can ignore the blatant contradiction here. While suicide and overdose silently claim the lives of mothers post-childbirth, far more political and financial energy is funneled into controlling whether people can become mothers in the first place.
Real prevention should not be limited to easy words and good intentions each September. Real prevention should be about intrenching mental health support into the daily lives of young folks. It means funding school counselors and social workers so that every child has someone to talk to. It means restoring services that center the needs of queer, Indigenous, and BIPOC youth, who are far too frequently left behind. It means guaranteeing that crisis lines are open. It means creating and nurturing environments where vulnerability is not discouraged but invited.
We also have to stop criminalizing mental health crises. Way too often, suicidal and struggling youth are met with handcuffs or hospitalization that adds layers to trauma rather than with compassion. Prevention must be proactive, not punitive. We need peer support groups, trauma-informed teachers, and trusted adults who are trained to notice the signs before the worst happens.
We are also overdue for a culture shift. A society with the alleged aim to value life does not shame those who are struggling to hold onto it. Contrary to popular unsaid belief, strength is not stoicism. Strength is connection. It’s knowing when to ask for help.
If we as a country actually and honestly cherish life, we have to prove it. We have to prove it not with words but with resources, policy, and compassion. Suicide prevention cannot begin and end with simple slogans and annual awareness. It has to mean a continuous investment in systems of care that affirm life, especially for those who are most vulnerable.
This September, as we recognize Suicide Prevention Month, I dare us to do more than to just memorialize those lost. Let’s start fighting for those living. Let’s create a world where no child, teen, or young adult feels that their only way out is to stop living. They are not expendable. They are not alone. And their lives are sacred. If only we had the heart to act like it.
I am almost ashamed to say that it wasn’t until I lost someone I love to suicide that I began volunteering my time to the American Foundation for Suicide Prevention. The work that the AFSP does is not only needed, it’s imperative today more than ever. If nothing else, please hit this link and donate.
Health
GLP-1s can help address LGBTQ healthcare barriers: experts
Queer people more subject to body dissatisfaction
Dana Piccoli tried everything to lose weight.
She frequented the gym, went on and off diets and hired a personal trainer. When Piccoli decided to get on a GLP-1, it wasn’t a “short cut” to drop weight – it was a way for her to live her life comfortably.
“When I told someone I was on it, they were like, ‘I’m going to the gym because I want to do it the right way,’” said Piccoli, managing director of queer media collaborative News is Out. “Obviously that kind of stung because for me, this is the right way.”
GLP-1 drugs have caused quite a stir since becoming more integrated into mainstream medicine. The newness of some brands, like Ozempic, have led to stigmas and mistrust surrounding them. These stigmas disproportionately affect the LGBTQ+ community since queer people are more subject to body dissatisfaction and have more trouble finding accessible healthcare.
Through all the noise, however, experts say taking GLP-1s are safe with the right counseling, and LGBTQ+ people could largely benefit from them.
So, what’s all the ruckus about? Are GLP-1s an “easy way out” to lose weight? And how do they really impact the LGBTQ+ community?
How GLP-1s work
GLP-1s, or glucagon-like peptide-1, mimic the actions of a GLP-1 that is released by the gut after eating. It can help people with Type-2 diabetes by lowering blood sugar through the release of insulin, and can help those with obesity by slowing down digestion and, in turn, reducing one’s appetite.
Like any medication, there are some side effects to consider. Sangeeta Kashyap, assistant chief of clinical affairs at Weill Cornell Medicine, said symptoms like nausea, diarrhea, and vomiting can occur. However, Kashyap said these side effects are less severe than past GLP-1 brands – a reason that contributes to their newfound popularity – and can be better managed with proper guidance.
Since the drug causes a loss of both fat and muscle loss, she said doctors should inform patients to do strength training to maintain any deteriorating muscle, and to eat high-protein diets, since fatty foods increase the risk of vomiting or nausea.
Getting on a GLP-1 isn’t just about shedding a few pounds. Kashyap said it’s a commitment to your health and body, which is why talking with a doctor and understanding the risks are crucial.
“We give patients appropriate guidelines,” Kashyap said. “We do blood tests, we monitor things, and give a lot of counseling to these patients. I don’t think you could just give the medicine out like candy.”
Piccoli, who started her GLP-1 journey with her wife, said the medication helped turn off “food noise.”
“Your motivation for things, your reward system with food is kind of disabled,” Piccoli said. “That really helped me understand my relationship with food.”
Turning down food noise
Losing weight isn’t as easy as getting on a GLP-1 and eating less. Piccoli said turning off the food noise in her brain led to a complete lifestyle shift.
“I had to completely change everything about the way I eat, everything about the way I approach food,” she said about her experience taking Mounjaro. “This has been one of the hardest things I’ve ever done.”
Kashyap said the lifestyle change that comes with taking a GLP-1 is why it’s important to consult a doctor first to understand how it could affect you not just physically, but also emotionally.
Kashyap said she sees higher rates of mental health disorders in transgender women, a community that already faces more barriers in finding accessible healthcare.
This could lead to someone getting on the drug for the wrong reasons, Kashyap said. She noted that those with eating disorders or body dysmorphia could face more severe side effects. Body dysmorphia and body image concerns are already an issue for the LGBTQ+ community, Kashyap said, so prescribing GLP-1s needs to be handled with care.
One way to ethically prescribe a GLP-1 to a patient would be to conduct a mental health screening, according to Kashyap. Mental health screenings aren’t required to get on a GLP-1, but Kashyap said they would be beneficial to patients who may be prone to negative effects by taking the drug.
Although some people may see more severe side effects, Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital, said GLP-1s are a completely safe and rigorously tested drug.
If a person faces negative side effects from taking a GLP-1, it’s more about how their body or brain is reacting to it than the drug itself being unsafe.
“Any kind of weight loss is going to affect your mood, either positively or negatively,” Apovian said.
With the queer community already facing increased barriers to healthcare, there’s another issue to consider: GLP-1s aren’t cheap.
Depending on where you get it from and whether or not insurance covers it, you could pay hundreds or even thousands of dollars for a limited supply.
Piccoli said she paid out of pocket and had to make sacrifices for her and her wife to both get on a GLP-1.
“I didn’t renew my car lease,” Piccoli said. “We decided to go down to one car so that we had some extra income monthly to be able to pay for it.”
On the other hand, Matt, who requested to be identified only by his first name due to the sensitivity of the topic, said he was shocked at how easy it was to get the cost of his GLP-1 covered by insurance. He had been warned by his doctor about the difficulty of getting it covered, and expected an “uphill battle.”
“[My doctor] wrote out the prescription for me, and on my way home, I got a text message from the drugstore saying it was ready to go,” said Matt, who’s lost 48 pounds on Ozempic since June 2024.
Matt said experiences like his, although not the standard, are why it’s important to talk with your doctor about getting on a GLP-1 and see for yourself rather than taking advice from social media stigmas.
Kashyap said the drug is also becoming more accessible through websites like Lilly, which provide vials for about $300-500. While that isn’t pocket change, it’s significantly cheaper than retail pharmacies.
You may have to make sacrifices like Piccoli did, but getting access to modern GLP-1s for weight loss isn’t only for the Hollywood elites like it seemed to be a few years ago.
Through all the social stigmas and uncertainty, Kashyap and Apovian agreed that GLP-1s are a major benefit for the queer community.
Trans women have increased rates of obesity, Type-2 diabetes and metabolic syndrome, according to Kashyap. Estrogen treatments increase fat mass and insulin resistance, leading to higher obesity rates in trans women. Kashyap said GLP-1s could be helpful in mitigating those effects.
GLP-1s also reduce alcohol cravings, so Kashyap noted that anyone struggling with alcoholism may see improvements with that condition upon getting on the drug.
Getting on a GLP-1 isn’t the walk in the park some may make you believe it is – it’s a lifestyle change and health commitment.
But it’s also a change that can provide good and healthy results if you seek the appropriate guidance from a professional.
While social stigmas in the queer community may lead to misinformation on who should use it and what it should be used for, GLP-1s are safe and can be a much-needed relief for a community facing significant healthcare obstacles.
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