The Centers for Medicare and Medicaid Services is pushing forward a proposed rule that would make it not only easier for people with HIV in need to get organ transplants from HIV-positive donors, but also make it a priority where there was often a barrier.

The Washington Blade sat down with people familiar with this topic — from former heads of the Centers for Disease Control and Prevention, to HIV activists and to the first HIV-positive person to donate an organ — about what this proposed change could mean.

HIV is a virus that attacks the body’s immune system, particularly targeting the body’s T-cells, which makes it harder to fight off infection and disease. If left untreated, HIV can become AIDS. Without treatment, AIDS can lead to death within a few months or years. The virus is spread through direct contact with bodily fluids — often through sex, unclean needles, or from mother to baby during pregnancy.

According to HIV.gov, a website managed by the U.S. Department of Health and Human Services, approximately 1.2 million people in the U.S. were living with HIV in 2022. Of those 1.2 million, 13 percent don’t know they have it.

The virus disproportionately impacts men who have sex with men and people of color.

The CDC’s statistics show men are most affected, making up almost 80 percent of diagnoses, with gay and bisexual men accounting for the majority. Racial disparities also are present — Black people make up 38 percent of diagnoses. The World Health Organization estimates that around 44.1 million people have died from AIDS-related illnesses globally as of 2024.

Since the virus was first detected 45 years ago, scientists have been working on ways to treat and prevent its spread. In 1987, the first breakthrough in fighting HIV came as the U.S. approved the first HIV medication, AZT — marking the beginning of antiretroviral therapy. This medicine — and later descendants of it, like today’s widely prescribed Biktarvy — stop the HIV virus from reproducing and allow the body to keep its T-cells.

Then in 2012, another big step toward minimizing the scope of the potentially fatal disease came as the CDC approved the first HIV prevention medication, Truvada, more commonly known as PrEP. As of 2024, nearly 600,000 people in the U.S. are using PrEP, according to AIDSVu, which uses data from Gilead Sciences (manufacturers of Truvada and Biktarvy) and is compiled by researchers at the Rollins School of Public Health at Emory University.

The following year, in 2013, the HIV Organ Policy Equity (HOPE) Act was signed into law, enabling the use of organs from HIV-positive donors for transplants into HIV-positive recipients, overturning a 1988 ban.

There are an estimated 123,000 people waiting for organ transplants in the U.S. The number of HIV-positive people on that list is estimated to be smaller, harder to precisely quantify, but they are still in dire need.

A study from the New England Journal of Medicine, published in 2024, analyzed the outcomes of 198 kidney transplantations to people with HIV at 26 medical centers across the U.S. from 2018 to 2021.

Results from the study showed that for kidney transplants performed using organs from 99 donors with HIV and 99 without HIV, one-year survival rates for HIV-positive recipients were nearly identical (94 percent and 95 percent, respectively). Three-year survival rates were also similar (85 percent and 87 percent). Organ rejection rates were also numerically on par after three years (21 percent and 24 percent). Other measures for surgical outcomes, including the number of side effects that occurred, were also roughly the same for both groups.

This shows that, overall, HIV-positive-to-HIV-positive transplants are nearly identical in outcome to transplants between HIV-negative donors and recipients.

Where we are now

Now in 2026, CMS is pushing past the clinical trial testing phase it has been in, making HIV-positive-to-HIV-positive organ transplants more widespread and more accessible.

Adrian Shanker, the former deputy assistant secretary for health policy and senior advisor on LGBTQ health equity at HHS, explained to the Blade that the HOPE Act was a step in the right direction, but this policy change from CMS will expand the ability to help HIV-positive patients in need.

“The original HOPE Act asked for scientific research,” Shanker explained. “There were 10 years of clinical trials. The Biden administration promulgated a rule that removed clinical trial requirements for kidney and liver transplants between people living with HIV. This proposed rule is further implementation on the CMS side with the organ procurement organizations to ensure they’re carrying out the stated intent of the HOPE Act law. It’s building on consensus that has existed through multiple administrations.”

The proposed change would go into effect on July 1, and, according to Shanker, would help everyone in need of an organ — not just HIV-positive people.

“People living with HIV, their ability to receive organs from other people living with HIV in a more streamlined way means that the overall organ waitlist is sped up as well,” he added. “So it benefits everyone on the waitlist.”

Shanker, who was also a member of the Presidential Advisory Council on HIV/AIDS, spoke about how this is a rare moment of bipartisanship.

“There’s no secret that the Trump administration has been quite adversarial to LGBTQI plus health, and to the health of people living with HIV/HIV prevention resources as well … From destabilizing PEPFAR to shutting down one of the primary implementation partners, which is USAID, to firing almost the entire staff of the Office of Infectious Disease and HIV Policy at HHS … But what this is is a glimmer of hope that we can have bipartisan solutions that improve quality of life for people living with HIV.”

Harold Phillips, the CEO of NMAC, a national HIV/AIDS organization that pushes policy education and public engagement to end the HIV epidemic, and an HIV-positive American, sees this as a huge gain for the HIV-positive community.

“For a number of years, we were excluded from that pool of potential donors,” Phillips said. “Many people living with HIV were excluded from being able to get organ transplants. So this opens up that door. This is a positive step forward that will help save lives.”

That “open door,” Phillips said, does more than just provide life-saving organs to people in the most need. It provides a sense of being able to support their community.

“I remember when I was no longer able to check that box on my driver’s license,” Phillips recalled during his interview with the Blade. “I remember what that meant — that my organs might not be able to save a life. The potential that now they could is really exciting for me.”

“To think about people living with HIV donating their organs to other people living with HIV and helping extend their health and well-being — that’s an exciting moment in our history. It reinforces that HIV is not a death sentence anymore.”

Human Rights Campaign Senior Public Policy Advocate Matt Rose also sat down with the Blade to explain the realities of HIV-positive people in the U.S. right now who are looking for a transplant.

“If you’re HIV positive and on the waitlist for an organ right now, your chance of getting one is slim to nil,” Rose said. “This at least gives you a real shot.”

He went on to explain that while the HOPE Act started to move in the right direction, it hasn’t done enough for HIV-positive people in dire need.

“This bill [HOPE] was supposed to fix that — and it never really has. But every administration, we keep chipping away at the next hurdle,” he said. “This latest move will drastically expand the ability for someone who is HIV positive to donate an organ.”

That slow chipping away, in addition to the non-stop trials being done to prove the efficacy and ability for HIV-positive people’s bodies to accept organ donation, is part of the broader push to normalize this practice and remove outdated restrictions.

Shanker elaborated, explaining all that time was necessary to figure out the efficacy of HIV-positive-to-HIV-positive organ transplants but now that the data has been collected — its time to expand the availability.

“There were over a decade of clinical trials between the original HOPE Act law being signed by President Obama and our rule being promulgated at the end of the Biden administration. It was to allow those clinical trials to run their course,” Shanker said.

Nina Martinez is the first HIV-positive person to donate an organ to another person with HIV.

She explained that the stigma and lack of understanding from the general public is another hurdle that those working to improve the quality of life for people living with HIV have to deal with.

“People don’t generally understand that treatment works,” Martinez said, who became the first person to undergo HIV-positive organ donation in 2019. “When you have access to antiretroviral therapy, it lowers the virus in your bloodstream to levels so low that lab tests can’t detect it. Clinically, that correlates to good health and an inability to transmit HIV sexually. I was healthy enough to pass the same evaluation as any other living donor without HIV.”

She continued explaining:

“Just by having a diagnosis of HIV, they’re labeling donors as medically complex, and that’s not accurate. Every donor with HIV has to pass the same evaluation as donors without HIV,” she said. “If someone passes that evaluation and still isn’t allowed to donate, that’s discrimination. If a patient is willing to accept that organ and you block it because of preconceived notions, you’re denying someone care based on disability. That runs counter to basic fairness.”

When asked about her decision to become a donor and what message she hopes it sends, Martinez emphasized that the choice should remain personal.

“I didn’t undertake this endeavor to say that people with HIV should donate. This is a community that’s been through a lot and has contributed to science — we have served. But for people who wanted a way to leave a legacy, and that is what I wanted, they should be supported in that. There shouldn’t be arcane scientific perceptions and myths getting in the way of that.”

National Donor Day, which raises awareness of organ donation, is on Feb. 14. To become an organ donor, visit registerme.org.

Canadian authorities on Wednesday said the person who killed seven people and injured more than two dozen others at a school in Tumbler Ridge, British Columbia, the day before was transgender.

Dwayne McDonald, the deputy commissioner for the Royal Canadian Mounted Police in British Columbia, during a press conference said Jesse Van Rootselaar, 18, “was born as a biological male who approximately … six years ago began to transition as female and identified as female both socially and publicly.” McDonald added it is “too early to say whether” the shooter’s gender identity “has any correlation in this investigation.”

The shooter died by suicide, and authorities found her body inside the school.

“We have a history of police attendance at the family residence,” said McDonald. “Some of those calls were related to mental health issues.”

Egale Canada, the country’s LGBTQ and intersex rights group, on Wednesday said it is “heartbroken by the horrific shooting in Tumbler Ridge.”

“Our deepest condolences are with the victims, their families, and the entire community as they navigate unimaginable grief,” said the group in a statement. “We unequivocally condemn this act of violence. There is no place for violence in our schools or in our communities. At this profoundly difficult time, we hold the people of Tumbler Ridge in our thoughts and stand in solidarity with all those affected.”

Mass shootings are relatively rare in Canada, unlike in the U.S.

GLAAD notes statistics from the Gun Violence Archive that indicate trans people carried out less than 0.1 percent of the 5,748 mass shootings in the U.S. between Jan. 1, 2013, and Sept. 15, 2025. The Human Rights Campaign, the National LGBTQ Task Force, and other advocacy groups last August condemned efforts to scapegoat the community after a trans woman shot and killed two children and injured 17 others inside the Annunciation Catholic School in Minneapolis.

While MAGA continues to attack LGBTQ rights in the U.S. — including erasing queer history and removing children’s books with LGBTQ characters from libraries and pushing an ever‑broader censorship agenda — and as the UK faces MAGA‑inspired campaigns demanding the removal of LGBT literature from public libraries, Russia’s assault on LGBTQ‑related media has taken an extreme and frankly absurd turn. It is a cautionary tale for Western countries of just how far censorship can go once it becomes normalized. From books to anime, TV shows, and even academia, queer existence is being systematically erased.

In January, one of Russia’s largest private bookstore chains, Chitai‑Gorod-Bukvoed, faced the risk of being shut down over alleged “LGBT propaganda” under a law that prohibits any positive mention of LGBTQ content and equates LGBTQ material with pornography and pedophilia.

Among the books targeted were “Beartown,” “Us Against You,”and “The Winners”by Fredrik Backman, “The Left Hand of Darkness” by Ursula K. Le Guin, and “The Heart’s Invisible Furies” by John Boyne.

According to Chitai‑Gorod-Bukvoed CEO Alexander Brychkin, once it became known in mid‑December that law enforcement agencies had launched inspections, the Chitai‑Gorod–Bukvoed network immediately removed these titles from sale nationwide. In a comment to Kommersant, Brychkin stressed that the chain “operates strictly within the legal framework,” noting that the books were not listed in any official register of banned materials at the time the inspections began and had been on sale for several years. 

Previously, two of the biggest online film distribution companies were charged as well under the “LGBT Propaganda law.”

Private businesses had no more right to speak up than writers or artists who are persecuted for their work. This is a nightmare scenario for many Americans who believe the free market itself can protect freedom of expression. This is the reality of modern‑day Russia.

A censored version of the anime “Steins;Gate” has also been released on Russia’s most prominent streaming platform, “Kinopoisk,” in which the storyline of one of the main characters was altered due to the ban on so‑called “LGBT propaganda,” as reported by opposition outlets Verstka and Dozhd, as well as fans on Reddit.

In the original series, the character Ruka Urushibara is a young person with an androgynous appearance who struggles to accept themself in a male body — an obvious indication that Ruka is a transgender girl. Ruka wears women’s clothing and dreams of becoming a girl. In episode eight, Ruka is given the chance to intervene in the past by sending a message to their mother in order to be born female.

In the Kinopoisk version, released in late 2025, Ruka is instead portrayed as a girl living with HIV — something entirely absent from the original anime and invented in translation. The storyline and dialogue were rewritten accordingly, completely distorting the original meaning: in this version, Ruka attempts to change the past in order to be born “healthy,” without HIV, rather than to be born a girl. This is not only absurd, but deeply offensive to the LGBTQ community, which has long been stigmatized in relation to HIV.

A similar distortion appears in “Amediateka”’s translation — or, better to say, rewriting — of the new AMC series “Interview with the Vampire.” Translators rewrote dialogue in ways that fundamentally misrepresented the plot, downplaying the openly queer nature of the characters to the point that romantic partners were translated merely as “friends” or “pals,” rendering entire scenes meaningless. At the same time, even brief critical references to Russian or Soviet politics were removed.

As for queer romance, such as the popular Canadian TV show “Heated Rivalry,”it has no official Russian translation at all and circulates only through fan translations. The show remains popular among millennials and Gen Z, and Russian social media platforms like X (Twitter) and Instagram are full of positive reviews. Yet, in theory, promoting such a show could put someone at risk under the law. People still watch it, still love it, still build fan communities, but it all exists quietly, pushed under the carpet.

The prohibition is not total, but it is a grotesque situation when even such a nice and harmless show is stigmatized.

Books suffer even more. Some classics fall under bans, and books are physically destroyed. In other cases, the outcome is worse: texts are rewritten and censored, as with “Steins;Gate.” This affects not only fiction but also nonfiction. For example, in “Deep Color” by Keith Recker, an American researcher of visual arts, all mentions of queer, feminism or BDSM culture were erased in the Russian edition. Even historically necessary references were removed, including mentions of the pink triangle used by the Nazis.

In the Russian edition of Skye Cleary’s “The Thirst for Authenticity: How Simone de Beauvoir’s Ideas Help You Become Yourself,” dozens of paragraphs were blacked out. Passages discussing the fluidity of gender and a person’s right to define themselves outside the rigid male–female binary were removed. Sections on contraception and abortion, critiques of biological reductionism and social pressure on women, details of Simone de Beauvoir’s intimate life and her relationships with women, as well as reflections on non‑monogamous relationships, were all excised. Even footnotes referencing quotes about gender identity were hidden. 

Those two books are one of the many examples of the fate of Russian-translated nonfiction. Actually, even books about animal reproduction were demanded to be censored because of the “LGBT propaganda law”. Apparently, the authorities couldn’t accept a neutral scientific description of same-sex behavior and reproductive diversity in animals.

The authorities know what they are doing. Most people are less likely to read dense nonfiction or search actual studies about animal sexual behavior than to watch a popular TV show about queer hockey players, which makes visual media easier to censor quietly and effectively. So they really could show LGBTQ as something negative and absolutely unnatural for most of the Russian population.

And this is the core of the problem. This is not just censorship of content — it is the rewriting of history, even the narrative around biology. It is the deliberate marginalization of queer existence, the systematic erasure of queer people’s ability to see themselves reflected in culture, literature, and art.

The U.S. still retains independence in academia, publishing, and private business when it comes to queer voices. Russia does not. History shows where this path leads: Nazi Germany burned books; the Taliban destroyed cultural and historical materials. This is always one of the first steps toward genocide — not immediate, perhaps, but inevitable once dehumanization becomes official policy. It never stops with just one group. In Russia, immigrants, people from the North Caucasus and Central Asia, Ukrainians, and even disabled citizens face daily dehumanization — it’s all part of the same system.

And now, alarmingly, the U.S. seems to be following in Russia’s footsteps — the same path that enabled war in Ukraine and the thriving of authoritarianism.