The United States and the world are waiting for the Supreme Court to hand down its decisions in two cases (Little v. Hecox and West Virginia v. BPJ) that would rule on whether young trans women can play women’s sports at their schools. As trans journalist Erin Reed explained, these two cases are not just about transgender sports. These cases are litmus tests for trans rights at the nation’s highest courts and will have wide-reaching implications for the rights of trans and nonbinary people in the United States.

And these cases will impact cis women. As Orien Rummler reported for the 19th and them, anti-trans legislation and rulings threaten the rights of all women, especially cis women of color. The best example is the allegations that woman boxer Imane Khelif faced at the last Paris Olympics.

The gender policing that Khelif faced shows how sports bans that police who are considered a man or woman legitimize and mandate invasive medical testing, a form of medical abuse, against all women and girls who want to play sports. And let’s be clear — there is historical precedence for this.

The Nazi regime did use genetic screening in order to police who could have children as part of their “racial hygiene” programs, including marriage partner hereditary testing that flagged anyone with “tainted” genetic lineages. While prisoners in concentration and detention camps were subjected to horrifying medical experimentation, Nazi officials experimented with their own followers, facilitating reproduction only among people with desirable characteristics — notably those with blonde hair and blue eyes — and sterilizing those with undesirable genetics.

In fact, trans and gender non-conforming people were some of the first targeted by Nazi violence, with one of the first book burnings occurring in 1933 when Nazi youth and members of the Sturmabteilung ransacked the Institute for Sexual Science and burned one of the largest libraries of medical texts about gender affirming care. Nazi officials first exerted control over gender before extending this to race and religion.

And this was not confined to Nazi Germany. As I’ve written about before, the United States has used eugenics to justify the forced sterilization of women of color, disabled women, poor women, and incarcerated women. Forced sterilization was one part of forced or coerced medical testing that targeted Black and Indigenous women.

This medical violence, along with non-consensual experimentation including Dr. James Marion Sim’s gynecological experimentation on enslaved Black women, was rooted in systemic racism and medical abuse, and has contributed to legacies of mistrust and health disparities in medical institutions and practitioners.

When sports organizations, like the U.S. Olympic and Paralympic Committee, require women to undergo “sex verification,” they set a precedent of forced genetic testing that violates everyone’s privacy and could very well exclude many cis women from sports if they fall outside the bounds of what is defined as a “woman.”

The best example is cis women with Polycystic Ovary Syndrome. Some people with PCOS have hyperandrogenism, an excess of androgen, or experience hirsutism (i.e. the development of more traditionally masculine features like increased muscle mass and more pronounced facial hair.) Mandatory sex verification may diagnose or “out” women as intersex without their consent. Differences of Sex Development, another term used to describe intersex experiences, is more common than most people would expect.

Would women with PCOS not be considered women? What about women with more pronounced facial hair or greater muscle mass because of natural variation? It’s important to note what is considered American standards of womanhood are rooted in White supremacy — one of the reasons why women of color have been and will be targeted by anti-trans violence.

The very people making these decisions are also beginning to ask these questions. According to Erin in the Morning, Supreme Court Justice Amy Coney Barrett is even worried about the implications of these two Supreme Court decisions. As Alejandra Carabello, a Harvard Law educator, told Erin in the Morning, a decision supporting anti-trans sports bans “could result in the segregation of women in a host of other areas of public life under the rationale that biologically, men are different and they need to be segregated.”

Barrett, a conservative justice who was appointed by Trump in 2020, seems to acknowledge these risks, saying “your whole position in this case depends on there being inherent differences.”

There is not. According to science, gender is not a strict binary but a spectrum determined by biological, psychological, and social factors, including cultural norms surrounding gender.

The best indication of this is that intersex people exist. Intersex people are individuals born with sex hormones and characteristics that differ from a strict male to female binary. Some people are born with atypical genitalia, specifically external genitals that don’t look male or female or are underdeveloped. Some are born with phallia, a condition where a baby is born without a penis, some born with a “mismatch” between their internal and external organs.

In all of these cases, the idea of normal, mismatched and properly developed genitalia and bodily presentation is conditional upon a male and female binary reinforced by the medical establishment — and to be clear, this gender binary has hurt people. For decades, intersex babies have suffered medical abuse because doctors perform unnecessary surgeries to “fit” these children into a female/male binary. These medically nonessential surgeries performed on children who cannot consent are a form of medical assault.

To be clear, this is not the same as gender affirming care performed on consenting individuals who are receiving hormone therapy and surgery to align their gender presentation with their identity. As major medical and mental health organizers assert, gender-affirming care is medically necessary and lifesaving healthcare for trans and nonbinary people.

And the vast majority of children who are having gender affirming surgery are cis ones. A June 2024 study found that the vast majority of minors undergoing gender-affirming surgeries were cis children. This did not include intersex people who underwent surgery or people who received surgery for an illness or injury. About 97 percent of 150 cases where minors received gender affirming surgery in 2019 were chest reduction surgery performed on cis boys. This surgery is commonly performed on boys with gynecomastia, or develop enlarged breasts due to a hormone imbalance.

So for many, the decisions expected on these Supreme Court cases may seem confined to sports but in actuality, they have profound ramifications not only for cis women but also amid the growing escalation and legitimization of eugenics in the United States.

It’s no mistake that earlier this month, Dr. Elisa von Joeden-Forgey, president of the Lemkin Institute, stated that the U.S. is in the “early-to-mid stages of a genocidal process against trans and nonbinary and intersex people.” Dr. Gregory Santon, former president of the International Association of Genocide Scholars, flags “a hardening of categories” surrounding gender in a “totalitarian” way.

Stanton argues that this is rooted in Nazi ideology’s surrounding gender — this same regime that killed many LGBTQIA individuals in the name of a natural “binary.” As Von Joeden-Forgey said, the queer community, alongside other “minority groups, tends to be a kind of canary in the coal mine.”

Even the fact that discussions of the trans sports ban foreground its potential implications for cis women (or that this is the primary concern voiced by Barrett) showcases whose bodies take priority. 

This framework reflects how members of the feminist movement have used and presently do use the movement to justify the very anti-trans exclusion that will harm them. Some call themselves trans-exclusionary radical feminists (TERFs); these women believe that codifying and protecting trans women’s rights threatens the rights of cis women and have even partnered with some conservative groups because of their commitment to enforce what it means to be a “biological woman.” 

As history can show us, it’s exactly the opposite — first, feminism is rooted in equity for all people, all women, not just cis women. Because protecting trans women from medical violence like sex verification testing and challenging people and organizations that police who a woman is, protects all women.

Emma Cieslik is a museum worker and public historian.

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.