Opinions
The struggle to maintain access to lifesaving HIV meds
Trump proposing dangerous changes to Medicare Part D
When I was diagnosed with HIV in 1985, there were no medications to treat it. Not one. I never imagined that the medical community would achieve the advancements in HIV treatment and prevention we see today. In fact, President Trump actually proposed a plan in his State of the Union address to end the HIV epidemic in America by 2030. This lofty goal would be thwarted, however, by proposed changes to Medicare Part D that jeopardize the advancements we’ve made in the fight against HIV.
I have lived with HIV for almost 35 years. I’ve dealt with more doctors, stubborn insurers, and drug formulations than I care to count. But I do it to stay alive. What other choice do I have?
By 1995, 10 years after I contracted the virus, AIDS claimed as many as 50,000 lives per year. Today, fewer than 7,000 people die from HIV related causes. And recent data shows that although there are nearly 19,000 people living in Baltimore with HIV and 15,000 in D.C., less than a quarter of all new D.C. HIV diagnoses develop into an AIDS diagnosis within three months. This means that approximately 80% of these individuals newly diagnosed with HIV are taking steps to control and reduce their viral loads.
Becoming an “empowered” patient with consistent and unimpeded access to my medications through Medicare Part D has kept me alive. Had I not been relentless in my pursuit of the latest research, drug trials, and newly approved treatment regimens — while also educating my own providers — I likely would have been counted among the nearly half million Americans who perished from AIDS between 1981 and 2000.
For many years after my diagnosis, insurance companies rejected my prescriptions or tried to force me to rely upon medications that had been proven ineffective. When I became disabled due to HIV, my newfound access to Medicare Part D changed all of that.
Medicare Part D and its protections against insurer interference finally brought some certainty to my treatment plan. With reliable access to effective medication, I was suddenly free to divert my time and energy away from day to day survival and focus it towards my friends, my family, and a better quality of life.
Unfortunately, the Trump administration is proposing a change to Medicare Part D in a way that would remove many of these certainties. The change — in the name of reducing drug pricing — removes the protected class status for HIV medication and would expose hundreds of thousands of people living with HIV to “step therapy” and “prior authorization.”
Step therapy allows insurers to require Part D enrollees living with HIV to prove that less effective medications don’t work before agreeing to cover more effective, but more expensive treatments, as determined by our doctor. Prior authorization forces doctors to pre-clear prescriptions for certain HIV medication with insurers before the insurer agrees to cover the costs, a time consuming and complicated process that delays treatment.
As someone who has failed multiple drug categories over the years, I know these changes are dangerous because they would force me to fail on one medication before trying another. I need highly customized, effective therapies to keep my viral load in check. When a viral load is rendered undetectable, I cannot transmit HIV to someone else. Successful treatment, then, also prevents new HIV infections.
Interfering with access to effective treatment formularies for Medicare Part D enrollees under the guise of pricing reductions will cause more harm than good. In fact, a recent study published in the American Journal of Managed Care estimates that there would be 16,200 more cumulative deaths by 2025 if more restricted treatment options are allowed to take effect.
The priorities for people living with HIV are stark. First you pay your insurance premiums, then you pay your prescription costs, and then you pay for food and housing. That is how important our medications are to our survival. For us, failure is not an option. We must fight this new proposal that would end guaranteed access to the treatments we need to stay alive.
Mark S. King is an award-winning author, and HIV/AIDS advocate who has been involved in HIV causes since testing positive in 1985. His blog, My Fabulous Disease, was awarded the NLGJA’s “Excellence in Blogging” honor in 2014 and 2016.
Opinions
A case of retaliation, not stalking
Disbelief in how Capital Pride Alliance continues to portray me
You don’t know me, but you have heard of me. What you’ve heard are rumors, stories, and narratives repeated by others. People often prefer labels and gossip over facts because it is easier than asking questions. But truth does not stay buried forever; it eventually comes forward.
I am grateful to the Washington Blade and Lou Chibbaro Jr., who has written multiple articles about this case. But I want to be clear: This matter is about retaliation, not stalking. Since I raised concerns during World Pride month, several individuals connected to Capital Pride Alliance have resigned or stepped away. One of them was Ashley Smith. Whether he resigned or left under pressure, there has been no clear explanation provided.
What matters to me is that I chose to speak up when I believed I was treated unfairly. Many people stay silent out of fear of backlash or social consequences. I chose not to remain silent. I am reserving many details for trial, where facts will be examined properly. I am confident in representing myself.
Under D.C. law, an Anti-Stalking Order requires two or more qualifying incidents, with at least one within 90 days before filing. That timing requirement is important. CPA intends to present numerous individuals, but I will address how those claims fit the legal standard in court. I recognize only a few of the individuals mentioned, and there are inconsistencies I will respond to in the proper setting.
I do not accept the label often used online to describe me. From the beginning, my position has been consistent: The truth will be established through the legal process.
My concerns began during World Pride when I confided in someone I trusted, June Crenshaw. I believed I was speaking to someone supportive. My experience since then has been one of feeling misled, which I consider a betrayal.
This case is retaliation, not stalking.
Crenshaw wrote an opinion piece published by the Blade that reflected advocacy more than neutral reporting. It suggested broader social implications and directly referenced me. It also framed court rulings in a way that implied risk, even though the order was limited and modified.
Opinion writing can influence public perception while legal matters are ongoing.
The article also questioned my visibility and framed it in a negative way, which feels discouraging to my ability to respond publicly.
The article suggested the court failed by modifying the order and allowing access to community spaces, implying danger simply because the outcome was not fully aligned with CPA’s position. I believe the court acted within its authority.
At this point, it feels as though CPA would prefer my exclusion from their spaces. That is difficult, given that CPA promotes pride, inclusion, and visibility in Washington, D.C.
I continue to believe that accountability and clarification will come.
Truth is established through evidence, not repetition. I will continue addressing these matters through the legal process rather than public speculation. I also want to emphasize that my intention has never been to escalate conflict outside of proper legal channels, but rather to ensure that my concerns are documented and addressed in a structured setting. I understand that public discussion can often blur important distinctions, which is why I am focusing on the court process itself. I am prepared to respond to all claims with evidence and clarity when the time comes, and I expect that process to provide a full and fair opportunity for the record to be examined. My position remains consistent throughout, and I will continue to rely on facts rather than speculation as this matter proceeds forward. I also recognize that misunderstandings can arise when information is shared in fragments, as the legal proceedings move forward in a careful and orderly manner based on evidence in court. I will let the facts speak for themselves in court proceedings.
Darren Pasha is a D.C.-based LGBTQ advocate.
Commentary
IDAHOBiT a reminder we all must stand up against transphobia
Trans rights remain under attack in U.S., around the world
May 17 is the International Day Against Homophobia, Transphobia, and Biphobia.
In 2026, transphobia is the biggest issue out there: all the stereotypes that were used against the LGBTQ community in general in the past are now used to attack the rights of transgender people and to create a moral panic against them. As a person who understood that they were not a girl — despite being assigned female at birth — since they were four, and who in their 30s had to wait in line for a gender clinic, I am obviously worried about this situation. Trans people continue to be seen less as people and more as part of an “agenda,” and there is a greater risk that the international trend of attacks on trans rights is just a first step in a broader attack on the LGBTQ community, and that soon bi, gay, and lesbian people will lose part of their hard-won rights to have the same protections and opportunities as heterosexual people.
When, in U.S. states such as Kansas, trans people face escalating legal and political restrictions on recognition that affect their everyday lives — for example, requiring their driving licenses to match the gender assigned at birth even after transition — while trans people in the U.S. are banned from military service and federal funding is stopped for gender-affirming care for trans youth, it is obvious to everyone that the problem is real. It is also global.
For example, there have been significant attacks on trans rights in the UK in recent years, especially against trans youth, many of whom have been denied gender-affirming care. The day when I finally found the energy to write this story was the day of the local British elections, when surprisingly many seats in city and town councils were won by the queerphobic populist Reform Party, creating some new Reform-dominated councils. Reform Party leader Nigel Farage has praised U.S. President Donald Trump and expressed admiration for Russian dictator Vladimir Putin — both of whom are known for endangering the lives of their trans citizens and rejecting trans identity as something that should be accepted.
So, who can challenge it? The general public often takes cues from public figures. Celebrities play a significant role in shaping public opinion and framing how different social issues are understood.
We need trans celebrities to speak up against transphobia when “anti-trans” celebrities like JK Rowling oppose our rights. It seemed that when conservatives around the globe stood up together to support each other, the trans community should unite, and trans celebrities should protect their trans siblings, while the broader LGB community should recognize the threat and unite around trans rights.
But not everything is so simple. Surprisingly, at a time of the greatest attack on trans rights in this century, many lesbian, gay, bi and even trans celebrities and influencers openly support transphobic policies and ideologies.
One of the clearest examples is Caitlyn Marie Jenner, a retired Olympic gold medal–winning decathlete and public figure known for her participation in the reality show “Keeping Up with the Kardashians.” She is one of the most famous trans people in the world.
From 2015 to 2016, she starred in the reality television series “I Am Cait”on E!, which focused on her gender transition and on telling a story to inspire the younger generation of trans people. In the first episode, Jenner also visited the mother of Kyler Prescott, a 14-year-old trans child who died by suicide earlier that year, and spoke openly about using her privilege to fight for awareness, equality, and dignity for trans people. The idea of supporting trans youth was one of the core themes of her TV series.
That was then.
Jenner’s perspective on trans rights became more and more transphobic. For example, in 2021 she opposed trans girls participating in girls’ school sports. In 2023, she launched a PAC campaign attacking trans youth rights. She also expressed support for Donald Trump and said about herself that she would never be a “real woman.”
Another famous example is transmasculine sex educator and activist Buck Angel, a former adult film actor. He was seen as a modern and progressive person in the 2000s and early 2010s, praised for increasing visibility for trans men through sex education, documentaries, public speaking, and media work. But later he started calling himself “transsexual” rather than “transgender,” following a more transphobic and rigid view of trans identity, and openly showed support for Trump and MAGA.
Of course, there are plenty of trans celebrities who continue to fight for trans rights — the most obvious example is Lana and Lilly Wachowski, notable film directors who gave us “The Matrix” films and the “Sense8” TV series. But the Wachowski sisters were known for being politically left-wing and progressive even before their transition. They are part of a progressive movement, not just a “famous trans person” like Jenner was.
So, why is this happening? Why have more mainstream and conservative trans celebrities, as well as some LGBTQ groups, turned away from trans rights? And what do we need to do?
One of the reasons is fear.
Popular and privileged people — whether they are socialites, actors or leaders of big organizations — are not used to being outcasts, and so they follow dominant trends. For them, the fear of not fitting in, being rejected by the audience and losing their position in society became bigger than their sense of justice. This is probably one of the reasons why some LGBTQ groups, such as the Log Cabin Republicans in the U.S., became more transphobic, or why the LGB Alliance in the UK became more popular.
Another reason is the polarization of society.
Some LGBTQ activists may hate me for saying this, but it is partly our fault. Mainstream trans communities sometimes make trans identity look like a “trend” or part of an ideology. The media — especially tabloids — are even more to blame for this stereotype than the trans community itself. When uninformed people hear about trans people today, many of them imagine left-wing, maybe even socialist, non-religious young supporters of Palestine who are good at understanding ecological issues and worried about global warming. Of course, many trans people are like that. But many are not. And those who are not often feel excluded and become more prone to public self-hatred.
It created a cycle in which people who did not feel part of the community started searching for an alternative that rejected them for being trans and encouraged them to accept transphobic rhetoric, betraying themselves and their trans siblings. This led to greater polarization and hatred against conservative trans people, pushing them even further away.
The International Day Against Homophobia, Transphobia, and Biphobia needs to be a day when we stand up against all transphobia, including the kind expressed by trans people, while at the same time supporting all trans people, no matter how uncomfortable their views may be for us.
Commentary
Disillusioned about democracy? Think of it as a community garden
May 17 is the International Day Against Homophobia, Transphobia, and Biphobia
A short walk from where I live, there is a community garden. People of all ages can participate in designing its areas and learn how to cultivate plants. Together, they build and maintain the space for the benefit of the entire community.
Democracy works the same way. It flourishes when people can bring their energy, knowledge, and presence to the common ground. It works precisely because most of us want to nurture neighborhoods where every life can flourish — no matter where we live, the color of our skin, or the food we enjoy on our tables.
But today, reactionary political movements and governments worldwide are poisoning our gardens with the invasive weeds of their authoritarian policies and exclusionary legislation. According to the CIVICUS Monitor, 73 percent of the world’s population lives in countries where governments repress fundamental civil society freedoms.
By now, we know the playbook. Whenever authoritarians seize our common garden, they drive out those they deem dispensable first. Very often, LGBTI people, racialized persons, and migrants are at the forefront of weathering the storm.
Only half a century ago, the wins that our movement has obtained seemed unthinkable. But those advances are always on the line, always one election away from the strongman of the hour deciding to unravel them.
On May 17, 1990, the World Health Organization removed homosexuality from the International Classification of Diseases (almost 30 years later, also in May, the removal of “gender identity disorder” followed.) The world celebrates this anniversary every year as the International Day against Homophobia, Transphobia, and Biphobia. This was a milestone in the global struggle for the rights of LGBTI people. Back then, 114 countries and territories worldwide still criminalized consensual same-sex sexual acts. Today, still 65 of them maintain those laws.
Progress has been steady. But in 2025, for the first time in years, that number started to grow again. Burkina Faso introduced a criminalizing law for the first time in its history. Trinidad and Tobago reversed recent gains. Senegal further tightened the threat after years of intensifying violence.
The obsession of legislators and policymakers with people’s bodies has translated into paroxysmal attacks against trans and intersex folks — from the 771 bills currently under consideration in the United States, to the disgraceful and misguided policy of the International Olympic Committee reintroducing sex testing and banning trans and intersex women athletes from competing in the female category.
And isn’t it ironic, really, that legislators worldwide put so much effort into driving LGBTI people out of public spaces, when at least 61 UN member states still have legal barriers that prevent civil society organizations working on sexual, gender and bodily diversity issues from formally registering and operating?
Political scientists Phillip Ayoub and Kristina Stoeckl, writing in the “Journal of Democracy”, show that illiberal governments deliberately deploy state-sponsored LGBTI-phobia to mobilize constituencies and frame liberal democracy as a cultural threat. These governments weaponise democratic pluralism for endless culture wars.
The playbook passes from one authoritarian to the next, activist Rémy Bonny showed. What started in Russia in 2013, with a law against the “promotion of non-traditional sexual relationships,” has grown into a pattern that illiberal leaders worldwide use to silence opposition and gain international influence amongst conservatives.
What makes this strategy particularly vicious is how it pits discriminated groups against one another. Time and again, reactionary people in power speak of “protecting women” just to attack trans and intersex people — manufacturing conflict among communities that, in fact, share a common struggle to protect the freedom to decide over their own bodies.
Whenever governments need to distract the public from their failures to create a better garden for everyone, they need a scapegoat. More often than not, it is LGBTI folks. Often, it is those fighting for safe abortions or against racism. Some other times, it is those advocating respectful relations with our land and natural resources. But the attacks never stop at a single movement. Case in point? Only 10 days ago, a government caved in to foreign influence and cancelled the largest global gathering on human rights in the digital age.
At ILGA World, we serve and work with LGBTI communities globally. We know that time and again, LGBTI people have resisted these pests, rolled up their sleeves alongside all the good people caring about their communities, and sown the seeds of change.
This year, the world will join to celebrate May 17 under the theme “At the heart of democracy.” Because, as disillusioned with the concept as people may be, deep down most of us believe that we all deserve a space where we can feel safe and thrive. And together, we can contribute to the beautiful, shared community garden that we deserve.
Julia Ehrt (she/her) is the Executive Director at ILGA World and a widely respected LGBTI activist and community leader.
Before joining ILGA World, she was the Executive Director of Transgender Europe, where she contributed significantly to how trans issues are perceived and debated today in Europe and beyond. She served as a founding Steering Committee member of the International Trans Fund (ITF) until 2019 and as a board member of the Association for Women’s Rights in Development (AWID) for six years. She is a member of the board of directors of the Astraea Lesbian Foundation for Justice, and a signatory to the Yogyakarta Principles plus 10.
Julia holds a PhD in mathematics and lives with her partner and child in Berlin and Geneva.
