Ten years ago, as the opioid epidemic ripped through communities across the United States, the recreational use of oxymorphone with contaminated needles led to an explosion of new HIV infections in southern Indiana’s Scott County.

In places like Austin, a city with about 4,000 residents, the rate of diagnoses quickly ballooned to levels seen in some of the hardest-hit nations of sub-Saharan Africa, more than 50 times higher than the national average.

Thankfully, by 2020, NPR reported that the area was rebounding from what was the most devastating drug-fueled HIV epidemic that rural America had ever experienced, with three-quarters of patients managing the disease so well with antiretroviral therapies that their viral loads were undetectable.

Five years after officials called a public health emergency over the outbreak in Scott County, Austin had opened new addiction treatment centers, support groups, and syringe exchanges. 

Initially, Indiana’s response was sluggish. The state’s governor at the time, Mike Pence, opposed clean needle exchanges for 29 days before ultimately signing an executive order allowing for a state-supervised program. 

The administration in which he would go on to serve as vice president, however, launched an ambitious initiative designed around the objective of ending the HIV epidemic in the U.S. by the end of the decade, using proven public health strategies including syringe exchanges. 

NPR further noted “the administration’s HIV goals were championed” by Pence along with Trump’s U.S. Surgeon General, Jerome Adamsthe, who was Indiana’s health commissioner during the outbreak in Austin. 

Still, the news service warned, the Centers for Disease Control and Prevention determined that 220 U.S. counties were vulnerable to outbreaks of HIV and other blood borne infectious diseases like hepatitis C. 

“When you have these outbreaks, they affect other states and counties. It’s a domino effect,” Dr. Rupa Patel, an HIV prevention researcher at Washington University in St. Louis, told NPR. “We have to learn from them. Once you fall behind, you can’t catch up.”

Trump’s approach to public health, including efforts to prevent, detect, mitigate, and treat  outbreaks of infectious diseases, looks radically different in his second term.   

‘I don’t know why they hate public health so much’

The Washington Blade spoke with Matthew Rose, senior public policy advocate for the Human Rights Campaign, during a recent interview about the the administration’s dramatic cuts and mass layoffs that will totally reshape the way America’s health agencies are run under Trump’s secretary of the U.S. Department of Health and Human Services, Robert F. Kennedy, Jr.  

“They’re dismantling all the things around” the first Trump administration’s Ending the HIV Epidemic in the U.S. effort, he said, eliminating key positions and offices within America’s health agencies that support this effort, including by tracking progress toward — or movement away from — the 2030 goalposts. 

Rose said there is no evidence to suggest the initiatives combatting HIV that were begun when Trump was in office the first time were ineffective,  either in terms of whether their long term cost-savings justified the investment of government resources to administer them or with respect to data showing measurable progress toward ending the epidemic within the decade. 

Therefore and in the absence of an alternative explanation,, Rose said he is left with the impression that the Trump-Vance administration does not care about Americans’ public health, especially when it comes to efforts focused on disfavored populations, such as programs supporting access to PrEP to reduce the risk of HIV transmission through sex. 

The outbreak in Scott County “can happen over and over again, if we don’t have CDC surveillance,” he warned. “We’re still having a fentanyl crisis in the country that we don’t seem to really want to deal with, but you end up with outbreaks that bloom and bloom very quick and very fast.” 

Rose added, “The really crazy thing is that they got rid of disease intervention and branch and response,” referring  to the CDC’s National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, specifically its Division of HIV Prevention, and the various branches within that division that are responsible for different aspects of HIV prevention, care, and research. They include HIV Research, Behavioral and Clinical Surveillance, and Detection and Response. 

“These are literally the disease detectives that chase down outbreaks,” Rose added. “When there’s a syphilis outbreak in an area, when COVID came along and we had to trace COVID outbreaks, like, those folks are the folks who do this.”

If (or perhaps when) communities experience an outbreak, “We wouldn’t truly know what’s going on until probably 10 years later, when those folks’ CD4 counts finally crash to an AIDS diagnosis level,” he said, at which point “they’re very, very sick.”

“They’ll start looking like we haven’t seen people look since probably 30, 40 years ago,” Rose said, a time well before the advent of highly effective medicines that from the perspective of many patients turned HIV from a death sentence to a manageable disease.   

Additionally, “every person that we lose to follow up and care, if they don’t know their status, that’s where the majority of new diagnoses come from,” he said, noting that without the CDC’s work “bringing people back into care,” there is “no way of tracking that.” HIV positive people will continue to potentially transmit the disease to others as “their own health deteriorates at levels that it doesn’t need to deteriorate at,” Rose said, “so, we make it worse.” 

Along with the breakthroughs in drug discovery that led to the introduction of highly efficacious and well tolerated antiretrovirals, the use of PrEP by those who are HIV-negative to drastically reduce the risk that they may contract the virus through sex has put the goal of eliminating the epidemic within reach. 

“One of the things we learned from things like the PROUD study,” Rose said, referring to randomized placebo-controlled HIV trials conducted in the U.K. in  2016 “ is that if you can get to the highest impacted folks, the most vulnerable folks, for every one person you get on PrEP, you’re getting anywhere from 16 to 23 infections averted.” 

Disparities in health outcomes are likely to worsen 

Rose noted that “we’re finally starting to stabilize” the disproportionately high rate of new infections among gay and bisexual Black men who have sex with men thanks in large part to the federal government’s work by employees and divisions that were cut by Kennedy’s restructuring of HHS, initiatives like culturally competent public health messaging campaigns for vulnerable populations, addressing subjects like PrEP, other prevention methods, the importance of regular HIV/STI screenings, and the availability of treatments for HIV and other sexually transmitted infections. 

There is no way of knowing if any intervention was effective in the absence of “surveillance units” to monitor the disease’s spread through communities and track mitigation efforts, he said, adding that the gutting of these positions comes as “Latin men have actually been catching [up to] Black men in terms of new diagnoses” while rates among Black and Latina trans women remain high. 

Along with NCHHSTP’s Prevention Communication Branch, the health secretary’s near 20 percent cut to CDC staff also eliminated the center’s  Division of Behavioral & Clinical Surveillance Branch, its Capacity Development Branch, its Quantitative Sciences Branch, and its HIV Research Branch. 

As a result, Rose said “You’re going to see these populations get hit hardest again,” communities that have long suffered disproportionately from the HIV epidemic due to factors like racial or income-based disparities in access to testing and treatment. 

Broadly, the CDC is distinguished from other agencies because the Atlanta-based agency’s remit is focused to a significant extent on the population level implementation of public health interventions, endeavoring to change health outcomes, he explained. With respect to PrEP, for example, once the drug was shown safe and effective in clinical research and the evidence supported its use as a critical tool in the federal government’s effort to stop the epidemic, the CDC is responsible for work like making sure at-risk populations who are disinclined to use condoms can stick with (or are sticking with) the medication regimen.  

The administration’s cuts encompass programs on the research side as well as the implementation side, Rose said. For example, he pointed to the “decimation” of divisions within the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, which conducts studies on HIV interventions from the preclinical basic science stage to double blind clinical trials such as those that led to the introduction of injectable PrEP, which can be administered once every other month after the first two doses. 

In fact, Rose said he worked alongside Dr. Jeanne Marrazzo, who succeeded Dr. Anthony Fauci as head of NIAID, on the Microbicide Trials Network board looking for behaviorally congruent HIV prevention products for populations that might not wish to take an oral or injectable formulation of PrEP. He added that she is a “brilliant scientist” who helped him better understand the vaginal microbiome as well as the ways in which “we fall short on women’s health and women’s sexual health, and what that means in the context of HIV prevention.” 

Together with other top officials like Dr. Jonathan (“Jono”)  Mermin, who led the NCHHSTP, on or around April 1, Marrazzo was reportedly offered the chance to either be placed on administrative leave or relocate to Indian Health Service outposts in rural American Indian or Native Alaskan communities located in states like Montana, Oklahoma, and Alaska. 

Infectious disease related risks and benefits of research extend beyond HIV 

Rose stressed the risks presented by the  administration’s decision to shutter divisions within NCHHSTP that were responsible for communications, education and behavioral studies around tuberculosis, especially provided how the disease is underdiscussed as a public health issue within U.S, borders — where rates of infection are elevated in certain communities, like unhoused and incarcerated populations, where queer folks are disproportionately represented. 

The restructuring of NCHHSTP and NIAID also raises the chances of outbreaks of viral and bacterial infections spread through sex that these public health workers could have prevented or better contained, Rose said. 

Instead, “for some reason, someone thought it was a good idea to get rid of labs at the Division of STIs,” at a time when “we’ve had increases in STIs for the last, like, six years,” including rising rates of congenital syphilis, “the one that kills babies” and increased diagnoses of the disease among gay men.

Additionally, Rose noted disparities in health outcomes for people living with hepatitis C are likely to worsen by the cessation of federal government initiatives to slow the spread of the disease  — which co-infects one of every four patients with HIV and can be fatal if untreated because the virus can cause cirrhosis, cancer, failure of the liver — because direct acting antivirals that cure 95 percent of all cases are covered by most insurance plans only when the policyholder has already sustained severe liver damage. 

Broadly, “the fact that we’re like, getting rid of the labs to test people means that we’re literally choosing to go backwards, stick our heads in the sand, and hope that no one has the ability to want to say anything,” he added. 

Even populations who are less susceptible to infection with diseases like HIV stand to benefit from basic and clinical science research into the disease, Rose said. 

He pointed to such examples as the drug discovery studies targeting a vaccine for HIV that ultimately led to the identification of combinations of antivirals that were capable of curing most cases of hepatitis C, the inclusion of participants with HIV in clinical trials that led to the introduction of Ebola vaccines, and breakthroughs in the biomedical understanding of aging that were reached through research into why patients with untreated HIV age more rapidly. 

“We continuously find new scientific endeavors that are able to help the general population, but also able to help the LGBTQ population,” Rose said, as “the things that happen in the HIV space spill over to other places.”

“From the LGBTQ health perspective, and especially from the research side,” he said, “we have just, in the last decade, started to really think about what interventions those populations need — not just [with respect to] HIV, but [other health issues like] smoking, alcohol and substance use and abuse,” including “crystal meth, which is always the number two drug in most major cities.” 

Likewise, as large swaths of America’s public health infrastructure are unraveled under the direction of the president and his health secretary, the dissolution of each position or each division should not be considered in isolation given (1) the interdisciplinary nature of the work in which these individuals and entities are engaged and (2) the administration’s efforts elsewhere to restrict access to healthcare, especially for disfavored populations like trans and gender-diverse communities. 

“There’s first the attack on the research pipeline,” Rose said, such as the HIV Vaccine Trials Network’s identification of an urgent or unmet need (behaviorally congruent methods of HIV prevention for women) and its discovery of a new intervention through research and clinical trials (a ring worn inside the vagina that releases an antiretroviral drug to stop the virus from entering the body during sex). 

“Then there’s the destruction of key health interventions,” he said. For example, “STI testing is a public health intervention. It keeps people healthy, and we’re able to reduce the amount of STI floating in populations” through regular testing and monitoring of new diagnoses. “Getting rid of programs that look at and support these [efforts] is really, really bad,” Rose said. 

He noted that the administration has endeavored to restrict healthcare access along a variety of fronts, especially when it comes to transgender medicine for youth, Rose said, from working to pass regulations circumscribing the scope of the ACA’s coverage mandate to gutting the HHS Office of Civil Rights such that vulnerable populations have less recourse when they are denied access to care or experience unlawful discrimination in healthcare settings, and conditioning the government’s federal funding for providers and hospital systems on their agreement not to administer guideline directed, evidence based interventions for the treatment of gender dysphoria in youth. 

“Last year, CDC documented that we had reduced new HIV infections by 6% and by 23% and 26% in counties that were in the Ending the Epidemic jurisdictions,” Rose said.  

In the face of these challenges shortly into the president’s second term, he said, “we will stand up to a scientific rigorous process every time, because we’ve done it every time, and every time we’ve done it, the world has been better for it.”

The Trump administration has launched a series of executive orders and other initiatives restricting the rights of the transgender community since taking power in January, targeting military service, affirming healthcare, and participation in sports. 

Though many executive orders are being challenged in court, it’s an uncertain time for a community that feels threatened. Despite the uncertainty, there are resources out there to help.

From legal assistance to mental health support, here’s a list of nonprofits and organizations dedicated to improving the everyday livelihood of trans and gender diverse people. These are mostly national organizations; there are many additional groups that work in local communities across the country. Some of these national groups will connect those in need of help to a local organization.

LEGAL HELP

President Trump issued an executive order declaring there are only two genders –– male and female –– which applies to legal documents and passports. The order doesn’t recognize the idea that one can transition their gender at birth to another gender.

Ash Lazarus Orr filed to renew his passport with a gender marker reflecting his identity. That was in January, and he still hasn’t received it. He refused to accept a passport without an accurate identification of who he is, so he filed a lawsuit with the ACLU in what is now known as Orr v. Trump.

Orr told the Washington Blade that not receiving his passport back has taken away his freedom of visiting family in Canada and receiving gender-affirming care from a trusted provider in Ireland.

The one thing getting him through this uncertain time is knowing who he’s fighting for –– the trans community, his loved ones, and himself.

“I’m trying to be that person that those younger parts of me needed growing up,” Orr said. Check out a couple of legal support organizations below:

Transgender Law Center

The Transgender Law Center (TLC) provides legal resources and assistance. TLC has a list –– called the Attorney Solidarity Network –– of attorneys that can provide advice or representation for trans people.

The organization also has a legal information help desk that answers questions regarding laws or policies impacting trans people.

Website: transgenderlawcenter.org

Phone: 510-587-9696

Email: [email protected]

Advocates For Trans Equality

With a variety of different programs tailored toward legal assistance and advocacy work, Advocates For Trans Equality’s reach is wide.

The non-profit offers the Name Change Project, which provides pro bono legal name change services to low-income trans, gender-non-conforming and nonbinary people by utilizing its partnerships with law firms and corporate law departments.

Advocates For Trans Equality also has departments and programs dedicated to increasing voter engagement, educating lawmakers on trans issues and offering litigation assistance to a small number of cases.

Website: transequality.org

Phone: 202-642-4542

General email: [email protected] 

To contact a specific department or program, visit its website above.

ADVOCACY

Looking to take action and get involved? Act now.

American Civil Liberties Union

The ACLU is a national nonprofit organization that mobilizes local communities and advocates for national causes.

Getting involved is as easy as filling out letters to representatives or signing petitions. One live petition is to “defend trans freedom.”

You can also join its People Power platform, where you serve as a volunteer in your community to “advance civil liberties and civil rights for all.” ACLU has different chapters across the country, so visit its website for more information.

Website: aclu.org

Phone: 212-549-2500

MILITARY AND VETERANS

Trump signed an executive order in January banning transgender service members from serving, stating their identity “conflicts with a soldier’s commitment to an honorable, truthful and disciplined lifestyle, even in one’s personal life.” 

Though the order has been legally challenged and struck down by a judge, U.S. Navy Lieutenant Rae Timberlake said it’s created an uncertain atmosphere for themself and other troops.

“All of the transgender service members I know have served with honor and integrity for many years…[and we’re] targeted for removal and not subject to any kind of review based on merit,” Timberlake, who joined the Navy at age 17, said. “There’s kind of just this cloud looming over our organizations and our units, because we know any day our transgender shipmates could no longer be on the team.”

But Timberlake’s message to any service member struggling because of the executive order was one of compassion and truth: “There’s no policy that can take away what you’ve accomplished and what you’ve done.”

Here are some organizations that support service members and veterans:

SPARTA Pride

SPARTA is a peer-support group composed of active duty, veteran and “future warrior” service members.

The group also engages in advocacy work and has helped change policies on gender neutral uniforms and reducing the time a trans service member would have to wait to return to their duties during their transition.

Contact SPARTA to learn more about joining its support network.

Website: spartapride.org

Email: [email protected] 

Modern Military Association

Modern Military supports service members and veterans through advocacy, legal assistance and mental health support.

It tracks LGBTQ+ and HIV discrimination through reports made on its website, and offers guidance and advice to whoever submitted the report.

It also supports the mental health of LGBTQ+ veterans and their families through its Resilient Heroes Program. By signing up, you’ll receive virtual peer support and case management services with a mental health coordinator.

Website: modernmilitary.org

Phone: 202-328-3244 

Email: [email protected] 

CRISIS & MENTAL HEALTH SUPPORT

If you have a more urgent matter, or just need someone to listen, here are some organizations you can reach out to:

The Trevor Project

The Trevor Project offers 24/7 counseling services. Calling, texting or chatting is free and confidential, and you’ll get to speak with someone specialized in supporting LGBTQ youth.

The organization also focuses on public education by hosting online LGBTQ suicide prevention trainings. It advocates for policies and laws that contribute to supporting queer youth.

Website: thetrevorproject.org

Crisis hotline: 1-866-488-7386

General inquiry phone number: 212-695-8650

Trans Lifeline

Trans Lifeline is a hotline run and operated by trans people. Whether you’re questioning if you’re trans or are a trans person just wanting to talk, someone will be there to help. It’s free and confidential, and there won’t be any non-consensual active rescue, such as calling the emergency services.

The line is not 24/7, however. Check out its website for hours within your time zone.

Website: translifeline.org

Phone: 877-565-8860

Here are other organizations that offer support to the trans community:

TransFamilies (support): Support for families with a gender diverse child.

TransLatina Coalition (advocacy): Advocates for the specific needs of the transgender, gender expansive and intersex communities in the U.S.

TransAthlete (information): Provides informative resources about trans athletes.

Campaign for Southern Equality’s Trans Youth Emergency Project (healthcare support): A fund to help trans youth access lifesaving healthcare.

TransTech Social (economic empowerment): Dedicated to discovering and empowering the career-ready skills of LGBTQ+ people.

World Professional Association For Transgender Health (health): Resources, symposiums and research dedicated to improving transgender health.

Sylvia Rivera Law Project (legal): Legal programs and services for marginalized communities.

Gender Spectrum (support): Resources and support groups for trans youth and families.

The Okra Project (support): Creates and supports initiatives that provide resources for the Black Trans community.

White House Press Secretary Karoline Leavitt and a senior advisor in the Department of Government Efficiency rejected requests from reporters who included their pronouns in the signature box of their emails, each telling different reporters at the New York Times that “as a matter of policy,” the Trump-Vance administration will decline to engage with members of the press on these grounds.

News of the correspondence between the journalists and the two senior officials was reported Tuesday by the Times, which also specified that when reached for comment, the White House declined to “directly say if their responses to the journalists represented a new formal policy of the White House press office, or when the practice had started.”

“Any reporter who chooses to put their preferred pronouns in their bio clearly does not care about biological reality or truth and therefore cannot be trusted to write an honest story,” Leavitt told the Times.

Department of Government Efficiency Senior Advisor Katie Miller responded, “I don’t respond to people who use pronouns in their signatures as it shows they ignore scientific realities and therefore ignore facts.”

Steven Cheung, the White House communications director, wrote in an email to the paper: “If The New York Times spent the same amount of time actually reporting the truth as they do being obsessed with pronouns, maybe they would be a half-decent publication.”

A reporter from Crooked media who got an email similar to those received by the Times reporters said, “I find it baffling that they care more about pronouns than giving journalists accurate information, but here we are.”

The practice of adding pronouns to asocial media bios or the signature box of outgoing emails has been a major sticking point for President Donald Trump’s second administration since Inauguration Day.

On day one, the White House issued an executive order stipulating that the federal government recognizes gender as a binary that is immutably linked to one’s birth sex, a definition excludes the existence of intersex and transgender individuals, notwithstanding the biological realities that natal sex characteristics do not always cleave neatly into male or female, nor do they always align with one’s gender identity .

On these grounds, the president issued another order that included a directive to the entire federal government workforce through the Office of Personnel Management: No pronouns in their emails.

As it became more commonplace in recent years to see emails with “she/her” or “he/him” next to the sender’s name, title, and organization, conservatives politicians and media figures often decried the trend as an effort to shoehorn woke ideas about gender (ideas they believe to be unscientific), or a workplace accommodation made only for the benefit of transgender people, or virtue-signaling on behalf of the LGBTQ left.

There are, however, any number of alternative explanations for why the practice caught on. For example, a cisgender woman may have a gender neutral name like Jordan and want to include “she/her” to avoid confusion.

A spokesman for the Times said: “Evading tough questions certainly runs counter to transparent engagement with free and independent press reporting. But refusing to answer a straightforward request to explain the administration’s policies because of the formatting of an email signature is both a concerning and baffling choice, especially from the highest press office in the U.S. government.”