As the second Trump administration rolls back LGBTQ+ rights and visibility, some of his early decisions could prove to be an indirect hit to already marginalized members of the community.
The federal government recently terminated millions of dollars in grants towards HIV-related research. The Trump administration is also considering eliminating the CDC’s HIV prevention division, and there are concerns about the future of the Ryan White HIV/AIDS program—a federal initiative aimed at providing support for people with HIV.
One of Trump’s most controversial executive orders in his first few days was the reversal of Executive Order 14087 — a Biden-era order aimed at lowering prescription drug prices. Some of the points in Biden’s order included “a cap for out-of-pocket costs at the pharmacy” and the power of the Secretary of State “to negotiate prices for selected high-cost prescription drugs for Medicare beneficiaries for the first time ever.”
According to a 2023 report by UCLA School of Law’s Williams Institute, LGBTQ+ people experience poverty at a higher percentage rate than their non-LGBTQ+ counterparts. The same is true for the uninsured — in Dec. 2021, nearly 10% of LGBTQ+ adults reported being without insurance compared to just over 7% of non-LGBTQ adults.
Looking at HIV infections themselves, of 31,800 estimated new infections in 2022, 71% were among gay and bisexual men. Hispanic and Latino men make up 36% of these and Black and African American accounted for another 34%, the two highest percentages among demographics.
Latino and Black communities also report higher rates of poverty and uninsurance than white Americans, making them more susceptible to the effects of rising drug costs.
Nadeen Israel, Senior Vice President of Policy and Advocacy at AIDS Foundation of Chicago, said most of her work is done with a close focus on Medicaid. She said with the current political climate, the organization’s resources, time and efforts are being put into “defense mode.”
“We’re spending most of our time, essentially trying to hold the line as much as possible on the programs, funding, structure of the systems [amd] the policies that undergird our healthcare system,” she said.
Part of Israel’s current research involves finding and seeing which demographics are disproportionately affected by HIV or lack of access to care. She said the data has been consistent for many years that there is a disproportionate impact on Black and Latine folks, specifically men who partner with men, trans women of color and Black cisgender women.
“They’ve been hit hardest for a while now, and unless we can do better year over year, that’s not going to change,” Israel said. “Unfortunately, in this environment, the worry is that we’re going to get worse instead of better because of all the attacks on these particular populations.”
Dr. Richard M. Novak, Chief of the Division of Infectious Diseases at UI Health, received his MD in 1981—the year HIV was first described. He started his infectious diseases training in 1986 and began a career of work with the disease and its treatment.
When he was working in clinics and initial HIV drugs, he said government support via funding allowed them to get access to the drugs for treating patients. He said this type of program is especially key today for the uninsured or underinsured.
“The assistance program included coverage of anybody who couldn’t afford their medication,” he said. “You can only hope that the current government doesn’t end the Ryan White Program.”
In regards to Trump’s executive order against prescription drugs—which could be challenged in court like many of his orders—Israel said the impact will not be felt right away. However, she said Medicare is able to negotiate prices over some drugs with pharmaceutical companies, and she could see that being one of the first things to be limited.
“Unfortunately, in this environment, the worry is that we’re going to get worse instead of better because of all the attacks on these particular populations.”
Nadeen Israel
The funding cuts to social services and organizations could—and are already—causing problems of their own. Israel said when these people get laid off and lose their jobs, communities also lose “all of that institutional knowledge” as well as access to the services, which could take decades to build back up.
Novak said drug treatment has evolved over the years and given rise to “incredible options,” but many are still highly priced. He said there are slightly less expensive generic options—or even those which have been more or less phased out due to more intense side effects—which could be options for people if the government were to withdraw support for medication.
When it comes to how that could affect marginalized communities, Novak said those types of rollbacks could just continue to pile on to the attacks on the trans community.
“I mean, this government is anti-trans, so it’s really making it very difficult for trans people to exist in society,” he said. “Fortunately here in Illinois we have a haven, but elsewhere in the country, it’s more difficult.”
During the peak of the COVID-19 pandemic, Israel said they saw a jump in HIV diagnoses because they weren’t able to be out in communities testing and talking about PrEP and PEP. She said cutting services related to HIV will have the same effect and send prevention work backwards.
Potential Medicaid cuts would also disproportionately harm those living with HIV—according to Israel, 41% of HIV+ people are on the program. She said those cuts, if they occurred, would be felt immediately.
“Illinois and other states cannot bear [or] makeup for the cost,” she said. “There’s no way, just because it’s to the tune of billions, a few billion dollars a year. Even if states were willing to raise some taxes that they have control over in order to make up for it, they can’t raise taxes enough without impacting other parts of the economy.”
Beyond changes and attacks on policy, Israel said Republicans’ verbal and psychological attacks on queer young people, the trans community, the HIV+ community and more equates to “lifetime damage” that won’t just reverse undo a new administration. However, she said there are small actions people can take to help fight back, such as going to protests or town halls.
“Joining as folks can is really, really important, and it works,” she said. “It works in pushing back and we can beat them back. We can stop these policies, but it will take many, many people to turn out … until we ultimately win.”
