Targeting the Most Vulnerable: How Trump’s Executive Orders Undermine Progress in HIV Care

Following his inauguration ceremony on January 20, President Trump signed and rescinded a record number of executive orders. The orders ranged in topic from halting immigration at the Mexican-American border to cutting back on LGBTQ+ and diversity, equity, inclusion, and accessibility (DEIA) initiatives. The executive orders issued and rescinded by President Trump have numerous implications for the well-being and livelihood of those living with and impacted by HIV. Many of these executive orders are likely to undermine the years of progress we have made in securing the rights of our communities and ensuring an end to the HIV epidemic.

Nonetheless, advocacy organizations are closely examining potential consequences and, where possible, identifying actions to prevent further harm from these executive actions. While the full scope of impacts has yet to be determined, we at AIDS United will continue to monitor and assess the impacts of these executive orders on our communities and provide you with updates as they arise. The following will provide the latest breakdown of the executive orders and their expected impacts:

Attacks on the Transgender Community and Gender Identity
Transgender people and the broader LGBTQ+ community are being unfairly and deliberately targeted and attacked in many of the Trump Administration’s executive orders. With executive orders bearing titles like “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government” and “Protecting Children From Chemical and Surgical Mutilation,” and the issuance of debilitating and unlawful funding freezes in service of targeting programs that serve transgender and gender non-conforming individuals, it is clear that President Trump is keen to make good on his transphobic rhetoric on the campaign trail while in the White House.

The ramifications of these executive orders are numerous and profound. At their core, they seek the erasure of transgender and non-binary communities from all federal policymaking, mandating that, “it is the policy of the United States to recognize two sexes, male and female”, and that, “these sexes are not changeable and are grounded in fundamental and incontrovertible reality.” These executive orders reject scientific understanding and medical best practices while relying on rhetoric that is vile and divisive.

These orders compel federal agencies to make all government-issued identification documents, like passports, visas, and global entry cards reflect a binary view of sex as assigned at birth, and mandate that federal agencies not collect any data related to gender identity. The executive orders also seek to end all federal funding for gender-affirming care while threatening to restrict research and education grants for medical schools and hospitals that provide gender-affirming care to “children” under the age of 19.

In addition, one of the orders mandates that gender-affirming care and other discrimination protections be unavailable in federal prisons, and rescinds a previous rule that prohibited discrimination in federal housing programs based on gender identity. Lawsuits challenging Trump’s executive orders concerning gender-affirming care and the rights of transgender and gender-nonconforming people have been and will continue to be filed.

Yet another executive order seeks to bar trans people from joining and serving openly in the U.S. military. It tasks military officials with developing a new policy that prioritizes “readiness and lethality,” while attacking pronouns and restricting use of certain gender-specific facilities. The ban is not immediate, yet aims to end coverage for transition-related medical services for enlisted personnel and their families, and revises Department of Defense medical standards. If allowed to go into effect, the order is certain to lead to “operational gaps” for the military and compromise troop readiness.

Racial Equity
President Trump has called for the end of DEI-related programs, initiatives, positions, and efforts within the federal government through his executive order “Ending Radical and Wasteful Government DEI Programs and Preferencing.” This has led to many DEI-related federal jobs being immediately placed on leave, in addition to the recent announcement that a temporary freeze is to be placed on all federal financial assistance. This assistance is wide-ranging, including foreign aid, grant support for nongovernmental organizations, and initiatives related to diversity, equity, and inclusion, gender policies, and environmental projects associated with the “Green New Deal.”

The administration’s efforts to block DEI efforts, and in turn limit federal funding for such programs, will have negative consequences on our ability to effectively respond to the HIV epidemic in the U.S. The National HIV/AIDS Strategy and Ending the HIV Epidemic Initiatives are both built on the understanding that any efforts to combat HIV in the U.S. are predicated on eliminating racial health inequities. This requires targeted and sustained investment in communities of color who are disproportionately impacted by the epidemic. Great progress and achievement have been made by programs that address health disparities of Black and Latine people living with HIV. HIV initiatives rely heavily on these grants and their potential recession will make efforts to address racial health disparities among people living with HIV more difficult.

Immigration
President Trump issued two executive orders that will have a profound effect on noncitizens, “Protecting the American People Against Invasion” and “Protecting the Meaning and Value of American Citizenship.” Since President Trump’s inauguration, his administration has supercharged ICE raids and deportations across the United States — in line with these executive orders. However, immigration advocates and attorneys were prepared with legal challenges to prevent certain executive orders from going into effect, particularly the order targeting birthright citizenship, a constitutional right. In Seattle, a federal judge has placed the executive order on hold and 22 states have filed a lawsuit claiming that the executive order violates the 14th Amendment.

The U.S. immigration system creates numerous barriers for noncitizens living with HIV — the recent executive orders targeting noncitizens will likely exacerbate existing health inequities, limiting HIV testing, treatment, and prevention efforts and halting progress toward ending the HIV epidemic. In addition, fears of ICE raids will likely prevent people living with HIV, both noncitizens and those with family who are noncitizens, from taking what they may deem unnecessary risks by traveling for health care visits.

Foreign Aid Funding
The President has also issued the executive order, “Reevaluating and Realigning United States Foreign Aid” which initiates a 90-day pause on all U.S. foreign aid, including the President’s Emergency Plan for AIDS Relief (PEPFAR). According to amFAR, The Foundation for AIDS Research, the pause would prevent life-saving HIV treatment and services in over 54 countries where more than 190,000 healthcare providers provide core health services every day. Hundreds of thousands of people across the globe will have their access to care disrupted, halting the global HIV response. Numerous federal agencies play a part in the implementation of PEPFAR, an initiative established in 2003, that has seen countless successes such as providing testing services for 71.1 million people and supporting live-saving ART for 20.5 million people. The recent executive order will not only disrupt the operations of these organizations but harm the people being served by them.

On January 28th, Secretary of State Marco Rubio issued a waiver for lifesaving medications and medical services, which appears to cover antiretroviral drugs for HIV, but it is unclear whether the waiver also applies to PrEP. It also remains to be seen if organizations are truly allowed to operate since funds supporting other aspects of their programs remain blocked.

The impacts of some executive orders are not immediate — we will likely see their impact over weeks, months, and years. Legal and advocacy organizations have already taken action against many of these orders that seek to harm our communities. But it will require ongoing and diligent resistance. We will continue to provide updates on the status of these orders — and forthcoming orders — as new information arises.

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