If Donald Trump truly wants to be a "friend to the gays," as he pledged during his presidential campaign, he has a strange way of showing it.
Shortly after being inaugurated Friday as the 45th president of the United States, all references to the LGBTQ community immediately disappeared from the White House's website, including the webpage for the Office of National AIDS Policy. That erasure triggered longstanding fears about how the Trump administration will treat queer people, particularly those living with HIV.
LGBTQ advocates are particularly concerned about the future of the Ryan White Care Act. That national program provides critical resources for HIV-positive individuals, particularly those in low-income populations. While campaigning for Congress in 2000, Mike Pence advocated for diverting resources from Ryan White to organizations "which provide assistance to those seeking to change their sexual behavior." That coded language is a reference to conversion therapy, the discredited practice of seeking to "cure" LGBTQ people of same-sex attraction.
As Trump's vice president, Pence is now just a heartbeat away from the presidency. And given that the former Indiana governor passed a law in 2015 giving businesses in that state the right to deny services to LGBTQ customers, it's doubtful his feelings have changed much in the past two decades.
Should Pence attempt to chip away at the Ryan White Care Act in his new position, it would have an enormous impact on HIV-positive individuals living in Chicago and Illinois—as well as the LGBTQ organizations that advocate for their care. The state received $88.5 million in Ryan White funding in 2014, the last year the program’s allotment was reported.
A failure to reauthorize those federal dollars would result in the drastic reduction of services offered to an extraordinarily vulnerable community. For many people living with HIV/AIDS, getting this money or not is a matter of life and death.
The Chicago-based Test Positive Aware Network, a HIV/AIDS community organization, estimates that Ryan White funding comprises 10 percent of their overall budget, or more than $400,000 annually. Losing that money would jeopardize the group's case management programs, mental health services, and support groups provided to the HIV-positive community.
Lorraine Hayes, the associate director of development for TPAN, explained that these resources are crucial in connecting people living with HIV to care. Case managers help their HIV-positive clients find affirming medical providers to help manage their symptoms and get access to medications. These antiretroviral regimens (ARVs), which help decrease the presence of HIV in the bloodstream, prevent the virus from being spread to others. If patients don’t receive this medication, it could lead to an outbreak in the community.
"If you are HIV positive, seeing a doctor, and virally suppressed, the amount of HIV in your blood is pretty low," Hayes says. "You're 95 percent less likely to transmit the virus to someone else. If people were not able to receive case management, that would increase the likelihood that they would transmit the virus to someone else."
A resurgence in the virus would be a major about-face from recent years, as programs like the Ryan White Care Act have helped keep annual rates of HIV transmission relatively steady. There are between 38,000 and 40,000 new infections each year nationally, says David Ernesto Munar, CEO of the Howard Brown Health Center. Currently, 1.2 million people are living with HIV in the United States.
The consequences of rolling back Ryan White funding would be "devastating for public health," Munar says:
"These are communicable diseases that don’t recognize borders—like gender, ethnicity, or sexual orientation. Every segment of the country is affected by HIV, so there are real consequences to allowing it to flourish. It becomes a bigger problem and maybe impossible to manage if we don't take advantage of the tools we have at our disposal. Without providing access to medications, the only thing we have to offer is palliative care—which is to die with dignity."
Peter Johnson, director of public relations for the Center on Halsted, compared the possible battle over Ryan White to the Illinois budget crisis, an impasse that forced many nonprofits to "close their doors or deeply cut back their services."
As the Reader reported last August, that legislative logjam hit the LGBTQ community particularly hard. Ninety percent of advocacy organizations servicing the homeless community were forced to turn away potential clients, many of whom are LGBTQ. Statistics from the Williams Institute, a UCLA-based think tank, show that 40 percent of homeless youth identify as queer or transgender.
A national battle over the Ryan White Care Act in Congress could result in similar consequences.
"If this funding were not reauthorized, we would have to look at our budget and make some difficult choices," Johnson says. "We would work to the best of our ability to make sure that we would not impact any of the individuals currently receiving services."
John Peller, president and CEO of the AIDS Foundation of Chicago, warned that there could be a much bigger threat facing the LGBT community, though: Republican threats to the Affordable Care Act. Trump, who campaigned against Obamacare, as it's called, signed an executive order on his first day in office declaring his intention to "repeal and replace" the health care legislation, although he has yet to outline an alternative.
If the current system isn't swiftly replaced, it could be devastating for people living with HIV.
"One in three people living with HIV in Illinois gained coverage through the Affordable Care Act," Peller says. "That's 12,000 people out of about 38,000 people living with HIV in the state."
Prior to the ACA, a majority of these individuals were virtually uninsurable due to preexisting condition clauses in private health plans. By eliminating the ability of insurers to discriminate against people living with HIV, the ACA offered this population unprecedented access to primary care, as well as medication, testing, and treatment. Without these options, HIV-positive individuals would be forced to rely on the Ryan White funding, which is itself in jeopardy under a Trump presidency.
The Ryan White Care Act was designed to be a last-ditch solution, a safety net for those who are uninsured or underinsured. Absent these programs, there would be few remaining safeguards in place for the community.
"We've got a lot to worry about," says Patti Capouch, the CEO of Test Positive Aware Network. "If the Affordable Care Act is repealed and Ryan White isn't reauthorized, that is a really scary situation for our clients and our community. Before the Affordable Care Act, if you didn't have insurance, you only had Ryan White to rely on. I can't even imagine what that would look like without them."