Dear community members, supporters, clients, and advocates,
It’s been a busy summer for SFAF and for organizations and communities across the country working to advance HIV prevention, LGBTQ+ health, and health equity. We continue to navigate an escalating series of attacks from the Trump administration on our communities, programs, services, and funding. I wanted to share a few of these updates with you–and, importantly, what SFAF is doing in response.
Healthcare access and affordability–particularly for those in our communities who are most underserved–continue to be a primary concern for all of us. The Trump administration’s changes to Medicaid (Medi-Cal in California) are at the top of a growing list of damaging federal policy that will create more barriers to care.
Across the nation, Medicaid is our safety net insurance program for children, people who are pregnant, and people with disabilities. In states that have expanded Medicaid, like California, low-income people also qualify for this program. In California, Medi-Cal is the largest source of health coverage for people living with HIV–making it an incredibly important program for many of the communities SFAF serves.
The Trump administration has taken drastic steps to restrict access to Medicaid. New work requirements, narrower access for people who are immigrants, and more frequent eligibility checks will cause many people to lose coverage. It’s estimated that 7.5 million people will lose access to health insurance by 2034 because of these changes. Behind that number are millions of people who may be forced to delay care, go without medications, or navigate an already complicated healthcare system without coverage. For people living with or vulnerable to HIV, those consequences are particularly serious.
On top of this, the administration continues its relentless and dehumanizing attacks on transgender people and their access to medically necessary care. The Centers for Medicare and Medicaid Services (CMS) recently announced a rule that would prohibit federal Medicaid and Children’s Health Insurance Program (CHIP) funding for certain gender-affirming medical care for young people under the age of 19. It’s estimated that about 130,000 young trans people may be affected by these restrictions. Gender-affirming care is evidence-based health care supported by leading medical organizations—and decisions about that care belong with patients, their families, and their healthcare providers, not politicians.
Our federal policy team is working alongside national partners and coalitions to challenge these policies, make clear their real-world impact, and advocate for the health and dignity of our communities.
At the same time, our lawsuit SFAF v. Trump continues to shield SFAF and other co-plaintiffs from some of these impacts. The preliminary injunction in our case currently prevents the federal government from enforcing certain challenged funding conditions targeting DEI, “gender ideology,” and the “transition of a child under 19” against SFAF and our co-plaintiffs.
The case is now before the Ninth Circuit Court of Appeals. Both sides have submitted supplemental briefing requests by the Court, and we are awaiting a new date for oral argument. We will continue to keep our community informed as the case moves forward.
And while the federal landscape remains challenging, we are seeing what is possible when our communities organize and fight back. We led very successful budget advocacy campaigns at the local and state levels this year, preventing drastic cuts in public health in San Francisco and securing more than $500 million for HIV-related programs across California over the next four years. At the federal level, however, funding for HIV and LGBTQ+ communities remains uncertain.
This summer, we learned that the Centers for Disease Control & Prevention (CDC) would not renew its main HIV prevention grant for community-based organizations– putting at risk more than $230 million in funding to nearly 100 organizations across the nation. Some local health departments may try to continue this funding to community organizations including here in San Francisco, where funding will instead flow through the San Francisco Department of Public Health. But that will not be the reality everywhere, and many community-based organizations across the country may be unable to replace these federal resources. The result could be fewer HIV tests, fewer people connected to PrEP and treatment, and fewer trusted community organizations able to reach people where they are.
There is no question that the months ahead will require vigilance, advocacy, and courage. But SFAF has spent more than four decades meeting moments like this one. We will continue to fight for access to care, defend the dignity and health of our communities, and use every tool available to us—from advocacy and organizing to litigation—to protect the progress we have made together.
We are not doing this work alone. We stand alongside our partners, our clients, our supporters, and all of you who believe that health care is a right and that every person deserves the opportunity to live with health, dignity, and belonging. Thank you for continuing to stand with us.
In solidarity,
Tyler TerMeer, PhD
CEO, SFAF