Trump administration takes away life-saving HIV prevention medications from vulnerable LGBTQ+ people worldwide

The Trump administration has launched yet another calculated attack on LGBTQ+ lives—this time by withholding access to pre-exposure prophylaxis or PrEP under the longstanding President’s Emergency Plan for AIDS Relief or PEPFAR program. While PrEP distribution has resumed under a limited waiver following a 90-day foreign aid freeze, the administration has imposed a deadly restriction: most LGBTQ+ people are explicitly excluded from receiving the medication that would protect them from HIV.

In late January, Secretary of State Marco Rubio issued a 90-day freeze on foreign aid. Days later, he issued a waiver for “life-saving humanitarian assistance” that would resume some programs, including the distribution of HIV prevention medications. A February 6 memo from the U.S. Department of State, first published by UNAIDS, spells out the policy: “Pre-exposure prophylaxis (PrEP) should be offered only to pregnant and breastfeeding women.” The document goes on to declare that “people other than pregnant and breastfeeding women who may be at high risk of HIV infection or were previously initiated on a PrEP option can not be offered PEPFAR-funded PrEP” during the foreign aid freeze.

Related: Trump administration erases mentions of LGBTQ+ & HIV resources from government websites

The exclusion is part of a broader effort by the administration to defund programs that deal with diversity or gender and block aid to organizations that support transgender people. The impact is already devastating—UNAIDS estimates that since the administration’s 90-day foreign aid freeze began, more than 3,000 new HIV infections have already happened worldwide as a direct result of the policy. The organization warned on Monday that any sustained restrictions on PEPFAR funding would have catastrophic consequences for millions who rely on it for HIV prevention and treatment, Them reports.

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A death sentence for LGBTQ+ communities

The fallout from the administration’s decision is being felt in real-time. According toThe Washington Blade, the Trump administration’s funding freeze forced the closure of Fahari ya Jamii, a PEPFAR-funded HIV program in Kenya that provided services to over 72,000 people. The program, launched in 2022, focused on providing HIV tests, treatment, and prevention to high-risk groups—including men who have sex with men and sex workers.

Related: Trump’s foreign aid freeze will stop AIDS funding under PEPFAR — a program that’s saved millions

With the program shuttered, over 700 healthcare workers have been placed on unpaid leave, and over 150 clinics have shut down indefinitely.

South African organizations have also been forced to cut services. Two organizations, OUT and Engage Men’s Health, which provide HIV prevention services to men who have sex with men, transgender people, and sex workers, have suspended operations due to the funding freeze, the Washington Blade reports. With no immediate alternative, clients have been told to seek services at public hospitals—many of which lack LGBTQ+-specific expertise and are already overwhelmed.

The Trump administration’s decision to exclude LGBTQ+ people from PrEP access has been met with outrage from global health leaders. The AIDS Vaccine Advocacy Coalition, an international nonprofit focused on HIV prevention, issued a stark warning:

“With this new guidance, the Trump Administration is choosing politics over science, discrimination over compassion, and ultimately, death over life.”

AVAC called the move a “death sentence for thousands of people at risk of HIV globally.”

The status of PrEP in the U.S.

While the Trump administration is blocking PrEP access abroad, it is also attacking it at home. A case before the Supreme Court threatens to gut the Affordable Care Act’s requirement that insurers cover PrEP at no cost.

At the heart of the case is Braidwood Management, Inc., a Texas company that claims covering PrEP violates religious freedoms by “encouraging homosexual behavior.”

Related: Supreme Court will decide if insurance companies must cover PrEP for HIV prevention, cancer screenings

A lower court ruling already granted an exemption to the plaintiffs, and now theU.S. Supreme Court will decide whether the ACA mandate should be overturned. If it rules in favor of the plaintiffs, insurers will no longer be required to cover PrEP, making it unaffordable for many who need it most.

A coordinated effort to erase LGBTQ+ lives

The Trump administration’s PrEP restrictions are just one facet of a broader campaign to erase LGBTQ+ people from federal policy. As The Advocate has reported, the administration has systematically removed references to LGBTQ+ identities and HIV-related resources from federal websites, including those of the White House, the Centers for Disease Control and Prevention, and the Department of State.

The administration’s actions go beyond digital erasure. In January, Trump signed an executive order mandating that all federal policies reflect the belief that “there are only two genders: male and female,” effectively revoking recognition of transgender and nonbinary people in government programs.