In the first installment of the new Health Equity Series on Science Speaks, the leadership of IDSA’s Proudly ID Interest Group reflects on resistance, resilience and how to take action this Pride Month amid setbacks affecting gender-affirming care and essential public health programs and services.
When public health is politicized, our silence does not equate to neutrality; our silence becomes complicity and yet another barrier to achieving health equity.
In 2024, over 500 anti-LGBTQ+ bills swept through U.S. legislatures, targeting access to gender-affirming care, inclusive education and LGBTQ+ visibility itself. (1) These assaults are not just ideological, they’re clinical, and their effects are dismantling decades of public health infrastructure, fracturing trust in care systems and endangering lives.
At the same time, HIV and sexually transmitted infection programs are being gutted. Proposed cuts to the Ryan White HIV/AIDS Program, the Ending the HIV Epidemic initiative and core STI prevention services threaten the very programs that have helped communities survive and thrive. (2,3,4) Let’s be clear: This is a public health emergency.
We are in the middle of a national STI crisis, and the silence is deafening
The U.S. is experiencing record-high rates of syphilis, including congenital syphilis, alongside rising gonorrhea and chlamydia. LGBTQ+ individuals, in particular non-Hispanic Black or African American and Latinx men who have sex with men, continue to be disproportionately impacted by these infections. (5)
Yet, the very services that detect and treat these infections (e.g., Title X clinics, STI programs and sexual health outreach teams) are being underfunded or shut down altogether. In some states, restrictions on LGBTQ+ health education have made it nearly impossible to provide even basic information on STI prevention and treatment. This isn’t just a health crisis; it’s a human rights crisis.
The criminalization of gender-affirming care doesn’t just harm transgender youth, it breaks HIV PrEP pipelines. Restrictions on comprehensive sex education contribute to misinformation and foster conditions that facilitate the undetected transmission of STIs. Each legislative attack on evidence-based care contributes to poorer patient outcomes, increased rates of missed diagnoses, and preventable morbidity and mortality. (6)
As infectious diseases clinicians, we are trained to respond to biological threats; but when those threats are amplified by structural violence, racism, homophobia, transphobia and policy neglect, we are called to more than just treatment. We are called to advocacy!
History demonstrates that LGBTQ+ communities have consistently responded to adversity with resilience, advocacy and an unwavering commitment to health equity and justice
From the HIV/AIDS epidemic to the rise of undetectable = untransmittable (U = U) and community PrEP programs, LGBTQ+ leaders have turned grief into power, stigma into science, and isolation into solidarity. (7, 8) We’ve seen what’s possible when communities lead, and systems follow.
That legacy continues today in harm reduction mobile clinics, in rural tele-PrEP clinics and in STI outreach efforts led by transgender individuals. These aren’t just services, they’re lifelines.
We need to act — and we need to act now.
We need more than allies. We need accomplices. Here are some actionable steps you can take for a coordinated response:
- Advocate through policy: Contact your members of Congress through the IDSA/HIVMA Advocacy Action Center to protect HIV/STI funding and LGBTQ+ rights.
- Sign up to be an IDSA/HIVMA advocate: Stay engaged and ready to act as policies move at the local and federal level. Join the Member Advocacy Program.
- Center STI prevention and LGBTQ+ equity in your practice: Use IDSA’s inclusion, diversity, access and equity resources to build inclusive, affirming clinical environments.
- Demand robust HIV/STI and harm reduction services: These are not “extras” — they are foundational to ending both the HIV and STI epidemics.
- Advocate for virtual PrEP, PEP and/or doxy PEP prescribing platforms to expand access, especially in rural and underserved areas.
- Support mobile clinics, syringe service programs and community-based sexual health hubs that meet people where they are.
- Invest in sexual health navigators who help link individuals to affirming, evidence-based care.
- Ensure widespread access to condoms, lubricant, dental dams and culturally relevant sexual health education materials.
- Promote relationship-based outreach and stigma reduction, especially through peer-led programs grounded in community trust.
- Rest and recharge: Pride Month is not just a celebration, it’s survival. Claim joy. Claim community. That is part of the work too.
Pride is more than a celebration with glitter: Pride is resistance, resilience and advocacy
Pride Month honors the resilience of LGBTQ+ communities in the face of stigma, loss and systemic neglect. It is a call to reflect on how far we’ve come, grieve what we’ve lost and recommit to the ongoing work for health equity and human rights.
In the words of queer Black activist Joseph Beam, “Visibility is survival,” and we must continue claiming our seat at the table. Pride is not just symbolic. It is a reminder that joy, healing and solidarity affirm both our purpose and our power.
Learn more about the new Health Equity Series on Science Speaks. To join IDSA’s Proudly ID Interest Group, complete this form (member login required).
References
- Movement Advancement Project. Equality Maps: LGBTQ Policy Tally. 2024.
- Dawson L. Domestic HIV Funding in the White House FY 2026 Budget Request. KFF. 2024.
- Centers for Disease Control and Prevention. Ending the HIV Epidemic in the U.S. Updated 2024.
- National Coalition of STD Directors. Out of Control STI Epidemic Continues to Put Lives at Risk. 2024.
- Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2023.
- Turban JL, Kraschel KL, Cohen IG. Legislation to Criminalize Gender-Affirming Medical Care for Transgender Youth. JAMA. 2021;325(22):2251–2252. doi:10.1001/jama.2021.7764
- ACT UP Oral History Project.
- Prevention Access Campaign. U=U (Undetectable = Untransmittable).