Was this email forwarded to you? Subscribe for bi-monthly emails from PWN in your inbox!

Content Warning: many of these updates include information about harmful attacks on Black, Indigenous and people of color (BIPOC) and LGBTQ+ folx.

🔥Hot Topic: Budget and Appropriations

The federal budget process is heating up and funding for HIV programs is at risk. Every year, Congress is supposed to pass 12 spending bills to keep the government funded. This process (known as the appropriations process) has been fraught, divisive, and often pushed through under the threat of a government shutdown. This year promises to be no different. 

There are two big dates to watch: October 1 and December 31. If Congress cannot find common ground by the start of the next fiscal year (October 1), the U.S. could see its fourth partial government shutdown in a decade. Moreover, a deal made during last month’s debt-limit agreement adds an additional layer of urgency: if Congress does not pass the 12 spending bills by the end of the year (December 31), there will be 1 percent cuts on all discretionary spending. (Mandatory spending on programs such as Medicare and Social Security would not be included in that 1 percent cut.) 

This is a rapidly shifting issue. Right now, U.S. House and Senate subcommittees are creating their own proposed spending bills, which will change as they move through Congress. These spending bills fund programs and agencies that impact most aspects of our lives, from housing to healthcare to education. Congressional budget priorities are deeply divided along party lines. With a Democrat-led Senate and a Republican-led House of Representatives, those bills—and the priorities they represent—will likely vary widely between the House and Senate versions.  It’s important to keep track of the moving parts and what’s at stake. 

The spending bills we have seen from the U.S. House are already deeply concerning for people living with HIV. One of those bills (known as “Labor-HHS” because it impacts funding for Labor, Health and Human Services, Education, and Related Agencies) will largely determine the budget for the federal HIV response.  

On July 13, 2023, the House’s Labor-HHS subcommittee proposed a bill with nearly $500 million in cuts to programs related to HIV prevention and care. If passed, the bill would cut $238.5 million from the Ryan White HIV/AIDS Program, $226 million from the National Center for HIV, Viral Hepatitis, STD and TB Prevention at the Centers for Disease Control and Prevention, and $32 million from the Minority HIV/AIDS Fund. Amongst these cuts are the complete defunding for programs such as Part F of the Ryan White HIV/AIDS Program. These program cuts would put the lives, health, and well-being of many in our communities, and particularly Black, Brown, Indigenous, people of color, trans*, and non-binary people, in danger.  

Another spending bill, the defense bill, passed the full U.S. House on July 14, 2023. This one included devastating restrictions on abortion access, gender-affirming care and diversity training for military personnel. While this defense bill will nearly certainly not pass the U.S. Senate, the harsh political reality is that negotiations over these spending bills are just beginning. There will undoubtedly be more harmful “compromises” and additional “riders” as these bills move through Congress for a vote. 

In the coming months, PWN-USA will continue its federal advocacy alongside partners in spaces like the U.S. People Living with HIV Caucus. We will provide updates on the budget process and how it impacts people living with HIV. This budget update is just one more example of how our systems were built to fail us. We will stay vigilant in practicing community care while advocating for the services, programs and funding that our communities need and deserve. 

LGBTQ+ Health, Rights, and Justice


Federal judges in multiple states –including Arkansas, Florida, Indiana, Tennessee – are  rejecting anti-trans legislation ranging from anti-drag show laws to gender affirming care bans. Click on the links to find out more details about the laws blocked in each state. 



  • Vanderbilt University Medical Center turned over transgender patients’ medical records to the Tennessee attorney general as part of an investigation into medical billing. This has rightfully sparked backlash and stoked fear surrounding the medical privacy of trans* youth in the state. Instances like this are directly related to other medical privacy concerns, like Molecular HIV Surveillance, and how collaboration between healthcare and carceral agencies continue to be a real and present threat, especially to BIPOC, queer, and trans* communities.  
  • But states across the U.S. continue to push anti-LGBTQ+ policies. For example:
    • The North Carolina legislature passed a bill restricting transgender youth in sports. The state’s governor vetoed the bill, but State lawmakers are poised to override the Governor’s veto. 
    • Louisiana’s Republican-led legislature passed a ban on gender-affirming care for most minors in the state. The state governor vetoed the bill but the state lawmakers overrode the veto.
    • Texas enacted multiple pieces of harmful, anti-LGBTQ+ legislation, including banning transgender students at public Texas colleges from competing on teams that align with their gender identity and banning ‘sexually oriented performances’ that take place in the presence of young people. 
  • Democratic lawmakers introduced a bill to amend the Civil Rights Act to include LGBTQ+ protections, such as protections against discrimination in employment, housing, and education. 
  • New Jersey’s state attorney general sued to stop three school districts from outing trans students by requiring the school to contact a parent if the student has decided to be recognized by a new gender and name.
  • A federal court exempted a Houston company from following anti-discrimination law protecting LGBTQ+ workers. This case was brought by the same conservative activist that brought the case challenging the Affordable Care Act’s insurance coverage requirement for preventative care (including PrEP). 

Access to Healthcare

  • The Department of Justice and the challengers to the Affordable Care Act (ACA) in the Braidwood case reached a deal to keep no-cost preventative care largely in place while the case is being appealed. Most major health insurers don’t anticipate making changes to no-cost preventive services while the case proceeds through the courts.  
  • The U.S. Supreme Court upheld the right of Medicaid (and other spending clause program) beneficiaries to sue for damages in federal court when their rights are being violated by state officials. This is an immense relief.
  • Major drug companies sued the federal government seeking to stop the negotiation of drug prices in Medicare. Legal experts think it will be tough for the drug companies to win their cases. 
  • In a significant move, there is a proposed rule updating the Older Americans Act Program regulations to include listing people living with HIV in the definition of “greatest social need” and also makes it clear that states must incorporate this population in their plans. Comments on the proposed rule are due by Aug. 15, 2023—PWN-USA will provide an easy way to submit public comments so keep a look out for this outreach!
  • New York state lawmakers passed an LGBTQ+ and HIV long-term care residents’ bill of rights. The bill bars discrimination against potential residents based on actual or perceived sexual orientation, gender identity or expression, or HIV status. 
  • Iowa passed a law removing HIV education from required school curriculum. 

Reproductive Health, Rights, and Justice

  • Biden signed an executive order to expand birth control access through considering actions such as ensuring private health insurance cover all contraceptives approved by the Federal Drug Administration (FDA). Additionally, the FDA approved the first ever over-the-counter birth control pill. 

  • The U.S. Supreme Court unexpectedly upheld a crucial provision of the Voting Rights Act that prohibits racial gerrymandering. The case stems from an Alabama redistricting plan that sought to dilute the voting power of Black voters. Voting rights is a reproductive justice issue because abortion rights and access to abortion rights oftentimes rely on voters, especially in the current landscape where state elected officials have a lot of power in deciding state abortion laws. 
  • The U.S. Supreme Court also upheld The Indian Child Welfare Act (ICWA) of 1978, which was a law passed in response to nationwide removal policies which saw more than 1/3 of native children systematically taken from their homes and stripped of their identities. This ruling upholding ICWA is good news because the law is an essential tool to maintain the preservation of Indigenous families and to ensure tribal sovereignty is respected.   
  • A year after the fall of Roe v. Wade, the Guttmacher Institute shared the state of abortion policy landscape. All the while, abortion policies continue to shift at the state level: for example, elected officials in Arizona, Maine and New York moved to protect abortion access and judges in Iowa and Wyoming blocked abortion bans from going into effect. 

Economic Justice

  • Congress has passed the Fiscal Responsibility Act, which will allow the country to meet its obligations and avoid default – but it also imposes harmful cuts and requirements to essential programs, such as the Supplemental Nutrition Assistance Program and (SNAP) and the Temporary Assistance for Needy Families (TANF).  
  • Several groups sued to block Florida’s inhumane anti-immigration policies which, among other things, bar undocumented immigrants from driving even if they have a driver’s license from another state and require state hospitals that receive Medicaid to ask patients about their immigration status. 
  • The Illinois Supreme Court ruled in favor of eliminating the state’s racist cash bail system. 
  • Billions in federal subsidies for child care providers are set to run out in September, leading some lawmakers to warn of a “child care cliff.” Meanwhile, Harris County in Texas launched a free childcare program. 

Ending Criminalization

  • The UN Special Rapporteur on the Right to Health released her report on digital innovations and the right to health—the report also voices concerns about Molecular HIV Surveillance (MHS). 
  • The U.S. Justice Department accused the Minneapolis Police of disproportionately targeting Black and Indigenous communities and frequently using excessive use of force, a reality that many Minneapolitans have experienced for years. The city is required to make specific policy changes to change the police department’s patterns and practices that have led to its racist targeting of residents. 
  • Tennessee removed the requirement of sex offender registration for someone convicted of not disclosing an HIV diagnosis to a sexual partner. Although this is progress, the law fails to address outdated components that disproportionately impact sex workers. 
  • Oregon legislators are considering amending an appropriations bill to allocate over $600k to study and consider the decriminalization of sex work.