On April 14, the San Francisco Department of Public Health (SFDPH) confirmed the first case of clade I mpox in a San Francisco resident. The case occurred in an unvaccinated adult who was hospitalized and is improving. The individual reported close contact with someone who traveled internationally.
SFDPH strongly encourages people at risk for mpox to receive both doses of the mpox vaccine. The vaccine provides the best protection against the mpox virus and protects against both clade I and clade II. At this time, mpox exposure risk is low for individuals who are not in higher‑risk groups.
The mpox vaccine is available through healthcare providers and local pharmacies. Those who do not have insurance or are having difficulty accessing care may visit the locations listed at sf.gov/mpox.
About Mpox
There are two types of mpox, clade I and clade II. The 2022 outbreak in the United States and California was caused by clade II mpox. In the United States, both types are spread primarily through close skin-to-skin contact, including during sexual activity.
Both clade I and clade II mpox cause similar symptoms, which may start with flu-like symptoms such as a fever, swollen lymph nodes or fatigue, followed by a rash that looks like pimples or blisters. People who have a rash that looks like mpox should contact their healthcare provider to get tested and talk to their partners so they can take steps to prevent the spread of infection.
While anyone can get mpox, most reported cases in the United States are among gay, bisexual, and other men who have sex with men, as well as transgender persons who have sex with men.
Reported cases of clade I mpox in the United States remain rare. Public health officials are monitoring cases to determine if clade I mpox is more severe than clade II mpox in this country.
“SFDPH is closely monitoring mpox. While clade I mpox cases remain rare in the United States, clade II mpox cases continue to occur in San Francisco and throughout California,” said San Francisco Health Officer Dr. Susan Philip. “This development reminds us just how important it is to be fully vaccinated against mpox if you are at risk. With summer travel and events quickly approaching, now is a great time to seek the mpox vaccine.”
Mpox Vaccine
SFDPH strongly encourages people at risk for mpox to receive both doses of the mpox vaccine. This includes people at risk who plan on traveling to places where clade I mpox has been reported, including Europe and Africa.
The mpox vaccine remains the best protection against both clade I and clade II mpox. It significantly reduces the chance of infection, and it helps prevent severe illness, hospitalization, and death among people diagnosed with mpox. The mpox vaccine is safe for people who are immunocompromised, including people living with HIV and people taking immune suppressing medications.
People can receive their second dose of the mpox vaccine if it has been at least 28 days since their first dose. There is no need to restart the two-dose series if it has been over 28 days since the first dose. Booster doses are not recommended at this time for people who have completed the two-dose series. In addition, mpox vaccination is not currently recommended for people who have previously been infected.
No vaccine is 100% effective, and people who are fully vaccinated against mpox should still be aware of mpox symptoms and get tested if they have them.
In addition to getting vaccinated, condom use and reducing the number of sexual partners can further decrease the risk of mpox infection.
At 8 years old in rural Kansas, Hayden Dawson remembers being forced to eat outside with the dogs.
Other times, they weren’t fed at all.
“I would chew sunflowers outside because I was so hungry until my face would become splotchy with a rash,” Hayden, now 20, told Uncloseted Media.
Photo by Mark Felix for Uncloseted Media.
Hayden, who is nonbinary and gender fluid, says whenever they wanted to wear boy clothes, play with boy toys or express themself in a gender nonconforming way, their foster parents were “highly offended” and worried that Hayden would be a “bad influence on the other kids.”
They lived in the turberlance for eight months until their caseworker changed their placement after noticing the severity of Hayden’s weight loss and the rash spreading across their face.
But the next home was not safe either. Or the one after that.
“You have to pick and choose,” Hayden says. “Do I wanna be happy in the identity that I am and the body that I want to have, or do I want to survive?”
From age 8 to 18, Hayden was placed in over 150 foster homes. They say roughly 80% of the homes were “non-accepting”: their foster parents refused to use their chosen name, called them a girl, told them God doesn’t love them and they’re going to hell, and physically beat them with the Bible as they chanted, “Be gone, Satan.”
By the time Hayden was a teenager, they became suicidal, cycling through mental health facilities and hospitals.
“I felt like no one was looking out for me. I was a very angry kid because no one understood me,” says Hayden. “I felt like I had no reason anymore.”
Advocates and former foster youth describe Hayden’s experience as part of a broader pattern.
A 2021 Trevor Project brief found that LGBTQ youth who are in foster care are three times more likely to attempt suicide than LGBTQ youth who are not. And 45% of fostered trans and nonbinary youth have attempted suicide.
This is particularly alarming because LGBTQ kids make up a third of all children in America’s foster system, and trans youth enter the system at five times the rate of the general population.
In 2026, there are few guardrails that protect transgender foster youth from abuse. Even though federal law requires safe placements, it’s unclear what that means for trans youth as protections vary across the U.S. While some states have explicit protections that prohibit discrimination based on a child’s LGBTQ identity, lawmakers in at least 11 states this year have introduced bills that would allow foster parents to refuse to affirm a queer child.
“As a kid, you’re basically rolling the dice on who you get,” Currey Cook, director of the Youth in Out-of-Home Care Project at Lambda Legal, told Uncloseted Media. “It’s frustrating and exhausting that, despite clear federal legal obligations, … this administration is erasing information and protections that are critical to a large share of the young people in the system. There is no justification for that.”
A Patchwork of Rules
According to Lambda Legal, there are 16 states without any explicit child-welfare nondiscrimination protections for gender and sexuality. Additionally, only one of these states, along with 15 others, has specific guidance for child-welfare staff on how to work with LGBTQ youth, such as information about asking how they identify, how to respect their names and pronouns, and how to consider their needs when making placements. Only 11 states require specific training for caseworkers for LGBTQ youth, and 16 states do not list gender identity as a protected class.
Lambda Legal Table explaining which states have protections.
“It’s a complete patchwork,” says Cook. “You can have a caseworker doing their best to be supportive for an LGBTQ kid and right down the street, another caseworker having their own personal opinion for whatever reason that may be saying, ‘We don’t have to do that.’”
While the 14th Amendment guarantees that youth in state custody be treated equally and kept safe from harm, these laws aren’t always followed.
“The constitution isn’t top of mind for a caseworker,” Cook says. “They’re dealing with what’s in front of them and what their agency policy is.”
In 2024, the Biden Administration’s Department of Health and Human Services (HHS) adopted the federal designated placement rule, which would have required state and tribal agencies to make affirming placements available to children in foster care who requested them. But a federal court vacated the rule last year. And last month, Trump’s HHS proposed rescinding it altogether.
“[The] rule theoretically protected children from going into a situation where they would be rejected,” says Mary Kelly Persyn, vice president of legal affairs for Boys & Girls Clubs of San Francisco, an organization that provides community-based youth development services. “Putting a child in an LGBTQ-rejecting household is dangerous. It’s not a philosophical disagreement. It’s actually dangerous to that child—physically, emotionally, psychologically and developmentally.”
After the rule was vacated, advocates say agencies have grown increasingly uncertain about what protections, if any, they are expected to provide.
Threats and Rollbacks
Because HHS acts as the primary source of funding for state foster care agencies, it has significant control over them, according to Cook. “[The Trump] administration, out of the blue, has sent letters to states that say foster parents are to be affirming in their care saying, ‘We are investigating you,’” says Cook. “We haven’t seen this before.”
The letters, obtained by The Imprint, instructed agencies to “review and, where necessary, amend” policies that require foster parents to affirm the gender identity of foster youth.
In addition to threats at the federal level, a spate of bills that target affirming families is swirling through state legislatures. In New Hampshire, a proposed billsays that refusing to affirm a child’s gender identity cannot legally count as abuse, explicitly stating that a parent “is not guilty of endangering the welfare of a child … for raising a child consistent with the child’s biological sex.” In South Carolina and Georgia, versions of these measures seek to block the state from intervening in cases where parents deny gender-affirming care, including restricting how abuse, neglect and “best interest of the child” standards can be applied. In North Carolina, a similar bill became law last year.
“There’s this confusion over what’s legal that’s actually making people scared to do their jobs,” Hinkle told Uncloseted Media. “People are so afraid to talk about LGBTQ youth that care is being delayed, kids aren’t being placed or [are] placed in unaccepting homes, or they are being ignored, and that’s harmful. … LGBTQ youth make up about a third of the system—this is not a small issue.”
Unsafe Placements
For kids in care, the lack of standards creates a fear over where they will end up.
“[Caseworkers] should do more research before placing a child in a home,” says Grayson Dawson, Hayden’s partner, who also spent time in foster care.
“Being trans makes you more vulnerable, and a lot of the time in foster homes, you learn to hide who you are just to keep a roof over your head and food in your stomach.”
Photo by Mark Felix for Uncloseted Media.
Grayson says that he was mistreated for being trans and had to “dim down” his identity to receive placement. “My foster families would use our pronouns around our caseworkers,” he says. “As soon as they’d leave, they would just completely treat us like shit again.”
“As a trans kid, you’re really relying on luck to find a good housing situation,” says Amanda Finely, a mom in Kansas who took in Hayden and Grayson for a few months. “You’re relying on people who may have these same hateful beliefs. Hayden and Grayson really went through hell. I can’t imagine trying to navigate all of that as a child.”
Hayden says they went through at least eight caseworkers “that didn’t understand and didn’t want to understand.”
They say when they were placed on adoption websites, they were often referred to by their deadname and by the wrong pronouns, even though they explicitly told their caseworkers they identified as trans.
Hayden’s foster agency, KVC, wrote in an email to Uncloseted Media that there is “no specific field for sexual orientation in Matching Families,” the program they use to match foster kids to families.
“Caseworkers and foster parents really just don’t care,” Grayson says. “We’re children going from abusive and terrible homes back to more abuse.”
Grayson’s and Hayden’s caseworkers did not respond to Uncloseted Media’s request for an interview.
Faith-Based Objections
Part of the reason foster parents are able to get away with such treatment is because of religious exemptions.
Some states allow foster agencies to refuse services or act according to religious beliefs as it relates to LGBTQ kids and foster parents. These laws are of particular concern to queer kids because Christians are far more likely to foster compared to the general population.
Lifeline Children’s Services, a private agency that has been cited as a resourceon ADF’s website, “doesn’t have any policies regarding LGBTQ kids,” according to a social worker who works for them.
While she told Uncloseted Media that she tries to place LGBTQ kids in accepting families, she says that’s more of a “personal preference.”
In November 2025, Trump signed an executive order titled “Fostering the Future for American Children and Families,” which says that parents should be allowed to foster even if they report religious beliefs that would prevent them from caring for an LGBTQ child.
On top of the order, there have been a slew of lawsuits from religious parents, some represented by ADF, saying that they should be allowed to foster even though they will not accept an LGBTQ kid’s identity.
In 2023, a Catholic couple filed a lawsuit against Massachusetts officials after the state denied their request to foster because they “would not be affirming to a child who identified as LGBTQIA.”
In a 2023 case, Jessica Bates argued that her religious beliefs prevented her from complying with some of Oregon’s trans-inclusive policies, including using a trans child’s pronouns.
The court sided with Bates, saying that Oregon’s policy likely violated her First Amendment protections. While the case is ongoing, the judge ordered a preliminary injunction that blocks the state from enforcing those requirements against her.
Cook disagrees with these policies. “Individuals from any background and faith are welcome to be a foster parent,” he says. “Your personal beliefs are your personal beliefs, but they cannot transfer out to the kids you are being paid to care for and who are being placed in your care to mitigate the abuse they came from.”
Persyn agrees, saying that sexual and gender minorities need to become a protected class to safeguard them against First Amendment lawsuits.
“If we have a bunch of Muslim faith kids and we need to place them, are we going to say no if your religion tells you? Would we allow that in the case of Black kids? Would we allow that in the case of the children of immigrants?” Persyn says. “Is there any other social category that the law recognizes where we would allow that?”
Why No Protections Are Problematic
Benjerman Xander, now 22 and living in Roseburg, Oregon, says his experience in the foster care system led him to participate in a class action lawsuit.
In the suit, it came out that the state’s foster-care data didn’t even know how many LGBTQ youth were under its care. The state assumed that only 2% of children in the system were sexual- and gender-minority youth, while the plaintiffs’ expert estimated the number to be nearly 10 times higher.
The order alleged that the state had “a policy of not asking” children in care whether they identified as LGBTQ, making it harder to place them with affirming families.
Xander was placed in the foster care system at 10 years old. He moved through 13 foster homes, eight facilities and three therapeutic homes, and said many caseworkers seemed to care more about whether a placement was “technically adequate” than whether it respected his identity.
Before he told his foster family he thought he was a boy, he remembers feeling like he had a hot iron in his throat.
“I choked on my words a little but then eventually it kind of poured out. And then once I said it, I felt so much better. I felt like that hot iron went away.”
Seconds later, his foster family erupted, saying they wouldn’t allow it in their house and immediately took him to church to get him baptized.
Many homes later, Xander was transferred to River Rock, a group home in a former juvenile detention center. There, staff stripped his access to testosterone, which he had been taking for two years.
He was teased mercilessly, with other residents calling him “shemale,” telling him he was broken, putting makeup on him against his will and physically fighting him.
“I was very suicidal. I felt like I was alone in the world, and I had no one to go to, no one to talk to,” he says. “It rips your heart apart, it rips your whole soul. It breaks you down to the point where trusting that you’re allowed to be loved, to be who you are, feels impossible.”
When Xander was finally placed in an affirming home, the difference was immediate. His new caseworker understood him, gave him options for where he could stay and tried to place him in LGBTQ households. “He changed my life.”
River Rock and the attorneys on Xander’s case did not respond to multiple requests for comment.
The Search for Affirming Homes
Hayden and Grayson say affirming homes save lives for trans kids. They both say that it was not until they were placed in an LGBTQ-affirming group home in Kansas that they felt their depression and suicidality began to ease.
“Through 10 years of foster care, I’d never been in a place like that,” Hayden says. “A lot of it was just abuse after abuse and no one understood. But when I got with them, they really, really helped. They need more homes like that,” they added, recalling that staff helped them get on testosterone, into therapy and into routine medical care.
Because the LGBTQ-affirming homes are in demand but somewhat undercover, they are hard to find, according to caseworkers who are looking for them.
“It even took my caseworker some time to find it,” Hayden says. “They also only have so many beds. And there are so many kids who need it.”
A caseworker in North Carolina says that it took them months to find placement for a trans girl.
“We actually found out about a hidden program with one of the private agencies in our state where a youth basically has to be referred internally,” she says. “So it’s a program within this private agency where they license foster parents specifically for LGBTQ children. But it’s not like you can find it on a Google search, which is really bizarre, because if families want to meet this need, you have to know somebody who knows somebody to get you that information.”
Looking Forward
Right now, most of the safety for trans youth relies on which state they live in and who their caseworker is.
In an ideal system, Persyn says, foster parents would not need a special rule telling them to treat LGBTQ kids with respect and dignity. But because the law still does not consistently recognize sexual orientation and gender identity (SOGI) the way it recognizes other identities, those protections remain fragile.
“There has to be some way to establish SOGI minority identity as an actual thing,” she says. “This is not a matter of politics or personal belief, but this is part of what the system is obligated to safeguard for the children it takes into its care.”
Hayden, who has now been out of the foster system for two years and is living in a trailer with Grayson in Texas, feels for the countless trans foster kids who are in unsafe situations. Their advice: “Do not lose hope.”
“People are going to continue to try and break your spirit, don’t let them,” Hayden says. “I know it’s hard and I know you feel like you don’t have a single person in the world, but you do.”
“There’s a huge community that cares about you,” Grayson adds. “They have your back and if you just keep fighting through your battles and keep going and find that light at the end of the tunnel, you’ll get there and then when you do get there it’s gonna feel amazing.”
In an email to Uncloseted Media, KVC’s PR and Media Relations Director Christina Santiago, wrote, “We cannot comment on any specifics regarding youth in our care due to HIPAA and privacy restrictions. However, we can share that we are deeply committed to our core values, including that the heart of our work is helping people. Our team prioritizes placing youth with families that are best suited to meet their individual needs, and we are constantly reviewing our practices and protocols. We always welcome and greatly appreciate feedback from youth with lived experience, to ensure that our mission-driven care continues to evolve with the needs of the youth and families we serve.”
Minnesota’s largest pediatric health system is restoring gender-affirming care for minors after a federal judge blocked a Trump administration effort to label the treatment unsafe, reversing a suspension that had disrupted care for families across the state.
Children’s Minnesota said it resumed services this week after pausing some forms of gender-affirming care in February, after Health and Human Services Secretary Robert F. Kennedy Jr. issued guidance declaring such care for minors outside accepted medical standards. The hospital system had suspended services on February 27 and restored them on April 6, according to Minnesota Public Radio.
“Offering science- and research-based health care to transgender and gender diverse youth is part of Children’s Minnesota’s vision of being every family’s essential partner in raising healthier children,” the hospital network said in a statement to MPR.
The reversal follows a ruling by U.S. District Judge Mustafa Kasubhai, who said he would vacate Kennedy’s directive after Democratic attorneys general from multiple states challenged it in court. The judge found the administration had overstepped its authority in attempting to restrict care that remains legal under state law in Minnesota and elsewhere.
The Trump administration’s push against pediatric gender-affirming care escalated earlier this year when President Donald Trump signed an executive order seeking to cut federal funding to hospitals and institutions that provide such care to minors. That order triggered alarm among transgender youth advocates and medical providers nationwide, who warned it could force hospitals to scale back services even in states where the care is protected.
In Minnesota, that chilling effect was immediate. Children’s Minnesota’s monthlong suspension left families scrambling after one of the state’s most prominent pediatric providers abruptly halted treatment. The hospital system said it has contacted all families previously served through its Gender Health program to notify them that care is resuming.
While more than half the states in the country now place restrictions on medical providers delivering gender-affirming care, Minnesota Gov. Tim Walz signed an executive order in 2023 urging officials to protect access to such services. Minnesota Attorney General Keith Ellison was among the Democratic officials suing the administration’s anti-trans directives.
“Gender-affirming care is health care, and health care decisions should be left up to doctors, their patients, and if the patient is younger, their parents or guardians,” Ellison said after the ruling, defending providers.
Ellison said the federal government has no role in overriding medical standards set by doctors, states, and professional associations, calling the Trump administration’s intervention an unlawful intrusion into private medical decisions.
“The federal government should not be part of that equation, and there’s no room in Minnesota doctors’ offices for Donald Trump, RFK Jr., and other politicians who want to dictate what health care we can and cannot receive,” he said.
A cheap antibiotic that has been sitting in medicine cabinets for decades is suddenly doing something remarkable: helping reverse one of America’s fastest-growing sexually transmitted infections, and offering one of the clearest measurable successes of a Joe Biden-era LGBTQ+ public health initiative just as President Donald Trump’s administration dismantles many of the federal systems that made it possible.
A new University of Washington study published in Clinical Infectious Diseases and highlighted recently by the Center for Infectious Disease Research and Policy found that doxyPEP, short for doxycycline post-exposure prophylaxis, is sharply reducing syphilis infections after federal health officials issued prescribing guidelines in 2023.
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The scale of the decline is striking. In King County, Washington, researchers estimate that doxyPEP prevented 3,031 syphilis cases, amounting to a 52.3 percent relative reduction after the strategy was introduced. That is among the clearest real-world signs yet that the federal strategy is associated with large declines in syphilis where doxyPEP uptake is high.
That means that if someone at elevated risk for bacterial sexually transmitted infections takes one dose of doxycycline soon after sex, it can stop infections like syphilis and chlamydia before they start.
And now there is strong population-level evidence that where doxyPEP is widely used, syphilis infections can fall dramatically.
For the scientists and officials who helped build the policy during the Biden administration, the findings are a satisfying thing in public health: confirmation that the plan is producing measurable results.
“This is an example of successful public health,” Dr. Jonathan Mermin, who led the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention during the Biden administration and is now dean of Columbia University’s Mailman School of Public Health, told The Advocate.
“We saw that just issuing doxyPEP guidelines for the populations at highest risk resulted in large decreases in STI incidence among them and overall,” he said. “A public health approach focused on efficiency and equity benefited everyone.”
How doxyPEP works
Think of doxyPEP as the STI equivalent of grabbing an umbrella before the storm hits. A person takes 200 milligrams of doxycycline — ideally within 24 hours after sex, and no later than 72 hours — to prevent bacterial infections from taking hold.
Doxycycline itself is not new. It has long been used for acne, Lyme disease, malaria, and other bacterial illnesses. What changed was the science.
Before CDC guidelines existed, many doctors hesitated to prescribe doxyPEP because there was no national standard explaining when and how to use it.
That is where the Department of Health and Human Services came in.
Adrian Shanker, who led LGBTQI+ health equity policy at HHS as deputy assistant secretary for health policy and senior adviser on LGBTQI+ health equity, helped finalize the doxyPEP guidance and frame it as a major LGBTQ+health initiative.
“This was an LGBTQ health priority for the Biden administration,” Shanker told The Advocate.
He said the lack of formal guidance had created uneven access across the country.
“Outside of the large metropolitan areas, it was pretty difficult, if not impossible, to access doxyPEP for gay and bisexual men for STI prevention,” he said. “There needed to be clinical guidelines because without that, too many providers were uncertain about how to prescribe it.”
Once those guidelines arrived, prescribing expanded quickly.
A coordinated Biden-era science effort
The doxyPEP rollout was part of a deliberate federal campaign to reverse a worsening syphilis crisis.
Dr. Rachel Levine, then assistant secretary for health, chaired the Biden administration’s National Syphilis and Congenital Syphilis Task Force, a government-wide initiative launched to combat a surge that had become deeply alarming to federal health officials.
“We decided to really address this in a comprehensive way,” Levine told The Advocate, describing a task force that brought together HHS, CDC, the Department of Veterans Affairs, the Defense Department, and the Indian Health Service. “The right research, at the right treatment at the right time, is having an impact.”
The task force focused on the communities most affected: LGBTQ+ Americans, Black Americans, Native communities, and pregnant patients facing rising congenital syphilis risk.
That targeted approach is central to understanding the significance of this study. The success of doxyPEP is not simply in reducing infections. It reduced them because federal officials deliberately focused resources on areas where the epidemic was hitting hardest.
Why did LGBTQ+ communities adopt it quickly?
For many LGBTQ+ Americans, doxyPEP felt familiar from the start.
After decades of HIV prevention campaigns involving PrEP and PEP, many patients and providers in LGBTQ+ communities were already comfortable using medication to prevent infection before illness develops.
Dr. Demetre Daskalakis, now chief medical officer at Callen-Lorde Community Health Center in New York, said that cultural familiarity mattered. He is one of the most trusted public health experts in the LGBTQ+ community.
“We’re used to science because science has been important in so many aspects of our lives,” Daskalakis told The Advocate. “There is muscle memory about HIV.”
Daskalakis, who also served in the Biden administration as White House National Mpox Response deputy coordinator and later held senior CDC leadership roles, said the study confirms what frontline clinicians had already seen in practice.
“We’ve got studies and guidelines that indicate to do it,” he said. “And when you do it and launch it, you see a difference.”
The Advocate previously reported on Daskalakis’s 2025 departure from CDC, during which he warned that political interference under the Trump administration was undermining scientific independence within federal health agencies.
What the study does and does not solve
The results are dramatic, but not universal.
CIDRAP notes that congenital syphilis continues to rise, and cases among pregnant people remain deeply concerning. That is partly because doxyPEP is not routinely used in pregnancy because of dangers to the fetus, and is not broadly recommended for cisgender women under current guidelines.
So while doxyPEP is helping bring down syphilis overall, it is not yet fixing every part of the epidemic.
The big scientific concern: antibiotic resistance
Antibiotic resistance has been the biggest scientific question around doxyPEP from the start:m. If more people take antibiotics preventively, could bacteria adapt and become harder to treat?
Mermin said CDC scientists treated that concern seriously when writing the guidelines.
“Antibiotic resistance is always a concern,” he said. But he noted that syphilis and chlamydia — the infections doxyPEP works best against — are unlikely to become resistant to doxycycline in the way some other bacteria can. The larger unknown is whether increased doxycycline use could affect unrelated bacteria elsewhere in the body, something researchers are still monitoring.
What makes doxyPEP different is how it is taken. Doxycycline has been prescribed safely for decades, including for acne patients who may take it daily for months at a time. DoxyPEP, by contrast, is intermittent: one 200-milligram dose after sex, not continuous daily use.
Daskalakis said that contrast is often overlooked.
“There is sort of an alternate discourse around the fact that doxyPEP could potentially increase resistance for other organisms,” he said. “But where’s the other place that people use minocycline or doxycycline? And it’s for acne. And they’re getting acne meds for months and months and months continuously, but no one seems so concerned about that.”
For him, the immediate danger is untreated infection.
“On the flip side, we have infections that can kill people or can cause long-term neurological complications or can transmit to newborns and cause a catastrophe,” he said.
Mermin added that if doxyPEP prevents thousands of infections, it could actually reduce overall antibiotic use by reducing the need for later treatment. Shanker said that the trade-off was debated before approval.
“The question was asked, and it was clear that the benefit would outweigh the risk,” he said.
For now, scientists are still watching resistance closely, but the evidence so far suggests that doxyPEP’s benefits outweigh the risk.
Why this matters politically now
The study lands at a moment when many of the federal LGBTQ+ health frameworks that helped make this success possible are being dismantled.
According to KFF, the Trump administration’s executive actions have laid the groundwork to roll back explicit LGBTQ+ health protections, including by narrowing how federal agencies interpret sex discrimination in health care and by scaling back sexual orientation and gender identity data collection used to measure disparities and target care.
Early in Trump’s second term, federal health agencies began scrubbing webpages and datasets tied to transgender people, LGBTQ youth, HIV, and health disparities in response to orders targeting what the administration called “gender ideology. CDC and other agency pages were removed or altered, and a federal judge later ordered the restoration of some health information after doctors argued the deletions had cut off access to critical medical guidance.
Ironically, one of the clearest surviving federal explanations of doxyPEP remains on the CDC’s website because of a court order requiring the administration to restore health pages that had been altered or removed. The CDC’s doxyPEP guidance page now carries a Trump-era disclaimer stating that, “Per a court order, HHS is required to restore this website,” even as the administration denounces references to what it calls “gender ideology” on restored LGBTQ-inclusive health pages. It’s a striking contradiction on a site explaining a prevention strategy built largely for gay, bisexual men, and transgender women.
Under Health and Human Services Secretary Robert F. Kennedy Jr., the administration has also pushed additional restrictions affecting LGBTQ+ health, including moves aimed at cutting access to gender-affirming care for minors.
To the Biden administration officials, the study results confirm that targeted LGBTQ+ health policy works and that deleting LGBTQ+ people from the science does not make disparities disappear. It just makes them harder to measure and harder to fight.
“You’re missing important epidemiological data,” Levine told The Advocate. “Thus, infectious illnesses can spread because we’re not targeting where we need to go.”
That warning echoes what Shanker called “precision public health” in his interview: the idea that public health works best when it actually looks at who is getting sick, where, and why. In the case of doxyPEP, that meant focusing on communities with the highest syphilis burden, including gay and bisexual men and transgender women.
In the current political climate, former officials argue, that kind of targeted work is becoming harder precisely because the Trump administration is stripping away the language, data, and infrastructure that made it possible in the first place.
In Pastor Doug Wilson’s Christian nationalist America, there would be no minarets — only the sound of church bell towers. There would be no statues of Hindu deities or other non-Christian religious symbols in public spaces. Adultery would carry legal penalties, and Obergefell v. Hodges would be overturned. Under that framework, public celebrations of LGBTQ+ identity would not be tolerated.
Wilson went further, offering praise for the 1969 Stonewall raids — the police action against a New York gay bar that sparked the modern LGBTQ+ rights movement. He added that said sodomy laws — which were on the books in some of the 50 states until 2003 — should be restored, though not aggressively enforced. “I would not want a sexual Gestapo,” he said. Voting rights would belong to the head of each household — not to individuals. Women in households led by a husband would not.
Last month Wilson declared that under his Christian nationalist theocracy, all non-Protestant public events – such a Catholic parades that venerate the Virgin Mary – would be banned.
Also last month, a separate pastor at Hegseth’s church prayed for God to kill Senate candidate James Talarico.
Twelve states actually still have anti-sodomy laws on the books: Florida, Georgia, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Mississippi, North Carolina, Oklahoma, South Carolina, and Texas.
Wyoming has quietly become the ninth US state to effectively ban gender marker changes on driver’s licences, doing so without any public announcement.
The policy change, first reported by Transitics via Substack on 9 April, weeks after it took effect, requires residents to present an amended birth certificate to update their gender marker.
But because the state has already blocked those amendments, the rule creates a de facto ban on accurate identification for many trans people.
The move is part of a broader wave of restrictions across the US, with multiple Republican-led states tightening rules around identity documents in recent months.
In Wyoming’s case, the change follows earlier legal and administrative shifts, including the rollback of a long-standing policy that allowed gender marker updates on birth certificates via court order in November 2025.
With no media coverage or public comment during the rule-making process, the policy was implemented largely unnoticed.
Advocates say the impact could be significant. Without IDs that reflect their identity, transgender residents may face barriers in everyday situations – from voting and travel to employment and housing – while also risking being outed in routine interactions.
A ban on transgendermilitary service ordered by President Donald Trump within days of taking office, the second time, has left thousands of service members in an unusual and costly limbo. They are still on the payroll but barred from performing the jobs they were trained to do.
For Sabrina Bruce, a Space Force master sergeant who led a cybersecurity team protecting classified satellites, the impact was immediate and operational. Bruce was removed from her post and left on the personnel rolls, meaning her position could not be filled even as critical national security work continued.
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“I was just gone,” Bruce told the New York Times.
In an earlier interview with The Advocate, Bruce warned that sidelining highly trained transgender service members does not just affect individuals but weakens the military itself. Removing experienced personnel from specialized roles midstream, she said, creates gaps that are not easily or quickly replaced.
The policy, issued days after Trump took office, was framed by the administration as a move to improve military readiness and reduce costs. But the reality described by affected troops is far messier. Highly trained pilots, doctors, lawyers, and intelligence specialists have been pulled from their posts, often with little notice, and left waiting months for discharge decisions while continuing to collect full pay, the New York Timesreports.
Among them is Army Capt. Katie Benn, a decorated air defense officer who had spent 13 years in service and was preparing to deploy to Iraq when she was abruptly told she could not go because she is trans. Nearly a year later, she remains sidelined at home, her bags still packed, waiting for orders that have not come. “I’m trained to take care of soldiers,” she told the Times, “and my soldiers are over there in harm’s way.”
The disruption has cut across ranks and specialties. Navy Chief Petty Officer Parker Moore, who supervised roughly 80 sailors running the nuclear reactor aboard the aircraft carrier U.S.S. Abraham Lincoln, was pulled from duty despite a senior commander warning that Moore’s technical expertise was essential. The ship deployed without Moore, who was later discharged as it entered combat operations, the paper reports.
In the Army’s legal corps, Capt. Ryan Gunderman saw a career cut short after the military paid for three years of law school at Harvard in exchange for six years of service. According to the Times, Gunderman had served less than two years when she was placed on leave, then discharged after months of waiting. “They spent more than half a million dollars on me,” she said.
Others have tried to salvage their careers outside the military. Alyxandra Demetrides, a Blackhawk helicopter pilot deployed in Thailand when the ban took effect, was sent home and spent nearly a year on paid leave before being discharged. She has since retrained as a commercial airline pilot.
For many, the impact has been deeply personal. Army Sgt. 1st Class Julia Becraft, a Bronze Star recipient who deployed three times to Afghanistan, had been slated to lead a platoon before she was ordered to stay away from her unit and placed on leave. The sudden removal led her to seek inpatient mental health care. “It makes you lose faith in the whole system,” she said.
Even those who have tried to fight the decision have faced a pre-determined outcome. Army Sgt. Clara Davis, a military police officer who led investigations and supervised patrols, challenged her separation before a review board but was not allowed to participate unless she conformed to male grooming and uniform standards. She refused and was separated after a hearing in which she could not speak. She remains in limbo awaiting final discharge.
The Pentagon has not publicly disclosed how many service members have been affected or the total cost of paying troops who are not allowed to work. The government told judges last year that about 4,240 transgender troops served in the military, a fraction of the overall force.
The financial rationale for the ban has been undercut by the government’s own data. The Defense Department said in a court filing that it spent about $52 million over a decade on transgender-related medical care, a tiny share of its health budget. In a striking comparison, the military spent more on lobster and crab in a single month than it typically spends in a year on care for transgender troops.
Defense Secretary Pete Hegseth has defended the ban, arguing that transgender identity is incompatible with military standards.
But a recent analysis published in the International Journal of Transgender Health and reported by The Advocate in March found no evidence to support those claims. The review of 58 studies concluded that transgender service members do not undermine readiness, unit cohesion, or deployability, and that the cost of their medical care is negligible compared to overall military health spending. Researchers found that poorer outcomes among trans troops are linked to discrimination and stigma, not their ability to serve.
The Defense Department declined to comment to the Times on the operational or financial impact of the ban.
Legal challenges are ongoing. Two federal lawsuits, Shiling v. United States, out of Washington state, and Talbott v. United States, out of Washington, D.C., are still pending, though the U.S. Supreme Court allowed the ban to take effect while litigation proceeds.
The Trump administration has backed out of an agreement to protect trans students in five district schools and a college.
AP reported that the Education Department terminated the agreements, which were previously negotiated by the Obama and Biden administrations under Title IX, on 6 April.
Title IX is a civil rights law that prohibits sex-based discrimination in schools and other education programmes that receive funding from the federal government. The previous administrations interpreted the law to include protections for LGBTQ+ students, particularly trans students.
The original agreement pledged to help protect trans students by setting a federal obligation for the schools to run measures like faculty training on using trans students’ preferred names and letting trans students use bathrooms and other facilities that align with their gender identity.
Which areas are affected?
The change has been met with mixed reactions from the school districts affected.
Delaware Valley School District in Pennsylvania was reportedly notified of the change in February and has responded by rolling back its anti-discrimination measures that were in place to protect trans students.
Sacramento City Unified School District in California found out about the news on 6 April and is waiting to see if the rescinded measures will affect district policy or federal funding, according to the Sacramento Bee.
In a statement, district spokesperson Al Goldberg said: “The Sacramento City Unified School District remains committed to the support of our LGBTQ+ students and staff.”
The Bee also reported that Sacramento City Unified could find itself in a vulnerable position as it also faces a “$170 million budget deficit and threats of state takeover”.
Other school districts and colleges affected by the news include Cape Henlopen School District in Delaware, Fife School District in Washington, and La Mesa-Spring Valley School District and Taft College in California.
Assistant Secretary for Civil Rights Kimberly Richey said that the protections agreement would be terminated in an attempt to keep transgender students out of girls’ and women’s sports and locker rooms.
“Today, the Trump Administration is removing the unnecessary and unlawful burdens that prior Administrations imposed on schools in its relentless pursuit of a radical transgender agenda,” she wrote in a statement.
Lilith Barraza Garcia, 22, says she and her friend were physically assaultedoutside Rumors Cabaret Bar in Bellingham, Washington, while simply trying to provide aid to someone who was intoxicated and slouched over outside.
Garcia filed a police report with the Bellingham Police Department on the day of the incident, and the suspect was initially charged with a misdemeanor. However, Garcia told The Advocate that the misdemeanor is being upgraded to a felony, citing hate crimes against LGBTQ+ people.
According to Garcia, on March 23, she was outside the queer bar helping a visibly intoxicated person, “getting him a bottle of water and checking in on him,” when the person’s friend, a man whom she had previously seen inside the bar on other occasions, confronted her and her friend.
The suspect who allegedly attacked her was arrested outside the bar.
Garcia says she and her friend frequently visited the LGBTQ+ bar and says she had noticed the man and his friend there before.
“I found out from a couple of people that he actually goes there with a group of his friends to flirt with women,” Garcia told The Advocate. “I would say the men themselves are not part of the queer experience. Let’s just say that they are more there to pick up on girls that have their guard down.”
Garcia, who is transgender, said that at first the assailant tried to compliment her by stating that she had “great breasts for a man.” According to her, he continued to spout insults before striking Garcia. She says she and her friend started to argue back, and it eventually turned physical. She says he started off by pushing them and then he started punching her in the chest and face, breaking her glasses.
“I was told he was part of the Navy and at first I was a little bit shocked, but then I was like, ‘Oh that makes sense and why he was so strong’ because when he hit me, I did go unconscious for like two seconds and now I understand what people mean now by ‘seeing stars,’” said Garcia.
Garcia is still currently recovering from multiple non-life-threatening injuries. She says the suspect who attacked her pushed her so hard she has bruising on her chest, where, less than a year ago, she had a breast augmentation procedure. “I’m gonna have to go to Seattle to get my boobs looked at, just because I did have top surgery less than a year ago,” Garcia said. “So that’s another thing I’m kind of concerned about.”
A GoFundMe campaign to help Garcia with medical and associated expenses has raised more than $6,300.
When Congress returns to session next week, Republicans in the House of Representatives are expected to move forward on a bill that would give the federal government unprecedented power to pressure public schools into removing books and materials that acknowledge the existence of transgenderpeople.
H.R. 7661, introduced by GOP Rep. Mary Miller of Illinois and titled the “Stop the Sexualization of Children Act,” is claimed by its supporters as a measure to shield children from inappropriate content. But buried in the text is language that has alarmed educators, librarians, and LGBTQ+ advocates. The bill defines “sexually oriented material” to include anything that “involves gender dysphoria or ‘transgenderism.’”
Detractors use that term to dehumanize trans people as part of an ideology as opposed to a human reality. In practice, the proposed law means a book does not need to contain sexual content to be swept up by it. A story about a transgender teenager simply existing could be enough.
Opponents argue that the distinction makes this less a bill about obscenity than one about erasing transgender people from public education.
If enacted, the legislation would bar schools that receive federal Elementary and Secondary Education Act funds from using those funds for any program, activity, or material involving the prohibited category. The penalty is severe: districts that refuse to comply could lose federal education funding. For schools already operating on tight budgets, critics say, that threat alone could trigger widespread preemptive censorship.
The reach of the bill extends far beyond library shelves. As The Advocate previously reported, when the House Committee on Education and the Workforce advanced the measure last month, the wording was broad enough to affect anti-bullying resources, counseling materials, transgender student support groups, and Gay-Straight Alliance programming if those programs are part of federally funded school operations.
The bill exempts standard science instruction, major religious texts, and certain approved “classic” works, but defines acceptable literature through narrow, preselected canons such as the Great Books of the Western World. That means that while Shakespeare is safe, a contemporary novel about a trans high school student may not be.
Sarah Kate Ellis, president and CEO of GLAAD, called the bill a federalized culture war weapon dressed up as child protection.
“Banning books that reflect our lives and stories is an attack on everyone’s family and freedoms,” Ellis said in a statement. “H.R. 7661 is a massive overreach by Rep. Mary Miller and right-wing politicians to force their narrow agenda into local communities.”
Miller is no stranger to inflammatory rhetoric. The Illinois Republican has repeatedly drawn condemnation for anti-LGBTQ+ remarks, including publicly misgendering Delaware Congresswoman Sarah McBride, the first out transgender member of Congress.
“Books help us understand ourselves and each other, and make our schools, communities, and country safer, stronger, and more successful. It’s past time to turn the page on the book ban era,” Ellis said, adding, “LGBTQ Americans belong in our schools and libraries, and everywhere.”