Adrian Shanker

The Trump administration is wrong about a lot of things when it comes to LGBTQ+ health and well-being. They have attacked transgender medicine, disbanded federal HIV prevention offices, and even endorsed conversion therapy under a new name. There seems to be no floor to how low this administration will go to undermine the health and well-being of LGBTQ+ people in the United States and around the world.

Their most recent action is yet another example of the destructive policies that worsen LGBTQ+ health: President Trump signed an executive order instructing SAMHSA, the nation’s scientific agency administering behavioral health and substance use interventions, to defund harm reduction programs nationwide.

Harm reduction is a proven public health intervention that acknowledges that incremental steps toward healthy decision-making can save lives and prevent the spread of disease. Case in point: syringe access programs are an effective public health intervention for people who use drugs and who are not yet ready to quit.

By providing new syringes, harm reduction organizations prevent the spread of communicable blood-borne diseases like HIV and Hepatitis C. Harm reduction agencies also educate their clients about methods to prevent and reduce overdose as well. They distribute naloxone and provide training on its proper usage. They inform people of the drug consumption methods that are least likely to result in overdose. They provide care to people who are often forgotten about: people who actively use drugs, including those who are unsheltered or unhoused.

The Trump administration goes so far as to call for the forced institutionalization of homeless populations. Despite the constitutional concerns, this is not an effective public health strategy. It will worsen mental health and isolation. And the evidence is clear that the effectiveness of substance use treatment requires the person to want to quit. We can’t institutionalize our way out of this problem. We can address it by providing care, building trust, and helping people quit drugs when they are ready. And keeping them safe from HIV, Hepatitis C, and overdose until they are prepared to quit.

That’s harm reduction. That’s what Trump is defunding.

In the Biden-Harris administration, the U.S. Department of Health and Human Services published the first-ever federal Harm Reduction Strategy. It increased the federal investment in evidence-based harm reduction programs. This aligned with the National HIV/AIDS Strategy and efforts to respond to the opioid epidemic. President Trump’s executive order stated that harm reduction programs “only facilitate illegal drug use and its attendant harm.” This is a bold-faced lie.

The evidence is clear that harm reduction programs work as intended, preventing HIV, Hepatitis C, and overdose. Trump’s team just didn’t read any of it. There is no evidence that harm reduction programs increase drug usage or encourage non-drug users to start using.

While it’s reasonable to periodically reassess evidence-based programs to ensure that funded programs continue to be effective and aligned with current research, the people who should be deciding which programs to fund should be scientists at federal agencies that administer these grants, not political leaders and certainly not the President.

This is happening at the same time as the other components of the U.S. HIV prevention infrastructure are being systematically dismantled. The entire staff of the HHS Office of Infectious Disease and HIV Prevention was fired. The CDC / HRSA Advisory Council on HIV/AIDS was disbanded. Numerous grants in LGBTQ+ sexual health and HIV prevention have been cancelled.

LGBTQ+ Americans are disparately impacted by HIV and STIs. Our communities have increased rates of substance use compared to the majority population. So, harm reduction programs are of unique importance to the LGBTQ+ community because of these disparities. While harm reduction programs serve all people who need support equally, the existing health disparities in substance use mean that LGBTQ+ people are at increased risk for new cases of HIV and Hepatitis C, as well as overdose, as a result of Trump’s executive order.

Harm reduction works. Harm reduction saves lives and prevents the spread of disease. Harm reduction treats drug users with dignity and humanity. When people are ready to quit using, they have a trusted agency they can talk to for a referral for medically assisted treatment.

Defunding these programs will cost lives. We cannot afford for politically-driven decisions to undermine evidence-based healthcare that saves and improves LGBTQ+ health and well-being. President Trump is wrong about this and so much more. Preventing HIV and Hepatitis C and reducing mortality from drug overdose is actually a good thing.