Trump administration axes more than $125m in LGBTQ health funding, upending research field

The LGBTQ research sector in the United States faces a significant crisis, with funding rescissions imperiling its future. Academics dedicated to enhancing the well-being of lesbian, gay, bisexual, transgender, and queer Americans are encountering widespread grant cancellations from the National Institutes of Health (NIH). Recently, over 270 grants, amounting to at least $125 million in unspent funds, have been terminated, though researchers indicate the actual total could be considerably larger. These abrupt cancellations undermine essential efforts to address LGBTQ health disparities and provoke anxieties about the stability of this critical research domain.

‘An incredible lack of transparency’

Transgender individuals are confronting explicit marginalization from the national research priorities. Initially, the White House’s directives primarily focused on transgender populations, suggesting gay individuals might be unaffected. However, the justification provided by the Trump administration for NIH grant rejections, citing concerns over Diversity, Equity, and Inclusion (DEI) principles in academia, has also impacted numerous research grants centered on gay communities.

This encompasses investigations into decreasing rates of HIV and other STIs. Studies incorporating transgender individuals as a supplementary at-risk demographic have also faced cancellation.

Brian Mustanski, a prominent figure in LGBTQ health research, stated that the NIH revoked two significant grants for his team in the past month. One grant supported a longstanding study examining the determinants of HIV acquisition, substance misuse, and other adverse health outcomes in young gay men. This study, having gathered nearly two decades of data from some participants, received a highly favorable evaluation from the NIH the previous year.

According to the termination notice shared by Mustanski, the grant was canceled due to purported engagement in DEI initiatives.

“The definition of DEI remains unclear,” he commented. “This ambiguity poses a substantial challenge for scientists, as precision is fundamental to scientific inquiry.”

Mustanski added that his second grant supported the execution of effective HIV prevention and treatment strategies within the framework of the Ending the HIV Epidemic initiative launched by the prior Trump administration.

“There is a remarkable absence of openness surrounding this process and those orchestrating it,” Mustanski remarked concerning the grant rejections. “Such conditions are not conducive to producing optimal scientific outcomes.”

Amid the potential for both gay and transgender individuals to be removed from national research priorities, 30 editors of leading journals focused on sexuality and gender research published an editorial last month in The Journal of Sex Research emphasizing the significance of this work.

“Research into sexuality and gender is indispensable for pinpointing social, cultural, and medical needs of populations, and tackling inequalities across populations,” they affirmed. “Any constraint on research and the imposition of specific research agendas constitutes an encroachment on academic freedom and integrity.”

Indeed, a palpable apprehension has gripped numerous LGBTQ-focused researchers facing—or anticipating—grant cancellations. NBC News contacted over 80 researchers, but few responded, and only seven agreed to speak on the record, with others expressing fear of reprisal from the Trump administration.

“Most of my colleagues are hesitant to voice their concerns, or their institutions are imposing silence,” stated Julia Marcus, an infectious disease epidemiologist at Harvard Medical School.

“This situation epitomizes authoritarian tactics. Fear silences dissent,” remarked Marcus, who lost all NIH grant funding for three HIV and STI prevention studies and shared the rejection letters with NBC News. With future grant opportunities appearing bleak, she indicated she is facing the potential end of a 20-year career dedicated to HIV prevention and promoting LGBTQ health.

She suggested that existing sources of private funding from pharmaceutical corporations, nonprofits, and foundations could not adequately sustain the entire field.

A Quarter-Century Effort

The infrastructure for LGBTQ-focused research across the nation has largely been developed over the past twenty-five years. A critical impetus was a 2011 Institute of Medicine report advocating for increased research to document and address health disparities among LGBTQ individuals. The report highlighted poorer mental health and elevated rates of smoking, substance use disorders, STIs, certain cancers, and suicidal ideation in this population.

“Decades of evidence-based LGBTQ+ research have validated the necessity of tailored strategies to improve health outcomes in this community,” noted Dr. Philip Chan, an associate professor of medicine at Brown University. He clarified that he was not speaking on behalf of his institution.

The Biden administration prioritized addressing the needs of sexual and gender minorities, leading to a surge in NIH research funding. Researchers explained to NBC News that this prioritization broadened avenues for precision public health or precision medicine, where research identifies the specific needs of subpopulations and develops targeted, evidence-based interventions. Researchers like Marcus contend this approach represents the most effective utilization of public resources.

Recently, NIH-funded research achieved a significant breakthrough, demonstrating that post-sex doxycycline prophylaxis substantially reduced STI rates among gay men and transgender women—an intervention believed to be responsible for a notable recent decline in such cases. However, $7.4 million in NIH support for two follow-up studies, including one focused on safety monitoring for drug-resistant pathogens, has been discontinued, according to the lead investigators.

The Adolescent Medicine Trials Network, which was terminated last month, was in its third year of a seven-year grant, totaling over $70 million in lost funds, aimed at improving the prevention, diagnosis, and treatment of HIV among adolescents and young adults, particularly young gay men.

“Considering concerns about government waste and efficiency, it is illogical to terminate studies that have already received substantial investments in their concluding phases,” Chan asserted.

Chan reported losing two NIH grants last month, totaling approximately $3 million in unspent funds, and provided termination letters to NBC News. One grant focused on enhancing the mental health of LGBTQ individuals negatively impacted by the Covid pandemic. The second pertained to a program designed to improve adherence to PrEP, the HIV-prevention medication, among Black gay and bisexual men.

“Given the overarching objective of LGBTQ+ research to not only improve but extend the lives of LGBTQ+ Americans, the effective dismantling of this research risks exacerbating health disparities related to HIV, mental health, substance use, and chronic diseases, ultimately affecting society at large,” he cautioned.

Potential Elimination from Vital Government Surveys

Ilan Meyer, a professor at the Williams Institute at UCLA School of Law, has raised concerns that LGBTQ individuals may also face exclusion from major, ongoing federal surveys on health and crime victimization, as well as the census.

“We are on the verge of losing critical knowledge about the LGBT population, knowledge essential for policy formulation, legal advice, court evidence, and public awareness,” he stated.

The inclusion of questions about sexuality and gender identity in these surveys was a hard-won victory for LGBTQ advocates. The resulting data has informed hundreds of academic publications—including some, Meyer noted, that contributed to a judge’s decision to overturn California’s ban on same-sex marriage in 2010.

A recent Williams Institute report co-authored by Meyer posited that it “appears probable,” to appease the Trump administration, that forthcoming cycles of federal health surveys will eliminate questions on gender identity, and possibly sexual orientation. The CDC, for instance, announced in February it would stop collecting data on gender identity in its surveys.

“The removal of such data from public records and the absence of future data would regress the United States decades, back to a time of limited information about the demographics, health, and well-being of the 14 million LGBT people residing in the United States,” the report warned.

Inside NIH: An Agency in Disarray

Sources within the NIH, speaking anonymously due to restrictions on speaking to the media and fear of repercussions, described an agency in significant turmoil.

In 2015, the NIH established the Sexual and Gender Minority Research Office to coordinate LGBTQ research across the agency and standardize terminology related to sex, gender, and sexual orientation in research projects.

This office became a specific target for conservatives, who alleged it introduced ideological, unscientific viewpoints into research. Consequently, Trump’s election in November triggered fears within the NIH that the new administration would abolish the office. In December, the office was effectively dissolved, and its seven staff members were reassigned to various positions, hoping to continue their work discreetly, according to two NIH employees with knowledge of the situation.

On March 4, all seven employees were placed on administrative leave. By that time, the Trump administration had already implemented extensive layoffs of federal employees focused on initiatives characterized as DEI-related.

NIH grantees informed NBC News that their designated agency program officers were excluded from the grant cancellation process.

“It’s a massacre,” one NIH source described the cancellations.

On Wednesday, the American Public Health Association and other entities initiated legal action against the NIH in federal court concerning the grant cancellations, including those supporting HIV-prevention research. The lawsuit alleges that the cancellation notices originated from Elon Musk’s Department of Government Efficiency, not within the HHS or NIH. The suit states, “For example, metadata associated with at least one notice indicates authorship by ‘JoshuaAHanley.’ An attorney named Joshua A. Hanley, a 2021 law school graduate, is employed at DOGE.”

Hanley did not immediately respond to an email from NBC News seeking comment.

Internal guidelines issued to NIH grant management staff last week, cited in the lawsuit, suggest the agency used “template notices to terminate hundreds of grants.” The document provided language for communication with grantees, including: “It is the policy of the NIH not to prioritize [select one of the following: diversity, equity and inclusion (DEI) research programs, gender identity, vaccine hesitancy, climate change or countries of concern, e.g., China or South Africa.]”

Numerous cancellation letters reviewed by NBC News stated: “Research programs based on gender identity are frequently unscientific, provide minimal return on investment, and do not improve the health of most Americans. Many such studies disregard, rather than rigorously examine, biological realities. It is the NIH policy to not prioritize these research programs.”

Researchers pointed out to NBC News that only a fraction of the canceled grants pertain to gender transition treatments for minors, which has become a contentious political issue.

Even prominent right-wing critics of the agency’s approach to gender identity research have challenged the Trump administration’s method of grant cancellations.

Leor Sapir, a fellow at the Manhattan Institute, has advocated for NIH reforms aligned with Trump’s directives on DEI and trans-related issues. However, he criticized the administration’s overly broad “search-term-based cancellation” of NIH grants.

“It’s a classic bull in a china shop approach—quintessentially Trumpesque,” he remarked in an interview. “A more nuanced approach is essential.”

The pressing question for NIH-funded researchers is whether such recalibration will occur now that Bhattacharya has assumed the role of director. During his confirmation hearing last month, Bhattacharya, a health economist formerly at Stanford, was repeatedly asked if he would restore the NIH to a semblance of normal operations.

“I will adhere to the law,” he stated—a recurring response to such inquiries. He added he would “ensure” that researchers within and funded by the NIH “have the resources necessary for their research.”

In response to questions about grant cancellations—including inquiries about the Trump administration’s intentions concerning transgender-specific research—Bhattacharya’s statement on Wednesday affirmed the agency’s commitment to research improving the health of all Americans, “regardless of their sexual identity,” notably omitting mention of gender identity.

The statement further indicated the agency would prioritize “research aimed at preventing, treating, and curing chronic conditions such as cancer, diabetes, heart disease, obesity, and numerous others causing significant suffering and mortality among all Americans, including LGBTQ individuals.”

The statement conspicuously omitted any mention of HIV, a chronic health condition disproportionately impacting gay men and transgender women. It also failed to acknowledge that at least 16 of the terminated LGBTQ-focused grants were related to cancer, diabetes, or heart disease.

The Hard Work Begins

Looking toward an uncertain future, Northwestern’s Mustanski expressed hope for successful appeals against his grant rejections.

Dr. Kenneth Mayer, medical director of Fenway Health, a leading LGBTQ-focused health center in Boston, voiced optimism for “some legal victories” regarding the grant cancellations. Speaking in his personal capacity and not on behalf of his employer, he added, “However, I am realistic, and acknowledge the field could collapse.”

Mayer and other LGBTQ-health researchers expressed concern that their field could lose a generation of academics specializing in these populations—due to layoffs, hiring freezes, and the likelihood that promising young individuals will avoid an increasingly precarious career in academia and public health.

Many established researchers in this field reported experiencing a sense of ominous déjà vu reminiscent of the initial impact of the AIDS crisis.

Dr. Chris Beyrer, director of the Duke Global Health Institute, stated that recent events evoked memories of the devastating period he witnessed in the 1980s.

“When I began my career in HIV research, there were virtually no dedicated funds” for LGBTQ-specific research, he explained. He added that he has been recently haunted by memories of that time four decades ago when he cared for infants dying from AIDS—an era when tens of thousands of gay men succumbed to the disease while then-President Ronald Reagan remained largely, and infamously, unresponsive.

UCLA’s Mayer, however, offered a more hopeful perspective, emphasizing the resilience of lesbian, gay, bisexual, and trans Americans in the face of political adversity.

“One key message I convey to students is that LGBT people have been fighting for their rights for over a century,” he concluded. “This situation serves as a reminder of the necessity to continue this struggle.”