On 22 and 23 June 2026, the United Nations General Assembly convened the High-Level Meeting on HIV and AIDS, where Member States adopted the 2026 Political Declaration on HIV/AIDS, reaffirming their global commitment to ending AIDS as a public health threat by 2030.
This was not without contest. Some Member States attempted to introduce hostile language into the Political Declaration: invoking ‘traditional family values’ and ‘cultural and religious’ factors to remove references to gender equality, sexual and reproductive health and rights (SRHR), and key populations, with the ultimate aim of excluding trans and gender diverse communities from hard-won global health funding and protections.
But on the ground, far from the UN Hall, the health infrastructure that actually delivers life-saving services such as HIV, mental health services and safe spaces to trans and gender diverse communities is not just suffering but being dismantled.
The anti-gender movement is a health crisis
GATE’s 2026 survey of 64 trans and gender diverse-led member organizations across Sub-Saharan Africa, Latin America and the Caribbean, Asia-Pacific, Eastern Europe and Central Asia, and the Global North (Europe, North America, Australia and New Zealand) makes this visible in the data. 92% of our surveyed members report that anti-gender movements have become more visible in the past three years, with 80% saying significantly so.
The anti-gender movement is not a grassroots concern about fairness or safety. It is a well-funded, transnationally coordinated political project that targets trans and gender diverse communities as a strategic entry point for gaining electoral and political power and rolling back human rights more broadly, including sexual and reproductive health and rights, gender equality, and comprehensive sexuality education. It operates through disinformation, legislative capture, and the instrumentalization of marginalized communities for political gain. And increasingly, it is dismantling health infrastructure at every level.
According to our 2026 survey, the anti-gender movement driving these attacks is a diverse group of actors, sometimes with distinct and even opposing agendas, but coalescing around gender issues:
- Social media influencers and content creators: 84%
- Religious institutions and leaders: 73%
- Political parties and politicians: 69%
- Domestic security services, including police: 56%
- Mainstream media: 52%
- Foreign-funded religious networks: 47%
The forms of attack reported were:
- Harassment of activists and organizations: 77%
- Restrictions on legal gender recognition: 75%
- Anti-trans political rhetoric: 70%
- Various types of restrictive legislation: 70% (this includes criminalizing laws, anti-civil society laws, etc)
- Media hate campaigns: 70%
- Restrictions on gender-affirming care: 69%
- Attacks on comprehensive sexuality education: 67%
- Online disinformation: 66%
As a result, the communities most affected are those already bearing the greatest burden: trans women were identified by 91% of respondents as the group most impacted, followed by trans youth at 84%, trans men at 75%, and people living with HIV at 70%.
This phenomenon is not new. In 2023, GATE conducted a global survey on the impact of anti-gender opposition on trans and gender diverse movements across seven regions. That research already documented a clear pattern.
This coordinated targeting of trans communities through legislation, media campaigns, and institutional exclusion has direct consequences for safety and organizational survival. Our 2026 data reveal that the crisis has not stabilized. It has accelerated particularly in health access.
The Impact on Health Access for Trans and Gender Diverse Persons
Our 2026 survey revealed that 75% of trans-led and gender diverse-led organizations report reduced HIV prevention outreach as a result of the anti-gender movement. 73% report reduced donor funding for HIV services. 66% report increased stigma in healthcare settings. Access to the full prevention and treatment cascade has been disrupted, with PrEP (63%), PEP (55%), HIV testing (56%), and antiretroviral treatment (56%) all affected.
Community-led services, the backbone of the HIV response for trans and gender diverse communities, have closed in half of the contexts represented. Over half of the respondents report that fear of accessing services has increased. 83% of our members report that healthcare providers have changed their practices under anti-gender pressure.
Even where services technically still exist, fear and self-censorship are reshaping what care is actually delivered. This means that a trans woman in Sub-Saharan Africa may avoid the health facility that could save her life, not because the service does not exist, but because she fears what will happen when she walks through the door.
Long-acting antiretrovirals, including injectable PrEP like lenacapavir – a twice-yearly injection that prevents HIV, now approved in over 10 countries – represent a breakthrough. But for trans communities, these technologies cannot fulfill their equity promise if the community-led delivery sites are shut down, the outreach workers are criminalized, and the service users are too afraid to show up.
27% of GATE’s member organizations report that anti-gender attacks have already specifically disrupted the rollout of long-acting antiretroviral technologies in their contexts, with 65% of that disruption concentrated in Sub-Saharan Africa. The barriers are political and structural, and they are being created deliberately by anti-gender actors.
Damage Beyond HIV
The damage extends far beyond HIV. According to 73% of respondents, gender-affirming hormone therapy, one of the most evidence-based and life-saving interventions for trans people, has been negatively impacted. Mental health services follow at 72%, sexual and reproductive health services at 64%, and legal gender recognition linked to healthcare access also at 64%. HIV treatment and care (59%), gender-affirming surgeries (53%), primary healthcare (50%), and harm reduction services (45%) complete a picture of near-total service disruption across the health system.
89% of respondents identify fear of discrimination or violence as the single most cited barrier to accessing health services. Community members are avoiding health facilities entirely due to fear of arrest, exposure, family rejection, and retaliation, which directly contributes to breaks in the HIV cascade of care, poor health outcomes, and unsafe self-medication, particularly among young trans and gender diverse people.
What Trans Communities Are Doing, and What They Need
It is clear that the anti-gender movement produces the systematic dismantling of the services that keep people alive. GATE’s trans and gender diverse-led member organizations have not been passive. They are resilient and fighting back.
77% have launched mental health support initiatives. 67% have deployed security and risk mitigation strategies. 63% are building coalitions. 59% have turned to community-led mutual aid. Documentation and research (56%) and legal advocacy (52%) signal that members are also investing in the longer-term work of evidence-building and accountability.
However, trans organizations are simultaneously losing resources, facing greater threats, and watching their staff reach a breaking point. 89% report reduced funding opportunities, 83% face increased security risks, and 77% report staff burnout. At the same time, 70% report increased community demand for support. The gap between what communities need and what organizations can provide is widening precisely when it should be closing.
“While community leadership is recognized as essential to ending AIDS, the HIV response among transgender people in Armenia and beyond has not yet fully realized this principle. Too often, decisions are still made about our communities rather than with our communities. Yet it is community organizations that identify barriers, build trust, generate evidence, and reach people who are otherwise left behind.” — Hmayak Avetisyan, Programs Director of the National Trans Coalition (a GATE grantee and member organization), delivering the statement at the 2026 High-Level Meeting on HIV/AIDS at UN Headquarters.
This is the cruelest irony of the current moment. The global health architecture speaks of community-led responses and of leaving no one behind. But the communities that are actually leading the response on the ground are being defunded, criminalized, and burned out, not by neglect but by a deliberate political project.
If we are serious about the commitments made at the UN, if we are serious about universal health coverage, if we are serious about the 2030 Agenda, then we must confront the fact that the anti-gender movement is one of the most significant threats to global health equity today.
Neither sustainable development nor the goal of ending AIDS can be achieved without sustained, flexible, and politically protected investment in trans-led health infrastructure. The kind of support that keeps trans individuals safe allows trans and gender diverse organizations to stay alive and keeps health clinics providing life-saving services.
Behind every number in this report is a trans or gender diverse person who was denied healthcare, turned away from services that could save their lives, or left without the support they needed. These are not merely statistics; they are human lives and a stark warning about the growing global threat to health equity.
The evidence is clear, and the consequences are already unfolding. The question is whether we will act on it before there is nothing left to save?
The science exists. The evidence exists. The medications exist. What is being systematically dismantled is the social and political infrastructure needed to deliver them equitably. Addressing this requires, urgently, protecting the civic space in which trans-led organizations operate; ensuring that long-acting HIV medication rollout strategies explicitly name and address anti-gender attacks as implementation barriers; and committing to long-term, flexible, politically protected funding—not emergency injections, but structural investment.
Democratic backsliding is a health emergency for not only our communities but for everyone. If we don’t ensure everyone’s access to long-acting HIV medication, not only will trans and gender diverse communities suffer—everyone will.
Further readings
GATE. (2023). Impact of anti-gender opposition on TGD and LGBTQI movements: Global and regional reports. Global Action for Trans Equality (GATE). https://gate.ngo/knowledge-portal/news/anti-gender-opposition-impact-global-regional-reports/
GATE. (2023). How does anti-gender opposition impact trans and gender diverse health rights? Global Action for Trans Equality (GATE). https://gate.ngo/knowledge-portal/article/anti-gender-opposition-impact-trans-and-gender-diverse-health-rights/
GATE. (2024). Recognizing, Documenting and Addressing Anti-Gender Opposition: A Toolkit. Global Action for Trans Equality (GATE). https://gate.ngo/knowledge-portal/publication/download-anti-gender-opposition-toolkit/
GATE. (2025). The impact of the US foreign aid freeze on trans and gender diverse communities: A call to action. Global Action for Trans Equality (GATE). https://gate.ngo/knowledge-portal/article/impact-us-foreign-aid-freeze-on-trans-and-gender-diverse-communities/
GATE. (2025). Attacks on trans rights are harming women’s health. Global Action for Trans Equality (GATE). https://www.linkedin.com/pulse/attacks-trans-rights-harming-womens-health-gateorg-lglff/
GATE. (2026). Report: Democratic Erosion as a Health Emergency: How Anti-Gender Movements are Dismantling Access to Health for Trans and Gender Diverse People Worldwide – Global Action for Trans Equality (GATE).
