223. The HIV Money Trail Behind Global Transgender Health Policy | Róisín Michaux Returns

Today I welcome back Róisín Michaux — the Irish writer based in Brussels who covers women’s rights and free speech in the context of the transgender movement — for her second appearance on the show. When I booked this interview I had no idea what we’d cover; I simply trusted her to bring something worth digging into. What she brought is her ongoing investigation into the new World Health Organization guidelines for global transgender healthcare, and I’m hearing most of it for the first time right alongside the listener.

Róisín walks me through how a 2019 reclassification in the International Classification of Diseases — moving gender identity out of mental health and into sexual health in order to “depathologize” it — created a conundrum: how do you get hormones and surgeries reimbursed for a condition that’s no longer a condition? That question, she argues, is the thread that connects the WHO’s guideline development group to a much larger story about HIV funding, the Global Fund, Open Society Foundations money, and decades of AIDS-elimination targets.

We get into the “third gender” populations of India, Thailand, and Latin America; why so many of these vulnerable young men end up in prostitution and at high risk of HIV; and how offering the hormones and surgeries people want became a mechanism for getting them into clinics and onto antiretrovirals. We also cover the insurance-coding sleight of hand happening closer to home — mastectomies billed as “scar repair,” girls documented as males with gynecomastia — and what it all means for the parents and therapists trying to make sense of what their kids and clients are actually saying.

The question the episode keeps returning to: if the price of ending AIDS is medicalizing vulnerable kids and reframing whole populations as trans, is that a victory worth claiming?

Róisín Michaux is an Irish writer based in Brussels, Belgium. She writes about women’s rights and free speech in the context of the transgender movement. She is specifically interested in LGBTIQ activism, activists’ relationship to EU/European bureaucracies, the funding they receive, and how it has all led to deep and anti-democratic policy capture. She has 2 kids and a cocker spaniel. Follow her on Substack Róisín Michaux or on X @RoisinMichaux.

Listen to our previous conversation: 206. The Intersex Lie: Róisín Michaux on How Queer Theory Hijacked a Rare Medical Condition.

Watch this episode on YouTube | listen on any audio platform of your choice | or stay here on Substack

{{chapters}}
[00:00:00] Start
[00:02:54] The WHO Guidelines and the ICD Reclassification
[00:12:34] Third Gender Populations and the India Model
[00:20:25] Open Society Foundations and "False Consciousness"
[00:32:31] Prostitution, HIV Risk, and Marsha P. Johnson
[00:37:34] GATE, Global Fund Money, and Legal Gender Recognition
[00:47:17] Mainstreaming Trans Healthcare Into Public Systems
[00:54:16] Insurance Coding, Endocrine Disorder, and Scar Repair
[01:07:11] "End the Wait, End AIDS" by 2030
[01:27:17] PrEP, Decriminalization, and the AIDS Infrastructure
[01:36:38] Autism, Rescuers, and How Girls Get Roped In
[01:43:33] Conversion Therapy Bans and Criminalized Therapists

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