Love in the Time of Aid Cuts: On Queer Citizenship and the Politics of Aid

Various reports and studies hail the Philippines as one of the most accepting countries of the LGBTQ+ community. One reporter notes that for a predominantly Catholic country, the Philippines seem to be very LGBTQ+ friendly, as it hosted the biggest Pride gathering in the region in 2023. In a Social Weather Stations survey, a huge number of Filipinos agreed that “gays or lesbians are just as trustworthy as any other Filipinos.” Furthermore, 73% affirmed that queer Filipinos contribute a lot to the progress of society. However, there seems to be a disconnect here, as members of the LGBTQ+ community do not necessarily feel that way.  Additionally, the legislation that aims to protect every Filipino regardless of their sexual orientation, gender identity, and gender expression, known as the SOGIE Equality Bill, has remained unpassed. The Bill’s earliest version was first filed more than two decades ago and up until now, it has not seen the light of day. I assert that because of this lack of legislation, queer Filipinos continue to struggle for equal rights, protections, and access to different social services. This is quite apparent on queer Filipinos’ access to healthcare services. 

Members of the Filipino LGBTQ+ community were identified as the key population suffering from HIV/AIDS. The latest report from the Philippine Department of Health (DOH) suggested that by the end of 2024, People Living with HIV (PLHIV) in the country is estimated to be around 215,400 (1). In a recent study, it was also found that queer Filipinos engage in sex at a very young age. Most of them have never been tested for HIV nor used protection consistently (2). Given this alarming number, healthcare services to prevent and end AIDS are in place by the government and civil society organizations. It appears, however, that healthcare services for queer Filipinos are too narrowly focused on HIV/AIDS. In as much as this is a win, it is important to acknowledge the fact that queer health goes beyond this.

Access to various healthcare services is a struggle for many queer Filipinos. Studies show a disproportionately heightened prevalence of suicidal ideation, suicide attempts, depression, and stress among queer Filipinos as compared to their heterosexual peers (3). A recent report from the Trevor Project found that 77% of queer Filipino youth indicated their want for emotional counseling or therapy, but only 15% among them reported that they actually received proper mental healthcare (4). Most of this emotional and mental stress is due to the social stigma and discrimination they experience. Their fear of stigma, discrimination, and lack of social support leads queer Filipinos to self-medicate with hormones and go to unlicensed providers for their surgeries. Problematically, trans health in Philippine healthcare and education of health professionals has zero visibility. Healthcare providers then have limited to zero knowledge about trans health and gender-affirming care. Some of them even perpetuate social stigma and discrimination further by refusing to provide services (5).

These stories and statistics on queer Filipinos’ health access or lack thereof is very telling of the kind of citizenship they get to practice and enjoy. Alessio Ponzio argues that citizenship is a measure of belonging and inclusion within a rights-bearing community (6). By being denied access to gender-affirming care and experiencing social stigma and violence, are queer Filipinos experiencing a diminished form of citizenship — relegated to a de facto status of non-citizenship?

Aware of the community’s plight, civil society organizations are at the forefront of bridging gaps between queer Filipinos and essential healthcare services. Different civil society organizations have long provided for the lack of gender-affirming care, mental health services, sex education, and other resources for our queer brothers and sisters. To operate, they rely on external funding and aid to which the United States has played a key role in through USAID. Earlier this year, the Trump administration issued a “stop-work” order for all of its foreign aid programs. This stoppage will cause huge barriers for the operation of civil society organizations.

Given this, how will the global politics of aid shape queer health and citizenship in the Philippines henceforth? I posit that aid is a double-edged political tool that empowers and undermines queer health and citizenship in the Philippines. It reflects the geopolitical interests of donor states rather than the needs of receiving states. Thus, relying on external funding for the needs of the marginalized sector further disenfranchises them given the precarity of aid flows. Though it initially fills the gap in queer citizenship, it also further expands spaces of unfreedom queer Filipinos currently struggle with. This calls for other actors both locally and internationally to step up — this is not exclusive to the Philippines but a pressing global issue that requires concerted global action.

Aiding Queer Citizenship

Citizenship extends beyond legal status. Different factors influence who gets full acceptance in a rights-bearing community which leads to the creation of hierarchies and varying levels of belonging (7). Diane Richardson argued that sexuality is among the crucial factors at play. This entails not only legal protections but fundamentally, social and cultural recognition. It tells us who gets to be included or excluded based on one’s sexuality and whose identities and relationships are validated and respected (8). 

To this end, social and cultural recognition may also influence economic entitlements like healthcare. Access to these services serves as a crucial determinant of who is a citizen. Queer Filipinos, as earlier laid out, have long been disenfranchised without access to appropriate health and gender-affirming care services. Medical professionals are ill-equipped in dealing with the unique experiences and challenges of queer Filipinos because of the inadequate attention given to their needs. This resulted in discriminatory practices and attitudes even within health institutions. For instance, on national television in 2011, a mental health professional advised the parents of Filipino queer youth to engage in conversion therapy for a “happy life” (9). Furthermore, gender-affirming care in the Philippines is very limited and expensive. Trans Filipinos are forced to self-medicate, purchase, and consume hormones from unregulated markets such as Facebook and Shopee to cut costs (10). These experiences underscore the de facto status of non-citizenship that queer Filipinos are relegated to because of their sexuality and gender identity. This invisibility costs them their full participation in society and reinforces their status as second-class citizens.

Fortunately, external funding from sources like  USAID has allowed for the establishment and operation of various LGBTQ+ civil society organizations in the Philippines. LoveYourself, Transmasculine Philippines, and HASH, among others, are at the forefront of this important work. By providing services for the unique challenges of queer Filipinos, they serve as crucial intermediaries. They broker access to appropriate healthcare services that might otherwise be unavailable, inaccessible, and/or unsafe for queer Filipinos due to the social stigma, lack of specialized knowledge, and other systemic barriers. USAID, in its provision of funds, supported the well-being of queer Filipinos and indirectly contributed to increasing their visibility. 

Foreign aid has been instrumental to queer Filipinos’ empowerment and visibility, which fostered greater recognition, a cornerstone of queer citizenship. It has allowed not only improved access to queer healthcare but also safe and affirming spaces where queer Filipinos can find community and support. By doing so, it helped address the stress that queer Filipinos, as a marginalized group, suffer from. Alongside the civil society organizations aid funds, it combats the impact of discrimination, stigmatization, and lack of comprehensive legal protection empowering queer Filipinos to fully participate in society. Foreign aid ultimately empowers organizations to shake heteronormative structures and build a society where queer Filipinos are not only seen but enjoy full the entitlements and belonging of a citizen.

Precarity Expands Unfreedoms

Aid flows are inherently precarious. Foreign aid can be withdrawn at any given time. As fundamentally a political tool, the provision and continuation of aid flows are dictated by the donor’s evolving interests and strategic objectives, not mere altruism (11). This very nature of aid is something that civil society organizations have to face and take into account in their operations.

The ‘stop work’ order reminds us of this brutal asymmetric relationship. In their statement, the White House said that the stop work order is to allow them to reassess the current foreign system, as it does not align with American interests and promotes ideas and values that contradict theirs. This is a clear manifestation of how foreign aid is politically used to reinforce donors’ agendas and interests. Given the re-elected U.S. President Donald Trump’s stance on the queer community, the reasoning is not a surprise. During his first term, he initiated a wave of discriminatory measures targeted at limiting the protections of queer communities across the country.

Unfortunately, queer Filipino civil society organizations must deal with living in limbo as they depend on USAID for funding. LoveYourself, the biggest among them, which advocates for sexual health, trans health, and mental health, has already reported that the delivery of their services such as testing kits and pre-exposure prophylaxis (PREP) are no longer free. Additionally, the organization’s smaller testing clinics had to close down because they relied on USAID funds for their staff’s payroll. Other services of LoveYourself such as HIV testing and medicines remain free for all. However, without the free delivery services, as pointed out by its executive director, those who are afraid and anxious because of social stigma may no longer access these crucial services (12). Last year, USAID also provided funds for the Tanggap Trans Hub, the first community center for trans Filipinos. Two months after it was launched, the organization had to shut down, including the various workshops lined up for the center like employment equity, medical transitioning, and legal rights. Mattias Alea, the founder, shared that the closure is due to funding.

Reliance on foreign aid expands the unfreedoms that queer Filipinos already face. Unfreedoms happen because organizations do not have total control over their initiatives. The precarious nature of funding gives the donor an upper hand as the provision of critical resources relies on them. Because queer Filipinos have to rely on aid, they are forced to beg for help. This thereby reduces their agency, which is oxymoronic with the very idea of citizenship. As this cycle of dependency (dis)continues, it strips queer Filipinos of the dignity that must be afforded to them as de jure citizens, regardless of the SOGIE Bill. 

Ultimately, as much as we are grateful that gaps are filled as queer organizations are able to broker essential services through USAID funding, queer health is transformed from basic rights to a transactional vulnerability. The system is built on fluctuating donor priorities that make queer Filipinos’ existence contingent on external benevolence; further denying them bodily autonomy and political agency. Until locally driven solutions are enacted for queer Filipinos’ health access, as an inherent right of citizenship, expansion of unfreedoms shall persist, leaving them in a perpetual cycle of precarious existence. 

Call to Action

Queer Filipinos’ ability to access healthcare has demonstrated the precarious nature of dependence on external donors. As reiterated, this system has emphasized their position as second-class citizens in their own homes when they should be accorded the same entitlements as other de jure citizens. Efforts are made, but clearly, they are not enough. The vulnerable and insecure system that queer communities depended on for healthcare access exposed abdication of national responsibility. As de jure citizens, queer Filipinos too possess an inherent right of being able to access gender-affirming, appropriate, and sensitive care. It is high time that the national government recognizes its fundamental obligation to its queer citizens. 

This critical gap is a site of queer unfreedoms. It has always been there, and now expands with the withdrawal of USAID. The withdrawal will certainly not only affect queer Filipinos but other queer communities across the globe and other marginalized people that rely on aid for sustenance. Queer Filipinos’ struggle is a microcosm of a global challenge and fight for universal human rights. This opens the stage for other international actors to step up. With the current geopolitical tensions brought about by the U.S.-China rivalry, this may seem to be an open opportunity for China to intercede, banking on soft power. However, China’s policies and stances do not seem to reflect a tendency to weigh in on this issue. Multilateral organizations and progressive nations can surely offer beyond just mere pecuniary support; they should provide technical expertise. May they lead advocacy efforts that can yield sustainable healthcare models that empower local communities and marginalized groups. We need to shift our focus and prioritize long-term investment in infrastructure and rights-based frameworks that can help build a world where queer citizenship is a reality and not mere aspiration.