Orion Rummler, The 19th

Originally published by The 19th

We’re telling the untold stories of women and LGBTQ+ people. Subscribe to our daily newsletter.

Clark Williams lost his first love, Robert Wisler, in 1994 to AIDS. Wisler died in his arms, and like so many other gay men, he died before the most effective treatments to control the virus destroying his immune system were available — after political indifference stifled early medical efforts.

As Wisler died, the couple were together in his hospital bed, at home, finding refuge with the doors locked to the outside world. Five days before, Wisler had chosen to stop taking treatments that were wrecking his body. Williams knew the decision was an act of love to preserve what time they had left.

“Those last few days were the most beautiful times of our relationship. It was a snowy winter in Milwaukee. Snow was falling, we were isolated in the house,” he said. A home health nurse visited at night. After years of fighting, the end fell on them slowly, with the February snow, and Williams knew there was nowhere else in the world he would rather be. “I just held him, the entire time, for days. I just held him as he continued to weaken.”

Williams was stunned when he saw those final moments with the man he knew to be his husband — and echoes of the life they had built together in a world hostile to those with HIV and AIDS — mirrored, almost 30 years later, in “The Last of Us,” an HBO series chronicling a fungus-driven zombie apocalypse. He watched as two men living through a deadly pandemic decided to trust and love each other in spite of how easily it could all be taken away from them. He watched as they exchanged rings and vows in a world that couldn’t legally recognize their marriage.

“As I'm watching it, I'm like, ‘Oh my god,’ [‘The Last of Us’ co-showrunner] Craig Mazin wrote this piece that just made me feel like someone saw me and Robert,” he said. “Somehow Mazin wrote this piece of art that reflected not just the life that Robert and I had, a falling in love in this dystopian time, but the lives of so many of my friends who also found loves that they loved and lost.”

Clark Williams and his first love, Robert Wisler

(Courtesy of Clark Williams)

Bill and Frank’s decades-long relationship depicted in HBO’s “The Last of Us” was an unexpected departure from the award-winning video game that inspired the series. In the game, released in 2013, Frank is not even a living character — and he expresses contempt for Bill before dying. Their reimagined story resonated strongly with many LGBTQ+ viewers as a heartfelt homage to queer love found late in life, and in times of uncertainty.

It also struck a chord with some of those who lived through the spread of HIV and AIDS in the 1980s and 90s. Peter Staley, one of the country’s most prominent AIDS activists of that time, called the episode’s metaphor “a gift,” saying that “tears flowed remembering the tender love and bravery gay men summoned when facing death during the plague years” as he watched.

Perry Halkitis, dean of the Rutgers School of Public Health, lived and mourned through those years too. He lost his partner, the Village Voice editor Robert Massa, to complications caused by AIDS at St. Vincent’s hospital in New York City. Halkitis was holding him in his arms as they went to sleep. On that Saturday morning in 1994, Massa woke up and died in his arms.

The relationship between Bill and Frank didn’t resonate with him as a metaphor for those with HIV or AIDs — and Halkitis has spent time documenting the lived experiences of other HIV-positive gay men who survived that era. However, he did find meaning in Bill realizing his own identity once he found the right person. Many men today suppress their sexuality, he said, but still have the ability to love and discover who they really are.

“When he met Frank, he became his authentic self and his life had meaning. And then because his life had meaning, he was afraid to die,” he said.

Nick Offerman and Murray Bartlett playing Bill and Frank in The Last of Us.

(Warner Media)

Williams watched as the character Bill became a caretaker for his partner, Frank — helping him get out of bed, cutting up his food, picking out his pills. He recalled the struggle and profound intimacy of taking care of Wisler as they both did whatever they could to keep him alive. But ultimately, they didn’t have enough time. The fight was taking a physical toll on both of them. Wisler’s health was declining. He chose to let his life end prematurely without the stress of constantly trying to fight what they both knew had become inevitable.

In the latest episode of “The Last of Us,” which aired Sunday, Williams watched as Frank made a similar decision: to end his life. His symptoms from an unspecified degenerative neuromuscular disorder, either multiple sclerosis or early ALS, had left him unable to move, paint, or live how he wanted to live. “Then you will take me by my hand … bring me to our bed … and I will fall asleep in your arms,” Frank tells Bill ahead of time, while asking for his help to have “one more good day.”

Williams remembers his husband’s last moments alive as an unexplained burst of energy, a vital insistence that seemed like he had something to share, if only he could get the words out. He sat up suddenly and yelled “Clark!” several times — not in pain, but as if in amazement.

“Whatever it was, it was remarkable and he wanted to share it with me. And that's when he cast his last breath, was with me holding him and him trying to share something with me. It's a mystery. I hope one day I’ll find out what it was.”

In “The Last of Us,” Bill ends his life alongside Frank, as the two retreat into their bedroom and lock the door to the outside world. Williams recognized that urge to follow a deceased loved one. After his husband died, he had moments where he wanted to end his own life. He felt broken — like he had given everything.

“I didn’t want to face a world without the person I loved the most,” he said. Moving through his grief was messy, confusing and lonely. His father, the first person he came out to, stayed with him in the weeks after Wisler’s death, standing as a witness to his grief and to how much he loved his partner. It took time to put the painful experience in context.

“He did not want to see me end my life. He fought too hard to live for me to end my life,” Williams said. “So I had to figure it out. I had to figure out what my life was going to look like without him. And to allow myself to change.”

Williams has built that new life, the one he believes that Wisler wanted for him, with his husband Jim Moore and his daughter Caroline. And yet, when he watched Bill and Frank retreat into their bedroom to share their last moments together — a private scene that no viewers, or any other characters in the show, are welcome to join — he felt seen.

“I’m glad they didn’t show the end of their lives. … There was no need to. It is so intimate. I guess because I’ve been in that room, I understand what that’s like,” Williams said.

(Courtesy of Clark Williams)

Matthew Rose, who has worked as a health equity and HIV patient advocate for over a decade, felt that the “Last of Us” episode offered a clear depiction of committing to love in the face of death and portrayed a level of queer intimacy not often seen on screen. It laid bare Bill’s awkwardness and tentative vulnerability in expressing feelings for another man seemingly for the first time. As Bill’s partner, Frank, breathed new life into their post-apocalyptic surroundings by sprucing up their barren town and planting strawberries, those small touches became symbols of hope and faith in their relationship that transcended their bleak circumstances.

That such a relationship was between two older men is an important representation of enduring love, or finding love at an older age, Rose said. Depicting that kind of love — wherein two middle-aged gay men find happiness growing old together — was also vital to the showrunners, as Mazin explained on the official companion podcast for “The Last of Us.”

There are many untold stories of those who lived with HIV and AIDS, Williams said. That’s why he believes seeing a love story between two older gay men being told on “The Last of Us” was surprising and compelling for so many.

“To have it be told in such an honest way, that really reflected the dignity of so many of the people I knew who were finding each other during a time of chaos, that’s why it resonated so much with me. The years of the HIV, AIDS pandemic felt dystopian. There was death all around us. There were threats all around us. And yet we were all trying to survive in our own way and trying to find love in our way. And I’m an example of that.”

Williams met Wisler, a “brutally handsome” doctor who had just finished his residency, in Milwaukee in 1990. Because of where they lived, and the times they lived in, coming out as gay or admitting to being HIV-positive meant taking on real risk. Wisler was terrified to share his status; he didn’t disclose it to Williams for a couple weeks after they met. As more time passed, Williams learned that Wisler had received an AIDS diagnosis – his symptoms were worsening. Both of their lives were upended. Williams lost his job after his employer learned of his personal circumstances. After paying out of pocket for the mounting costs of treatments, Wisler eventually used his insurance — which meant his job found out about his condition. He was asked to resign.

They exchanged rings and vows in 1992 — becoming married, although in the eyes of the government, they were little more than roommates — while on vacation in Hawaii.

The stigma that Williams and Wisler experienced was common for many queer men in the early 1990s, experts say — and it was coupled with a lack of comprehensive medical care and slow-moving federal funding to support that care.

“In those early days, before a combination therapy hit, you were waiting to die,” Rose said. Even in the early 1990s, a lack of real treatment options prompted difficult decisions about how to die with dignity, once someone’s quality of life had deteriorated, he said. The initial AZT treatment was toxic and full of side effects. Early on, so-called treatments managed pain, but didn’t offer much more than that, said Lindsey Dawson, director for LGBTQ health policy and associate director for HIV policy at the Kaiser Family Foundation.

The early federal response lagged as the Reagan administration failed to acknowledge the spread of HIV. Change was driven by activists who pushed the Food and Drug Administration (FDA) to accelerate approval pathways for treatment and who pushed the National Institute of Health to conduct more research into the virus, Dawson said. It took until the mid-1990s for real federal funding to be brought to the fight, especially through the Ryan White HIV/AIDS Program. Breakthroughs came with the first FDA-approved protease inhibitor in 1995 and the use of combination therapy as a new standard of care.

Williams was thrilled that these pivotal advancements were healing his friends. It was also gut-wrenching that they came just a few years too late to save Wisler’s life. Halkitis remembers thinking, if only his own partner could have held on for just a bit longer — and what a difference that would have made for everyone else who was playing the same waiting game.

Current treatments now stave off the progression of HIV, preventing or delaying the more advanced stages that invite opportunistic infections, like those that killed Williams’ partner. The understanding that “undetectable = untransmittable” also marks a key turning point in society’s relationship to the virus as a mangeable one.

Although there’s been progress among society’s emotional response to the virus, Halkitis sees regression in state-level policy. Tennessee recently rejected federal funding to combat HIV, and a federal judge in Texas last year ruled that a Christian-owned company does not have to cover preventative HIV drugs under the Affordable Care Act. That ruling sets a scary precedent that could allow employers to discriminate against people who are HIV positive, he said.

When Williams thinks back to meeting Wisler, to making the easy decision to build a relationship with him despite the struggles ahead, he reflects that he was too young to know what the power of grief would do to him. He was in his 20s. He didn’t think Wisler would die — he did everything he could to prevent it. Letting him die equaled failure.

“We all fought really fucking hard in order to live. So there’s no glory in death. I wish death hadn’t come. I’ve got enough rage for the way our government responded in the early days of the epidemic. That many people didn’t have to die,” he said. “There’s no beauty in that. It didn’t have to happen.”

Choosing to move forward, to accept love despite the odds, is part of what made Bill and Frank seem familiar to him.

“Bill had a million reasons not to let Frank inside those gates. You know, a lot of very good reasons. And the same with Frank. He had a ton of reasons to leave,” Clark said. “But they allowed their human nature to love, to find each other, through all of that. And that's how I think Robert and I ended up finding our love … until death do us part.”

Originally published by The 19th

Sen. Tammy Baldwin wants her Republican colleagues to understand the dire consequences of losing access to same-sex marriage.

Baldwin, the country’s first openly gay senator, has taken the lead on trying to convince her colleagues to vote to protect marriage equality — seven years after that right was seemingly settled by the Supreme Court.

“There will be constituents of every senator who take this vote very personally,” Baldwin told The 19th in an interview on Wednesday.

LGBTQ+ advocates and legal experts fear Obergefell v. Hodges, the ruling that secured marriage equality for Americans, could be on the chopping block after the fall of Roe v. Wade.

That’s where Baldwin said she usually starts her appeal.

“I think a number of my colleagues are first questioning the timing of this and so I’m walking through why we’re bringing this up now, in the wake of Roe v. Wade being overturned by the Supreme Court and placing in jeopardy a number of rights and freedoms that were decided based on the same reasoning,” Baldwin said.

Baldwin said she stresses to her colleagues just how important it is for Americans to have certainty in their marriages.

“The idea that you might in the future lose that recognition has huge consequences,” she said. “I think lots of folks think more about the ceremony or the wedding cake than they do the idea that if you are not married, you’re a legal stranger,” she said.

One consequence that’s on Baldwin’s mind: If someone’s spouse or partner gets hospitalized after an accident, being in an unrecognized marriage means having no right to information about their condition or to be at their bedside.

The House took protective action this month, with 47 Republicans backing a Democrat-led bill to repeal the Defense of Marriage Act and require that all states legally recognize LGBTQ+ marriages that take place in other states. This legislation would set up a fail-safe route to marriage equality even if Obergefell is overturned. In the Senate, at least 10 Republicans need to get on board for the bill to succeed.

Democratic Sen. Kyrsten Sinema, plus Republican Sens. Rob Portman, Thom Tillis and Susan Collins have joined Baldwin’s effort to recruit Republican support for the bill. Five Senate Republicans have backed the bill publicly, and Baldwin said on Wednesday that more had have privately expressed their support — inching the total tally “very close” to 10 senators.

But Collins reportedly said on Thursday that the timing of Democrats’ deal on a bill aiming to curb the federal deficit, fight climate change and cut health care costs could jeopardize efforts to win Republican support for the Respect for Marriage Act.

Baldwin said that while sentiments in the Senate toward marriage equality have changed since she was sworn in in 2013, especially since more of her GOP colleagues know LGBTQ+ friends and family directly impacted by their policy positions on it, the chamber has not moved quickly enough to match public opinion.

A record 71 percent of Americans now support LGBTQ+ marriage – an indicator that has grown year over year.

“Arguably the Senate hasn’t progressed quite as fast as the American public has on this issue, but we’re getting there,” she said.

With the Defense of Marriage Act still on the books, the federal government would not recognize LGBTQ+ marriages if Obergefell is overturned — unless the Respect for Marriage Act is passed.

Twenty-five states have both a constitutional amendment and statute banning marriage for same-sex couples, per the Movement Advancement Project, which tracks LGBTQ+ rights nationally. Five other states ban LGBTQ+ marriage through constitutional amendment, and five more have statute bans.

The bill Baldwin and her colleagues want would offer interstate and federal protections for same-sex marriage, although it would still allow states to deny couples the ability to marry within their own state if Obergefell were overturned, LGBTQ+ experts told The 19th. Americans would be able to travel to another state to get married and their home state would have to recognize that marriage — but having to travel would still present obstacles to LGBTQ+ people of color and transgender people.

Baldwin hopes the Senate will be able to take up the Respect for Marriage Act for a vote before a month-long recess begins on August 8.

Until then, she’ll keep appealing to her colleagues — which sometimes involves invoking their personal relationships with LGBTQ+ people in their lives, although that’s not where she typically starts the conversation.

“We’re very close to 10, which is what we need to overcome a filibuster in the Senate. But I think I will keep on going beyond 10, just as extra insurance,” she said.

Ten anti-LGBTQ+ bills largely focused on sports and education restrictions are going into effect today across six states — Alabama, Florida, Indiana, South Dakota, Tennessee, and Utah. Two of the most prominent bills are one in Florida restricting classroom discussion of gender and sexuality, dubbed “Don’t Say Gay” by opponents, and a bathroom bill in Alabama that was amended to include its own education restrictions.

Collectively, the bills build toward an atmosphere of silence around LGBTQ+ people and restrict how LGBTQ+ youth can learn about themselves and participate at school, advocates say.

National LGBTQ+ advocates are especially concerned that more bills restricting classroom discussions on sexual orientation and gender identity are being passed into law.

“These curriculum censorship bills hurt me the most,” said Vivian Topping, director of advocacy and civic engagement of the Equality Federation, a coalition of state LGBTQ+ organizations.

It is already hard enough for transgender and LGBTQ+ youth to see themselves reflected in the culture or in the academic materials they’re learning from, Topping said — and harder still for LGBTQ+ youth to simply go to school if they are getting bullied. Taking away the ability for students to talk with teachers about their identity or learn about queer communities in school may hamper their ability to dream of a future with people like them in it.

Sam Ames, director of advocacy and government affairs at LGBTQ+ suicide prevention organization the Trevor Project, is particularly worried about Alabama’s bathroom bill, which includes an amendment seemingly styled after Florida’s “Don’t Say Gay” law.

Alabama’s bill passed with an amendment that prohibits public schools from teaching or allowing classroom discussion on gender identity and sexual orientation for students in kindergarten through fifth grade. The bill was sent to Gov. Kay Ivey’s desk on the last day of the state’s legislative session in an 11th-hour move that shocked the state’s LGBTQ+ advocates.

“We got this weird Franken-bill, this education bill that is also a bathroom bill. That is one I’m particularly concerned about,” Ames said, noting that LGBTQ+ youth in Alabama will be hit with two restrictions in the same legislation.

Also in Alabama, a federal judge has blocked the state’s separate felony ban against prescribing hormone treatment or puberty-blocking medication to trans youth — but the state’s law still requires school counselors and teachers to alert parents if children come out as trans or gender-nonconforming.

Across the state line, Florida’s “Don’t Say Gay” bill outright bans classroom instruction on sexual orientation or gender identity in kindergarten through third grade — but LGBTQ+ advocacy groups have interpreted the fine print of the bill to also restrict that instruction in grades four through 12. The law states that such instruction cannot take place in a manner that is not age-appropriate or developmentally appropriate for students.

A jury trial for Equality Florida and the National Center for Lesbian Rights’ lawsuit against the state over the “Don’t Say Gay” bill is currently set for February 13 next year. Parties currently have until November of this year to finish exchanging information on witnesses and evidence that they’ll present.

Equality Florida argues that the ripple effect of this legislation has already expanded beyond the classroom: A Florida high school class president was prevented from talking about his experience as a gay student in May, and some Florida teachers have reported being told to take down Pride flags (a trend that surfaced last year among teachers in other states as well).

Anita Carson, a former sixth-grade science teacher in Florida, told reporters on a Friday press call hosted by Equality Florida that the “Don’t Say Gay” bill is one reason she resigned from teaching about a month ago — after spending 12 years in the profession.

“I could not see myself in a classroom where I could not support students in the best way possible,” she said. “This law prevents that.”

Conversations around education have grown “increasingly toxic” in the state, she said, pointing to the “Don’t Say Gay” bill and the “Stop Woke Act” — a law setting boundaries on discussions of race that also went into effect on Friday. Teachers have been accused of trying to harm kids while doing their jobs, she said.

“It’s already a hard job. And if you add to that this very toxic narrative surrounding what we do and why we do it, it’s untenable,” she said.

Dempsey Jara, who is trans and will soon enter fifth grade, told reporters on the call that she doesn’t feel safe in school with the bills that Florida has passed. Jara’s mom said that she feels the bills seek to hide and invalidate her child’s existence.

In South Dakota, an anti-trans sports bill and bill limiting classroom discussion on race, sex and ethnicity that advocates say would also affect LGBTQ+ students are going into effect on Friday.

Jett Jonelis, the ACLU of South Dakota’s advocacy manager, said the vagueness of the bill’s language — and how it defines “divisive concepts” that schools should not direct students to affirm — could especially restrict discussions on two-spirit identities. (While being two-spirit means different things to different tribes and Indigenous communities, it broadly refers to gender variation and those who are neither men nor women, who possess both spirits, or who occupy a separate gender identity.)

“It’s very overly broad and it opens the door to a wide variety of dangerous interpretations that would censor free speech and academic freedom,” they said.

Early next month, a Louisiana bill restricting school sports access for trans youth is also expected to go into effect.

Topping warned that a significant amount of confusion may be caused by the enforcement of these laws as they go into effect — whether that’s teachers figuring out how curriculum restrictions work, or how athlete bans would actually be implemented in schools.

“What these bills are encouraging is a culture of censorship and surveillance,” she said. “It’s encouraging people to report on each other.”

Originally published by The 19th.

Leaders of a now-defunct health clinic — known for years as the largest program of its kind for transgender youth in Texas — came under pressure to restrict gender-affirming care from the governor’s office and a state House investigative committee, according to recordings of internal meetings among hospital leadership and staff obtained by The 19th.

Hospital administrators and doctors at GENder Education and Care, Interdisciplinary Support (GENECIS), a state-run medical institution, struggled to reconcile halting care with the knowledge that doing so could severely jeopardize the mental health of their patients, the recordings reflect.

GENECIS, which was jointly run by the University of Texas Southwestern Medical Center and Children’s Medical Center Dallas, quietly closed to new patients in November, with all references removed from the Children’s Health website. The 19th obtained nearly five hours of meetings among UT Southwestern leadership and staff, as well as staff and leadership at Children’s Medical Center and GENECIS employees, that took place during 2021 and 2022.

The shuttering of GENECIS is part of Texas officials’ efforts to restrict health care and full access to services for trans youth. Gov. Greg Abbott called three special sessions of the Texas legislature that prioritized anti-trans legislation, pledged to take action against gender-affirming care for trans youth, and has backed the state attorney general’s interpretation that giving puberty suppressing drugs and hormone therapy to trans youth is child abuse. These moves have put multiple parents seeking care for their trans children under investigation by the state. (A state court issued an injunction on Friday evening blocking these investigations.) On a March 2 call with reporters, Abbott’s campaign reportedly described the push to investigate parents of trans kids as a winning issue.

In an emailed statement, a UT Southwestern spokesperson said that hospital leadership was not contacted by the governor himself about GENECIS and its services. When asked if leadership was contacted by the governor’s office, the spokesperson said that inquiries into actions by the governor’s office should be directed there. The governor’s office and Children’s Medical Center Dallas did not respond to requests for comment.

Texas Attorney General Ken Paxton’s nonbinding opinion about gender-affirming care was issued in response to state Rep. Matt Krause, chairman of the Texas House General Investigating Committee, who asked the attorney general last August whether puberty-suppressing drugs and hormone therapy count as child abuse. Krause had also written a letter dated June 30 to the GENECIS clinic, obtained by The 19th, saying that he had begun an inquiry into their work as part of an investigation into gender-affirming care in Texas. Krause did not respond to requests for comment.

The hospital leadership and staff at GENECIS began to discuss the political pressure on the clinic as early as July, according to the recordings, as the Texas investigative committee looked into their work and the governor’s office probed for more information.

Meetings among hospital leadership and staff beginning last summer portray disarray and distress. They worried that halting care could lead to suicides and poor mental health among trans youth in a state with few options.

“How can we minimize the risk of suicidality in patients who could otherwise have come into GENECIS? I think that’s a very high priority,” Dr. Perrin White, director of pediatric endocrinology at UTSW, said at a November meeting.

“We’re taking away the life-saving medical care for the new patients,” one GENECIS employee said in response. “If we’re mitigating suicidality, let’s be clear, it’s because in large part, we’re taking away medical care.”

The GENECIS team was instructed by UT Southwestern leadership in November to stop prescribing hormone treatment and puberty blockers to new patients, several days after the website suddenly came down on November 12. Existing patients were allowed to continue all treatment, but new patients would only be able to access psychiatric evaluation and counseling, and be evaluated for gender dysphoria.

Physicians and staff debated how to maintain some semblance of care for trans youth under their new normal. Several GENECIS staff members raised concerns that the program was not designed to offer psychological care alone — and that the ultimate point of evaluating patients’ mental health is to determine whether they can receive hormone treatment or puberty blockers, considered life-saving care by families of trans kids and many of the physicians who work with them.

Access to hormone therapy and puberty-suppressing drugs, widely recommended by medical authorities, is linked to lower rates of suicidal ideation and improved mental health among trans youth. Kids who received one year of hormone therapy through GENECIS reported small to moderate improvements in symptoms of depression, per research by leaders of the program published in the American Academy of Pediatrics in March 2020.

Evan Singleton, 19, who lives outside Dallas, told The 19th that he believes the gender-affirming care he received through GENECIS — puberty blockers and hormone treatment — saved his life.

“I feel scared and sorry for these kids that can’t get the help that they need,” he said. For him, starting puberty blockers soon after he turned 10 was a relief. His mother, Mela, added that finding a way to halt her son’s puberty afforded her time to learn the best course of action for her child’s future, while halting the extreme emotional distress caused by his puberty.

Another recurring concern discussed among staff was the potential for the clinic, or even individual physicians, to face lawsuits after denying hormone treatment to trans kids while prescribing that same treatment to cisgender kids with precocious puberty.

Although UT Southwestern will not provide puberty blockers and hormone treatment to new patients if they are diagnosed with gender dysphoria, the hospital does provide hormone therapy to patients with precocious puberty, spokesperson Rian Russell said in a statement, pointing to FDA approval as a reason for the discrepancy.

UT Southwestern is tied to Texas officials. The medical center relies on state funding that is approved through the governor’s office. Texas’ governor also appoints members for the governing body for the University of Texas System, pending approval by the state Senate.

Dr. John Warner, the executive vice president of health system affairs at UT Southwestern, referred to that unique pressure faced by UT Southwestern as a state agency in the recorded meetings. A senior leadership official with the Children’s Medical Center also shared that sentiment in a meeting earlier this year. Both men, in addition to White, spoke about pressure and questioning into the GENECIS program by the governor’s office.

Prior to July, the governor’s office had requested information about the clinic with “an expectation that something different would occur,” Warner later told his colleagues in November.

“We weren’t sure what that was going to mean,” he continued in the recorded meeting. “We thought that might mean that portrayed something that would come via this legislative session, so again, we’re fortunate in that it did not, because it gives us a little room to work,” Warner said.

Through the meetings, details of how the governor’s office purportedly reached out to the hospital or what the governor’s office said were not clear.

The 19th independently identified Warner from introductions made for him during a recorded meeting as well as public videos of him speaking professionally. White was also identified independently by The 19th from public videos of him discussing his work. White offered to respond through official channels at UT Southwestern, but the medical center’s press office had not responded as of publication time. Warner did not respond to requests for comment.

“I think people will come after it until it’s gone,” Warner said at the November meeting. During the previous legislative session, the clinic had come under significant pressure from state legislators, plus scrutiny from the governor’s office, he said.

Although Abbott’s third special legislative session did not result in the worst-case scenario outlined by Warner — GENECIS being “eliminated entirely” through legislative amendment — he explained to colleagues that he still did not believe the clinic would be allowed to continue without some modifications.

The pressure from Krause, who headed the investigative committee looking into GENECIS, was a precursor of what would come in 2022. In his June 30 letter, Krause had asked the clinic to provide details about their services, including what age groups the clinic treats, what other practitioners the clinic makes referrals to, and for copies of consent forms required of patients. All of these questions were discussed by UT Southwestern leadership and staff in a meeting that summer, with hospital leaders voicing particular concerns about whether the clinic could continue to provide gender-affirming care while beholden to the state.

Over the course of three special sessions from July to October last year, Republicans in Texas introduced nearly 50 bills that proposed to restrict access to gender-affirming care or school sports for trans youth, in addition to a few other bills focused on birth certificates — in total, triple the number of anti-trans bills of any other state in 2021. One restricting trans youth’s sports participation passed.

Then the GENECIS website disappeared.

During meetings in November, attorneys representing UT Southwestern had assured hospital leadership that halting gender-affirming care for new trans patients would not make them liable if faced with a lawsuit.

But physicians and staff with GENECIS still expressed discomfort about what they were being asked to do — and what it would mean for the trans youth they treat.

GENECIS is an early example of a trend unfolding across Texas in the wake of Paxton’s nonbinding opinion: clinics shuttering gender-affirming care for minors in response to state pressure.

Texas Children’s Hospital, a nonprofit hospital in Houston, announced last week it will cease gender-affirming care in response to Abbott’s call to investigate families to avoid “potential criminal legal ramifications” for health care staff and families seeking care, spokesperson Natasha Barrett emailed in a statement.

One parent of a trans child living in Texas, who asked to remain anonymous due to fear of being reported to the state and investigated, told The 19th that the Legacy Community Health in Houston stopped prescribing hormone treatment or puberty blockers for trans minors on Monday, March 1. They could not get access to their son’s testosterone prescription for three days until the clinic resumed prescriptions on Wednesday.

The parent said they weren’t told why the clinic started providing prescriptions again, and that they did not receive any written communication when their son’s prescription was first denied. Legacy Community Health clinic did not respond to requests for comment.

Last week, as the Biden administration admonished Texas for its push to investigate the parents of trans youth, the Department of Health and Human Services encouraged health care providers who believe that they have been unlawfully restricted from providing gender-affirming care to patients based on their gender identity to file a complaint with the agency’s office of civil rights.

“We are evaluating the tools at our disposal to protect trans and gender diverse youth in Texas,” HHS Secretary Xavier Becerra said in a statement.

Charis Sharp, a 21-year-old psychology student living in Hawaii, told The 19th that care she received through GENECIS — puberty blockers when she was 12, and then hormone treatment — were a critical lifeline at a time when she was suicidal due to gender dysphoria and discrimination she faced from her peers.

“The fact that they’re no longer allowed to accept new patients, this can have disastrous impacts on these childrens’ mental health, and I know it because that was me,” she said.

Texas' law banning abortions after six weeks of pregnancy took effect at midnight on September 1. Lawsuits are currently pending, but for now, clinics must comply with the six-week ban. Whole Woman's Health, one abortion provider in the state that was named in the joint plea to the Supreme Court by providers to block the law, was still providing abortions up to 11:59 p.m. Tuesday night, CEO Amy Hagstrom Miller tweeted.

Originally published by The 19th

The law also empowers private citizens to sue anyone they believe may have “aided or abetted" someone getting an abortion after six weeks, which has caused confusion.

Here's what you need to know now that the law has taken effect.

What does this mean for abortion access right now?

The law is currently in effect. There is an exemption for broadly defined medical emergencies, but no exemptions in the law for rape or incest.

If believe you may be pregnant and would want an abortion, you essentially have a two week window — the luteal phase of pregnancy, where early symptoms include food cravings, headaches, bloating and breast tenderness — to seek abortion care.

The pregnancy clock starts by counting back to the person's last menstrual cycle, as The 19th's Shefali Luthra explained earlier this year. A typical menstrual cycle is 28 days, or four weeks, though many people have irregular periods. Those factors mean someone might not realize they are pregnant until 30 or 40 days, which is just shy of the six-week deadline.

“This is essentially a ban of almost all abortion in Texas except for those who know pretty immediately that they are pregnant — a physician cannot hear a fetal heartbeat or there is a medical emergency," Rachel Rebouché, a law professor at Temple University and an expert on reproductive rights case law, told The 19th.

Jamila Perritt, an OB/GYN and president of Physicials for Reproductive Health, said the law leaves people seeking abortion care “with very few options."

“Those with resources can try to leave the state to seek care. But this is not an option for most people who do not have the time, money or support needed to travel out of state for care," she said.

“Those with fewer financial resources, Black and Latinx women, young people will bear the brunt of this inequity in access," she continued. “Abortion funds in and outside of Texas have been working around the clock to provide people the support people need to get abortion care."

Are there still pending legal challenges?

Multiple lawsuits, including a challenge by the Center for Reproductive Rights and reproductive health clinics in the state filed last month in Texas' Western District Court, are still pending.

The Supreme Court did not act ahead of the law taking effect Wednesday, but they still could. So far the court has not issued any statements or responded to plaintiffs' requests to block the legislation. The justices do not have a firm deadline to respond, per Bloomberg Law.

The 5th Circuit Court of Appeals' hearing on the Texas law — which was scheduled for Monday — was canceled without explanation.

Rebouché noted over email that the Supreme Court may not be weighing in “because the 5th Circuit allowed the law to go into effect."

Outside of Texas, Perritt said advocates and providers are watching other lawsuits — including the start of oral arguments for the Jackson Women's Health case challenging a 15 week abortion ban in Mississippi, which the Supreme Court is set to take up next term.

So anyone report someone for “aiding and abetting" an abortion?

The law empowers private citizens to sue anyone they believe may have “aided or abetted" someone getting an abortion after six weeks. In a successful lawsuit, the plaintiff would receive at least $10,000 and be reimbursed for legal fees. Defendants would not be entitled to fees.

Family, friends, lawyers, members of the clergy, abortion providers and fundraisers, could all be implicated in potential lawsuits for helping someone in Texas get an abortion, Perritt pointed out.

Texas Right to Life launched a website soon after the law took effect that solicits anonymous reports on how the law may have been violated. The form asks for tipsters to explain how they obtained evidence and what clinic or doctor their evidence relates to.

A Texas Right to Life spokeswoman told NPR on Wednesday that there are currently no imminent lawsuits planned against abortion providers. In Travis County, District Judge Amy Clark Meachum barred the organization from encouraging and filing lawsuits against a Dallas nonprofit, per the Texas Tribune.

This story will be updated.