A month into Donald Trump’s presidency, and the ways in which Trumpism is a threat to lesbian, gay, bisexual and transgender existence are almost too many to count. However, those most vulnerable to HIV/Aids will be hit the hardest.

The threat of actually losing health insurance due to the president’s promise to repeal the Affordable Care Act is making millions of Americans so terrified, even his own voters are increasingly warming up to Obamacare.

But the ACA’s death is still a real possibility, and it would take a particular toll on queer Americans. According to a Yahoo investigation: “Before the ACA was passed, only about 13% of people with HIV had private health insurance and 24% had no coverage at all.” Indeed, the ACA has been a lifesaver for many people living with HIV: its subsidies for private insurance and its robust expansion of Medicaid in many states have greatly increased their access to medical treatment. If you doubt the scale of the continuing epidemiological emergency, consider that only about half of African Americans with HIV have access to continuous medical treatment, according to the Centers for Disease Control.

One way the ACA has addressed the crises is by funding the prevention efforts of Aids service organizations. Beyond people living with HIV, this work is helping to keep the transmission of the virus from further harming the most vulnerable communities, such as transgender women of color, or the one in two black gay men the CDC predicts may become HIV-positive in his lifetime unless radical action is taken.

But if “silence equals death”, as the Act Up slogan says, then loud protest is needed to keep people living with HIV from losing access to medication.

Creating swaths of uninsured people living with HIV who will likely lose access to viral suppressing medication (which makes HIV almost impossible to transmit) will also increase the likelihood of transmission to others. We know that when people in prison who are HIV-positive are released with little medication, they often stop taking it altogether when they run out; their viral load then becomes very high and, research has shown, their sex partners are more susceptible to becoming HIV-positive. (And if Republicans failed to keep the Obamacare provisions which allow people with pre-existing conditions to buy insurance without discrimination, it would be even worse.)

Remember: when then Indiana governor Mike Pence presided over one of the worst HIV outbreaks in the history of the country in 2015, he first turned to prayer before then turning to Obamacare to ameliorate the outbreak (the latter worked).

But as vice-president, Politico reported this week: “Pence is helping to lead the Republican effort to dismantle the program that helped him halt the deadly outbreak in an impoverished swathe of Indiana.” Pence wants to end what he knows worked. His horrific HIV record, steeped in heterosexism, racism and Christian supremacy, is going to hurt people living with HIV, queer people, ethnic minorities and the poor the most.

Advocates of science were alarmed when the Environmental Protection Agency was told it could no longer talk to the public because, among other reasons, the EPA protects the public from environmental harm by giving information and guidance. Similarly, LGBT Americans should be very worried that the Trump administration seems to be dialing back on providing information on HIV/Aids and LGBT health to the public. The website for the White House office of Aids policy is now blank, and the office’s future is unclear. A CDC summit in the works to address LGBT youth health (meant to address pressing issues a CDC report exposed such as how “young gay and bisexual males have disproportionately high rates of HIV, syphilis, and other sexually transmitted diseases”) was infinitely postponed after Trump was elected.

In funding prevention programs, the ACA still remains an important channel of government information about HIV/Aids. But if it disappears, the loss may be especially harmful in states which only teach “abstinence only” sex education.

As an LGBT community (and this applies to our supporters too), we cannot be focused simply on the Trump administration’s conservative stance on our civil rights. We must be vigilant about how HIV/Aids stands to harm the most vulnerable among us first, do all we can to protect the 1.2 million people in the US already living with HIV, and insist that the government keep the epidemic from getting even worse.