In July, two packages arrived at Naithe Rivera’s doorstep that would change his life.
Months before, like so many others at the beginning of the pandemic, the 28-year-old lost his health insurance, after being laid off from his job at a financial firm in Lake Worth, Florida.
Without insurance, Rivera, who is trans, could no longer afford testosterone injections. And without hormones for four months, Rivera’s health rapidly deteriorated – he says he lost weight, cysts swelled around his body, and he fell into a deep depression. Eventually, Rivera wound up in the hospital, where he was diagnosed with diabetes.
But the diagnosis brought Rivera, who says his care team treated him differently because he was trans, more stress than comfort. It reminded him of how another doctor treated him like a “science project” when he began taking hormones. “I’ve never had a doctor who just talks to me, human to human,” Rivera said. “It’s scary as hell.”
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That’s when Rivera turned to social media for help – and got connected with two initiatives aimed at getting trans people, especially Black trans people, the care they need: the Binder Project and the Trans Needle Exchange. The packages on his doorstep contained a new binder, to flatten his chest, and a year’s supply of syringes for his weekly hormone injections. Both were free of charge.
Trans people have long faced barriers to safe and affordable gender-affirming healthcare – but over the summer, things took a turn for the worse.
In June, the US Department of Health and Human Services announced it would roll back the Obama-era definition of sex in Section 1557 of the Affordable Care Act. The department’s move would define sex as one’s biological birth and erase trans identities’ protected status, according to Lambda Legal, an LGBTQ+ legal advocacy organization.
A New York federal judge temporarily halted the provision in August – but the ruling motivated trans organizers across the country to ensure their communities have access to binders, hormones, and funds for surgeries, as well as a network of people who best understand their needs.
Throughout US history, the trans community has engaged in mutual aid as a form of survival. In the 1970s, the trans activists Marsha P Johnson and Sylvia Rivera created Star, a safe house for trans women in New York; similarly, during the Aids epidemic of the late 70s and 80s, volunteers set up unlicensed clinics to treat those turned away from traditional medical settings, according to the queer health history book Before Aids by the gender studies professor Katie Batza.
Today, LGBTQ+ communities are drawing from this radical history to meet people’s immediate needs – from healthcare to food security, safe housing, jail support and other, more informal exchanges.
The day the Trump administration announced its final rule in June, Jabulile Mickle-Molefe, a writer based in Chicago, remembers telling her friend Rebekah Frumkin how she wished she could add friends to her insurance.
Many of them had lost their jobs due to Covid. If the Trump administration’s ruling actually went through, what would they do? she asked Frumkin.
The next day, the two created the Trans Gender Non-Conforming Medical Relief Fund, a program that offers micro-grants to trans people to cover co-pays, prescriptions, surgeries and other healthcare-related costs. The model has no strings attached; those in need fill out a form with the basics – their name, pronouns, location, and Venmo or Cashapp handle – and receive funds in a few days or weeks.
Since June, Mickle-Molefe and Frumkin have raised and distributed a little over $5,500 in donations to 15 people across the country. Their goal is to one day register as a non-profit, apply for grants, and be able to provide greater support — with the kind of sizable donations that would cover the cost of top surgery or a medical emergency.
For Cienna Mayfield and Maliyah Worthy, two Black non-binary organizers in Atlanta, mutual aid has meant creating a new kind of family.
After Worthy created a spreadsheet of trans health fundraisers that went viral in June, they and Mayfield wanted to build a digital community that would help other Black trans folk secure safe housing, healthcare, and food.
In July, they launched For Our Sibs, and they have connected with more than 120 Black trans people in the US, the UK, and Ireland.
For Worthy, a journalism student at Georgia State University who lives with their disabled mother, mutual aid is more than a side project. When they didn’t qualify for the stimulus, they used Twitter to ask for assistance and were overwhelmed by the response.
“If it wasn’t for mutual aid, this government would not be looking out for me at all,” they said. Worthy was able to put away money toward future gender-affirming care, which, for now, remains unaffordable to them.
In the US, 14% of trans adults are uninsured, compared with 11% of all adults, according to the 2015 US Transgender Survey. Even when people have access to care, 33% of trans adults say that they have had a negative experience with a healthcare provider.
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Direct actions help alleviate some of those financial and emotional barriers. But for Dean Spade, the founder of the Sylvia Rivera Law Project and author of the forthcoming book Mutual Aid, this work is much more than a Band-Aid solution; it’s an act of world-building.
Spade sees mutual aid as helping trans people divest from what he calls “authoritarian medical and legal systems”, which allows them to affirm their trans identities through means beyond the state and the operating table.
For Genesiss Mejia, a 26-year-old Black trans bike mechanic and drummer in New York, that world is beginning to take shape.
After their top surgery – coincidentally scheduled, after months of delays, the day after Trump’s ruling was blocked – Mejia was able to afford rent and after care thanks to donations from strangers. They are optimistic about the possibility of a repeal — but they also see mutual aid as a tool for navigating an uncertain future.
“It would’ve been hard to go through this alone,” Mejia said. “That’s why mutual aid is such a lifeline. It’s always been by us, for us.”
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