On Friday, the Washington Post reported that Health and Human Services officials had banned the Centers for Disease Control from using seven words or phrases on documents relating to next year’s budget. The list itself consists of words like “science-based,” “diversity,” and “vulnerable,” but perhaps the most concerning is the banning of the word “transgender.” Despite a statement from an HHS spokesperson denying that these words have been banned, a restriction like this represents an astonishing attack on reality-based medical treatments and has the potential to exacerbate what is already a public health crisis within the trans community.

Looming in the background is a long-term effort to revoke Obamacare Rule 1557, which prohibits discrimination on the basis of gender identity in the healthcare. Rolling back those protections has been a priority of the religious right since it was first enacted. HHS has been considering allowing religious groups to ignore some regulations, mostly related to healthcare for trans people and abortions; the agency has received over 10,000 comments from the public but has chosen to only release 80 of those comments, the vast majority of which support revoking the rule. (HHS’s refusal to cooperate with multiple requests to release the full list of comments is unprecedented and may violate federal law.)

This is clearly part of a new policy of opacity on the part of HHS, with a follow-up Post story reporting that multiple other HHS agencies were instructed to similarly avoid certain words in budget documents.

But trans advocates in particular were worried about these changes and how they fit into the Trump administration’s assault on their community.

“The CDC not being allowed to use the word ‘transgender’ in budget documents could have a cost in people’s health and lives,” said Harper Jean, policy director at the National Center for Transgender Equality. “At best, it means a chilling effect on the work of the CDC’s scientists and public health professionals, keeping them from pursuing the most effective public health interventions. At worst, it could mean a priority population for preventing HIV is completely ignored.”

According to data released by the CDC, transgender people, particularly trans women of color, are especially at risk for contracting HIV. Trans people also have tremendous difficulty accessing affirming care for a multitude of health ailments, HIV included. Among the most critical public health initiatives currently underway at the CDC are several programs aimed at testing and preventing HIV transmission and accessing HIV care specifically among the trans population. Those initiatives could now at risk because a handful of hardliners with connections to the anti-trans Family Research Council have been appointed to high-level HHS positions.

“I want to assure you there are no banned words at CDC,” CDC Director Brenda Fitzgerald, a Trump appointee, said in a statement posted to Facebook. “I want to assure you that CDC remains committed to our public health mission as a science- and evidence-based institution. As part of our commitment to provide for the common defense of the country against health threats, science is and will remain the foundation of our work.”

Fitzgerald, however, has her own history of peddling anti-scientific medical solutions. As Health Commissioner of Georgia she allied with Coca-Cola on an anti-obesity campaign that emphasized fitness rather than diet. And in her previous career as an OB-GYN, Fitzgerald was certified by the American Academy of Anti-Aging Medicines to peddle anti-aging medications which have no scientific backing whatsoever. It remains to be seen what the net effect on dozens of CDC-backed transgender health initiatives will be in the long term after years of Trump administration policies.

“Without being able to talk about a priority population, the CDC can’t do its job, and if the CDC can’t do its job, people’s health and lives are at risk,” the NCTE’s Harper Jean told me. “CDC officials are being told essentially to pretend that until now what they called a priority population for HIV, doesn’t exist... Without talking about a population, how can you budget for critical efforts to enhance prevention, access to treatment, and critical research research and data collection that inform public health efforts?”

The CDC provides many programs important to trans health, Jean said, including encouraging HIV testing (nearly two-thirds of trans people have never been tested, despite being a high-risk population), conducting a vital survey called the Behavioral Risk Factor Surveillance System, and monitoring tobacco use and mental health among the LGBTQ community.

Without being able to request specific budget allocations for these programs, there’s a real risk they could be deprioritized by Congress or even cut entirely.

According to Jean, the CDC has in the past gone to great lengths to include transgender people in their HIV prevention public health campaigns. An April letter from the CDC to health officials around the country about National Transgender HIV Testing Day discussed why trans people are such a vulnerable (there’s that reportedly banned word again) population at risk of infection. Any move to curtail existing efforts to promote testing within the trans community could result in a worsening public health crisis.

This brand of ideological government neglect has a gruesome precedent. In the 80s, the Reagan administration infamously ignored a growing AIDS crisis within the gay community, with former Reagan press secretary Larry Speakes even mocking LGBTQ people suffering as the crisis raged. “The slogan back then was ‘silence equals death,’” said Jean. Trump’s new policy is a throwback to the willful harm of neglect from administrations’ past for transgender people.

Several trans related public health projects that have already been funded could now be at risk from this new Trump budgetary policy. “A few weeks ago they published a notice about an evaluation that [the CDC] is doing of the efficacy of an in person health insurance enrollment assistance intervention targeting black and Hispanic [men who have sex with men] and trans people living in Chicago,” said Jean. “This is an important, innovative public health effort that the CDC has funded and now they’re trying to evaluate it to see what they can learn from it and how it can inform efforts around the country.” Given how many trans-specific initiatives currently underway, it’s unclear how the CDC can continue these efforts if they’re not allowed to even put the word “transgender” in any budget requests.

The official stance of the Republican Party is that sex is established by God at birth and is immutable. But the consequences of deciding transgender people don’t exist or don’t have unique health needs is going to lead to a lot of pain, suffering, and even death.