Gilead Sciences is giving a sizable donation to commemorate Transgender Day of Remembrance.

The pharmaceutical company's TRANScend Community Impact Fund, under the advisement of a board of trans activists and leaders, selected 15 transgender organizations that each will receive a portion of a $4.5 million donation. The amount, to be distributed over two years, was described as "an unprecedented investment in empowering and protecting this community" in a release sent to press.

These resources are sorely needed. In addition to increased risk of violence, the estimated 1.4 million trans Americans have sizable barriers to health care; an alarming 31 percent of this group lack access to health services, according to a 2017 report from NPR.

The Trump administration is only worsening the situation. A new proposed rule from the Department of Health and Human Services would permit health care providers to discriminate against transgender people in the name of "religious freedom." Job discrimination is also pervasive — particularly within the nation's largest employer of trans people, the U.S. military; thanks to the president's ban, these service members are no longer allowed to serve openly.

Drawing from the recommendations of 12 transgender advisers, Gilead developed three tiers of investment in order to best allocate the fund's resources for the trans community. The first category, "grantmaking," applies to the organization Destination Tomorrow, which will receive $1 million to dispense grants to trans-led groups and programs on the grassroots level.

The second category, "capacity-building," applies to the Transgender Strategy Center. Gilead will give $1 million to this group so that it may improve the infrastructure and programs of smaller but more established trans organizations. This in turn will hopefully encourage other investors to take notice and support them as well.

Other organizations benefitting from Gilead's donation — Translatinx Network, Brave Space, Princess Janae Place, Hawaii Health, T.A.K.E Resource Center, Nationz Foundation, Translifeline, Casa Ruby, Bienestar, Advocates for Better Care, Translatin@ Coalition, FLAS Inc., and the Transgender Law Center — will receive smaller amounts ($90,000 to $200,000) to provide direct services for the transgender community in areas like housing, health care, education, job training, and the fight against HIV.

“Destination Tomorrow is excited to be working with Gilead Sciences on the TRANScend Community Impact Fund. We are pleased to be able to provide support and guidance to grassroots, transgender-led agencies," said Sean Coleman, executive director of Destination Tomorrow, in a statement. “We are dedicated to ensuring that funding is allocated to the most diverse cohort of grantees, providing services that address the HIV epidemic in communities that are oftentimes overlooked."

“Gilead is proud to invest in trans-led organizations that will work improve the overall health and wellness of the transgender community,” said Darwin Thompson, associate director of corporate giving at Gilead Sciences, in a statement. “We believe gender identity should not dictate anyone’s access to quality healthcare, safety or employment. TRANScend grantees will be empowered to provide community-led solutions in addition to providing direct services to ensure the needs of the transgender community are met.”

According to Thompson, the idea for a fund managed by trans leaders had been considered at Gilead for some time. But it was a 2018 partnership with a Miami-area organization, Arianna's Center, which helped bring 40 transgender women to the United States Conference on AIDS, that advanced the conversation. The fund formally launched in May of this year.

"One of the things that we heard very loud and clearly is this FUBU model: for us by us. And so we needed to bring the community and to be a part of the decision making and planning process," Thompson told The Advocate.

The Transgender Day of Remembrance, held annually on November 20, memorializes victims of transphobic violence around the world. By The Advocate's count, at least 19 trans people have been murdered this year alone in the United States.

Gilead tied the announcement of its donation to this day because it wanted to draw attention to the many other factors that can be detrimental to the health and lifespans of transgender people, such as access to medical care, housing, and employment. "We feel like the programs that we're funding and supporting can help to improve the health and wellness of the transgender community, but ultimately help them to live longer and healthier lives," Thompson said.

Additionally, transgender women are an at-risk group for HIV. The Centers for Disease Control and Prevention estimates that 44 percent of Black trans women live with the virus. A key part in fighting HIV is access to Truvada, a drug used for pre-exposure prophylaxis (PrEP) that is shown to be 90 percent effective in the prevention of the virus if administered daily, according to the CDC.

However, Gilead, which manufactures Truvada, has come under heavy fire in recent months regarding the pricing of the drug. The pharmaceutical company is currently mired in a legal battle with the federal government over patent rights (the government issued $50 million in grants to researchers to develop PrEP) and activists over cost inflation, which makes the lifesaving drug inaccessible to many members of marginalized communities, including trans people.

Gilead earned $3 billion from sales of the drug in 2018 — and none of that money went back to the taxpayer. In May, in the midst of growing criticism, Gilead announced it will be donating 2.4 million bottles of Truvada to 200,000 uninsured individuals each year for 11 years, as part of a partnership with the CDC.

Thompson said a stipulation of the new grant is that the money can't be used to buy Gilead medications or services. When asked about the controversy over Truvada's pricing, he pointed to "other social determinants" — meaning the economic and social conditions that create health disparities — that the grant addresses.

"We believe that all that all people at risk for HIV should have access to a medication," he said. "We also believe that there are other social determinants that we must address, which is why we create funds like this to address those social determinants that people live with every day."