Federal and state health officials and staff members scrambled on Friday to comply with a 5 p.m. deadline by the Trump administration to terminate any programs that promote “gender ideology,” and to withdraw documents and any other media that may do so.
Federal workers had already been ordered to halt diversity, equity and inclusion initiatives, to scrub public references to those efforts and to place employees involved in them on administrative leave.
At federal health agencies, veterans hospitals, and local and state health departments, compliance took a variety of forms. At the Centers for Disease Control and Prevention, employees hurried to remove terms like “transgender,” “immigrant,” L.G.B.T.” and “pregnant people” from the website.
Employees at some VA Hospitals were told that L.G.B.T.Q. flags and other displays were no longer acceptable, according to an administrative email reviewed by The New York Times.
Bathrooms at health agencies were to be set aside for use by a single “biological sex,” according to federal directives, and the word “gender” was to be removed from agency forms.
The instructions are a 180-degree pivot for health scientists and clinicians, who have worked for years to integrate diversity and equity into research and clinical services, including those for gay, lesbian and transgender individuals.
The directives “risk dismantling programs that have been built up over decades to serve the needs of Americans,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health.
“What I’m worried about here is that in this attempt to make headlines, we’re issuing very bold and broad statements,” she said of the administration.
The upheaval followed two executive orders that President Trump issued on Jan. 20. The one entitled “Ending Radical and Wasteful Government DEI Programs and Preferencing” terminated the federal government’s D.E.I. efforts.
The other, “Defending Women From General Ideology Extremism and Restoring Biological Truth to the Federal Government,” shut down governmental efforts to be more inclusive of a variety of gender expressions, including in scientific research.
In both instances, the federal Office of Personnel Management followed up with memos explaining how to carry out the changes and issuing deadlines. The memos affected a broad swath of programs at all levels of government, but details were sparse.
Some employees at the C.D.C. were befuddled by an order, for example, to delete mentions of gender from research databases, some dating back decades, as other government rules prohibit manipulation of scientific data.
Agency web pages that have been deleted as part of President Trump’s “Defending Women” initiative include ones about ending gender-based violence and supporting L.G.B.T.Q. youths, and another about racism in health.
C.D.C.’s AtlasPlus, which holds 20 years of surveillance data for H.I.V., tuberculosis, hepatitis B and other diseases, is missing.
Also removed were the pages of the C.D.C.’s Youth Risk Behavior Surveillance System, which surveys youngsters about dangerous activities like drinking and drug use, smoking and risky sexual behaviors that can lead to unintended pregnancies and sexually transmitted diseases.
The survey reported recently on the high rates of depression among teenage girls and lesbian, gay and bisexual youth.
Some directives from agency administrators, including one emailed to Veterans Affairs hospitals and reviewed by The Times, ordered the termination of “accessibility’’ programs, as well as other diversity and inclusion initiatives.
The hospitals treat military veterans, many of whom are disabled.
The C.D.C. itself told funding recipients on Wednesday that “any vestige, remnant, or renamed piece” of diversity programs funded by the federal government “are immediately, completely, and permanently terminated,” according to an unsigned memo obtained by The New York Times.
Diversity and inclusion programs at federal agencies have also been disbanded, and scientific work groups have been ordered to halt their activities, according to an email reviewed by The New York Times.
Public health experts warned that the D.E.I. prohibitions affect not only diversity in staffing, but health equity programs aimed at disadvantaged populations.
For example, some programs help low-income seniors gain access to vaccines and communities of color who are at increased of conditions like diabetes.
Including gender as a research factor in studies helps identify groups at risk of sexually transmitted diseases like syphilis, which has reached its highest levels in 50 years.
“Health equity is basically all of public health,” Dr. Nuzzo said.
“This work and these data and these studies are really important for us to answer the essential question of public health, which is who is being affected and how do we best target our limited resources,” she said.
None of this would seem to align with the goals of Robert F. Kennedy Jr., President Trump’s nominee for health and human services secretary, who has made chronic disease a main talking point. Most chronic conditions disproportionately affect people who are socially disadvantaged, including rural Americans and people of color.
Some state health administrators have interpreted the D.E.I. directives as applying only to staffing and hiring. Health programs that do outreach to disadvantaged groups, including ethnic and racial minorities, will not be affected, they have told staffers.
But one employee at a state H.I.V. prevention program said it was difficult to disentangle the two.
“We are still not sure how this will affect our work if we are not allowed to talk about individuals who are transgender, as that is a lot of the population we work with in H.I.V.,” said the employee, who asked not to be identified for fear of retribution.
Some V.A. hospitals have warned employees that prohibited D.E.I. activities “include displaying of pride symbols, e.g. flags, lanyards, signature blocks, etc.,” prompting staff at New York hospitals to remove wall hangings indicating they were welcoming to lesbian, gay and transgender patients.
Some asked their supervisors whether they also needed to get rid of books in their offices. The ambiguity of the federal directives, coupled with employees’ heightened anxiety, “may lead them to take a sledgehammer when they really need a scalpel,” Dr. Nuzzo said.
At one V.A. facility, administrators deleted all computer folders and files with the term “D.E.I.” in the name. “We gave them access to files and they disappeared from our folders,” said one employee speaking on condition of anonymity.
“I think no one knows what to say,” the employee said. “Everyone’s walking on eggshells.”
Agencies were instructed to turn off software features that prompted users to enter their pronouns in their signatures. The C.D.C. also deleted personal pronouns from its internal directory.
The administration has also threatened employees who don’t inform on colleagues who defy the orders or try to “disguise these programs by using coded or imprecise language.”
Already, contractors working on health equity issues are being let go. At least one worker on a longtime contract was fired because of his role supporting such a project a year ago.
Some C.D.C. officials began preemptively censoring material that discussed health equity even before Mr. Trump took office.
Fearing that their programs would be shut down, they began deleting content from websites and holding back research findings, including those from a project that cost about $400,000.
But for other projects, merely snipping out mentions of equity or gender is impossible because they are aimed specifically at reducing health disparities in chronic conditions.
“I don’t think that there’s anything that our division works on that wouldn’t have to stop,” said one C.D.C. employee who wished to remain anonymous or fear of retaliation.
Anticipating that the Trump administration may take aim at certain issues, some scientific groups have archived data related to H.I.V. and other sexually transmitted diseases, births and deaths, education, environment and housing.
On Friday, hundreds of scientists gathered for a “datathon,” in an attempt to preserve websites related to health equity.
“There’s been a history in this country recently of trying to make data disappear, as if that makes problems disappear,” said Nancy Krieger, a social epidemiologist at Harvard University and a co-leader of the effort.
“But the problems don’t disappear, and the suffering gets worse,” she said.
Ellen Barrycontributed reporting.
