She held leadership positions at the LGBTQ HIV/AIDS care nonprofits GMHC and Apicha, co-founded a free clinic for sex workers at Callen-Lorde Community Health Center, and co-founded DecrimNY, an organization which advocates for decriminalized sex work in New York and successfully lobbied for the repeal of the "Walking while trans law".
Gentili also filed a lawsuit challenging the Trump administration's removal of non-discrimination protections for gender identity in the Affordable Care Act.
She was detained by U.S. Immigration and Customs Enforcement but released with an ankle bracelet after being assaulted in both the male and female sections of the detention facility.
[12][13][14] While part of the GMHC, she championed the Gender Expression Non-Discrimination Act (GENDA), a proposed piece of state legislation which was eventually signed into law in 2019.
[14][13] With her extensive background in collaborating with organizations such as the AIDS Institution, the Department of Health and Mental Hygiene, Funders for LGBTQ Issues, Borealis Foundation, and Cicatelli Associations Inc., Gentili continued her deep commitment to helping the queer and trans communities.
[16] That year, she also joined the Board of Directors of Stonewall Community Foundation, a New York-based, LGBTQ-focused grantmaking organization, where she served until her death.
The services provided by Trans Equity Consulting include workshops and trainings, organizational developments, conference and convening planning, speaking and story telling and conflict medication.
[14] In 2020, under the Trump Administration, the Department of Health and Human Services removed provisions in the Affordable Care Act on sex discrimination, which included gender identity.
This occurred only a few days before the Supreme Court issued a ruling that protections in the Civil Rights Act on the basis of sex extend to gay and transgender people.
[23] In January 2022, she was one of several community leaders who sent a letter asking Governor Kathy Hochul to create the Lorena Borjas Trans Equity Fund.
[24] In 2022, she was a finalist for The David Prize where she was recognized her effort to make New York a more inclusive city for transgender and sex worker rights.
[25] In February 2023, she was one of hundreds of New York Times contributors who signed a letter condemning the newspaper's biased coverage of transgender people.
[28] Between 2018 and 2021, Gentili appeared as Ms. Orlando in 4 episodes of Pose, a TV drama following people of color amidst the AIDS crisis in 1980's New York City.
[1][15] Tributes to her were posted by GLAAD President and CEO Sarah Kate Ellis, deputy director for Transgender Justice with the ACLU National LGBT & HIV Project's Chase Strangio, New York Governor Kathy Hochul, Callen-Lorde's CEO, Patrick McGovern, New York State Senator Brad Hoylman, and fellow actors on Pose such as Angelica Ross and MJ Rodriguez.
[37] After her death The Human Rights Campaign Foundation (HRCF), and the Trans Justice Initiative (TJI) program launched the Cecilia Gentili grant in her honor.
[38] Gentili's cause of death was not publicly disclosed until April 1, 2024, when it was announced that she had died from "the combined effects of heroin, xylazine, cocaine and fentanyl".