Anti-LGBTQ Laws are Propagating as Violence, Undermining Transgender Health

By: Ranier Simons, ADAP Blog Guest Contributor

As 2024 ends there is the painful reality that Donald J. Trump is returning to The White House, and with him promises of rolling back protections for LGBTQ people…and in some cases, even denying them care. The anxiety and fear are very authentic, and there is real world evidence of how discriminatory policies adversely impact already marginalized communities. One glowing example is how HIV prevention is undermined by LGBTQ-related attacks (legislation) and violence!

Photo Source: Le Monde

The concept of infrastructure does not always connote a physical embodiment of something. Infrastructure also encompasses societal structures, including culturally pervasive attitudes and legal policies. The problematic domestic and global infrastructure adversely affecting the lives of LGBTQ people is harmful to their well-being on many levels, including HIV prevention. The societal infrastructure set against LGBTQ contains aspects of physical violence as well as anti-LGBTQ legislation. The rate of violence perpetrated against LGBTQ in general, in addition to specific Transgender violence, is higher than the heterosexual general population.[1] Transgender violence and anti-LGTBQ laws and policies impede HIV prevention efforts, resulting in avoidable individual and public health adverse outcomes.

Over 500 anti-LGBTQ bills were introduced in the United States in 2023, almost tripling in number from 2022 to 2023.[2] This legislation is multi-focused, including attacks on health care, civil rights, public accommodations, and even education.[2] A recent study from the UNC Gillings School of Global Public Health found that there is a clear interconnection between discriminatory anti-LGBTQ legislation and HIV prevention.[3] Anti-LGBTQ legislation and policies adversely affect HIV prevention by increasing stigma and decreasing health care access.[3]

Photo Source: FiveThirtyEight

Many of the laws target transgender people and youth specifically, including efforts to deny gender-affirming care. This includes laws to prohibit the changing of gender or sex on identification or medical records. Some laws are purposed to ban the discussion of LGBTQ issues in schools. Regardless of the focus, the legislation contributes to LGBTQ stigma that even occurs in health settings.[4] This is due to a history of pathologizing LGBTQ identity, behavior, and desire in medicine.[4] Two-thirds of LGBTQ adults have experienced discrimination in the past year compared to four in ten non-LGBTQ adults.[4] The stigma fueled by anti-LGBTQ legislation is dehumanizing. It adversely affects the self-worth of individuals affected, which contributes to discouraging positive health-seeking behaviors and influences treatment when it is obtained.

Testing and PrEP use are significant tenets of HIV prevention. The UNC study showed that PrEP use was lower in states with more anti-LGBTQ legislation activity. Youth living in states with fewer anti-LGBTQ policies or counties with majorities of Democratic voters had higher levels of PrEP use. This positive increase in PrEP use was compounded for youth who lived in both a more progressive state and county.[4] Approximately 7.6% of U.S. adults identify as LGBTQ in 2024, and that number is increasing. Regular testing is a part of PrEP adherence. When stigma negatively affects access to testing, it simultaneously weakens the ability to maintain PrEP adherence even if PrEP is available.

Anti-LGBTQ laws are propagating concurrently as violence, specifically against transgender individuals, is an issue. One study out of San Diego, for example, showed that there were 229 documented cases of fatal violence against transgender women in the United States between 2013 and 2021.[5] The bulk of these cases, 78%, were Black victims, which included Afro-Latinas. Over half of these occurred in the South, followed in prevalence by the Midwest. This also reflects the number of recent anti-LGBTQ bills, with most being introduced in the South and the Midwest.[6] As of November 19, 2024, the Human Rights Campaign reports 372 transgender and gender-expansive victims of fatal violence from 2013 to the present.[7] These fatalities are only the reported ones. The actual numbers are estimated to be higher.

Prevention of violence against transgender people is a public health issue. Anti-LGBTQ policies and laws amplify the insecurity of daily existence that transgender individuals face. Adversity in dealing with daily survival is compounded by discrimination and lack of access to health care. Globally, on average, approximately 2/3 of transgender individuals are aware of their HIV status.[8] Also globally, the percentage of transgender individuals who avoid HIV testing due to discrimination and stigma is estimated to range from 47% to 73%. Additionally, those who have experienced discrimination in a healthcare setting are three times more likely to avoid seeking out healthcare than transgender people who have not experienced it.[8]

Photo Source: CDC

Social attitudes, the reality of violence, and anti-LGBT laws, including criminalization based on gender identity, contribute to the isolation of transgender people. Regardless of whether the isolation is externally or internally propagated, it adversely affects their mental health. Transgender individuals’ continuous exposure to harassment, bias, and discrimination contributes to poor mental health.[6] Poor mental health leads to things such as substance abuse and other detrimental patterns of behavior, which are barriers to effective HIV prevention, which includes medication adherence for transgender individuals living with HIV. 

Approximately one million people identify as transgender in the U.S., with 9.2% of those living with HIV. In addition to intravenous drug use, unsafe injection practices while injecting hormones can contribute to the increased likelihood of HIV transmission.[7] Sexual violence against transgender individuals also contributes to HIV transmission, especially since it is mainly unreported, and the victims do not seek out medical attention. Additionally, transgender people face housing and employment discrimination, which exacerbates challenges with maintaining proactive health maintenance, including HIV prevention.[7]

The adverse impact of HIV prevention challenges among people who identify as LGBTQ because of anti-LGBTQ laws and policies is significant. It is imperative to repeal toxic legislation and create beneficial policies that strengthen infrastructure to support HIV prevention and care. Legal protections and proactive policies will help fight against stigma and systemic structural barriers.

[1] Truman, J. L., Morgan, R. E., & U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. (2022). Violent Victimization by sexual orientation and gender Identity, 2017–2020. In Statistical Brief. https://bjs.ojp.gov/content/pub/pdf/vvsogi1720.pdf

[2] Choi, A. (2024, January 22). Record number of anti-LGBTQ bills were introduced in 2023. Retrieved from https://www.cnn.com/politics/anti-lgbtq-plus-state-bill-rights-dg/index.html

[3] Kelly, N. K., Ranapurwala, S. I., Pence, B. W., Hightow-Weidman, L. B., Slaughter-Acey, J., French, A. L., Hosek, S., & Pettifor, A. E. (2024). The relationship between anti-LGBTQ legislation and HIV prevention among sexual and gender minoritized youth. AIDS (London, England), 38(10), 1543–1552. https://doi.org/10.1097/QAD.0000000000003926

[4] Dawson, L., Kates, J., Montero, A., and Kirzinger, A. (2024, September 30). LGBTQ Health Policy. Retrieved from https://www.kff.org/health-policy-101-lgbtq-health-policy/

[5] Halliwell, P., Blumenthal, J., Kennedy, R., Lahn, L., & Smith, L. R. (2024). Characterizing the prevalence and perpetrators of documented fatal violence against Black transgender women in the United States (2013–2021). Violence Against Women. https://doi.org/10.1177/10778012241289425 

[6] ACLU. (2024). Mapping Attacks on LGBTQ Rights in U.S. State Legislatures in 2024. Retrieved from https://www.aclu.org/legislative-attacks-on-lgbtq-rights-2024

[7] HRC. (2014, November 19). The Epidemic of Violence Against the Transgender & Gender-Expansive Community in the U.S. Retrieved from https://reports.hrc.org/an-epidemic-of-violence-2024#epidemic-numbers

[8] UNAIDS. (2021). HIV and Transgender and Other Gender-Diverse People: Human Rights Fact Sheet Series. Retrieved from https://www.unaids.org/sites/default/files/media_asset/04-hiv-human-rights-factsheet-transgender-gender-diverse_en.pdf

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

New CDC Surveillance Reveals Risks Among Transgender Women, Including HIV

By: Jen Laws, Board Member, ADAP Advocacy Association, and HIV/transgender health advocate 

On April 15, 2021, the U.S. Centers for Disease Control released a new special report on HIV infection, risk, and tertiary issues impacting transgender women. The report included a literature review and community survey among 1,608 self-identified transgender women in 7 US cities (Atlanta, Los Angeles, New Orleans, New York City, Philadelphia, San Francisco, and Seattle), which was conducted between late 2019 and early 2020.

The findings of the report could be considered startling to those unfamiliar with HIV data among transgender populations. However, advocates for transgender equality have been shouting about this issue for years. Despite the CDC issuing guidelines for collecting data on transgender people in 2015, many state and local health departments were slow to implement this guidance; from debate on language to a grueling process in the massive undertaking to update official HIV screening forms. Further down the “food chain”, contract providers did not necessarily have the funding to reprogram electronic health records to reflect collecting this information or did not prioritize doing so. As a technical issue, this is the least of concerns in reaching out to transgender people. Cultural competency is lacking, programs directed toward transgender people may be managed by cis gender people, creating a disconnect between the experience of a target audience and program design. The Denver Principles demand “nothing about us, without us” and, even in HIV, this part gets forgotten about when establishing or operating transgender programs.

Photo Source: CDC

Back to the CDC’s findings.

The special report found an HIV prevalence of 42% among participants with a valid HIV screening within the last 12 months (note: 3% of participants did not have a valid HIV screening within the last 12 months, all findings are self-reported). Of those tested, along race and ethnic identity, the highest rates of HIV prevalence were among Black (62%), Hispanic/Latina (35%), and American Indian/Alaska Native (65%) transgender women. The cities with the highest prevalence were Atlanta (58%), New York (52%), and Philadelphia (51%). Of prevention activities, participants were generally well-educated regarding pre-exposure prophylaxis (PrEP) at better than 90% overall, however, uptake was lagging at around 30%. Participants cited medical mistrust due to incidents of transphobia in medical settings, lack of information regarding interactions with gender-affirming hormone therapies, and lack of trans oriented PrEP marketing materials. 63% of self-reported HIV-positive participants reported receiving HIV related care within 1 month of diagnosis and 89% having received care within the year prior to interview. 

The most stunning findings of the study include 63% of participants reporting living at or below the federal poverty level and 17% being uninsured. As a result, unsurprisingly, 42% of participants had experienced homelessness in the last 12 months. The statistic that should receive the greatest attention but - also unsurprising as 2020 was the worst year on record for anti-transgender violence in the US – 54% of participants reported having experienced verbal abuse or harassment as a result of their gender identity. Additionally, 15% of participants reported having experienced verbal threats or physical attack resulting in rape.* 

*Editor's Note: the report refers to “forced sex” – this author will not coddle this experience. “Sex” without consent, either by force, threat, or coercion, is rape.

Advocates, myself included, argue the Trump administration’s anti-transgender agenda released a social contagion of permission to enact violence against transgender people, Black transgender women in particular. Despite the precedent set by the Supreme Court’s Bostock decision in 2020, several states have decided to make 2021 a record-breaking year in introducing anti-transgender legislation. Again, experienced advocates expect this pattern to result in more violence against us. 

This is of particular note, given the CDC’s report cited medical mistrust due to experiences of transphobia in medical settings. 

Small, yet meaningful steps that can be taken in the immediate: both private and public funders must change the metrics in which they consider funding transgender programming and acceptable “competency”. Funded entities must conduct transgender cultural competency at onboarding of all staff and at least once annually and demand their staff satisfy a post-training assessment as part of their employment. Funders must require these metrics in order for an entity to receive funding. Entities should not be “developing” new transgender programs but courting existing trans led by-for organizations to manage trans oriented HIV programing. 

The Denver Principles were meant for all of us, every one of us, every piece of us. And beyond our status we have failed to implement these cornerstone values into our HIV prevention efforts and care programs. 

For providers seeking resources on trans oriented HIV prevention materials, the CDC provides model materials at no cost to providers via the CDC’s Let’s Stop HIV Together campaign. You can order these and other materials here.

Additionally, "TRANSGENDER HEALTH: Improving Access to Care Among Transgender Men & Women Living with HIV/AIDS under the AIDS Drug Assistance Program" are educational resources published by the ADAP Advocacy Association. They include an infographic, and a policy white paper.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

Spotlight on Bobbie Hondo: Trans Femme Dancer & HIV/AIDS Advocate (PART TWO)

By: Fernando Cerezo III, Queer Latinx Writer

<- Click here to read, "Spotlight on Bobbie Hondo: Trans Femme Dancer & HIV/AIDS Advocate (PART ONE)"

New York is a polarizing city, where the privileged brush shoulders with the impoverished. A city that promises to chew you up and spit you out, to test your will to stay. And the reward for sticking it out? Excess, temptation, accessibility and a city that honors the individual. At just 16, Bobbie was newly independent, to figure this city out on her own. After declining a dance program overseas and against her parents’ wishes, she landed in Queens, only a short train ride from Manhattan. She still held the struggles of her past on her shoulders, but it was a new day and Bobbie was determined to once again see her body as an instrument rather than a detriment. She briefly enrolled in Parsons School of Design and if she wasn’t in class, she was in doctors’ offices and clinics all over the city. “You have to be proactive or you will just become a ticket number.”

Bobbie arrived in New York unsure about her Cd4 count, the most important laboratory indicator of immune deficiency. She was taking Abacavir, an HIV medication that severely affects your REM sleep. But what six different hospital visits cost her in Texas was treated at a New York doctor’s office in just one afternoon. She learned about the AIDS Drug Assistance Program, a supplemental program that provided her free medications for treatment. She realized that the key to her health was specifying a formula that worked best for her. “If you’re trans and you’re taking hormone medication, then you have your HIV pills, then if you’re on psychotropics those pills all pile up… These are daily medicines and you feel them working in your body to help your cells function at half the degree they would.” So instead of the 12 pills she had taken for years, Bobbie found medications that were much lighter on her body. Her health was progressing, but she was lonely. Though during these routine visits to clinics, she met fellow patients who saw themselves in her. “I would go to all these AIDS clinics and I would get tidbits from these older queens who would give me books to read and songs to listen to. They wanted to help me grieve [the life I had] then celebrate the life I was taking on.” 

Photo by Marquale Ashley

Bobbie kept up with her health, signed up to a gym and started going out dancing in the West Village nightlife scene. Fatefully a 19 year old Bobbie came to befriend drag artists Mistress Formika, Joey Arias, Hattie Hathaway and the cheeky, southern-born, mother of Wigstock, Lady Bunny. “When I got to New York and saw them in real life my heart dropped… I was like ‘wait you’re the person from my TV set.” They saw potential in Bobbie and took her in, encouraging her to foster a relationship with drag. “I’d get to see and hear all these references and I’d just study these queen’s banter. I wanted to join the repartee but wasn’t ‘polished’ enough and they knew that… so they turned me out.” But there were queens that felt Bobbie was cramping their style and would go as far as blackballing her from gigs if she didn’t sleep with them. “Bobbie is here and she’s one of us” Bunny and Hattie testified. “I really believed I was worthless until Bunny was like, ‘do you know who the fuck you are? Show these motherfuckers how you do it!’...They gave me room to breathe for the first time, to help me get to a place where I can start creating my own history rather than being told [what to believe.]” Bobbie stepped in front of the mirror looking like a vision of herself, in voluptuous black hair, her glamourpuss face, wearing latex catsuits and Vivienne Westwood heels. 

In 2015, Lady Bunny thought it was time to bring Wigstock back. She was approached by HBO to do a contemporary look at the drag festival in the new documentary, Wig. Bobbie remembers the honor of Bunny choosing her as the cross generational gap for the film. Not only was this one of Bobbie’s wildest dreams realized but this also served as her coming out ball. She took the opportunity to share her experience with AIDS, in hopes of inspiring those who continue to struggle from lack of access and stigma.

Along with the boom in recognition, Bobbie received backlash from within her community. One older queen accused Bobbie of ruining the documentary by speaking about AIDS. “No one cares anymore. Why does everything new and gay have to be about AIDS?” she remembers him groaning. Bobbie was piercingly reminded of the exclusionary nature within the queer community.  “I spent a lot of years wearing the term faggot as a badge of honor. But when I came out as trans, suddenly all my gay friends were like ‘sorry sis you’re no longer in this circle group.’ It’s because I’m still too gay to be trans and too trans to be gay… I know a bunch of gay men and trans girls who hate me not because I’m a bitch but because I’m positive.” Some would go as far as outing Bobbie’s status in front of her and prospective lovers. They would say ‘Don’t think you’re something. You’re just AIDS on a stick’... I’m forced to realize I’m in this pocket bubble of living life one way that doesn’t scale to a large portion of people… I have been separated from the pack.” 

Romance was hardly any different. Anyone drawn in by her magnetism was swiftly repelled by Bobbie’s insistence that she wasn’t human and only the virus. So she began to date people who were also positive, who saw through her defenses and related to her trauma. As these relationships progressed, she found empathizing would fester into trauma ranking, differentiating their experience to hers. “The only thing we had in common is that we were both positive so there's a lot of shame associated there… It was very sad because you know what they’re going through and vice versa yet they’re choosing to perpetuate that self-hate.” Sex was even trickier, becoming a hotbed for insecurities. Intercourse, even consensual, was the ultimate trigger for conjuring up Bobbie’s dissonance with intimacy. During sex, Bobbie would only go on for so long before panicking and putting a stop to it altogether. These trauma attacks would come and go, lasting a couple minutes, maybe a few hours, sometimes lingering for a few days. She let go of these partners before they could inevitably abandon her. “They don’t see that side of the world; they’re not attuned to the same fears I have. For me, I really believed that I could not be loved so I left because of that fear.” 

With the uptick in education and forms of prevention, such as Truvada and PrEP, she’s seeing the veil of stigma gradually lifting. Language is changing with the current generation, differentiating “good bloods”: people who regiment their medications and “bad bloods”: for those who don’t. Living with HIV is no longer the death sentence it was in the 80s/90s. Bobbie remembers confiding her status to a lover whose response was “Well that’s what condoms are for, for people like you to have a chance at a normal sex life again.” This shift in social consciousness has allowed her access to a side of intimacy she’d felt was closed off to her. “Serodiscordant relationships I find are much easier now because people who don’t have the virus don’t seem to care. They don’t have these hang ups, so this gives you more room to not have hang ups either and to accept your whole self.” 

For so long Bobbie had been conditioned to believe her truth would be her undoing. “Tell someone you’re positive and they’re going to kill you,” was said by psychiatrists, teachers, doctors and Bobbie’s own parents. But when tasked to embrace herself wholly she’s learned that honesty is the key to loving and being loved. That to advocate for yourself means you’re advocating for others in the process. “You have to be honest about who you are in a way that is palatable for someone who doesn’t know about HIV, but in a way that’s comfortable for you.” At 26, Bobbie is diligent in reframing how we look at the reality of HIV/AIDS, to find deficiency in the stigma not the condition. “I hated when people would say ‘you’re going to have it forever.’ I always say, ‘you’re going to have it for a long time, so start learning about it.” 

Being a 12-year survivor, she has watched the pillars of stigma gradually crack under the tides of change. She raved about the pioneering work of Dr. Demetre Daskalakis, who’s made a reputation of radically preventing and controlling HIV/AIDS. She also boasts about Harlem United, a non-profit organization dedicated to offering social services to vulnerable populations. Bobbie looks forward to a new world that takes the power away from HIV stigma and uses it to uplift the stories of the present. “We’re so wrapped up in glamorizing the 80s AIDS crisis. We’re so subscribed to David Wojnaroqicz’s [work and AIDS advocacy] that we are refusing to acknowledge the voices of today to grow past the 80s. I love Wojnaroqicz but he died in 1992, AIDS didn’t stop when he died. But those seem to be the only stories we continue to hear. That’s why I’ve made it my mission to speak about [HIV/AIDS] as publicly and with as much candor as I possibly can because there is a whole new world out there.”

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

Spotlight on Bobbie Hondo: Trans Femme Dancer & HIV/AIDS Advocate (PART ONE)

By: Fernando Cerezo III, Queer Latinx Writer

The first time I saw Bobbie was on the dance floor at a New York nightclub, a nightlife watering hole for creatives and it people. I watched the sea of bodies darting their eyes, waiting for their liquid courage to kick in. Among them I saw a figure outfitted in black and pink latex, manicured nails with fingerless matching gloves and a long black ponytail held up with a headband of the same material. Her face was made up, highlighting her round Twiggy-esque eyes with hues of pink around her cheeks and temples. She was holding no drink, and her friends looked like they were trying to match her energy but didn’t yet have it in them. So, I watched her with curious enthusiasm as she grew more and more activated by the music, witnessing what I could only describe as her spirit. 

One weeknight over dinner with a handful of friends at Blue Ribbon Fried Chicken, East Village I heard “Fernando!”, called from behind me. Wearing an oversized leather jacket Bobbie embraces me warmly. She asks how I’m doing, her big eyes meeting mine from across the table as if we were the only people there. I introduce her to my bewildered friends, to whom she gives a friendly hello and a courtesy before bringing her eyes back to me. Recognizing her affinity for connection I insist we meet sometime one on one. That summer, in the Lower East Side, the two of us were dressed in all black despite the sweltering heat and walked over to the East River. Bobbie’s black wavy Joan Jett mullet encircles her fresh face. She reminds me of Brittany Murphy; skittish and eager but beaming with life. I look for a piece of myself in her to make sense of our unspoken kinship. We talked nightlife, our love of dancing, swapped dating misadventures, and realized we were born the same year. After sharing a few laughs and exchanging notes on managing adulthood, Bobbie starts to open up to me about her past. In late August, we got a chance to speak on the phone and with her permission I share it with you.

They say we’re all products of our environment, the triumphs and struggles of the children we were dictating the adults we soon become. In 2006, during a Bush era America, we find Bobbie as a curious 12-year-old in El Paso, Texas. She joined the all-girl cheerleading team and wore skirts to school against everyone’s wishes, dancing over the boundaries of the status quo. Born into a Mexican American community she was met with disapproving glares from adults, peers whispering about her in the halls, and evasion from strangers altogether. “It was unsafe to be queer, let alone be open about it [but] I wasn’t shameful. I didn’t subscribe to other people’s projections. I was going to live my life, wear what I wanted to wear, feel how I wanted to feel. Nobody was going to stop me.” Bobbie found solace at local gay bars, if not sneaking in, then peeking through the windows to catch drag performances and studying those she considered to be her people laughing, dancing and drinking, envisioning herself alongside them someday.

At 14, Bobbie earned her way into a summer dance program at Pacific Northwest Ballet School in Seattle, Washington. After days of vigorous training, Bobbie would sneak out to gay bars at night, where unlike El Paso she had an easier time getting in, despite being so young. “I didn’t know that I was being fetishized as this effeminate being and how that attracted certain characters into my orbit. I didn’t understand what a ‘tweaker’ looked like and I didn’t know what a ‘chicken hawk’ was.” It was 2009 and gay marriage hadn’t yet been legalized in most states, so homophobia permeated popular culture. These chicken hawks were men shrouded in secrecy who preyed on the young and impressionable. These were clergymen, CEOs and public defenders who had everything to lose, so in exchange for Bobbie’s discretion they offered her an affection she hadn’t felt before. One chicken hawk in his 50s, posing as a 9/11 firefighter, took Bobbie under his wing that summer, driving her around, filling her with alcohol and escorting her to “dad parties” where other men of the same breed would parade themselves with underage dates. But on their last meeting, Bobbie was lured to a bathhouse where the “firefighter” introduced her to meth. The next thing she remembered was waking up to a dozen of these tweakers abusing her 14-year-old body.

The following summer, Bobbie was back in Seattle but noticed a steep decline in her stamina during ballet class. She found herself in a doctor’s office, waiting pensively for the result of an HIV test. She can hear her mother’s warning echoing in her ears, that her behavior would only attract HIV and despair. The doctor came back with her result: positive. As the world drew silent Bobbie’s body had cemented. She looked blankly at the doctor, thanked them and solemnly walked back to class. Her fellow ballerinas detected something wrong, so Bobbie confided in them, “I have something called HIV.” After sympathizing with her, their word spread to their parents, who informed school administration and the state of Washington. It was rare for a child under 18 to be diagnosed with HIV and Bobbie didn’t get a chance to process what it all meant, the ignorance, fear and stigma. She made meaning out of the reactions from adults around her, showing concern for Bobbie with looks of terror and discomfort smeared on their faces. Amidst the dizzying chaos, Bobbie’s ballet director, Peter Boal, shared his experience of living in New York during the AIDS pandemic. “He could see me before I could see myself.” He assured her there was no better place to find access to proper care, maybe finding herself in the process. 

After getting pulled out of her program early, Bobbie was back in El Paso, sitting in waiting rooms after waiting rooms of medical professionals. Bobbie had contracted anal cancer from undiagnosed HPV and knew her body’s ability to dance was now in jeopardy. But in 2009, insurance companies and pediatricians could legally discriminate against children living with HIV/AIDS.  She had faced rejection from doctors of all kinds before landing in the office of one Dr. Rhonda Flemming. Dr. Flemming, an infectious disease doctor wasn’t trained in HIV care but after hearing Bobbie’s struggles she expressed compassion. So, Dr. Flemming trained herself in order to counsel and care for her. But HIV research was still severely lacking, which resulted in Bobbie’s new costly prescription of 12 intrusive, daily pills thought to suppress the effects of the virus. 

Bobbie returned to face her family and the changing dynamic of the house. Bobbie’s father, a local judge, took necessary measures to protect his child (and reputation) by enforcing the use of the HIPAA privacy act, restricting third parties from disclosing Bobbie’s medical records without consent. He was the most involved in seeking treatment, but he was emotionally blocked, dismissing her when she confided in him. Her mother acclimated no better. “I could be getting purses. But we have to spend money on your medication. So shut up, you don’t get to be upset,” Bobbie remembers hearing. She grew estranged from her three older siblings who only thought up ways to cure her queerness. Certain bathrooms became off limits. If Bobbie would join her family pool parties everyone would scurry out. She became a shut in to avoid facing her own flesh and blood recoiling from her. To this day, Bobbie struggles with her family’s unwillingness to talk about HIV. “I want them to say something so that I can move forward. We can grow together to get back to a time before AIDS was introduced to our lives because it does affect everyone around you.” The once curious, high spirited child had hardened and became a recluse.

The opening weekend of Twilight: New Moon, Bobbie snuck her mother’s car out for a drive. She passed the theater, flooded by her peers, drove past her high school and the gay bars she once frequented. Everything was different now. ‘We know what you have. You’re just going to be a tr*nny with AIDS,” students said to her. “Don’t talk to that person, they have the gift,” they whispered at the bars. There was nowhere to seek refuge, so to supplement her sorrow she started taking ecstasy every night. “I was driving, thinking ‘Am I going to face another year of fighting kids or am I just going to end it all now?’” So that night Bobbie made an attempt to do just that right off the nearest cliff. With the car severely damaged and her mental health slipping, her frustrated parents committed Bobbie into a mental institution without her knowing. Here she was not only encouraged but conditioned to make lying a habitual practice, to lie about her status to any and everyone she meets.

Bobbie survived the public shaming, spiraling drug use and her dance with death and was convinced she was meant for more. “No one would rise to save me until I finally decided--not to quote Donna Summer and Barbra Streisand but I’m going to--‘Enough is enough.’” She took to the then two year old website, YouTube seeking any sliver of queer history, immersed herself in gay texts like City of Night and Dancer in the Dark and, though information was sparse, she took to outlets such as “Susan’s Place” to better understand her trans femme identity. A summer film series spearheaded by queer TV channel Logo had broadcast such films as But I’m a Cheerleader, Mambo Italiano and a lifetime staple of Bobbie’s, Wigstock. The 1995 documentary highlights the irreverent talents of the New York drag festival featuring high spirited queer performers such as Joey Arias, Lipsynka and of course the Lady Bunny, and touched upon the AIDS pandemic. “That’s where I first saw these insanely vibrant personalities and their struggles as LGBTQ+ people,” she tells me passionately. While her environment was failing her, she found hope in Dr Flemming, Peter Boal and her newfound Wigstock idols. There was only one solution. Goodbye, El Paso. Hello, New York City.

-> Click here to read, "Spotlight on Bobbie Hondo: Trans Femme Dancer & HIV/AIDS Advocate (PART TWO)"

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

Love in the Time of COVID-19

By: Riley Johnson, Executive Director, RAD Remedy

As many readers may know, COVID-19 is a novel coronavirus for which there is currently no vaccine available in the United States. But what folks may not know is that many state public health departments managing COVID-19 do not collect data on sexual orientation and gender identity, meaning there is minimal public health data available about the impact of COVID-19 on transgender people, including trans folks living with HIV. Like non-pandemic times though, trans organizations are able to provide an understanding of not only the ways in which trans folks are impacted but also how grassroots mutual aid efforts continue to sustain us.

Trans Lifeline recently reported that between March and July 2020, they experienced a 40% increase in calls, and that number continues to climb (Fowers, 2018). Outside of COVID-19, trans people already experienced mental health issues at nearly four times the rate of the general population (Wanta, 2019). In addition, trans people can face increased risk for COVID-19 due to several issues: trans communities’ higher rate of smoking - 50% higher than the general population (National LGBT Cancer Network, 2020) - access to care barriers leave us less likely to get medical care, and existing health disparities mean more of us live in a state of compromised health, which can leave us more vulnerable to COVID-19 infection. Trans people also at times use binders and/or corsets which, while helpful presenting aids, can restrict breathing. Trans folks have also faced unexpected consequences of hospitals and surgical centers trying to cope with COVID-19. Transition surgeries have been classified as non-emergency and have been cancelled after trans patients have already waited months or even years, causing even more stress and depression. Trans Lifeline counselors also report many callers have talked of being forced to quarantine with families or partners who were unsupportive or abusive. Prior to COVID-19, many trans people engaged in sex work and street economies due to stigma and underemployment, and with the onset of the pandemic, many are continuing to do so to meet survival needs despite the increased risk of COVID-19 transmission due to lack of social distancing. And not insignificantly, many trans people are also reporting an increase in misgendering due to the use of masks for COVID-19, which, while helpful for prevention, may limit gendered visual cues such as facial hair and make-up.

At the same time, trans folks also have been targeted politically like never before, including a reinstatement of the trans military ban, an attempt to remove nondiscrimination protections in Section 1557 of the Affordable Care Act which would allow medical personnel to refuse to care for trans patients, proposed regulations that would all but ban LGBTQ asylum seekers, and proposed modifications to the Housing and Urban Development’s Equal Access Rule that would require trans folks who are houseless to stay in shelters associated with their assigned sex at birth. To be honest, dear reader, all of this oppression on top of the pandemic has been a bit much even for me.

So I began to ask myself - what does love and resilience look like in a time of COVID-19?

From a self-care and community care perspective, many trans people are looking after each other by reminding each other to unplug from social media and news cycles, to drink water and eat, and sharing quality goat and puppy content and curbside drop-offs of food. These small graces remind us that while the pandemic is ongoing and the world seems to be on fire, there is goodness, kindness, and adaptation too. Like we have for decades, trans people are still thriving and resilient in the face of uncertainty. On September 2, 2020, a federal district court issued an injunction which immediately blocks the Department of Health and Human Services’ attempt to allow discrimination against LGBTQ people on religious grounds. Grassroots mutual aid projects have also blossomed all over the U.S., including the TGNC Peoples COVID Crisis Fund of Louisiana, the Okra Project, and the Heavenly Angel Fund which assists Black trans women in getting tested for COVID-19 and provides care packages for those who have been tested. These are just a sample of the many efforts by and for trans people to uplift each other and help those who need it most. For a truly fantastic deep rabbit hole of mutual aid during COVID-19, check out COVID-19 Collective Care (http://bit.ly/covid19collectivecare). As Vivian Topping, a peer support facilitator at Trans Lifeline puts it, “Trans folks push really hard to support our people and be resilient. There’s still beauty. There’s still joy. There’s still a life to keep looking forward to .”

I’d like to leave you with a quote from Dr. Lourdes Ashley Hunter, Executive Director of Trans Women of Color Collective: “Every breath a trans person takes is an act of revolution. Everyday, you will wake up in a world designed to destroy you, invalidate you and tell you that you don’t belong and that you have to assimilate to be accepted. Everyday you will also wake up with great purpose to dismantle that shit. Ashé.” Breathe deeply, sanitize, and mask up, friends. Whether it’s a pandemic or policy designed to oppress us, we are resolute, resourceful, and stronger than we know. 

About RAD Remedy: RAD Remedy is a national grassroots organization dedicated to connecting trans, gender non-conforming, intersex, and queer (TGIQ) folks to accurate, safe, respectful, and comprehensive care. The Referral Aggregator Database (RAD) is a comprehensive and nationally-collaborative database that combines the referral lists of trusted community organizations and the detailed reviews of TGIQ clients. In addition to the organization's database activities, RAD Remedy provides community-informed policy and practice guidance and consulting to organizations, agencies, and individual providers looking to help TGIQ communities thrive. Donate to RAD Remedy.

References:

• Fowers, Alyssa, and William Wan (2020, August 18). "The volume has been turned up on everything': Pandemic places alarming pressure on transgender mental health. Washington Post. Retrieved online at https://www.washingtonpost.com/health/2020/08/18/coronavirus-transgender/?arc404=true.
• National LGBT Cancer Network (2020). Coronavirus Information. Retrieved online at https://cancer-network.org/coronavirus-2019-lgbtq-info/.
• Wanta, Jonathan, et. al. (2019). Mental Health Diagnoses Among Transgender Patients in the Clinical Setting: An All-Payer Electronic Health Record Study. Transgender Health. Retrieved online at https://www.liebertpub.com/doi/pdf/10.1089/trgh.2019.0029.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates. 

Trump HHS Proposes Eliminating Most Non-Discrimination Protections of Section 1557

By: Jen Laws, Board Member, ADAP Advocacy Association, and HIV/transgender health advocate

On June 14th, 2019, the Trump administration issued a near complete regulatory overhaul of the Patient Protection and Affordable Care Act’s (ACA) non-discrimination provisions known as Section 1557. The issued proposed rule began a 60-day public comment period, ending on August 13th, 2019.

Photo Source: thompsoncoburn.com

The public may submit comment using the following link to the Federal eRulemaking Portal: https://www.regulations.gov/comment?D=HHS-OCR-2019-0007-0001.

Or by regular, overnight, express mail, hand delivery or courier to the following address:

U.S. Department of Health and Human Services
Office for Civil Rights
Attn: Section 1557 NPRM, RIN 0945-AA
Hubert H. Humphrey Building, Room 509F
200 Independence Ave. SW
Washington, DC 20201

For a background, please visit our previous blogpost here (Laws, 2018): https://adapadvocacyassociation.blogspot.com/search?q=1557.

Stating the Trump Administration’s proposed changes to Section 1557 are a revision would be misleading. A lie actually. The proposed rule seeks to so drastically change the regulatory interpretation and applicable federal agency guidance so much, that one can only adequately describe the changes as eliminating any meaningful sense of protection offered by the Obama Administration’s interpretation.

The case made by the U.S. Department of Health & Human Services ("HHS") for these changes is embarrassingly weak. Relying near exclusively on the Trump Administration’s own refusal to defend the regulation in Franciscan Alliance, Inc. et al v. Burwell, which resulted in an unchallenged injunction issued by Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas and a second ruling from a federal district in North Dakota - which relied on the Franciscan Alliance decision. By taking an intentionally flawed approach, the listed changes would have a wide impact, including eliminating protections affecting transgender people, women, reproductive care in general, people living with HIV, people with disabilities, people who speak and read any language other than English as a primary language, and more. The move builds upon the Trump Administration’s efforts to not only reshape the judicial landscape in a politically motivated fashion but to do so with precise aims, including eliminating the ACA entirely (see Texas v. United States, another Reed O’Connor ruling – this should tell you something about “court shopping”).

If you haven’t read Nicholas Bagley’s Atlantic piece, “Rise of the Know-Nothing Judge”, you really should (Bagley, 2019). This legal philosophy is being leveraged specifically by both the judges hearing the cases and the political appointments seeking to eliminate these necessary protections in healthcare. The story goes fairly simply as “we couldn’t possibly know what Congress was thinking (despite recent and public statements to the fact on certain votes and legislation) because it wasn’t spelled out explicitly and narrowly.” This is an effort to push issues of patient protections (and other issues) to a dysfunctional Congress. This approach also explicitly seeks to push legislation, which by its very nature is not supposed to be prescriptive, into an exceptionally prescriptive design or risk non-enforcement. Overall, the process removes the role of government in regulating and protecting tax payers entirely when applied broadly. This Administration will achieve the goal of eliminating necessary government intervention by weakening public trust and establishing court precedent to inaction.

In the case of a Section 1557 re-write, HHS ignores previous precedents that stretch back 30 years (Price Waterhouse v. Hopkins) to rulings as recent as 2017 (Prescott v. Rady Children’s Hospital) which rely on the plain language of the statue due to previous precedent, not the regulatory interpretation provided by the Obama Administration. HHS goes on further to ignore recent rulings both on issues of sex stereotyping as a form of sex-based discrimination and gender identity as an issue of sex by the nature of gender identity being a part of our medical definition of sex. HHS expands further by stating that even if gender identity were an issue of sex, “Religious Freedom” and its own “Conscience” regulations should allow all entities governed by HHS regulations to deny coverage and care even on the basis sex. As such, that denial of care extends in such a way that would eliminate the pre-existing conditions protections of women in the case of pregnancy history, termination of pregnancy, false pregnancy, and genetic history. Instances of care denial that were routine prior to the ACA’s pre-existing conditions protections requirements.

Kaiser Family Foundation argues the explicit nature of these interpretations including non-protection of sex stereotyping could result in antiretroviral treatment being denied coverage by an insurance company or a provider refusing to provide care to a person living with HIV because of assumed sexual activities with a same-sex partner. The interpretation removes the right of private action so coveted by patient advocates when section 1557’s original interpretation was written; meaning patients would no longer have either an administrative path to seek remedy or an explicit endorsement of HHS to go the path of the courts to seek remedy when harmed by care and coverage denials (Musumeci, 2019).

If this sounds like a wild, wild west situation of health care and insurance structures prior to the ACA, it is. That’s the goal, the campaign promise of Donald J. Trump. While the ACA certainly needs some work, consistently, the American public, regardless of political affiliation has polled support of health care protections the ACA provides. Like a mob thug in sneaking into a back alley, this Administration is using every angle to knee cap the protections afforded by the ACA, with intentional efforts to harm those who need those protections the most.

Lastly, of particular note, HHS states in the proposed regulation, as it has in every other regulatory change affecting civil rights protections, that disparate impact does not equate to intentional discrimination. Having historical data, predictive data that already guides our funding appropriations and distribution that is so pin-point precise the government – nay, THIS Administration relies on some of the very same data to focus funding its own Ending The Epidemic plans (HIV.gov, 2019), how can we not interpret knowingly and intentionally ignoring the same data as “unintentional” when other regulatory moves by this Administration seek to allow providers and insurers to deny care and coverage to PLWH just a whim?

We live in the day and age of Big Data, disparate impact is now intentional impact.

This effort to harm is intentional.

Comment today to ensure your voice is heard! Call your Congress member. Support your patient advocacy organizations by dollar and deed. We’re in a fight for our lives here, one court ruling and one regulation at a time.

References:

• Bagley, Nicholas (2019, July 15). Texas v. United States: Rise of the Know-Nothing Judge. The Atlantic. Retrieved online from https://www.theatlantic.com/ideas/archive/2019/07/texas-v-us-rise-know-nothing-judge/593959/
• HIV.gov (2019, June). Ending the HIV Epidemic: A Plan for America. Retrieved online from https://files.hiv.gov/s3fs-public/ending-the-hiv-epidemic-flyer.pdf
• Laws, Jen (2018, February 22). Trump & HHS Sanction Healthcare Discrimination. ADAP Blog. Retrieved online from https://adapadvocacyassociation.blogspot.com/2018/02/trump-hhs-sanction-healthcare.html
• Musumeci, MaryBeth, et. al. (2019, June 1). HHS’s Proposed Changes to Non-Discrimination Regulations Under ACA Section 1557. Henry J. Kaiser Family Foundation. Retrieved online from https://www.kff.org/disparities-policy/issue-brief/hhss-proposed-changes-to-non-discrimination-regulations-under-aca-section-1557/
• United States District Court for the Southern District of California (2017, October 13). Case No.: 16-cv-02408-BTM-JMA. Retrieved online from https://www.ebglaw.com/content/uploads/2017/10/Prescott-v.-Rady-Children_s-Hospital-San-Diego_-2017-U.S.-Dist.-LEXIS-160259.pdf

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.