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Dr. Rachel Levine speaks with trans youth at D.C. health clinic

Youth Pride Clinic is one of the few clinics in the nation to provide primary care & mental health services to LGBTQ youth from ages 12 to 22

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Dr. Rachel Levine, Assistant U.S. Secretary for Health and Human Services (Washington Blade photo by Michael Key)

WASHINGTON – It’s not unusual for Rachel Levine as assistant secretary of health to visit medical facilities on behalf of the Department of Health & Human Services. But her visit last week to the LGBTQ youth clinic at the Children’s National Medical Center was special because she was able to meet with transgender youth as an openly transgender presidential appointee.

The visit on Thursday by Levine at the D.C.-based hospital comes not long after the U.S. Senate approved her appointment, making her the first openly transgender presidential appointee to win a Senate-confirmed position. As such, her visit to the LGBTQ youth clinic, where transgender kids come for transition-related care and health services, held particular significance for the patients.

Levine, speaking with the Washington Blade at the end of her visit, said having the opportunity to speak with both transgender youth and medical professionals testing them was “tremendously, tremendously rewarding”

“It’s tremendously gratifying to be able to speak to the medical professionals and the clinic personnel at beds, particularly to the youth and their families from my experience,” Levine added. “So I have two aspects of that. One is that I’m a pediatrician and adolescent medicine specialist. So I’ve been teaching to children and their families my entire career, but the other is coming from my lived experience as an openly transgender woman, and so I find it tremendously rewarding.”

The warm environment of the hospital for children is readily apparent upon entering the main atrium of the building. Lights dressed up as hot air balloons fill the tall ceiling while a nearby TV shows music videos consisting of squares of kids’ faces singing, followed by easy-listening country music and Asian K-pop. Children and their parents await their appointments seated in comfy plush red chairs before white blocks meant for use as tables.

Key to Levine’s visit was taking part in a discussion at the hospital auditorium with three transgender youth and their families who obtain services at the clinic. During the question-and-answer period, Levine shared her experience as a transgender person who underwent transition later in life and went on to tremendous success as a high-ranking presidential appointee.

For the transgender youth, Levine’s presence at the hospital — at a time when state legislatures are busy enacting bills to restrict their access to medical care and school activities — serves as a reminder that barriers based on gender identity are breaking down and the sky’s the limit for their future.

After the question-and-answer session, Levine told the Blade she “learned a lot” about the Children’s National Medical Center, which she called “a world-renowned children’s hospital and academic medical center.”

“I’ve known about it before,” Levine added. “I’m a pediatrician, adolescent medicine specialist, but I learned more about what they’re doing. And I learned specifically about their gender clinic, where they take care of transgender and gender non-conforming youth and got to meet some of the staff as well as the kids and their families.”

The Youth Pride Clinic, which opened in 2015, is one of the few clinics in the nation to provide primary care and mental health services to LGBTQ youth from ages 12 to 22. Among the services offered are hormone replacement therapy, STP/STI treatment and PrEP services as well as individual and family therapy for transgender youth.

Among the transgender youth patients at the clinic who spoke to the Washington Blade was Amir, a 15-year-old Georgia native whose last name as a minor is being withheld for confidentiality purposes.

“I started out in fifth grade coming out as lesbian,” Amir said. “I didn’t even really know, but when I came out to my grandma in Georgia, where I’m from, I still didn’t feel like myself. So then, later on, me and my friend researched, and next thing you know we came across the term transgender, and I was like, ‘This is who I am. This is me.’”

Amir said he began taking shots as part of care regimen in January. Being able to receive care from the Youth Pride Clinic, Amir said, means a lot because he has an opportunity not available to other transgender youths, who face challenges and even hostility as they make the journey to transition. The staffers at the Youth Pride Clinic, Amir said, are “like a second family” who work hard to provide the services they offer.

Sonia Murphy, Amir’s aunt who became his legal guardian, said when she began reaching out for medical help for Amir she found a two- or three-year wait list to get access to treatment, which she said makes her “saddened” such care isn’t widely available.

“There’s a population of kids and parents out there who need the services and just can’t access it because there’s not enough bandwidth, not enough manpower,” Murphy said.

Amir said he’s getting other avenues of support from his two cousins, one who is older at age 18 and one who is younger at age 12. “They’re like sisters to me, so I call them my sisters,” Amir said. Amir also identified two other male cousins as well as his uncles and his aunt.

“They’re all very supportive of me,” Amir said. “My auntie Tonya, for example, Pride month came up, first day, she sent me a paragraph, saying, ‘I’m glad you’re yourself and you’re open to who you are and things like that,” and that I’m not afraid to be who I am around anybody. It’s just things like that. And for my birthday, I had tons of Pride shirts, and I got a rainbow shirt with the fist in the middle for Black Lives Matter, and it was a ton of different things.”

Lawrence D’Angelo, director of the Youth Pride Clinic and an occupational health adolescent medicine specialist, told the Blade being able to start the facility in 2015 in and of itself was one of the key victories for the initiative, although he said the Children’s National Medical Center has been providing transition-related care since 1998.

“When we started it…we thought that we were going to be running a PrEP clinic, that we were going to be providing preventive services to LGBTQ kids,” D’Angelo said. “The first day, the first patient actually came in and asked for PrEP, and the other six patients that were scheduled that day all wanted transgender services. So, suddenly, it became obvious what we were going to be spending 90 percent of our time doing, which is exactly what we think we should be doing, because that’s where the need is the greatest.”

Despite the advantages of having access to the Youth Pride Clinic, transgender youth have clear challenges and face hostility based simply on their gender identity, especially in a year when state legislatures have in an unprecedented manner enacted legislation against them. The Youth Pride Clinic, in many ways, is an oasis of support.

Arkansas, for example, enacted a measure that would make criminal the kind of services provided at the clinic. Other states have enacted measures prohibiting “biological boys” from participating in sports, which essentially bars transgender girls from participating in sporting events.

While anti-trans measures aren’t being enacted in D.C. or any nearby states, the advancement of anti-trans legislation in states has had a negative effect on transgender patients at the Youth Pride Clinic.

D’Angelo, based on conversations he’s had with the patients, said they’re aware of the wave of legislation, which he said has led to fear, anger and being “unable to understand what is happening and why it’s happening.”

Amir said watching states enact legislation against transgender youth “makes me feel some type of weight,” pointing specifically to the anti-trans sports measures because he said he’d welcome the opportunity to participate in athletics.

“I’m athletic,” Amir said. “I do all types of sports. I play basketball, soccer, I’m going to do boxing…With sports and stuff, I just feel like I want to be able to do everything, just as a regular cisgender person will be able to do,”

Amir, despite the enactment of anti-trans laws, has an optimistic outlook and said the enactment of state measures against transgender youth demonstrates they’re now “on the radar” of the social conservative movement.

“I feel like if everybody who’s a part of LGBTQ and trans together, we can stand up and we can overcome this because the thing is, there are so many people out there who don’t understand what we do, and the thing is that they’re noticing us, so that’s a start to something big.”

Amir (Photo by Michael Key)

With many states hostile to transgender youth, others are looking to the federal government for support under the Biden administration. On his first day in office, Biden signed an executive order directing federal agencies to implement the U.S. Supreme Court’s decision against anti-LGBTQ discrimination to the fullest extent possible.

Levine cited an announcement from HHS that resulted from this order on implementing regulations prohibiting anti-LGBTQ discrimination in medical care, reversing a policy under the Trump administration that green lighted discrimination, as one of the ways it has answered that call and helped families like the Youth Pride Clinic.

“So the Affordable Care Act says that you cannot discriminate based upon sex,” Levine said. “The Department Health & Human Services and the Office of Civil Rights has interpreted sex to include sexual and gender minorities, to include sexual orientation and gender identity, which means LGBTQ individuals under that. So we need to look at all aspects of the Affordable Care Act, and to work to implement that interpretation of the statute. That was only done a month or so ago, so we’re going to be working on that now.”

Is there anything more the federal government can do to support the clinic? D’Angelo cited a number of key things already secured, including the hospital being able to offer insurance to patients and the affirmation from HHS against anti-LGBTQ discrimination. More research dollars and greater focus from the National Institutes of Health on gender diverse and sexual minority individuals, D’Angelo said, would also be welcome.

“There are things out there that the federal government can do, but I think…there are limitations of what they can do,” D’Angelo said. “They can’t, unfortunately, effect what’s going on in individual states, which is, in some cases draconian. That’s an awful thought if we were practicing medicine in Arkansas, we could be in jail.”

Meanwhile, Levine said the Biden administration, including Secretary of Health & Human Services Xavier Becerra, is working on both internal and external policies to facilities like the Youth Pride Clinic to help them secure their place in the health system and reach transgender youth.

“The secretary and I will be doing everything we can to advocate for the LGBTQ community,” Levine said. “So I think we’re going to be working externally, in terms of advocacy, and then we’re going to be working internally in terms of policy.”

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AIDS and HIV

$48 million earmarked for HRSA centers in effort to beat HIV/AIDS

“Community health centers are often a key point of entry to HIV prevention and treatment services, especially for underserved populations”

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The Hubert H. Humphrey Building, HHS headquarters Washington D.C. (Photo Credit: U.S. GSA)

WASHINGTON – The Biden administration has awarded more than $48 million in allocations earmarked to medical centers under Health Resources & Services Administration in localities with high incidents of HIV infection as part of the initiative to beat the disease.

Xavier Becerra, U. S. Secretary of Health and Human Services, in a statement said that the contributions are key component of the initiative, which is called “Ending the HIV Epidemic in the U.S.” and seeks to reduce new infections by 90 percent by 2030.

“HHS-supported community health centers are often a key point of entry to HIV prevention and treatment services, especially for underserved populations,” Becerra said. “I am proud of the role they play in providing critical services to 1.2 million Americans living with HIV. Today’s awards will ensure equitable access to services free from stigma and discrimination, while advancing the Biden-Harris administration’s efforts to ending the HIV/AIDS epidemic by 2025.”

The $48 million in government spending allocations went to HRSA centers 71 HRSA-supported health centers across 26 states, Puerto Rico and D.C. — areas identified with the highest rates of HIV infections — to expand HIV prevention and treatment services, including access to pre-exposure prophylaxis (PrEP) as well as outreach and care coordination, according to HHS.

The Ending the HIV Epidemic was set up under the previous administration, which made PrEP a generic drug after an accelerated effort and set a goal of beating HIV by 2030. Biden has continued the project, after campaigning on beating HIV a full five years earlier in 2025. Observers, however, are skeptical he can meet that goal.

Diana Espinosa, acting administrator for the Health Resources and Services Administration, (HRSA) said in a statement the $48 million will go a long way in reaching goals to beat HIV/AIDS.

“We know our Health Center Program award recipients are well-positioned to advance the Ending the HIV Epidemic in the U.S. initiative, with a particular focus on facilitating access to PrEP, because of their integrated service delivery model,” Espinosa said. “By integrating HIV services into primary care, and providing essential enabling services like language access or case management, HRSA-supported health centers increase access to care and improve health outcomes for patients living with HIV.”

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Coronavirus

LA County requiring vax proof for indoor bars & nightclubs by Oct. 7

Participants and workers at outdoor “mega events” with more than 10,000 attendees must provide proof of vax or show a recent negative test

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Photo Credit: County of Los Angeles

LOS ANGELES – The Los Angeles County Department of Public Health announced Wednesday that it will begin requiring verification of vaccination in select high-risk settings by October 7.

During a Los Angeles County Board of Supervisors meeting Wednesday, L.A. County Health Director Barbara Ferrer told the supervisors that vaccine verification will be required for customers and employees at indoor portions of bars, wineries, breweries, night clubs, and lounges.

The modified Health Officer Order would require customers and employees at bars, breweries, wineries, night clubs and lounges to have at least one dose of the vaccine by October 7 and both doses by November 4.

Public Health will require vaccination verification or a negative test within 72 hours prior to attending outdoor mega events. Participants and workers at outdoor “mega events” with more than 10,000 attendees must provide proof of vax or show a recent negative test.

Attendees at indoor mega events are already required to show proof of vaccination or a negative test result prior to entry. 

Los Angeles County Department of Public Health officials are prepared to move forward with the updated order later this week, Ferrer said.

“This modified health officer order aligns with the continued need to reduce risk for transmission and increase vaccination coverage,” Ferrer said. “This is a reasonable path forward that can position us to be better able to break the cycle of surges.”

She noted that while the health order won’t require it, Public Health will recommend that restaurants also begin verifying vaccination status for indoor dining.

“As evidence mounts affirming the safety and effectiveness of COVID-19 vaccines, vaccination mandates are an increasingly important tool to prevent future COVID surges that cause widespread suffering. The modified Health Officer Order aligns with the continued need to reduce risk for transmission and increase vaccination coverage; this is a reasonable path forward that can position us to be better able to break the cycle of surges,” Ferrer added.

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Coronavirus

LAUSD to require vaccines- Biden lays out new plan to require vaccines

“The COVID-19 vaccines are safe, effective & requiring students to be vaccinated is the strongest way to protect our school community.”

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Photo Credit: Los Angeles Unified School District

LOS ANGELES – The Los Angeles Unified School District announced Thursday that it will require for students 12 and older who are attending class in person to be vaccinated against the coronavirus.

The LAUSD Board of Education voted, 6-0, to pass the measure making it the first major school system, the second largest in the United States to require its more than 460,000 students, including some enrolled at independent charter schools located in LAUSD owned buildings, to be vaccinated.

Interim superintendent, Megan Reilly, said at Thursday’s board meeting that student vaccination was one way to ensure that the district’s classrooms would be able to remain open. Los Angeles had some of the country’s most extended school closures last year. All students ages 12 and up will be required to be fully vaccinated by Jan. 10, 2022, unless they have a “medical or other exemption,” Reilly noted.

The science is clear — vaccinations are an essential part of protection against COVID-19,” Reilly said in a statement following the vote. “The COVID-19 vaccines are safe, effective and requiring eligible students to be vaccinated is the strongest way to protect our school community.”

New York Times educational journalist Dana Goldstein tweeted:

As the Delta variant brought another wave of COVID-19 infections this summer, in California the number of unvaccinated young people being hospitalized has increased in certain areas of the state.

The Los Angeles County Department of Public Health noted that while case rates increased among children in all age groups between mid-July and mid-August, cases have declined by about 30% in all age groups among children (0-4, 5-11, and 12-17 years old) over the past two weeks.

The decrease is similar to the decreases we are seeing in cases among adult residents and occurred as many schools reopened with testing, masking, infection control and outbreak management protocols in place.  Over the past week, children under 18 comprised, on average, 27% of all cases seen in L.A. County.

Among L.A. County teens 12 to 17 years old, more than half of whom are vaccinated, we see just how powerfully protective the vaccines really are. As of August 28, the case rate among unvaccinated 12 to 17-year-olds was 424 cases among every 100,000 unvaccinated children in this age group compared with 51 cases among 100,000 of those vaccinated.

Among groups ineligible for vaccination, the case rate was 130 per 100,000 children aged 0 to 4, and 230 per 100,000 children aged 5 to 11.

As of September 5, 62% of L.A. County residents 12 to 15 years old received at least one dose of vaccine, while 51% were fully vaccinated. Sixty-nine percent of residents 16 to 17 years old received at least one dose, and 59% were fully vaccinated.

In K-12 school settings countywide, between August 15 and September 7, 7,784 student cases and 1,250 staff cases were reported, with the vast majority occurring at LAUSD, which tests everyone weekly.

The second highest number of cases came from other K-12 schools in L.A. County. With more than 1.5 million students and 175,000 staff countywide (by last year’s counts), 0.5% of the student body and 0.7% of staff have become infected since school districts reopened.  This is slightly higher than the 0.4% rate of infection experienced overall in the County.

“We support the actions taken by the Los Angeles Unified School District and other schools and school districts to add an additional layer of protection at schools through a sensible school vaccine requirement for eligible students,” said Barbara Ferrer, Director of Public Health.

“Vaccination remains one of the quickest and most powerful ways to decrease community transmission and prevent serious illness, which helps keep students, teachers, and staff in school, and the COVID-19 vaccines have proven to be safe and effective. Public Health will continue to work closely with school districts as they take critical actions to protect students and staff from a dangerous and highly infectious virus,” said Ferrer.

Battle over vaccinations and mask wearing has become so acrimonious in some parts of the country it is not unusual to see fistfights breaking out at school board meetings and law enforcement agencies effecting arrests as those who are adamantly opposed to coronavirus safety protocols protest, sometime violently, measures designed to protect the risk of infection by the COVID-19 virus.

As school boards weigh their options in implementation, in one highly publicized and now viral moment, anti-maskers in Rutherford County Schools in Tennessee at a school board meeting attacked a teen student who had lost a grandparent to the pandemic.

At the White House Thursday, President Joe Biden addressed the nation on his plans to implement plans to address the shortfall in the number of Americans who are vaccinated.

Many of us are frustrated with the nearly 80 million Americans who are still not vaccinated, even though the vaccine is safe, effective, and free,” the President acknowledged. 

This is a pandemic of the unvaccinated.  And it’s caused by the fact that despite America having an unprecedented and successful vaccination program, despite the fact that for almost five months free vaccines have been available in 80,000 different locations, we still have nearly 80 million Americans who have failed to get the shot

And to make matters worse, there are elected officials actively working to undermine the fight against COVID-19.  Instead of encouraging people to get vaccinated and mask up, they’re ordering mobile morgues for the unvaccinated dying from COVID in their communities.  This is totally unacceptable,” Biden argued. 

The President then took direct aim at officials and others who in his eyes who have blocked progress saying; “These pandemic politics, as I refer to, are making people sick, causing unvaccinated people to die.” 

President Joe Biden (Official White House photo by Adam Schultz)

Biden laid out the steps he was going to order to combat the lack of vaccinations in the nation.

I’m announcing that the Department of Labor is developing an emergency rule to require all employers with 100 or more employees, that together employ over 80 million workers, to ensure their workforces are fully vaccinated or show a negative test at least once a week. Some of the biggest companies are already requiring this: United Airlines, Disney, Tysons Food, and even Fox News,” he said.

He announced vaccination requirements for all nursing home workers who treat patients on Medicare and Medicaid and then expanded those requirements to include those who work in hospitals, home healthcare facilities, or other medical facilities –- a total of 17 million healthcare workers.

The President then said he would sign an executive order requiring all executive branch federal employees to be vaccinated as well as another executive order that will require federal contractors to do the same.

As part of his plan Biden said that the Department of Labor will require employers with 100 or more workers to give those workers paid time off to get vaccinated.  “No one should lose pay in order to get vaccinated or take a loved one to get vaccinated,” he said.

The President then noted; “And my message to unvaccinated Americans is this: What more is there to wait for?  What more do you need to see?  We’ve made vaccinations free, safe, and convenient. The vaccine has FDA approval.  Over 200 million Americans have gotten at least one shot.”

We’ve been patient, but our patience is wearing thin.  And your refusal has cost all of us.  So, please, do the right thing.  But just don’t take it from me; listen to the voices of unvaccinated Americans who are lying in hospital beds, taking their final breaths, saying, “If only I had gotten vaccinated.”  “If only,” he said. 

Biden also addressed the future availability of vaccines for children under 12 and schools.

Now, if you’re a parent of a young child, you’re wondering when will it be — when will it be — the vaccine available for them.  I strongly support an independent scientific review for vaccine uses for children under 12.  We can’t take shortcuts with that scientific work

Now to the schools.  We know that if schools follow the science and implement the safety measures — like testing, masking, adequate ventilation systems that we provided the money for, social distancing, and vaccinations — then children can be safe from COVID-19 in schools.

Today, about 90 percent of school staff and teachers are vaccinated.  We should get that to 100 percent.  […] And tonight, I’m calling on all governors to require vaccination for all teachers and staff.  Some already have done so, but we need more to step up,” Biden said.

The President castigated local and state officials he viewed as an impedimentg to winning the fight against the virus;

Let me be blunt.  My plan also takes on elected officials and states that are undermining you and these lifesaving actions.  Right now, local school officials are trying to keep children safe in a pandemic while their governor picks a fight with them and even threatens their salaries or their jobs.  Talk about bullying in schools.  If they’ll not help — if these governors won’t help us beat the pandemic, I’ll use my power as President to get them out of the way. 

The Department of Education has already begun to take legal action against states undermining protection that local school officials have ordered.  Any teacher or school official whose pay is withheld for doing the right thing, we will have that pay restored by the federal government 100 percent.  I promise you I will have your back,” he stated.

Addressing the increasing violence against mask wearing and other simple measures Biden noted;

In addition to testing, we know masking helps stop the spread of COVID-19.  That’s why when I came into office, I required masks for all federal buildings and on federal lands, on airlines, and other modes of transportation,” he said.

Today — tonight, I’m announcing that the Transportation Safety Administration — the TSA — will double the fines on travelers that refuse to mask.  If you break the rules, be prepared to pay.  And, by the way, show some respect.  The anger you see on television toward flight attendants and others doing their job is wrong; it’s ugly,” he added.

 







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