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Report documents abuse of LGBTQ+ asylum seekers in ICE custody

Incidents took place during Biden administration

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Eloy Detention Center, a privately-run ICE detention center in Eloy, Ariz. (Washington Blade photo by Michael K. Lavers)

WASHINGTON — Human Rights First on Thursday released a report that documents the abuse of LGBTQ+ asylum seekers who entered U.S. Immigration and Customs Enforcement custody after President Biden took office.

The report notes an ICE PREA (Prison Rape Elimination Act of 2003) coordinator at the LaSalle ICE Processing Center in Jena, La., in October 2021 “prevented” a Transgender Mexican man “from providing his attorney a draft copy of the complaint he wished to file” after he was sexually assaulted. Several Trans asylum seekers at the same facility said guards “subjected them to transphobic verbal abuse and other mistreatment.”

“A Mexican Transgender man reported that in August 2021 a guard pointed at him and said, ‘How many of them are there? That’s not a real man.’,” reads the report. “Guards intentionally called him ‘ma’am’ and ‘girl’ and used incorrect pronouns despite his repeated attempts to correct them.”

The report notes the U.S. Citizenship and Immigration Service’s Houston Asylum Office last spring “went forward with a CFI (‘credible fear’ interview)” for a gay activist from Angola, “even though he expressed that he was suffering symptoms of COVID-19, pain from a recent physical assault, and psychological distress from conditions of confinement, resulting in a negative credible fear finding.”

“The man told the asylum officer that he was experiencing anxiety and felt claustrophobic in the ‘tight space’ where the telephonic interview was being conducted,” reads the report. “The asylum officer proceeded with the CFI during which the man was unable to disclose that he is gay because he was afraid that the officer would inform others at the detention center of his sexuality.”

“He feared that such disclosure would further endanger his life since in detention he had been threatened and harassed by people who called him homophobic slurs, according to his attorney at the Southeast Immigrant Freedom Initiative,” it adds.

Asylum seekers with HIV denied medication

Pablo Sánchez Gotopo, a Venezuelan man with AIDS, died in ICE custody on Oct. 1, 2021. Sánchez had been in ICE custody at the Adams County Detention Center in Natchez, Miss., before his death.

The report not only mentions Sánchez’s death, but other cases of asylum seekers with HIV/AIDS who said they suffered mistreatment while in ICE custody. One case the report cites is a Cuban asylum seeker who said he was “denied access to HIV medication” while in ICE custody at La Palma Correctional Center in Eloy, Ariz., from April-July 2021.

“Despite sending around nine requests for treatment to medical staff, he reported to his attorney at Immigration Equality that he did not receive HIV medication for at least two-and-a-half months,” reads the report.

The report also documents the prolonged detention of asylum seekers who are LGBTQ+ and/or living with HIV.

Several Trans women from Jamaica who were in ICE custody at La Palma Correctional Center and the Eloy Detention Center in Eloy, Ariz., “were subjected to months of traumatic and unnecessary detention before they received CFIs (‘credible fear’ interviews), which confirmed their fear of persecution.” The report notes ICE did not release a bisexual asylum seeker from Ghana from La Palma Correctional Center last spring until an immigration judge granted him bond, even though he passed his “credible fear” interview.

The report cites a trans asylum seeker from Honduras who the Department of Homeland Security detained at the Otay Mesa Detention Center in San Diego for two months, even though he received an exemption to Title 42 that allowed him into the U.S. last summer.

Title 42 is a Centers for Disease Control and Prevention policy that closed the Southern border to most asylum seekers and migrants because of the pandemic. The Biden administration earlier this month announced it will terminate the policy on May 23.

The report notes a gay asylum seeker from Senegal did not receive his “credible fear” interview until he had been in ICE custody for three months. The report also cites the case of an LGBTQ+ person from Russia who the Department of Homeland Security detained at La Palma Correctional Center, even though he and his partner asked for asylum together at a port of entry in California.

“Under its flawed enforcement priorities, which effectively treat asylum seekers as detention priorities and do not contain exemptions for sexual orientation or gender identity, the Biden administration has detained many LGBTQ asylum seekers for months in ICE detention centers where they are particularly vulnerable to violence,” reads the report.

The report cites studies that indicates detained LGBTQ+ asylum seekers are 97 times “more likely to experience sexual assault and abuse than non-LGBTQ individuals.”

“Transgender people face a high risk of violence, discrimination and medical neglect in ICE detention, which has resulted in multiple recent deaths,” reads the report. “DHS has long recognized that detained LGBTQ people have ‘special vulnerabilities’ based on sexual orientation and gender identity and issued guidance on release of Transgender individuals. Yet despite a February 2021 memorandum committing to ‘protect the human rights of lesbian, gay, bisexual, and Transgender persons everywhere,’ the Biden administration continues to detain LGBTQ people, including asylum seekers who request protection at the border.”

Human Rights Report in its report makes a number of recommendations to the Biden administration, the Department of Homeland Security and Congress.

To the Biden administration:

  • End the mass jailing of asylum seekers and shift to community-based case support programs in cases where such support is needed. Community-based case support programs, which generate high appearance rates, should be used rather than “alternative to detention” programs that resort to punitive and intrusive ankle shackles and electronic surveillance or that amount to house arrest.
  • Do not designate or treat asylum seekers as priorities for detention, enforcement, or other punitive treatment. The administration and DHS should rescind the 2021 enforcement priorities memorandum and replace the policy with a protection framework that designates categories of individuals, including asylum seekers, as priorities for protection.
  • Support legislation, including the Dignity for Detained Immigrants Act, limiting the use of immigration detention and mandating bond redetermination hearings before an immigration judge for anyone subjected to immigration detention.
  • Work with Congress to further reduce funding for immigration detention and to instead fund: case support programs; the cost effective and successful Legal Orientation Program (LOP), which should be expanded to border shelter networks as well as all DHS facilities where asylum seekers are held, including CBP and Border Patrol facilities; and expanded legal representation for asylum seekers and other immigrants.

To the Department of Homeland Security:

  • Apply all applicable parole, bond, and other criteria with a presumption that release of asylum seekers is in the public interest, consistent with U.S. human rights and refugee treaty obligations, including the right to liberty under the ICCPR.
  • Issue parole guidance that includes a presumption that release of asylum seekers serves a significant public interest. The guidance should: apply to all asylum seekers regardless of whether they requested asylum at ports of entry or after entering the United States away from a port of entry and regardless of whether they are subjected to expedited removal; prohibit the use of bond as a condition for release on parole; and make all individuals seeking protection, including those placed in reinstated removal proceedings (which should not be used), eligible for parole consideration under the guidance.
  • Issue regulations that include a strong presumption against the use of detention, shifting the burden of proof to the government instead of the non-citizen in all custody determinations to show by clear and convincing evidence that the non-citizen should remain detained.
  • The Office of Inspector General and Office for Civil Rights and Civil Liberties should closely monitor and investigate allegations of abuse, improper use of force and solitary confinement, detention center conditions, medical neglect, racist treatment, disparate impact on Black asylum seekers in ICE detention facilities. These investigations must include interviews with asylum seekers, attorneys, independent medical experts, rights monitors, and relevant non-governmental actors.
  • ICE and detention facility operators should work with communities to implement Independent Medical Oversight Boards (IMOB) to increase public transparency and accountability on the delivery of quality medical and mental health care for detained individuals. The IMOB should have authority to review individual cases and medical files brought before it by detained individuals, attorneys, or advocates to ensure adequate care. IMOB members could include medical and mental health professionals, representatives of advocacy or community-based groups, and attorneys familiar with detention settings.
  • Avoid the use of the flawed and inefficient expedited removal process and instead refer asylum seekers for asylum adjudication before the USCIS Asylum Office. As Human Rights First and other NGOs have repeatedly explained, these adjudications should not take place within or rely on the expedited removal process.
  • To the extent expedited removal remains in U.S. law, DHS and the Department of Justice should issue regulations to, at a minimum, ensure access to counsel before and during credible fear interviews; provide appropriate interpretation, prohibit CFIs from being conducted in a language other than the asylum seeker’s native or best language, and permit asylum seekers to apply for asylum without a CFI if an interpreter in their native or best language is not readily available; and revise the March 2022 Interim Final Rule to preserve to the fullest extent a critical asylum office mechanism for review of erroneous negative credible fear determinations. DHS should not conduct these flawed interviews in CBP or ICE detention.

To the U.S. Congress:

  • Adopt legislation, including the Dignity for Detained Immigrants Act, limiting the use of immigration detention and mandating bond redetermination hearings before an immigration judge for anyone subjected to immigration detention.
  • Sharply limit funding for immigration detention to decrease its massive overuse and instead fund community-based case support programs, which should be employed only when additional measures are determined necessary to assure appearance in an individual case.
  • Support—along with state, local, and private entities—funding for universal legal representation without any carve-outs. Congress should also expand funding for LOP and improve access to counsel at immigration detention facilities, including by setting requirements for a minimum number of confidential attorney-client visitation rooms by facility capacity and guaranteeing in-person, contact visits for attorney- client meetings.
  • Conduct vigorous oversight on the administration’s compliance with laws, rules, and other authorities that authorize release of eligible asylum seekers from detention; access to counsel in detention; abuse, conditions, racist treatment, and disparate impact of detention on Black asylum seekers; continued violence, mistreatment, and unsafe placements of LGBTQ asylum seekers; unjustified and dangerous use of solitary confinement; and ICE’s failure to comply with necessary medical and mental health care to asylum seekers and immigrants in detention, as provided for by the NDS.
  • Ensure DHS complies with all legal requirements to provide data and information on the detention of asylum seekers, including reporting to Congress mandated by the Haitian Refugee Immigration Fairness Act of 1998. These reports have not been released publicly since the FY 2015 to 2017 reports were obtained through FOIA and posted by Human Rights First.

An ICE spokesperson on Friday in a statement to the Washington Blade responded to the report.

“U.S. Immigration and Customs Enforcement (ICE) focuses its civil immigration enforcement priorities on the apprehension and removal of noncitizens who pose a threat to our national security, public safety and border security,” said the spokesperson. “ICE takes seriously the health, safety, and welfare of those in our care, and commits to protecting their rights under the law.”

“In FY21, ICE shifted its operations away from the detention of families while adapting new and existing detention capacity to address an influx along the Southwest Border,” added the spokesperson. “ICE also previously announced it would discontinue or limit the use of certain detention facilities and will continue to monitor the quality of treatment of detained individuals, the conditions of detention, and other factors relevant to the continued operation of each facility, while assessing its operational needs for detention.” 

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Federal Government

Health & Human Services reverses Trump era anti-LGBTQ+ rule

Public support for nondiscrimination protections for LGBTQ Americans continues at high levels among the American public

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Xavier Becerra is the 25th Secretary of the Department of Health and Human Services and the first Latino to hold the office in the history of the U.S. (Photo Credit: HHS Public Affairs/Facebook)

WASHINGTON – The U.S. Department of Health and Human Services Office for Civil Rights  has issued a final rule on Friday under Section 1557 of the Affordable Care Act (ACA) advancing protections against discrimination in health care prohibiting discrimination on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, gender identity, and sex characteristics), in covered health programs or activities. 

The updated rule does not force medical professionals to provide certain types of health care, but rather ensures nondiscrimination protections so that providers cannot turn away patients based on individual characteristics such as being lesbian, gay, bisexual, transgender, queer, intersex, or pregnant.

“This rule ensures that people nationwide can access health care free from discrimination,” said HHS Secretary Xavier Becerra. “Standing with communities in need is critical, particularly given increased attacks on women, trans youth, and health care providers. Health care should be a right not dependent on looks, location, love, language, or the type of care someone needs.”

The new rule restores and clarifies important regulatory protections for LGBTQ+ people and other vulnerable populations under Section 1557, also known as the health care nondiscrimination law, that were previously rescinded by the Trump administration.

“Healthcare is a fundamental human right. The rule released today restores critical regulatory nondiscrimination protections for those who need them most and ensures a legally proper reading of the Affordable Care Act’s healthcare nondiscrimination law,” said Omar Gonzalez-Pagan, Counsel and Health Care Strategist for Lambda Legal.

“The Biden administration today reversed the harmful, discriminatory, and unlawful effort by the previous administration to eliminate critical regulatory protections for LGBTQ+ people and other vulnerable populations, such as people with limited English proficiency, by carving them out from the rule and limiting the scope of entities to which the rule applied,” Gonzalez-Pagan added. “The rule released today has reinstated many of these important protections, as well as clarifying the broad, intended scope of the rule to cover all health programs and activities and health insurers receiving federal funds. While we evaluate the new rule in detail, it is important to highlight that this rule will help members of the LGBTQ+ community — especially transgender people, non-English speakers, immigrants, people of color, and people living with disabilities — to access the care they need and deserve, saving lives and making sure healthcare professionals serve patients with essential care no matter who they are.”

In addition to rescinding critical regulatory protections for LGBTQ+ people, the Trump administration’s rule also limited the remedies available to people who face health disparities, limited access to health care for people with Limited English Proficiency (LEP), and dramatically reduced the number of healthcare entities and health plans subject to the rule.

Lambda Legal, along with a broad coalition of LGBTQ+ advocacy groups, filed a lawsuit challenging the Trump administration rule, Whitman-Walker Clinic v. HHS,  and secured a preliminary injunction preventing key aspects of the Trump rule from taking effect.

These included the elimination of regulatory protections for LGBTQ+ people and the unlawful expansion of religious exemptions, which the new rule corrects.  The preliminary injunction in Whitman-Walker Clinic v. HHS remains in place.  Any next steps in the case will be determined at a later time, after a fulsome review of the new rule.

Sarah Kate Ellis, CEO and President of GLAAD, released the following statement in response to the news:

“The Biden administration’s updates to rules regarding Section 1557 of the ACA will ensure that no one who is LGBTQI or pregnant can face discrimination in accessing essential health care. This reversal of Trump-era discriminatory rules that sought to single out Americans based on who they are and make it difficult or impossible for them to access necessary medical care will have a direct, positive impact on the day to day lives of millions of people. Today’s move marks the 334th action from the Biden-Harris White House in support of LGBTQ people. Health care is a human right that should be accessible to all Americans equally without unfair and discriminatory restrictions. LGBTQ Americans are grateful for this step forward to combat discrimination in health care so no one is barred from lifesaving treatment.”

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Lambda Legal praises Biden admin’s finalized Title IX regulations

The new policy also reverses some Trump-era Title IX rules governing how schools must respond to sexual harassment & sexual assault

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U.S. Secretary of Education Miguel Cardona (Photo Credit: Office of the U.S. Secretary of Education)

WASHINGTON – The Biden-Harris administration’s revised Title IX policy “protects LGBTQ+ students from discrimination and other abuse,” Lambda Legal said in a statement praising the U.S. Department of Education’s issuance of the final rule on Friday.

Slated to take effect on Aug. 1, the new regulations constitute an expansion of the 1972 Title IX civil rights law, which prohibits sex-based discrimination in education programs that receive federal funding.

Pursuant to the U.S. Supreme Court’s ruling in the landmark 2020 Bostock v. Clayton County case, the department’s revised policy clarifies that discrimination on the basis of sexual orientation and gender identity constitutes sex-based discrimination as defined under the law.

“These regulations make it crystal clear that everyone can access schools that are safe, welcoming and that respect their rights,” Education Secretary Miguel Cardona said during a call with reporters on Thursday.

While the new rule does not provide guidance on whether schools must allow transgender students to play on sports teams corresponding with their gender identity to comply with Title IX, the question is addressed in a separate rule proposed by the agency in April.

The administration’s new policy also reverses some Trump-era Title IX rules governing how schools must respond to reports of sexual harassment and sexual assault, which were widely seen as imbalanced in favor of the accused.

Jennifer Klein, the director of the White House Gender Policy Council, said during Thursday’s call that the department sought to strike a balance with respect to these issues, “reaffirming our longstanding commitment to fundamental fairness.”

“We applaud the Biden administration’s action to rescind the legally unsound, cruel, and dangerous sexual harassment and assault rule of the previous administration,” Lambda Legal Nonbinary and Transgender Rights Project Director Sasha Buchert said in the group’s statement on Friday.

“Today’s rule instead appropriately underscores that Title IX’s civil rights protections clearly cover LGBTQ+ students, as well as survivors and pregnant and parenting students across race and gender identity,” she said. “Schools must be places where students can learn and thrive free of harassment, discrimination, and other abuse.”

Rep. Mark Takano (D-Calif.), a Congressional leader on LGBTQ and education issues, also hailed the finalized rule on Title IX from the Biden Administration:  

The Education Department and Biden Administration showed real courage today, delivering on a long-held promise to ensure that the federal government does more to protect all Americans—especially LGBTQ Americans—from discrimination.  

This groundbreaking rule is a major victory, but we still have much to do. We need to enshrine and expand its protections by passing the Equality Act because for too many Americans, their rights and protections depend on the zip code they live in.   

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Guatemalan LGBTQ+ activist granted asylum in US

Estuardo Cifuentes fled country in 2019

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Estuardo Cifuentes outside a port of entry in Brownsville, Texas, on March 3, 2021, shortly after he entered the U.S. (Photo courtesy of Estuardo Cifuentes)

WASHINGTON — The U.S. has granted asylum to a Guatemalan LGBTQ+ activist who fled his country in 2019.

Estuardo Cifuentes and his partner ran a digital marketing and advertising business in Guatemala City. 

He previously told the Washington Blade that gang members extorted from them. Cifuentes said they closed their business after they attacked them.

Cifuentes told the Blade that Guatemalan police officers attacked him in front of their home when he tried to kiss his partner. Cifuentes said the officers tried to kidnap him and one of them shot at him. He told the Blade that authorities placed him under surveillance after the incident and private cars drove past his home.

Cifuentes arrived in Matamoros, a Mexican border city that is across the Rio Grande from Brownsville, Texas, in June 2019. He asked for asylum in the U.S. based on the persecution he suffered in Guatemala because of his sexual orientation.

The Trump administration forced Cifuentes to pursue his asylum case from Mexico under its Migrant Protection Protocols program that became known as the “remain in Mexico” policy.

Cifuentes while in Matamoros ran Rainbow Bridge Asylum Seekers, a program for LGBTQ+ asylum seekers and migrants that the Resource Center Matamoros, a group that provides assistance to asylum seekers and migrants in the Mexican border city, helped create.

The Biden-Harris administration in January 2021 suspended enrollment in MPP. Cifuentes entered the U.S. on March 3, 2021.

“We are profoundly relieved and grateful that my husband and I have been officially recognized as asylees in the United States,” Cifuentes told the Blade on Monday in an email. “This result marks the end of a long and painful fight against the persecution that we faced in Guatemala because of our sexual orientation.”

Vice President Kamala Harris is among those who have said discrimination and violence based on sexual orientation are among the root causes of migration from Guatemala and other countries in Central America.

Cifuentes is now the client services manager for Lawyers for Good Government’s Project Corazón, a campaign that works “hard to reunite and defend the rights of families impacted by inhumane immigration policies.” He told the Blade he will continue to help LGBTQ+ asylum seekers and migrants.

“In this new chapter of our lives, we pledge to work hard to support others in similar situations and to contribute to the broader fight for the rights and acceptance of the LGBTQ+ migrant community,” said Cifuentes. “We are hopeful that our story will serve as a call to action to confront and end persecution based on gender identity and sexual orientation.”

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FDA planning to lift ban on gay & bi sperm donors

When the FDA releases its draft policy around sperm donation, there will be a public comment period before the regulation is made final

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Los Angeles Blade graphic

By Rob Salerno | WASHINGTON – The Food and Drug Administration is planning to lift its ban on sperm donations from men who have sex with men, according to a report in the Wall Street Journal. The report also says the FDA would simultaneously lift the ban on donations of other tissues and organs from gay and bi men.

The Journal report suggests that the FDA could put out a draft of the new policy for public comment by the summer, with a final rule in place by the end of 2024 or early 2025.

Reached for comment, a spokesperson for the FDA would not confirm the Wall Street Journal story, but acknowledged that, “the FDA routinely reviews approaches regarding donor screening and testing for donors of human cells, tissues, and cellular and tissue-based products (HCT/Ps) to determine what changes, if any, are appropriate based on technological and evolving scientific knowledge.” 

Men who have sex with men have been barred from donating sperm since 2005

The FDA imposed the sperm donation ban on men who have sex with men in 2005, as part of an expansion on existing prohibitions on blood donations from gay and bisexual men which were meant to mitigate the risk that HIV could be spread through donations.

The policies stemmed from an erroneous belief that gay men were more likely to carry HIV, regardless of their individual behaviors and risk factors.

Last year, the FDA finally ended the ban on blood donations from men who have sex with men, which had been in place since the early days of the AIDS crisis. The FDA now requires that blood donors are screened based on individual behaviors in a gender-neutral manner, in addition to the donations themselves being tested for HIV and other blood-borne illnesses.

Alice Ruby, executive director of the Sperm Bank of California in Berkeley, says the lifting of the blood ban should provide a template for ending the sperm ban.

“I’m hoping it’s similar to the blood donation screening, where it’s based on behaviour, rather than being part of a population,” she says. “We test donors repeatedly for HIV as required by the FDA.”

The Sperm Bank of California has served many lesbian, bi, and trans people, and Ruby says that she’s often told her clients would like a queer donor, to ensure that the biological father won’t be someone who disapproves of queer families. The ban removes that choice from would-be mothers.

The Sperm Bank of California has been opposed to the gay sperm donation ban since the policy was first proposed twenty years ago and has advocated in tandem with the National Center for Lesbian Rights for the policy to be scrapped.

“People are pretty unaware that the ban exists. I think there’s a lot of gay men who would be happy to contribute in this way, especially since a large number of people using sperm donation are LGBT couples and single people,” Ruby says.

Sperm banks across the country have been experiencing shortages of donor sperm, especially from donors of color. Opening the donor pool to gay and bi men could help ease the shortage. Ruby has told the Blade that the Sperm Bank of California has had to turn away gay and bi donors every week, up to 400 men in a single year.

When the FDA releases its draft policy around sperm donation, there will be a public comment period before the regulation is made final. Ruby says anyone interested opening up sperm donation to gay and bisexual men should submit a comment to support the change.

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Rob Salerno is a writer and journalist based in Los Angeles, California, and Toronto, Canada.

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Adm. Levine celebrates trans joy on Transgender Day of Visibility

“Transgender medicine is absolutely necessary for transgender and gender diverse people including trans youth”

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Dr. Rachel Levine (Washington Blade photo by Michael Key)

WASHINGTON — The day after Sunday’s Transgender Day of Visibility observance, the Washington Blade connected with Adm. Rachel Levine, a pediatrician serving as assistant secretary of health at the U.S. Department of Health and Human Services.

“Trans joy means authenticity and being comfortable in your own skin and being able to be who you are,” said Levine, who is the highest-ranking transgender official in U.S. history.

“With my transition, I was able to be my authentic self,” she remembers. “At that time, I was still a professor at the Penn State College of Medicine, and an attending physician at the Penn State Hershey Medical Center in pediatrics and adolescent medicine, but then I had this unique opportunity to become the physician general of Pennsylvania for then-Gov. Tom Wolf, and then two and a half years later to become the Secretary of Health.”

“So it has been a tremendous journey, which has been very rewarding,” Levine said, adding that it has been “an honor” to work for the Biden-Harris administration under HHS Secretary Xavier Becerra — all allies of trans, nonbinary, and gender expansive folks and of the LGBTQ community more broadly.

Levine recounted how Transportation Secretary Pete Buttigieg, himself the first openly gay Senate-confirmed Cabinet secretary, had singled her out as one of the administration’s other high-ranking LGBTQ appointees during a 2021 Pride celebration at the White House.

At that moment, President Joe Biden “looked me in the eye and, you know, kind of gestured for me to stand up for the applause,” she remembered, and “I thought that that was just truly meaningful and shows his compassion and his attention to the people working for him and his administration.”

At the same time, Levine’s tenure has, unfortunately, come with bigoted attacks from the likes of U.S. Rep. Marjorie Taylor Greene (R-Ga.), but she said part of trans joy means “we fight hate with love, and we continue to live a life of joy in the face of adversity.”

“For me personally, I am able to compartmentalize those attacks,” she said. “You know, and I’ve learned this in my clinical work as a pediatrician, where, if you are in the emergency department or in the office or in the hospital and you have a very sick patient in front of you, you have to be able to function as a professional and compartmentalize your feelings and then be able to bring them out later and process them.”

Levine explained, “And so it’s the same thing so that if I am attacked, I’m able to compartmentalize any emotions about that and then I work that through with my friends and my family.”

“In addition, though, I’ve also learned the art of sublimation where, you know, the more people attack me, then I’m able to turn that around and it serves as motivation for me to work harder and advocate more.”

Rather than herself, Levine said, “What I worry about are the most vulnerable in our community, who I think it can be very challenging for, particularly in these times, to vulnerable transgender and nonbinary youth, their families, and even their medical providers in many states across the country.”

Levine shared her thoughts about the public’s eroding faith in science, medicine, and institutional expertise — themes that often arise in the context of debates over gender affirming healthcare, as guideline-directed and medically necessary interventions that are supported by every mainstream medical society have come under fire from right-wing politicians.

“There is a lot of misinformation and overt disinformation about transgender medicine,” she said. “You know, transgender medicine is an evidence-based standard of care, which continues to benefit from continued research and evolution from, you know, standards 10 or more years ago to the current standards now published.”

Levine added, “Transgender medicine is absolutely necessary for transgender and gender diverse people including youth — and transgender medicine is medical care, but it’s also mental health care, and it’s literally suicide prevention care” that has “been shown in study after study to improve the quality of life and can literally save lives.”

Transgender medicine “for young people [is often] conducted at many of our nation’s expert children’s hospitals,” Levine said. “Let me put it this way: if you have a child with a fever, you would take your child, perhaps, to a pediatrician. If they had severe diabetes, you would take them to a pediatric endocrinologist. If they had a mental health condition, you might take them to a child psychiatrist or psychologist.”

“So,” she said, “if you have a child with gender questions or gender issues then you’re going to take them to the pediatric and adolescent gender specialist, and it’s often a team — including the same endocrinologist and it might be the same psychiatrist or psychologist.”

“You’re not going to think, ‘oh, I’m going to call my state legislator.’”

Nevertheless, Levine said, “These issues have been politicized for political and ideological reasons” over the objections of physicians like Jesse Ehrenfeld, president of the American Medical Association, who during a panel discussion with Levine for the PFLAG National convention in November, agreed that politicians should not get between patients, their families, and their healthcare providers.

“We see other areas where there’s misinformation and disinformation,” Levine said, perhaps partly a consequence of the politicization of the public health response to the COVID pandemic, which has led to vaccine hesitancy for COVID as well as childhood immunizations.

Ultimately, she said, “physicians and other medical and public health professionals are trying to help people,” which is “what I tried to do when I was in academic medicine” where “I really worked to help people, the patients and families that I saw as well as teaching as well as clinical research — and I think, overall, that’s what most physicians and medical professionals and public health professionals are doing.”

Exciting work ahead at HHS

When it comes to the work in which her agency is engaged, Levine said “health equity is fundamental to everything that we’re doing at HHS under Secretary Becerra and so many of our key policy initiatives relate to health equity.”

“So,” she said, “that includes health equity for the LGBTQI+ community, working to end the HIV epidemic in the United States with a focus on health equity, working to safeguard LGBTQI+ youth from the harms of conversion therapy, promoting data equity for our community, SAMHSA’s work on on conversion therapy, ARC’s work in terms of a sample patient intake form to improve the patient care experience for LGBTQI+ people, and more.”

“We have an office of climate change and health equity with a sister office of environmental justice,” Levine added. “We’re working on health equity in terms of reproductive health and reproductive rights, in the face of the Dobbs decision,” which revoked the constitutional right to abortion.

“We’re working in terms of health equity in regards to food and nutrition,” she said, “in terms of long COVID, and more.”

As with many initiatives under Biden’s presidency, “There is a tremendous emphasis on breaking down silos within divisions at HHS and between departments,” Levine said.

She shared a few examples: “One is our work on long COVID. We have an office of long COVID research and practice, which is really working across the administration with that whole of government approach. Another is in terms of our work on climate change and health equity with the EPA, and the White House Climate Council.”

“And then another actually would be our work on syphilis,” Levine said. “We run — and I chair — a syphilis and congenital syphilis federal government task force, which includes all the divisions at HHS, but also includes the VA and the Department of Defense, trying to address the significant increases in syphilis and congenital syphilis that we’ve seen the United States.”

And then, “Another example within the LGBTQ space is a global interagency action plan about conversion therapy, which includes HHS, the Department of State, the Department of the Treasury, and USAID.”

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National Security Council meets with Ugandan LGBTQ activist

Mugisha, who is gay, is one of the most prominent LGBTQ advocates in Uganda, winning the Robert F. Kennedy Human Rights Award

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Sexual Minorities Uganda Executive Director Frank Mugisha (Washington Blade photo by Michael K. Lavers)

WASHINGTON — The U.S. National Security Council met with Ugandan LGBTQ rights activist Frank Mugisha on Monday, according to a spokesperson who reaffirmed America’s opposition to civil rights abuses against LGBTQ people in the East African country.

Last year, Uganda passed the Anti-Homosexuality Act, a law that criminalizes, with prison sentences, identifying as gay or lesbian and imposes the death penalty for “aggravated homosexuality.”

The Biden-Harris administration has repeatedly denounced the legislation and called for its repeal.

“There have been increased reports of evictions, vigilante attacks, and police harassment, abuse, and detainment of individuals who are or are perceived to be LGBTQI+, including reports of the Ugandan police subjecting individuals to forced anal examinations – an abusive, degrading practice that serves no investigative or public health purpose,” the White House wrote in a December 2023 fact sheet.

In a post on X about the meeting with Mugisha, Adrienne Watson, special assistant to the president and National Security Council senior director for press and spokesperson, wrote that the “United States continues to have zero tolerance for any form of discrimination or harmful activities.”

Mugisha, who is gay, is one of the most prominent LGBTQ advocates in Uganda, winning the Robert F. Kennedy Human Rights Award and Thorolf Rafto Memorial Prize for his work in 2011. He was nominated for a Nobel Peace Prize in 2014.

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EXCLUSIVE: USAID LGBTQ+ coordinator visits Uganda

Jay Gilliam met with activists, community members from Feb. 19-27

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U.S. Agency for International Development Senior LGBTQI+ Coordinator Jay Gilliam (Photo courtesy of USAID)

WASHINGTON — U.S. Agency for International Development Senior LGBTQI+ Coordinator Jay Gilliam last month traveled to Uganda.

Gilliam was in the country from Feb. 19-27. He visited Kampala, the Ugandan capital, and the nearby city of Jinja.

Gilliam met with LGBTQ+ activists who discussed the impact of the Anti-Homosexuality Act, a law with a death penalty provision for “aggravated homosexuality” that President Yoweri Museveni signed last May. Gilliam also sat down with USAID staffers.

Gilliam on Wednesday during an exclusive interview with the Washington Blade did not identify the specific activists and organizations with whom he met “out of protection.” 

“I really wanted to meet with community members and understand the impacts on them,” he said.

Consensual same-sex sexual relations in Uganda were already criminalized before Museveni signed the Anti-Homosexuality Act. Gilliam told the Blade he spoke with a person who said authorities arrested them at a community meeting for mental health and psychosocial support “under false pretenses of engaging in same-sex relations and caught in a video that purportedly showed him.” 

The person, according to Gilliam, said authorities outed them and drove them around the town in which they were arrested in order to humiliate them. Gilliam told the Blade that prisoners and guards beat them, subjected them to so-called anal exams and denied them access to antiretroviral drugs.

“They were told that you are not even a human being. From here on you are no longer living, just dead,” recalled Gilliam.

“I just can’t imagine how difficult it is for someone to be able to live through something like that and being released and having ongoing needs for personal security, having to be relocated and getting support for that and lots of other personal issues and trauma,” added Gilliam.

Gilliam said activists shared stories of landlords and hotel owners evicting LGBTQ+ people and advocacy groups from their properties. Gilliam told the Blade they “purport that they don’t want to run afoul of” the Anti-Homosexuality Act.

“These evictions really exacerbate the needs from the community in terms of relocation and temporary shelter and just the trauma of being kicked out of your home, being kicked out of your village and having to find a place to stay at a moment’s notice, knowing that you’re also trying to escape harm and harassment from neighbors and community members,” he said.

Gilliam also noted the Anti-Homosexuality Act has impacted community members in different ways.

Reported cases of violence and eviction, for example, are higher among gay men and Transgender women. Gilliam noted lesbian, bisexual and queer women and Trans men face intimate partner violence, are forced into marriages, endure corrective rape and lose custody of their children when they are outed. He said these community members are also unable to inherit land, cannot control their own finances and face employment discrimination because of their sexual orientation or gender identity.  

US sanctioned Ugandan officials over Anti-Homosexuality Act

The U.S imposed visa restrictions on Ugandan officials shortly after Museveni signed the law. The World Bank Group later announced the suspension of new loans to Uganda.

The Biden-Harris administration last October issued a business advisory that said the Anti-Homosexuality Act “further increases restrictions on human rights, to include restrictions on freedoms of expression and peaceful assembly and exacerbates issues regarding the respect for leases and employment contracts.” The White House has also removed Uganda from a program that allows sub-Saharan African countries to trade duty-free with the U.S. and has issued a business advisory for the country over the Anti-Homosexuality Act. 

Secretary of State Antony Blinken on Dec. 4, 2023, announced sanctions against current and former Ugandan officials who committed human rights abuses against LGBTQ+ people and other groups. Media reports this week indicate the U.S. denied MP Sarah Achieng Opendi a visa that would have allowed her to travel to New York in order to attend the annual U.N. Commission on the Status of Women.

Museveni, for his part, has criticized the U.S. and other Western countries’ response to the Anti-Homosexuality Act. 

Gilliam noted authorities have arrested and charged Ugandans under the law. 

Two men on motorcycles on Jan. 3 stabbed Steven Kabuye, co-executive director of Coloured Voice Truth to LGBTQ+ Uganda, outside his home while he was going to work. The incident took place months after Museveni attended Uganda’s National Prayer Breakfast at which U.S. Rep. Tim Walberg (R-Mich.) spoke and defended the Anti-Homosexuality Act.

The State Department condemned the attack that Kabuye blamed on politicians and religious leaders who are stoking anti-LGBTQ+ sentiments in Uganda. Gilliam did not meet with Ugandan government officials while he was in the country.

“We in the U.S. government have already made it clear our stance with government officials on how we feel about the AHA, as well as broader human rights concerns in country,” said Gilliam. “That’s been communicated from the very highest levels.”

The Uganda’s Constitutional Court last Dec. 18 heard arguments in a lawsuit that challenges the Anti-Homosexuality Act. It is unclear when a ruling in the case will take place, but Gilliam said LGBTQ+ Ugandans with whom he met described the law “as just one moment.” 

“Obviously there is lots of work that has been done, that continues to be done to respond to this moment,” he told the Blade. “They know that there’s going to be a lot of work that needs to continue to really address a lot of the root causes and to really back humanity to the community.” 

Gilliam further noted it will “take some years to recover from the damage of 2023 and the AHA (Anti-Homosexuality Act) there.” He added activists are “already laying down the groundwork for what that work looks like” in terms of finding MPs, religious leaders, human rights activists and family members who may become allies.

“Those types of allyships are going to be key to building back the community and to continue the resiliency of the movement,” said Gilliam.

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Federal Government

Senate confirms Sean Patrick Maloney as next OECD ambassador

Former N.Y. congressman lost to Mike Lawler in 2022

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Former New York Congressman Sean Patrick Maloney (Washington Blade photo by Michael Key)

WASHINGTON — The U.S. Senate on Tuesday confirmed former New York Congressman Sean Patrick Maloney to become the next American ambassador to the Organization for Economic Cooperation and Development.

Maloney, the former chair of the Democratic Congressional Campaign Committee who was also former President Bill Clinton’s White House staff secretary, in 2012 became the first openly gay person elected to Congress from New York. Maloney in 2022 lost to now U.S. Rep. Mike Lawler (R-N.Y.) after the state redrew its congressional districts. 

Biden last May nominated Maloney for the ambassadorship. The Senate approved it by a 63-31 vote margin.

“Thank you, all,” said Maloney in a short X post after the vote.

Michael Carpenter, the current U.S. ambassador to the OECD, is gay.

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Federal Government

VA expands IVF to cover same-sex couples, single veterans

About 2 million LGBTQ veterans are served by the VA, a number that is expected to “substantially increase in this decade”

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U.S. Department of Veterans Affairs Secretary Denis McDonough (Screen capture/YouTube)

WASHINGTON – The U.S. Department of Veterans Affairs will cover in-vitro fertilization treatments for same-sex couples and single veterans, the agency announced on Monday — a move that comes after lawsuits last year claiming that its policy of only treating legally married partners who could produce their own eggs and sperm was discriminatory.

The department said the change is expected to take effect in coming weeks, with Secretary Denis McDonough pledging to implement the new policy as soon as possible.

“Raising a family is a wonderful thing, and I’m proud that VA will soon help more veterans have that opportunity,” he said. “This expansion of care has long been a priority for us, and we are working urgently to make sure that eligible unmarried veterans, veterans in same-sex marriages and veterans who need donors will have access to IVF in every part of the country as soon as possible.”

Out in National Security, a nonprofit dedicated to serving and empowering queer national security professionals, celebrated the VA’s announcement in a press release proclaiming that “five years of ONS efforts have delivered.”

The group noted that about 2 million LGBTQ veterans are served by the VA, a number that is expected to “substantially increase in this decade.”

Also on Monday, the Defense Department announced its expansion of IVF eligibility requirements, which will now cover assisted reproductive technology for active-duty troops and their spouses, partners, or surrogates.

DoD will allow these service members to “use donor gametes (sperm, egg, or both) and embryos when procured at their own expense.”   

“We continue to identify ways to lean forward as much as we can in support of equity of access to reproductive health care for our service members,” said Kimberly Lahm, a program director in the Office of the Deputy Assistant Secretary of Defense for Health Affairs for Health Services Policy and Oversight.

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Federal Government

HHS smoking cessation framework focused on ‘most vulnerable’

Evidence suggests LGBTQ smokers may also less likely to call tobacco quitlines, & fewer are using counseling or smoking-cessation medications

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U.S. Department of Health and Human Services Secretary Xavier Becerra at 2023 HHS Pride Summit (Screen capture/YouTube HHS)

WASHINGTON — The U.S. Department of Health and Human Services introduced a new 28-page Framework to Support and Accelerate Smoking Cessation on Friday, an effort to support the Biden-Harris administration’s Cancer Moonshot, which aims to cut cancer-related deaths by at least 50 percent over 25 years.

“This framework focuses on advancing equity, engaging communities, and coordinating, collaborating, and integrating evidence-based approaches across every facet of our government and society,” HHS Secretary Xavier Becerra said in a press release.

“The Biden-Harris Administration will continue these efforts,” he said, “until smoking is no longer the leading cause of preventable death in the United States, and the communities that remain the most vulnerable get the help they need.”

The Department’s assistant secretary for health, Adm. Rachel Levine, said “Today’s announcement marks an important milestone reaffirming our commitment to helping people who smoke to quit by working to maximize their access to and awareness of evidence-based interventions and programs.”

According to the Centers for Disease Control and Prevention, which is a division of HHS, about 15.3 percent of lesbian, gay, and bisexual adults smoke cigarettes, a figure that is “much higher” than the 11.4 percent of heterosexual adults who do. Lesbian, gay, and bisexual middle and high school aged youth are also likelier to smoke than their straight counterparts.

Additionally, a 2017 study in the American Journal of Preventative Medicine found that 39.7 percent of transgender adults reported using cigarettes, cigars, or e-cigarette products in the last 30 days, and use of e-cigarettes is four times higher compared to use by cisgender adults.

As a result, the CDC reports that LGBTQ people “have more risk factors for cardiovascular (heart and blood vessel) disease – like high blood pressure – than straight adults.”

The agency warns that “if you are part of the LGBTQ+ community, you likely have seen tobacco ads in magazines, newspapers, and websites directed at you” because “Tobacco companies are focusing their advertising on your communities.”

Evidence suggests LGBTQ smokers may also less likely to call tobacco quitlines, and fewer are using counseling or smoking-cessation medications.

HHS’s framework document also notes the disparities cigarette smoking among LGBTQ adults, along with other populations who are likelier to smoke including Black men, blue collar or service industry workers, and adults living in rural areas.

The authors also highlight, in a list of existing HHS programs and activities for smoking cessation, the CDC’s National Networks Driving Action: Preventing Tobacco- and Cancer-Related Health Disparities by Building Equitable Communities.

The program “funds a consortium of national networks to advance the prevention of commercial tobacco use and cancer in populations experiencing tobacco- and cancer related health disparities” and lists LGBTQ people among the “focus population groups.”

According to the HHS press release, “The Framework is organized around six goals that serve as a foundation for long-standing HHS efforts to support and promote smoking cessation”:

  1. Reduce smoking- and cessation-related disparities.
  2. Increase awareness and knowledge related to smoking and cessation.
  3. Strengthen, expand, and sustain cessation services and supports.
  4. Increase access to and coverage of comprehensive, evidence-based cessation treatment.
  5. Advance, expand, and sustain surveillance and strengthen performance measurement and evaluation.
  6. Promote ongoing and innovative research to support and accelerate smoking cessation.
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