National
Tom Gallagher, U.S. Foreign Service officer, dies at 77
Longtime LGBT rights advocate came out publicly in 1975

Tom Gallagher
Tom Gallagher, who became the first known U.S. Foreign Service officer to come out as gay in 1975 and who switched careers to become a social worker before returning to the Foreign Service in 1994, died July 8 in his hometown of Tinton Falls, N.J. from complications associated with a bacterial infection. He was 77.
In a write-up of his life and career that he prepared shortly before his passing and in an earlier interview published in the online publication Slate, he said he decided to disclose his sexual orientation at a 1975 conference in Washington, D.C., organized by the then Gay Activists Alliance called Gays and the Federal Government.
Knowing the disclosure would jeopardize his then 10-year career at the State Department and Foreign Service, he decided to come out because he became tired of having to conceal the truth of who he was, he recounted in the interview.
One year later, in 1976, after he determined longstanding policies making it difficult if not impossible for gays working in the Foreign Service to retain their required security clearances, he resigned and moved to California, where he began a new career as a social worker
His biographical write-up says he was born Sept. 11, 1940 in Manhattan before his family moved to New Jersey. He graduated from Holy Spirit School and Red Bank Catholic High School in Asbury Park, N.J. before entering New Jersey’s Monmouth University, where he received a bachelor’s degree in 1962.
Five days after graduating from Monmouth he signed up as a Peace Corps volunteer and entered the first Peace Corps group to go to Ethiopia, his biographical write-up says. After completing a Peace Corps training program at Georgetown University he and his group of volunteers were invited to the White House, where President John F. Kennedy and first lady Jacqueline Kennedy hosted a send-off tea party.
According to his write-up, upon their arrival in Addis Ababa, Ethiopia, the Peace Corps group was welcomed by Emperor Haile Selassie, the country’s monarch and leader. A month after arriving in the city of Agordot for his assignment to teach a seventh grade history class, Gallagher recounted he heard the “first shot” of what became the province of Eritrea’s protracted war of independence.
His write-up says he “remained devoted to Eritrea and its people for the rest of his life” and “sixty years after leaving the Peace Corps Tom was still in touch with 13 of the 80 boys he taught in Agordot.”
Upon returning to the U.S. he began his first full salaried job at the White House where he worked for President Lyndon Johnson’s War on Poverty program. It was at that time that he met Carolyn Worrell, the bright young woman also interested in foreign affairs whom he married a short time later.
In his Slate interview with freelance journalist Jacqui Shine he said he believed he was in love with Worrell at a time when he was struggling within himself to fight what he always knew deep inside himself – that he liked men. He had “fooled around with boys” since he was a teenager growing up on the New Jersey shore, he said in the interview.
Gallagher began his first stint in the Foreign Service in 1965, with his first overseas assignment sending him to Jidda, Saudi Arabia.
Subsequent assignments took him to Nigeria and Ecuador, where he served as acting U.S. Consul General in the city of Guayaquil, becoming, at age 34, the youngest ever chief of a major U.S. diplomatic mission. He later returned to Washington where he served in various positions at the State Department headquarters before coming out at the gay conference.
In 1970, shortly after completing his tour in Nigeria, he told his wife he wanted a divorce and arranged for the couple to stay together until Worrell found a job with a federal agency and got “settled,” he said in the Slate interview. It wasn’t until years later that he told his then ex-wife that the marriage breakup was due to his struggle with his sexual orientation, he said in the interview.
Meanwhile, after resigning from the Foreign Service in 1976 he moved to California and underwent training to become a social worker. A short time later he began work in the first of a number of positions, including a post as an emergency room social worker at UCLA Hospital in Los Angeles. He also volunteered as director of counseling programs at the Gay Community Services Center in LA.
Other positions he held included supervisor for the Travelers Aid Society in San Francisco; director of a Napa County, Calif., psychiatric emergency program; and as a volunteer for AIDS programs in the state.
In 1994, when President Bill Clinton removed policies preventing gays from working in the Foreign Service, Gallagher returned to his earlier career as a Foreign Service officer, his write up says. His first assignment was that of the position of American Consul at the U.S. Embassy in Madrid, Spain. While holding that post Gallagher helped raise $3 million for the Spanish AIDS Foundation.
Following his post in Spain he was appointed as Country Officer for Eritrea and Sudan in the State Department’s Office of East African Affairs. In 1999, he became head of the visa section at the U.S. Embassy in Brussels, where he was credited with refusing a visa for a radical Moroccan who was linked to a terrorist organization considering a plot to spray poison on a U.S. city, according to his biographical write-up.
The write-up says he next returned to Washington and worked at the State Department’s Office of Central African Affairs where he served as Country Officer for the Republic of the Congo. His final tour at the State Department was with the Office of International Health, where he served as Regional Advisor for Europe and worked on an international AIDS program.
After retiring in 2005, Gallagher continued to take on short tours for the State Department including assignments at 17 embassies and consulates on five continents, the write-up says. He also taught a course on the Middle East as an Adjunct Professor of Political Science at Monmouth University.
In 2012, during an event at the State Department celebrating the 20th anniversary of the State Department’s LGBT employee group, to which Gallagher was invited, then Secretary of State Hillary Clinton talked about Gallagher’s role in advocating for LGBT equality when he came out as a Foreign Service officer in 1975.
“I don’t want any of you who are a lot younger ever to take for granted what it took for people like Tom Gallagher to pave the way for all of you,” Clinton told the gathering. “It’s not a moment to be nostalgic,” she said. “It’s a moment for us to remember and to know that all of the employees who sacrificed their right to be who they are were really defending your rights and the rights and freedoms of others at home and abroad.”
Shine, who conducted the Slate interview, said she got to know Gallagher when she interviewed him for another story about three years ago.
“I was very fond of Tom, who was very funny, sweet, and a hell of a storyteller,” she told the Washington Blade. “He was as astonished as anyone by the extraordinary turns his life took, and humbled by and grateful for all he experienced.”
Gallagher is survived by his former wife, Carolyn Worrell, who is now a judge in Nevada; and his husband, Amin Dulgumoni, a senior software engineer at Goldman Sachs.
Plans for a memorial were expected to be announced soon.
Florida
For LGBTQ youth starting with nothing, Pride House in Florida offers help
Many residents aged out of foster care or were kicked out by parents
Economic mobility usually assumes a starting line: a bedroom to return to, a parent to call, a place to regroup after things go wrong. For many LGBTQ young adults in South Florida, that starting line never existed.
That’s why Our Fund Foundation, SunServe, and Sunshine Cathedral partnered to build Sunshine Pride House, a 12-bed transitional home helping LGBTQ young adults stabilize, find work, and prepare for independence.
For the residents who live there, that support shows up in small, ordinary ways.
In the evenings, the house settles into a rhythm: dinner prep, shared chores, quiet conversations at the kitchen counter. As house mother, Martha Acevedo anchors the day-to-day life of Sunshine Pride House, creating a sense of consistency many residents have never known. A few nights a week, she cooks home-prepared meals, often inviting residents to join her in the kitchen — chopping, stirring, learning by doing.
For some, the meal itself is the moment that lands hardest.
“Some of them tell me they haven’t had a cooked meal in such a long time,” Acevedo said. “When I serve the food and they say ‘thank you,’ you can see it. They’re kids. They just needed a home.”
Acevedo says the reactions still catch her off guard. What feels routine to her — cooking, setting plates, sitting down together — can feel extraordinary to young people who have spent months or years without a consistent place to eat.
“When I cook, I do it proudly,” she said. “I give a lot of love.”
According to research from The Trevor Project, 28% of LGBTQ youth have experienced homelessness or housing instability at some point in their lives. Data from True Colors United underscores the scale of the disparity — LGBTQ youth are 2.2 times more likely to experience homelessness than non-LGBTQ youth.
“So these kids are coming to the house because they’ve either aged out of foster care or they’ve been kicked out of their homes because they’re LGBTQ,” said Tony Lima, CEO of SunServe. “You kind of have to start from zero. That’s the common theme of all of these youth.”
Those experiences carry lasting consequences: LGBTQ youth who have been unhoused report significantly higher rates of depression, anxiety, and other mental health challenges than their housed peers.
“In order to have proper mental health, that’s conducive to living a full life, you need to have a home,” Lima said. “You need to have a place to be able to rest your head.”
That reality isn’t unique to LGBTQ youth, though queer young people are far more likely to experience it — and far less likely to have family support to fall back on.
Elijah Manley’s experience with homelessness began during the 2008 financial crisis, when he was about 9 years old. After his single mother lost her job, his family was evicted and spent years cycling through instability — living in their car, rotating between friends’ homes, staying in an overcrowded apartment with relatives, and at one point sleeping in a storage unit in Lauderhill. Each morning, Manley and his siblings woke before dawn to shower at beach facilities before heading to school, trying to maintain a sense of normalcy without a permanent home.
Manley, who is now 27, was not yet out as queer during this period, and his homelessness was driven by economic collapse rather than family rejection. Still, he says the experience shows how early housing instability — regardless of cause — can derail childhood, education, and long-term opportunity. His family’s situation improved only gradually, and he credits a mix of early work, community connections, and “a little luck” for eventually finding stability — a path he notes many others never get.
Today, Manley points to LGBTQ nonprofits like SunServe as essential lifelines — especially for young people who face both economic instability and identity-based rejection.
“They’re very vital and lifesaving. Without them, a lot of people would be in a much worse situation,” he said. “They keep our communities housed and fed and connected to the social services and healthcare they need. They’re filling a void the government hasn’t filled.”
Manley, who has run for public office several times and is currently running for Congress to represent Florida’s 20th district in West Broward, argues that relying on private charity to fill that void leaves too many people behind.
“These are services the government should be providing or supporting,” he said. “Charity should not be public policy. It should be provided to everybody, regardless of their income, and not dependent on somebody else’s charity.”
Housing is Just The Starting Point
For now, Sunshine Pride House exists largely because private donors stepped in where public dollars did not. While public agencies can and do fund programs that reach LGBTQ people, government funding is often constrained by nondiscrimination and open-access requirements that make it difficult to support services explicitly limited to a single identity group.
The home is owned by Sunshine Cathedral, while SunServe runs the day-to-day programming and services inside. With no state or federal grants tied to the house itself, its roughly $250,000 annual operating budget is raised through individual donors and philanthropic partners, coordinated in large part through Our Fund Foundation.
“There’s no way to do this work without being clear about the population we’re serving — and that cuts off a lot of funding possibilities,” said David Jobin, CEO of Our Fund.
The funding covers housing, staffing, life coaching, and wraparound support — allowing the program to exist in a policy environment where targeting services to LGBTQ youth often disqualifies programs from public dollars altogether.
The idea for Sunshine Pride House began not as a programmatic expansion, but as a personal intervention. More than five years ago, philanthropist Michael Kalb approached Our Fund Foundation with a simple question: what would it take to create a safe, stable home for LGBTQ young people who had nowhere else to go?
Kalb had been deeply affected after witnessing unhoused youth being mocked in public spaces, and he believed housing could change the entire trajectory of a young person’s life. Working closely with Jobin, that initial conversation grew into a multi-year effort to design a model tailored specifically to South Florida’s LGBTQ youth.
“People hear ‘housing’ and think that’s the solution, but housing is just the starting point,” Jobin said.
Kalb ultimately invested more than $600,000 into the project, joined by fellow donor Terry Merlin, while Our Fund helped assemble the partnerships needed to make it work. Sunshine Cathedral agreed to purchase and own the property, drawing on its decades of experience managing community housing, while SunServe took on day-to-day operations and services inside the home. What opened first as a pilot in a rented house evolved into the current 12-bed facility — now fully owned, privately funded, and operating as one of the only LGBTQ-specific transitional housing programs in the region.
“If we want to continue to bring these services to life, that requires funding — and we’re really going to need help to do that,” said John Marler, Communications Director of SunServe. “Government funding has been harder and harder to come by, and foundation funding and corporate sponsorships are becoming more competitive.”
Kalb, who died unexpectedly in December, often said a safe place allows young people to “finally exhale,” and Sunshine Pride House stands as a direct reflection of that belief.
The structure of Sunshine Pride House reflects that focus on stability first, mobility second. The home is designed as short-term transitional housing rather than a permanent shelter.
They Have Nowhere Elsewhere to Go
For Mario DePedro, who helps oversee the program, the work often means stepping into roles most parents fill by default.
“We have youth who are just leaving home for the first time and their parents don’t support them. They have nowhere else to go. Now it’s up to us to take the place of what the parent should be,” he said.
Inside the house, residents share bedrooms and follow a structured daily routine. They are required to work or attend school, participate in therapy, and meet regularly with life coaches who help them set goals.
“We call it a future plan. We’re helping them with the goals they want to reach, so they can be successful in their life,” he said.
That plan can include finishing high school, enrolling in college, securing steady employment, learning financial literacy, or preparing for independent housing.
Many residents arrive carrying layers of trauma that extend far beyond the moment they lost housing.
“They’re coming from a lot of trauma,” DePedro said. “Being kicked out at 18 usually isn’t the first trauma — there’s often a cycle of abuse that leads up to that moment.”
For residents who began adulthood without savings, family support, or stable housing, that planning process can be the difference between cycling back into crisis and building a path toward long-term economic stability.
“They need jobs. They need mental health care. And they need community — they want to feel like they’re not alone in it,” he said.
The needs are immediate and interconnected. That’s why the house is built around flexibility rather than rigid benchmarks.
“This is absolutely not one-size-fits-all. Everything we do is client-centered and client-led,” DePedro said. “The reality is that we’re saving kids’ lives in this house. These are people who have nowhere else to go.”
Because of safety concerns, the location of Sunshine Pride House is not publicly disclosed, and residents are not identified.
“We’re really putting young people on a path for success that they might not otherwise achieve in their life without this lift,” said Jobin. “You hear the words ‘Pride House’ and you think it’s just a roof. But it’s the wraparound services that put young people on trajectories for successful lives.”
Instead of starting a new nonprofit, Jobin said the foundation focused on partnering with organizations already doing the work — bringing together SunServe, Sunshine Cathedral, and others to build a model that could move quickly and last.
Sunshine Pride House doesn’t promise transformation or guarantee success. What it offers is something far more basic — time, safety, and a place to rest their head. For young people who started adulthood with nothing, that pause can be enough to change what comes next.
(Editor’s note: This article is part of a national initiative exploring how geography, policy, and local conditions influence access to opportunity. Find more stories at economicopportunitylab.com.)
National
New data shows record-high LGBTQ population amid Trump attacks
12% of adults — 25.6 million people — identify as part of the community
The Human Rights Campaign Foundation (HRC Foundation), the public education, research, and policy arm of the Human Rights Campaign, the largest LGBTQ+ advocacy group in the United States, has released new data showing that there are more LGBTQ+ identifying people than ever before, just as the Trump administration continues efforts to minimize LGBTQ+ rights and visibility.
The data, released late last week, includes a multitude of updated population estimates for LGBTQ+ identifying people in the United States. It shows that a record-high 12% of U.S. adults — roughly 25.6 million people — identify as lesbian, gay, bisexual, transgender, or gender diverse.
The numbers were drawn from more than 2.4 million responses to the U.S. Census Bureau’s Household Pulse Survey collected between 2021 and 2024. The Household Pulse Survey is one of the last major federal data sources to include a gender identity measure before the Trump administration removed sexual orientation and gender identity questions from roughly 360 federal data collections.
HRC President Kelley Robinson spoke about the data, emphasizing that it shows not only that the LGBTQ+ community is bigger than the Trump administration would have Americans believe, but that LGBTQ+ Americans continue to be targeted for no reason other than being different.
“LGBTQ+ Americans are everywhere. There are 25 million of us across the country, and we now have critical mass in almost every state in the nation,” Robinson said in a statement. “We’re not a niche constituency, and no campaign, brand, or employer can afford to treat us like one.”
The survey also collected other important information about LGBTQ+ Americans.
40: The number of states with an LGBTQ+ population greater than 10%, plus the District of Columbia. This includes electoral battleground states such as Arizona (13.34%), Georgia (11.46%), Michigan (10.95%), New Hampshire (11.88%), North Carolina (10.56%), Ohio (11.29%), Pennsylvania (11.14%), and Texas (12.54%).
25.6 million: Number of U.S. adults who identify as LGBTQ+.
12% : Percentage of the adult population who identify as LGBTQ+.
More than half of all LGBTQ+ adults (53.8%) are between 18 and 34 — a signal of sustained, long-term growth in political and economic power as this generation ages into peak spending and voting years.
Other recent studies show that nearly 30% of the adult Gen Z population identifies as LGBTQ+.
The data also shows growing diversity across the community. Hispanic adults make up a larger share of the LGBTQ+ population (18%) than of non-LGBTQ+ adults (13%). Black adults make up a smaller share, about 9%, compared to 12%, reinforcing that LGBTQ+ identity cuts across every racial and ethnic community.
Bisexual+ people are the largest group, at over 7% of all U.S. adults.
Tari Hanneman, HRC Foundation’s senior director of research and education, spoke about how the White House’s recent decision to remove LGBTQ-specific data questions from federal surveys undermines the purpose of federal data collection: to collect data that accurately reflects the U.S. population, regardless of political ideology.
“Reliable data are essential for understanding who lives in this country and what our communities need to thrive,” Hanneman said. “Removing sexual orientation and gender identity questions from surveys like the one used for this analysis introduces significant gaps in this understanding. These findings show that LGBTQ+ people are a substantial and growing segment of the population, underscoring the need for our continued inclusion in data collection efforts.”
The data also included key demographics about the age of LGBTQ+ people, showing that younger Americans are increasingly more likely to identify as LGBTQ+, while overall, all age groups saw an increase in people self-identifying as LGBTQ+ in the data.
More than half of LGBTQ+ adults (approximately 54%) are younger than 35, compared with about 22% of non-LGBTQ+ adults. Adults ages 25–34 constitute roughly one-third of the LGBTQ+ adult population.
The data also shows a similar generational pattern within age groups. Nearly 32% of adults ages 18–24 and 22% of adults ages 25–34 identify as LGBTQ+, compared with approximately 12% of adults ages 35–44 and less than 8% of each older age group.
The data also included statistics on the education levels of LGBTQ+ Americans, indicating that they are more likely to have some college education or an associate degree than their non-LGBTQ+ peers.
LGBTQ+ adults are more likely (34.57%) to have an associate degree or some college experience and less likely to have only a high school education or less, or a graduate degree.
According to a report from the Williams Institute, a research organization dedicated to collecting and explaining data on LGBTQ+ people and related policy, during the first year of the second Trump administration, approximately 360 federal data collections removed at least one sexual orientation or gender identity measure, including 338 that removed gender identity measures and at least 60 that removed sexual orientation measures.
The Williams Institute, along with HRC, asserts that these changes diminish the federal government’s capacity to measure LGBTQ+ populations and understand their experiences and needs — something that should be detrimental to federal data collection and assessment, regardless of what political ideology one subscribes to.
In 2024, the Census Bureau conducted a large-scale test of questions on sexual orientation and gender identity for possible inclusion in the American Community Survey, the nation’s primary source of detailed demographic data. The test involved nearly half a million households, but the Bureau has not released the promised reports and datasets showing how those questions performed. In September 2025 Democracy Forward filed a Freedom of Information Act lawsuit seeking their release, alleging that the Census Bureau had unlawfully withheld the records.
The HRC Foundation also provided information about the methodology used to produce its estimates. The data uses weighted surveys conducted through its Community Insights research program. Community Insights is an opt-in research panel rather than a probability sample of the U.S. population; demographic benchmarks are used to adjust survey data so that respondents more closely reflect the broader LGBTQ+ adult population.
The HRC Foundation selected the Household Pulse Survey due to its large sample size, national probability-based design, detailed demographic data, separate measures for sexual orientation and gender identity, and availability of public-use survey weights.
The analysis includes 37 rounds of the U.S. Census Bureau’s Household Pulse Survey conducted between 2021 and 2024, yielding 2,452,769 responses before exclusions for missing or imputed data.
HRC’s estimate of 12.03% is based on the Census Bureau’s self-administered Household Pulse Survey, while Gallup’s most recent estimate of 9% is based on telephone interviews and a different approach to measuring LGBTQ+ identity.
HRC has suggested that self-administered surveys may offer greater privacy when people answer sensitive questions, which may contribute to differences in disclosure.
The analysis classifies respondents as lesbian or gay, bisexual+, transgender, or gender-expansive. The bisexual+ category includes respondents who selected bisexual as well as those who selected another sexual identity not represented by the available categories. The transgender or gender-expansive classification is determined using respondents’ reported sex assigned at birth and current gender identity.
The move to remove LGBTQ+ people from federal data collection is just one of many things the Trump-Vance administration has taken to minimize — if not hide — LGBTQ+ people in the country.
From the anti-transgender military executive order, which attempted to bar new recruits and remove transgender military members already serving, signed in January 2025, to attempts to prohibit gender-affirming medical care in federal health care programs and all but destroy gender-affirming care for minors, the administration has pursued a series of policies affecting LGBTQ+ Americans.
The administration has also attempted to make biological sex the only definition of gender on federal paperwork, rolled back DEI programs across the federal government, and taken other steps affecting how LGBTQ+ people are represented and recognized in federal policy and data collection.
New York
NYC lawmakers seek to repeal bathhouse ban
Current policy enacted in 1980s in response to AIDS crisis
New York City lawmakers are pushing to repeal a decades-old prohibition on adult bathhouses, arguing the regulation was created during the height of the AIDS crisis and no longer reflects modern science or public health practices.
Erik Bottcher, the openly gay New York state senator who represents the 47th District that includes the Upper West Side, Chelsea, Hell’s Kitchen and portions of the West Village in Manhattan, is leading the charge to remove the decades-old ban. (Openly gay state Assemblymember Tony Simone has sponsored the repeal bill in the New York State Assembly.) Bottcher sat down with the Washington Blade to discuss why he is advocating for more bathhouses in New York City.
“This is simply about ensuring that our public health policy is in line with today’s science,” he told the Blade. “The prohibition on adult bathhouses was put into place in 1985 at the height of the the AIDS epidemic, when there was very little information, very little treatment options, few treatment options, and great deal of fear. Science has changed. Treatment has changed, and the laws need to change too.”
The proposed legislation would direct the New York State Department of Health to repeal the 1985 regulation and establish a new framework for regulating bathhouses.
“Municipalities around the country and all around the world allow for adult bathhouses. There’s no reason why New York City alone needs to maintain this outdated prohibition. Our bill orders the New York State Department of Health to strike the 1985 regulation and replace it with a regulated public health framework that’s grounded in science.”
Under the proposal, bathhouses would operate as licensed and regulated facilities subject to health and safety standards. Backers of the proposal say that framework could also give public health officials greater access to people who may otherwise be difficult to reach through traditional health care settings.
“What the Department of Health would do is work with public health experts and advocates to develop a regulatory framework that allows licensed regulated facilities to operate under clear health and safety standards — and under this — it would allow public health agencies to have greater opportunities to provide STI and HIV prevention resources, connect people to testing and treatment, conduct instructions, and address legitimate health concerns.”
Supporters of the repeal also argue banning bathhouses does not eliminate the sexual activity that takes place in them or elsewhere. Instead, they say, it pushes those activities into the shadows, where public health officials have fewer opportunities to provide life-saving services that include STI and HIV testing.
“This is also about a safer alternative than pushing activity into unregulated settings where there’s little opportunity for public health engagement because these activities are happening, but they’re happening in the shadows,” Bottcher continued. “We know that the best public health policy is to establish clear public safe public health guidelines that allow for public health intervention.”
Demetre Daskalakis, a physician and longtime HIV prevention advocate who has worked to create sexual healthcare opportunities in bathhouses, also worked with Bottcher on the proposal.
Daskalakis was a high level Centers for Disease Control and Prevention employee until 2025, when he left federal health landscape after the Trump-Vance administration ousted then-CDC Director Susan Monarez. There he worked as director of the National Center for Immunization and Respiratory Diseases and was director of the Division of HIV Prevention at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
Daskalakis explained his experience has shown him the potential for these spaces to become points of contact for people who do not regularly access traditional health care.
“I’ve seen what happens when you push sex into the underground,” he said. “From my perspective, this is a great opportunity to be able to reach people who really will not come to normal clinical care and won’t go to normal routine places for testing or screening.”
“As a public health person, I look at it as a great opportunity,” added Daskalakis. “If there’s like regulation of those venues, and if there’s like a prevention plan that sort of sprouts in those places with really solid public health and clinical partners, I think it’s a great opportunity for public health good.”
Daskalakis said a regulated bathhouse could offer more than HIV and STI testing, potentially creating spaces where people could access prevention medications and other health services.
“The bottom line is if there is a good relationship between the government and the venues, we can develop spaces in the venues to actually deliver services,” he said. “It’s not just infectious disease services — I mean yes, you can do HIV testing, STI testing. You can provide doxypep and pre-exposure prophylaxis for people who are HIV negative and at risk for HIV.
“As an example, at Callen-Lorde Community Health Center (in New York City), where I’m the chief medical officer, we developed a prevention pack in a very low threshold way. We gave people enough doxypep and prep to get through Pride. You can also have Narcan and other things to reduce the risk of overdose.”
Daskalakis said that approach reflects what public health should be striving for: meeting the community where they are.
“If you have this sort of relationship with the government that’s not antagonistic, and the government, as New York is one to do, provides some regulatory oversight to these venues, I think what you’re going to have is a place that supports LGBTQ culture — which also which does include sexuality, and also creates a platform to be able to do like very solid prevention work.”
The public health landscape surrounding HIV has changed dramatically since the bathhouse regulation was adopted, Daskalakis said, pointing to advances in treatment and prevention.
“The bottom line is that HIV treatment and prevention have really converged. If you are someone living with HIV and you’re on HIV medicines and your viral load is undetectable, you don’t transmit HIV. That’s called undetectable is equal to untransmittable, or U = U. People who are on prep also have very low risk of acquiring HIV, and so you know the world is very different,” he said.
“Back in the 80s, when there was no way to impact transmission of HIV because we didn’t have effective ways to prevent it — or didn’t know very much about it at that point. It’s a very different world where we know a lot about HIV and have a lot of tools to be able to prevent transmission. Same with STIs,” added Daskalakis. “If you create a holistic strategy for prevention that is sex positive and aligned to these venues, you’re going to prevent HIV and STIs. Period.”
For supporters of the legislation, that public health argument is central to the effort to repeal the ban. Bottcher also sees the proposal as a way to restore LGBTQ community spaces at a time when many queer venues have disappeared and social interaction increasingly takes place online.
“In this era of social isolation created by social media and streaming services, people are desperate for third spaces,” Bottcher said. “Places for people to come together in person, to be together in person. That’s what this would help provide.”
Daskalakis echoed Bottcher’s point that bathhouses could transform from underground, tabooed spaces into venues that combine sexual health services with broader LGBTQ culture.
“When you make them illegal, they become seedy and dark. When you make them something that is allowed, they actually then become sites that may have sex on premises but also support other sorts of cultural things, and in a universe where people are trying to make LGBT folks seem invisible, creating a safe space for them is exactly what we need right now.”
That community-space argument is also tied to health disparities, Bottcher said, arguing that greater access to health education and prevention services could help people who are less likely to seek care through traditional medical settings.
“Creating opportunities for in-person public health education, prevention, treatment that will help improve health outcomes when you push people into less safe settings without any opportunities for education, prevention tools, or treatment. That’s when we see these disparities, these health disparities grow. So it’s very important that we be laser focused on opportunities to address these disparities and reduce them.”
He continued, explaining the proposed change is ultimately about updating public health policy as medical science evolves, just as other practices are updated when new information comes out.
“This is a matter of an outdated public health regulation and the government has a responsibility to continually revisit its public health regulation and ensure that they’re in line with modern day science,” Bottcher said. “Science and healthcare are continually evolving, and the HIV/AIDS prevention and treatment landscape has changed tremendously in the last few years. Our public health regulations need to keep pace with science.”
For LGBTQ New Yorkers who lived through the AIDS crisis, however, changing the policy could carry a different meaning.
Bottcher says the experiences of those who lived through the epidemic — one that killed nearly 300,000 gay men since the 1980s — should inform how any new system is implemented, rather than being dismissed.
“These are in order to help prevent the spread of HIV and AIDS and other STIs,” Bottcher said. “We have to bring people engaging in these activities out of the shadows and into safe settings that provide the opportunity for public health entities to engage with education, treatment, prevention — that’s what this would do.”
Daskalakis said those concerns should be approached through what he described as trauma-informed care.
“My response is that of trauma-informed care,” Daskalakis said. “We have totally been through it, but we need to sort of move past the trauma and realize that the science has changed. I’s not it’s not the ’80s anymore, but we definitely need to look at those folks who have gone through the experience (of the HIV/AIDS crisis) to make sure that what we’re building, from a public health perspective, are effective programs.”
“There’s a great opportunity to learn from folks with experience rather than to alienate them,” he added.
Bottcher also pointed out this policy revision and effort to bring regulations in line with modern science is not only happening in New York. Multiple other cities across the U.S. have moved away from bathhouse prohibitions.
“Minneapolis just passed their ordinance in June,” he said. “San Francisco, despite the fact that they repealed their prohibition some years ago, they are still working to change the policy … However, around the country, even in red states, they have bathhouses … and they haven’t presented a detriment to public health in any way.”
The proposed change could also revive a part of New York’s LGBTQ cultural history, Bottcher said.
“Bathhouses were a big part of gay culture for decades. We all know the legendary stories of Bette Midler and Barry Manilow performing at the Continental Baths. I envision a resurgence of bathhouse culture that includes things like live music, arts, and entertainment. So it’s exciting to think about.”
And if that resurgence happens, Bottcher already has a dream performer in mind to be the first to take the stage.
“Oh, that’s such a good question … Cher.”
Daskalakis picked a similarly essential female singer of gay culture that he’d like to see in the bathhouses of today.
“I feel like my list could be so long, but I think that would be a great place for Madonna.”
The debate over New York’s bathhouse regulation ultimately reflects a broader question about how public health policy should respond as science, medicine, and LGBTQ communities change.
For Bottcher, regulation, rather than prohibition, would give health officials more opportunities to provide prevention and treatment while allowing LGBTQ people to gather openly.
For Daskalakis, the central lesson from his extensive healthcare work in bathhouses is that pushing sexual activity underground will make public health outreach more difficult — the opposite of what the government and healthcare providers should be doing.
“The opportunity to create safe spaces means that we’ll have more opportunities to reach people, not just for public health, but for so many other things … The strategy of banning things that are natural really doesn’t tend to help you very much. It ends up creating misalignment between the community and policymakers.”
