Opinions
Here’s why LGBT people must fight Price confirmation for HHS
A homophobic nominee who would undermine Medicare

Rep. Tom Price (R-Ga.) (Photo by Iowapolitics.com; courtesy Wikimedia Commons)
This week, President-elect Donald Trump named Rep. Tom Price (R-Ga.) as his nominee for the post of Secretary of Health and Human Services (HHS). There will no doubt be Trump nominees for whom a confirmation fight will not be worth the battle. This is not one of those instances.
The Price pick was not unexpected — his name was on the administration’s short list from early on — but it nonetheless should be of great concern to all LGBT people as well as healthcare providers of all stripes. For the last 10 years I have worked with colleagues on advisory groups with the Substance Abuse and Mental Health Services Administration and other HHS programs and initiatives, as well with the Pan American Health Organization with the goal of providing culturally competent care for those of all sexual orientations and gender identities. During the Obama administration and under the leadership of HHS Secretary Kathleen Sebelius and subsequently Sylvia Burwell, a community of care professionals has collectively made tremendous progress in making good on that same goal.
The federal initiative Healthy People 2020 established specific goals to eliminate disparities for LGBT people and to improve the systems that deliver their care. Both HHS and the Justice Department now collect health and demographic data on sexual orientation and gender identity in 12 different surveys and studies with the goal of improving the lives of LGBT people. And the National Institutes of Health just this year designated LGBT people as a health disparity population that should be studied and cared for.
Throughout his six terms in the House and in the Georgia Legislature before that, Rep. Price has established a track record of supporting policies that threaten to derail these many years of progress for the health of both LGBT people and of all U.S. citizens. He has advocated for the dismantling of the Affordable Care Act, replacing it with the Empowering Patients First Act, a proposal that is unevaluated by the Congressional Budget Office or the Joint Committee on Taxation, and that has the potential to leave many of the roughly 21 million insured under Obamacare in the lurch. He has also supported diverting funds from the Medicare and Medicaid programs, depended on by millions, to state grants where patient care and rights would face a decidedly uncertain future.
In the domain of LGBT rights, his reputation is no better. He opposed the repeal of “Don’t Ask Don’t Tell,” opposed marriage equality, and supported a constitutional amendment defining marriage as “one-man-one-woman.” He also voted against the Employment Non-Discrimination Act, legislation that would have prohibited job discrimination based on sexual orientation. With that as background, it appears he would not be resistant to the endorsement or funding of conversion therapy, a dangerous and thoroughly discredited practice condemned by every major professional health organization, but that is nonetheless a plank in the Republican Party platform and championed by Vice President-elect Mike Pence. Not surprisingly he has garnered a “0” rating from the Human Rights Campaign Congressional Scorecard.
Of all Trump’s nominations for Cabinet posts and executive positions in his administration, this nomination of Tom Price should be of particular concern. The policies that Rep. Price advocates for contradict known best practices and a wealth of knowledge about good public health policy. His dogma runs contrary to the interests of the health of all people, the LGBT population especially so. And, like many of Trump’s nominees, Rep. Price has no particular qualifications for the job — beyond having once earned a medical degree — and has no experience managing a large government agency.
Trump’s nominee for Health and Human Services will face a confirmation hearing in the Senate next year. It is incumbent upon advocates for health care and LGBT rights to challenge Rep. Price’s policy positions and scrutinize his vision for HHS and the health of the American people.
Dr. Stephen Forssell is assistant professor, Professional Psychology Founding Director, LGBT Health Policy & Practice Program and The George Washington University.
Botswana
Lorato ke Lorato: marriage equality, democracy, and the unfinished work of justice in Botswana
High Court considering marriage equality case
As Botswana prepares for the resumption of a landmark marriage equality case before the High Court on July 14–15, the country finds itself at a critical constitutional crossroads.
At first glance, the matter may appear to be about whether two women, Bonolo Selelelo and Tsholofelo Kumile, can have their love legally recognized. At its core however, this case is about something far more profound: the dismantling of patriarchy, the decolonization of law, and the integrity of Botswana’s constitutional democracy.
Beyond marriage: a question of power
Marriage, as a legal institution, has never been neutral. It has historically functioned as a mechanism for regulating women’s bodies, sexuality, and social roles within a patriarchal order. To deny LBQ (lesbian, bisexual, and queer) women access to marriage is not merely to exclude them from a legal benefit, it is to reinforce a hierarchy of relationships, where heterosexual unions are deemed legitimate and all others invisible. This case therefore challenges the very foundations of who gets to love, who gets to belong, and who gets to be protected under the law.
As feminist scholars have long argued, patriarchy is sustained through institutions that appear ordinary but are deeply political. The law is one such institution. And it is precisely here that this case intervenes: by asking whether Botswana’s legal system will continue to uphold exclusion, or evolve to reflect the constitutional promise of equality.
A constitutional journey: Botswana’s courts and human dignity
This is not the first time Botswana’s courts have been called upon to affirm the dignity of LGBTQI+ persons. Over the past decade, the judiciary has built a progressive body of jurisprudence grounded in equality, nondiscrimination, and human dignity.
In Attorney General v. Rammoge and Others (Court of Appeal Civil Appeal No. CACGB 128-14, 2016), the Court of Appeal upheld the right of LEGABIBO to register as an organization. The court affirmed that:
“The refusal to register the appellant society was not only unlawful, but a violation of the respondents’ fundamental rights to freedom of association.”
This was followed by the ND v. Attorney General of Botswana (MAHGB-000449-15, 2017) case, where the High Court recognized the right of a transgender man to change his gender marker. The court held:
“Gender identity is an integral part of a person’s identity … and any interference with that identity is a violation of dignity.”
In Letsweletse Motshidiemang v. Attorney General (MAHGB-000591-16, 2019), the High Court decriminalized same-sex activity, declaring sections of the Penal Code unconstitutional. Justice Leburu powerfully stated:
“Human dignity is harmed when minority groups are marginalized.”
This decision was affirmed by the Court of Appeal in Attorney General v. Motshidiemang (CACGB-157-19, 2021), where the court emphasized:
“The Constitution is a dynamic instrument … it must be interpreted in a manner that gives effect to the values of dignity, liberty, and equality.”
These cases collectively establish a clear principle: the Constitution of Botswana protects all persons, not just the majority.
The marriage equality case now asks a logical next question: If LGBTQI+ persons are entitled to dignity, identity, and freedom from criminalization, why are their relationships still denied recognition?
Decolonizing the law: What is truly ‘UnAfrican’?
Opponents of marriage equality often argue that homosexuality is “unAfrican.” This claim, while politically powerful, is historically inaccurate. Same-sex relationships and diverse gender identities have existed across African societies long before colonial rule. What is foreign, however, are the laws that criminalize these identities.
Botswana’s anti-sodomy laws were inherited from British colonial legal systems, not from indigenous Tswana culture. As scholars of African history have demonstrated, colonial administrations imposed rigid Victorian moral codes that erased and suppressed existing sexual diversity. To claim that homosexuality is unAfrican, while defending colonial-era laws, is therefore a contradiction.
A truly decolonial approach to the law requires us to ask: Whose morality are we upholding? And whose history are we erasing?
Marriage equality, in this sense, is not a Western imposition: it is part of a broader project of reclaiming African dignity, plurality, and humanity.
Democracy on trial: the question of separation of powers
This case also raises important questions about the health of Botswana’s democracy.
Following the 2021 Court of Appeal decision affirming the decriminalization of same-sex relations, Botswana witnessed public demonstrations, including marches led by groups such as the Evangelical Fellowship of Botswana (EFB), opposing the judgment and calling for the retention of discriminatory laws.
While public participation is a cornerstone of democracy, these events raise deeper concerns about the separation of powers. Courts are constitutionally mandated to interpret the law and protect fundamental rights, even when such decisions are unpopular. When judicial decisions grounded in constitutional principles are publicly resisted on moral or religious grounds, it risks undermining the authority of the courts and the rule of law itself.
Democracy is not simply about majority opinion: it is about the protection of minority rights within a constitutional framework.
Botswana is not a theocracy
It is also important to clarify a recurring misconception: Botswana is not a Christian nation.
Botswana is a secular constitutional democracy and more accurately, a pluralistic society that recognizes and respects diversity of belief, culture, and identity. The Constitution does not elevate one religion above others, nor does it permit religious doctrine to dictate legal rights. The law must serve all citizens equally, regardless of faith.
To frame marriage equality as a threat to Christianity is therefore misplaced. The question before the courts is not theological, but constitutional: Does the exclusion of same-sex couples from marriage violate the rights to equality and nondiscrimination?
Love, equality, and the future of justice
At its heart, this case is about love, but it is also about power, history, and justice. It asks whether Botswana is prepared to move beyond colonial legal frameworks and patriarchal norms, and to embrace a future grounded in equality, dignity, and inclusion.
It asks whether the Constitution will continue to be interpreted as a living document, one that evolves with society, or remain constrained by outdated moral assumptions. Ultimately, it asks whether Botswana’s democracy can hold true to its founding promise: that all persons are equal before the law.
As the High Court prepares to hear this case in July 2026, the nation has an opportunity to affirm not only the rights of two individuals, but the broader principle that love, in all its diversity, deserves recognition, and protection.
Lorato ke lorato.
Love is love.
Justice, if it is to mean anything at all, must make space for it.
Nozizwe is the CEO of LEGABIBO (Lesbians, Gays and Bisexuals of Botswana)
Opinions
Border to border: modern slavery and human trafficking in refugee movements across East Africa
LGBTQ people disproportionately targeted for sexual exploitation
I did not choose to become a refugee. I did not choose to become a victim of trafficking. I only chose to live as myself. Yet in the world I come from, choosing to live as myself was enough to make me a target. As a transgender woman from Uganda, my identity alone placed me in danger. What followed was not just displacement, it was a journey through systems of exploitation that closely resemble modern slavery, hidden in plain sight along the borders and pathways that refugees are forced to travel.
People often imagine modern slavery as something that happens in secret: in locked rooms, in distant brothels, in hidden factories. Human trafficking is portrayed as a dark underworld run by organized criminals. But for many refugees in East Africa, exploitation does not hide in the shadows. It exists in the open, woven into the very routes of survival. It is present at border checkpoints, in refugee camps, in the hands of smugglers, and even in the institutions meant to protect us. It is not always marked by chains or cages. Sometimes it looks like a bus ticket, a border crossing, a promise of safety, or a demand for money that you cannot refuse.
My journey across borders is only one example of how these systems operate. But it is a story shared by many LGBTQI+ refugees whose lives are shaped by violence, silence, and the constant negotiation of safety.
In Uganda, being transgender is not simply misunderstood, it is dangerous. My family, deeply rooted in conservative religious beliefs, saw my identity as a disgrace. I was threatened, rejected, and made to feel that my life had no value. Outside the home, communities policed identity through violence. The legal environment offered no protection. Instead, it reinforced fear. Laws targeting LGBTQI+ people made it impossible to seek help from authorities. Reporting abuse often meant risking arrest. Every day became a calculation of risk: where to walk, who to trust, how to hide. Eventually, the threats became too real to ignore. Leaving was not a choice, it was survival.
My journey out of Uganda began through unofficial routes. Like many refugees fleeing persecution, I could not rely on safe or legal pathways. Instead, I was forced into networks of smugglers and traffickers operating along border regions. From Uganda through border points like Maraba, and later through movements connected to Kakuma Refugee Camp and into South Sudan, each step came with a cost financial, emotional, and physical. At border crossings, money speaks louder than rights. Payments were demanded at checkpoints. There was no transparency, no accountability. You either paid, or you risked being turned back or worse.
For LGBTQI+ refugees, these journeys are even more dangerous. Visibility can mean exposure. Exposure can mean violence. There is constant fear of being outed, harassed, or assaulted not only by traffickers but sometimes by those meant to enforce the law. This is how modern trafficking operates not always through chains, but through systems of dependency, coercion, and fear.
Human trafficking is often imagined as a distant or extreme phenomenon. But for many refugees, especially LGBTQI+ individuals, it exists in subtle and systemic ways. It is in the forced payments demanded at every step of the journey. It is in the exploitation of vulnerability by those offering “help.” It is in the silence of systems that fail to protect. Many LGBTQI+ refugees face extortion by smugglers and intermediaries, threats of violence or exposure, sexual exploitation and abuse, and discrimination by officials and communities. These experiences are rarely documented. Fear prevents reporting. Lack of access prevents justice. What remains is a hidden crisis, one that continues across borders.
Reaching South Sudan did not bring safety. I now live in Gorom Refugee Settlement Camp, where the reality for LGBTQI+ refugees remains harsh and dangerous. Discrimination is part of daily life. Access to food, water, and healthcare is often affected by stigma. Moving freely within the camp can be risky. Violence and threats are constant. As a transgender woman, I am highly visible. This visibility increases my vulnerability. I have faced harassment, intimidation, and threats from both host communities and other refugees. Some blame LGBTQI+ refugees for misfortunes accusing us of bringing curses or problems. These beliefs, rooted in stigma and misinformation, fuel violence and exclusion. Safety, even in a refugee camp, is not guaranteed.
Despite these challenges, I have chosen not to remain silent. In Gorom, I serve as a leader and representative of an LGBTQI+ Refugees and Asylum Seekers Network. Our community includes individuals who are traumatized, isolated, and often unable to advocate for themselves. Many cannot read or write. Some are dealing with serious medical conditions. Others are too afraid to speak. I support them by helping fill out applications and forms, writing emails to organizations, connecting them with protection pathways, and providing peer support and coordination. Through this work, several members of our community have managed to access opportunities for relocation and protection. Some have received case numbers and are progressing through international processes. While I am proud of this work, it comes with a cost. My visibility as a leader makes me a target. The more I help others, the more I am exposed.
The systems I have experienced reflect a form of modern slavery that is not always recognized. It is not defined by ownership, but by control. It is not enforced by chains, but by fear and dependency. When refugees are forced to rely on informal and unsafe systems to survive, exploitation becomes inevitable. International frameworks like the Palermo Protocol recognize trafficking as involving coercion, exploitation, and abuse of vulnerability. By these definitions, what many refugees experience during displacement falls within this reality. Yet, these experiences are rarely acknowledged in policy or response.
My story is one thread in a much larger tapestry of exploitation. Across East Africa, displacement has created informal systems where movement is controlled not by law, but by power, money, and vulnerability. Within these systems, trafficking and modern slavery are not isolated crimes; they are embedded in the everyday experiences of refugees. The blurred line between smuggling and trafficking becomes clear when a voluntary agreement turns into coercion. Payments increase unexpectedly. Conditions worsen. Threats emerge. At this point, smuggling begins to resemble trafficking. People are forced to pay additional fees under threat, detained or abandoned if they cannot pay, and subjected to coercion, intimidation, or violence. The journey becomes one of survival under control, rather than movement by choice.
Checkpoints are one of the most visible forms of exploitation. Across multiple borders, movement is regulated not only by official policies but by informal practices. Travelers are often required to make payments to pass through, regardless of their legal status. These payments are rarely documented. They are negotiated at the moment, often under pressure. Failure to comply can result in detention, forced return, physical intimidation, or exposure to further risks. For those already vulnerable, checkpoints become sites of control and exploitation. This system benefits from a lack of accountability. It thrives in environments where oversight is weak and corruption is normalized.
Modern slavery is not always about physical confinement. It can also take the form of economic exploitation. During transit, individuals may be required to pay escalating fees at each stage of the journey, surrender money or belongings, or depend entirely on intermediaries for movement. In some cases, individuals are left stranded if they cannot meet financial demands. This creates a cycle of dependency: you rely on the network to move, the network controls the cost, and the cost determines your safety. Such systems exploit vulnerability in a way that aligns closely with definitions of modern slavery particularly the abuse of power and the extraction of value through coercion.
Reaching a destination, such as a refugee settlement, does not necessarily end exposure to exploitation. In many camp settings, individuals continue to face restricted access to resources, dependency on aid systems, and informal economies that can be exploitative. Where formal support systems are overstretched or under-resourced, informal structures emerge again. These structures may involve gatekeeping access to services, manipulation of aid distribution, or continued financial or social exploitation. The conditions that enable trafficking do not disappear; they evolve.
Beyond East Africa, modern slavery takes other forms that mirror the same patterns of vulnerability and exploitation. Labor trafficking to the Gulf has become a major issue for migrants from Uganda, Kenya, and Tanzania.

Recruitment agencies promise good jobs, but many migrants end up in forced domestic labour, with confiscated passports, unpaid wages, and conditions amounting to slavery. Some never return home. Organ trafficking has also been documented, with victims from Africa ending up in countries such as Thailand, Malaysia, Russia, and China. Kidneys are the most commonly trafficked organs. Some victims are coerced; others are deceived; some are killed. Women, girls, and LGBTQI+ individuals are disproportionately targeted for sexual exploitation. For refugees, “survival sex” becomes a coping mechanism in the absence of protection and resources. Modern slavery thrives because the global economy rewards cheap labour. Migrants from East Africa are used in construction, domestic work, agriculture, and manufacturing. Their exploitation is hidden behind the products the world consumes.
From a humanist perspective, the existence of such systems raises urgent ethical questions. If all human beings have equal dignity, why are some forced to risk exploitation to survive? If rights are universal, why are they not accessible in practice? Human trafficking and modern slavery in refugee movements are not only criminal issues, they are moral failures. They reflect a gap between principles and reality. They expose the distance between what we claim to value and what we allow to happen.
Addressing these issues requires more than isolated interventions. Safe and legal migration pathways must be expanded. Border accountability must be strengthened. Anti-trafficking measures must be integrated into refugee protection. Refugee-led initiatives must be supported. Those with lived experience are best positioned to identify risks and solutions.
Modern slavery and human trafficking are not always visible in chains or confinement. In many cases, they exist within systems that appear as ordinary border crossings, transit routes, and refugee settlements. Recognizing these systems is the first step toward change. The movement of people across borders should not come at the cost of their dignity, safety, or freedom. Yet, for many, it does. Until safe alternatives exist, and accountability is enforced, these hidden systems of exploitation will continue.
The question is not whether they exist.
The question is whether we are willing to confront them.
Aby lives in the Gorom Refugee Settlement Camp in South Sudan.
Today nearly 99% of us watch wars on television. We see news reports, and watch bombs exploding and people dying, somewhere else. The only people actually involved are those who volunteered to serve in the military, and the national guard. I am sure most of them didn’t join to fight illegal wars like the one the felon in the White House is waging in Iran. But I respect them, and their willingness to serve our country.
But we are in Iran, and the felon is now asking Congress for $200 billion more for this war. We have been spending over a billion dollars a day. Who is paying for this? Right now, no one. We are simply adding it to the national debt, for our children to worry about. I propose a 5 or 10% surtax on every person, to cover the cost of this illegal war. Just have it added to your tax bill. If Congress passed such a surtax, I am sure we would already be out of Iran, as people would rise up to stop this illegal and unnecessary war very quickly.
I am old enough to remember the Vietnam War, and what we did to try to end it. It took time, but the people spoke. I did not serve, but unlike the felon in the White House, was willing to. I got my draft notice, along with a subway token, and reported to Whitehall street in NYC. It was as the Arlo Guthrie song, “Alice’s Restaurant,” said it would be. I got there at 7 a.m. and at 3 p.m. was told they wouldn’t take me because of my bad knee, sending me home with my 1Y designation. My friends had given me a going away party the night before, and my mom cried. So, it was a little embarrassing when my friends found I was still home. But my mom was happy and cried again.
I had been to anti-war demonstrations in D.C. in front of the DOJ, and got tear gassed. I demonstrated in London, in Russel Square, in front of the American embassy. While so many more were involved in that war because of the draft, we knew then if a 5% surtax had been levied, it would have ended much faster. Seems we never learn.
Today there is no draft, and no surtax. It is taking a while for people to recognize the felon who opposes any help for people to pay for their healthcare, easily asks for the $200 billion in funds for a totally unnecessary war. He closed USAID, which showed the United States in a positive light, helping people around the world, and that agency’s budget was only $25 billion. On top of not asking Americans to pay for this illegal war, he is giving tax breaks to millionaires, billionaires, and corporations, adding more to the national debt. What is the definition of insanity? Today it is clearly having voted for, and still supporting, the felon in the White House.
To make things worse and give us even less chance to stop his destruction of our democracy, the felon is trying to make it harder to vote. Millions of women who changed their names for marriage will not have a birth certificate with their current name on it, or a passport with their current name, allowing them to vote if the felon has his way. Reality is less than 50% of Americans even have a passport. The fact the Constitution gives states the right to set voting procedures, isn’t deterring the felon and his fascist cohorts, from trying to do it. He is doing it while we are losing American lives, the lives of heroes, who he has fighting a war he would have never signed up to fight himself. He is running it from the gold-leaf painted Oval Office, and from Mar-a-Lago, where he is golfing. He is a racist, sexist, homophobic, POS, working with the war criminal in Israel, causing a renewed spate of antisemitism and Islamophobia, and possibly creating World War III.
If you care about the future of the United States, you must stand up and speak out. We must defeat every Republican sycophant of his in the midterms — it’s the only way to let the felon know that we will not put up with his shit anymore. His grifting, and that of his family and appointees, must end. We the people, must not let him destroy 250 years of democracy, because he thinks he is a king. We fought a king once before and won. We will defeat him too. We will not let the felon implement the rest of Project 2025 and will take his name off everything he illegally plastered it on. He will be relegated to the trash heap of history, where he belongs, and we will reclaim our democracy for the next 250 years.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.
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