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A crossroads in HIV/AIDS fight: Will Biden build off Trump plan or go his own way?

HHS draft plan spells out high rates of infection among LGBTQ people

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Will President-elect Joe Biden build off President Trump’s HIV plan or go his own way?

With the transition underway from President Trump to President-elect Joe Biden, advocates in the fight against HIV/AIDS are at a crossroads on whether to hold firm or seek a change in plans as the Department of Health & Human Services is floating an updated National AIDS Strategy that would carry over into the next administration.

The decision on the way forward carries high stakes for people in the LGBTQ community, who continue to become infected at higher rates. As documented by the draft 87-page document made public on Tuesday, gay and bisexual men make up 67 percent of new infections. In new data, the draft report also finds 14 percent of transgender women have HIV, including 44 percent of Black transgender women.

A key component of the draft document, the first update on the National AIDS Strategy since the Obama administration in 2015, is the Trump administration’s plan to end the domestic HIV epidemic by 2030. The cross-agency, PrEP-centric initiative was one of a few policies during the Trump administration that stood out as beneficial to the LGBTQ community, despite an overall anti-LGBTQ record.

“The HIV Plan covers the entire country, has a broader focus across federal departments and agencies beyond HHS and all sectors of society, and addresses the integration of several key components that are vital to our collective work, including stigma, discrimination and social determinants of health,” the draft report says in the introduction.

Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said in a statement the updated draft strategy makes additional commitments on the uptake of PrEP, eliminating stigma and addressing disparities in priority populations.

“It is also reassuring to see an emphasis on the integration of efforts related to the syndemics of viral hepatitis, sexually transmitted infections, substance use and mental health along with a focus on stigma and discrimination and the social determinants of health,” Schmid said.

As part of the draft review process, which is set to last until Dec. 14, HHS asks interested parties to submit comments in consideration for the final report. The final report is expected to come out in mid-January 2021, an HHS spokesperson told the Washington Blade.

In contrast, Biden has campaigned on beating HIV by 2025, although the strategy isn’t as thorough as the plan developed by HHS during the current administration. In his World AIDS Day statement on Tuesday, Biden fleshed out his vision by saying he plans to reinstate the Office of National AIDS Policy, release a new comprehensive National Strategy on HIV/AIDS, and expand support for global programs like the President’s Emergency Plan for AIDS Relief, or PEPFAR, and the Global Fund to Fight AIDS, Tuberculosis & Malaria.

“An AIDS-free generation is not only imaginable, it is within our reach,” Biden said. “And under a Biden-Harris administration, America’s response to the HIV/AIDS epidemic in this moment will match their unparalleled example.”

It remains to be seen whether the Biden plan builds off the Trump plan, including the draft National AIDS Strategy, or scraps those efforts in favor of a new plan. A Biden transition spokesperson referred the Washington Blade to the Biden campaign’s health plan and the president-elect’s statement on World AIDS Day in response to a request to comment.

As proposed by the Trump administration, the National AIDS Strategy breaks down current numbers for HIV/AIDS in the United States, observing the number of new infections, including 36,400 in 2018, has become stable since the 1980s. That stabilization, the report says, has opened the door to combat the disease with renewed focus and coordinated development of the HIV plan, which seeks a 75 percent reduction in new HIV infections by 2025 and a 90 percent reduction by 2030.

The draft report indicates gay and bisexual men, Black gay and bisexual men continue to face the brunt of HIV/AIDS. The prevalence of HIV is more than 150 times higher in gay, bisexual, and other men who have sex with men and in transgender women than straight men and women.

Gay, bisexual and other men who have sex with men are “the population most affected by HIV in the United States” and make up 61.7 percent of the estimated 1.2 million people with HIV in the United States and 67 percent of the new infections, the draft report says.

Within this group of men who have sex with men, Black men are most severely affected by HIV, accounting for 26 percent of new HIV infections in the United States and 39 percent of new infections among all gay and bisexual men, while Latino men are also heavily afflicted and make up 22 percent of new HIV infections and 33 percent of new infections among gay and bisexual men, the draft report says.

For the first time, the draft report also includes data on transgender women, finding an estimated 14 percent have HIV. Broken down by race, an estimated 44 percent of Black transgender women, 26 percent of Latina transgender women, and 7 percent of white transgender women have HIV. Among the 3 million HIV testing events reported to CDC in 2017, the percentage of transgender people who received a new HIV diagnosis was three times the national average.

With regard to whether or not this plan will carry over into the Biden administration, Schmid said advocates in the fight against HIV/AIDS are in a wait-and-see mode until the transition team announces nominees for the chief health officials for the next administration.

“We’re anxiously awaiting who’s going to be the secretary and who’s going to be the head of CDC and all those agencies because a lot of the leadership was really dedicated and very vocal on HIV and I hope that will continue until the next administration,” Schmid said.

Schmid said he thinks the framework established under the Trump administration is “spot on,” but also was hopeful about the Biden administration because of the president-elect’s commitment to the Affordable Care Act, Medicaid and LGBTQ non-discrimination in health care.

“My hope is that the Biden administration will continue and ramp up this initiative,” Schmid said. “It’s sound, it’s targeted, it’s exactly what we want and it’s exactly what other countries are doing as well. I think they will have some welcome policy changes that could help speed implementation. Biden has already said he wants to end HIV by 2025 and we need to hold him accountable to that.”

Late last month, the Act Now: End AIDS Coalition announced it has reached out to the Biden transition team for a meeting on several concerns related to the federal Ending the HIV Epidemic: A Plan for America initiative. A community-driven policy paper from the coalition highlighted the need for transparency with the HIV community and when allocating resources from the federal government against the disease.

Edric Figueroa, an Act Now: End AIDS Coalition coalition spokesperson, said the team met with the Biden campaign in September, but hasn’t obtained any explicit commitment or a meeting despite the initial request and a follow-up last week.

Meanwhile, advocates in the global fight against HIV/AIDS are pushing hard for Biden to make new commitments to PEPFAR, which distributes anti-viral drugs to countries heavily afflicted by HIV, including countries in Africa. Trump had repeatedly sought drastic cuts to global AIDS programs, including PEPFAR, although Congress continued to fund the program at existing levels.

The Center for Health & Gender Equity is calling on the incoming Biden administration to make a massive $1 billion investment in PEPFAR in the DREAMS program, the first HIV prevention program aimed at adolescent girls and young women.

CHANGE President Serra Sippel said in a statement the investment “is not only the right thing to do, it is the smart thing to do because it contributes to the overall health and well-being of communities and countries.”

CHANGE has consistently heard from young women who are service providers and advocates in Malawi, Tanzania and Zimbabwe, that more resources are needed to ensure that adolescent girls and young women are at the table to design and implement programs and expand DREAMS to more communities,” Sippel said.

If the next administration were to build on the Trump domestic plan, time is running out for Congress to issue the next layer of funding for that. The White House has sought $450 million beyond existing levels for the second year of funding for the plan to end HIV, but Congress has yet to appropriate funds for that or anything else for fiscal year 2021.

Counterintuitively, the Democratic-controlled House, faced with budget caps, declined to provide the additional money for HIV, while the Republican-controlled Senate has proposed legislation that would provide $207 million. It remains to be seen what if any kind of agreement Congress will make on this money before funding for the government writ large expires on Dec. 11.

One issue that appears to have been decided going forward is the reinstatement of the Office of National AIDS Policy at the White House. The position was vacant for the entirety of the Trump administration, but Biden pledged to reinstate the position as part of his World AIDS Day statement.

Early on during the Trump years, six members of PACHA resigned in protest largely over Trump’s refusal to fill the role, saying it demonstrated his lack of commitment to fighting AIDS.

Schmid was undecided when asked by the Blade whether the addition of the White House czar would be helpful in coordinating the fight against HIV/AIDS, or just added bureaucracy.

“It all depends,” Schmid said. “It does provide a central, pivotal focus at the White House for HIV. So, I do think it’s important, and it shows the commitment to HIV.”

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Top 10 Blade news stories by web traffic

COVID breakthroughs, Equality Act, and anti-trans attacks

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Elliot Page created excitement by posting his first photo in swim trunks back in May.

Each year our staff gathers in late December to review the highest trafficked stories of the year and there’s more than a little bit of competitive spirit as we review the results. Here are the top 10 stories by web traffic at  HYPERLINK “http://washingtonblade.com”washingtonblade.com for 2021.

#10: Mark Glaze, gun reform advocate, dies at 51

The sad, tragic story of Glaze’s death captivated readers in November. 

#9: COVID breakthrough infections strike summer tourists visiting Provincetown

This one went viral in July after a COVID outbreak was blamed on gay tourists.

#8: Thank you, Kordell Stewart, for thoughtful response to ‘the rumor’

This opinion piece thanked the former NFL quarterback for writing a personal essay addressing gay rumors. 

#7: Elliot Page tweets; trans bb’s first swim trunks #transjoy #transisbeautiful

The actor created excitement by posting his first photo in swim trunks back in May.

#6: Romney declares opposition to LGBTQ Equality Act

Mitt Romney disappointed activists with his announcement; the Equality Act passed the House but never saw a vote in the Senate.

#5: White House warns state legislatures that passing anti-trans bills is illegal

The year 2021 saw a disturbing trend of GOP-led legislatures attacking trans people.

#4: Lincoln Project’s avowed ignorance of Weaver texts undercut by leaked communications

The Lincoln Project’s leaders, amid a scandal of co-founder John Weaver soliciting sexual favors from young men, have asserted they were unaware of his indiscretions until the Blade obtained electronic communications that called that claim into question.

#3: FOX 5’s McCoy suspended over offensive Tweet

Blake McCoy tweeted that obese people shouldn’t get priority for the COVID vaccine. 

#2: Transgender USAF veteran trapped in Taliban takeover of Kabul

Among the Americans trapped in the suburban areas of Kabul under Taliban control was a transgender government contractor for the U.S. State Department and former U.S. Air Force Sergeant. She was later safely evacuated.

#1: Amid coup chaos, Trump quietly erases LGBTQ protections in adoption, health services

And our most popular story of 2021 was about the Trump administration nixing regulations barring federal grantees in the Department of Health & Human Services from discriminating against LGBTQ people, including in adoption services.

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CDC still falling short on LGBTQ data collection for COVID patients: expert

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COVID-19 vaccine, gay news, Washington Blade
The CDC is still not issuing guidance to states on LGBTQ data collection among COVID patients.

Despite requests since the start of the COVID pandemic for the U.S. government to enhance data collection for patients who are LGBTQ, the Centers for Disease Control & Prevention is still falling short on issuing nationwide guidance to states on the issue, a leading expert health on the issue told the Blade.

With a renewed focus on COVID infections reaching new heights just before the start of the holidays amid the emergence of Omicron, the absence of any LGBTQ data collection — now across both the Trump and Biden administrations — remains a sore point for health experts who say that information could be used for public outreach.

Sean Cahill, director of Health Policy Research at the Boston-based Fenway Institute, said Wednesday major federal entities and hospitals have been collecting data on whether patients identify as LGBTQ for years — such as the National Health & Nutrition Examination Survey, which has been collecting sexual orientation data since the 1990s — but the CDC hasn’t duplicated that effort for COVID even though the pandemic has been underway for two years.

“It’s not like this is a new idea,” Cahill said. “But for some reason, the pandemic hit, and all of a sudden, we realize how little systematic data we were collecting in our health system. And it’s a real problem because we’re two years into the pandemic almost, and we still don’t know how it’s affecting this vulnerable population that experiences health disparities in other areas.”

The Blade was among the first outlets to report on the lack of efforts by the states to collect data on whether a COVID patient identifies as LGBTQ, reporting in April 2020 on the absence of data even in places with influential LGBTQ communities. The CDC hasn’t responded to the Blade’s requests for nearly two years on why it doesn’t instruct states to collect this data, nor did it respond this week to a request for comment on this article.

Cahill, who has published articles in the American Journal of Public Health on the importance of LGBTQ data collection and reporting in COVID-19 testing, care, and vaccination — said he’s been making the case to the CDC to issue guidance to states on whether COVID patients identify as LGBTQ since June 2020.

Among those efforts, he said, were to include two comments he delivered to the Biden COVID-19 Health Equity Task Force in spring 2021, a letter a coalition of groups sent to the Association of State & Territorial Health Officers asking for states to collect and report SOGI in COVID in December 2020 as well as letters to HHS leadership and congressional leadership in spring and summer 2020 asking for them to take steps to encourage or require SOGI data collection in COVID.

Asked what CDC officials had to say in response when he brought this issue to their attention, Cahill said, “They listen, but they don’t really tell me anything.”

“We’ve been making that case, and to date, as of December 22, 2021, they have not issued guidance, they have not changed the case report form. I hope that they’re in the process of doing that, and maybe we’ll be pleasantly surprised in January, and they’ll come up with something…I really hope that’s true, but right now they’re not doing anything to promote SOGI data collection and reporting in surveillance data.”

Cahill, in an email to the Blade after the initial publication of this article, clarified CDC has indicated guidance on LGBTQ data collection for COVID patients may come in the near future.

“HHS leaders told us this fall that CDC is working on an initiative to expand SOGI data collection,” Cahill said. “We are hopeful that we will see guidance early in 2022. Key people at CDC, including Director Walensky, understand the importance of SOGI data collection given their long history of working on HIV prevention.”

In other issues related to LGBTQ data collection, there has been a history of states resisting federal mandates. The Trump administration, for example, rescinded guidance calling on states to collect information on whether foster youth identified as LGBTQ after complaints from states on the Obama-era process, much to the consternation of LGBTQ advocates who said the data was helpful.

The White House COVID-19 Health Equity Task Force has at least recognized the potential for enhancing LGBTQ data collection efforts. Last month, it published an implementation plan, calling for “an equity-centered approach to data collection, including sufficient funding to collect data for groups that are often left out of data collection (e.g….LGBTQIA+ people).”

The plan also calls for “fund[ing] activities to improve data collection…including tracking COVID-19 related outcomes for people of color and other underserved populations,” and specifically calls for the collection of LGBTQ data.

The importance of collecting LGBTQ data, Cahill said, is based on its potential use in public outreach, including efforts to recognize disparities in health population and to create messaging for outreach, including for populations that may be reluctant to take the vaccine.

“If we see a disparity, we can say: Why is that?” Cahill said. “We could do focus groups of the population — try to understand and then what kind of messages would reassure you and make you feel comfortable getting a vaccine, and we could push those messages out through public education campaigns led by state local health departments led by the federal government.”

The LGBTQ data, Cahill said, could be broken down further to determine if racial and ethnic disparities exist within the LGBTQ population, or whether LGBTQ people are likely to suffer from the disease in certain regions, such as the South.

“We have data showing that lesbian or bisexual women, and transgender people are less likely to be in preventive regular routine care for their health,” Cahill said. “And so if that’s true, there’s a good chance that they’re less likely to know where to get a vaccine, to have a medical professional they trust to talk to about it today.”

Among the leaders who are supportive, Cahill said, is Rachel Levine, assistant secretary for health and the first openly transgender person confirmed by the U.S. Senate for a presidential appointment. Cahill said he raised the issue with her along with other officials at the Department of Health & Human Services three times in the last year.

In her previous role as Pennsylvania secretary of health, Levine led the way and made her state the first in the nation to set up an LGBTQ data collection system for COVID patients.

“So she definitely gets it, and I know she’s supportive of it, but we really need the CDC to act,” Cahill said.

Although the federal government has remained intransigent in taking action, Cahill said the situation has improved among states and counted five states — California, Pennsylvania, Rhode Island, Nevada and Oregon — in addition to D.C. as among those that have elected to collect data on sexual orientation and gender identity of COVID patients.

However, Cahill said even those data collection efforts are falling short because those jurisdictions have merely been public about collecting the data, but haven’t reported back anything yet.

“Only California has reported data publicly, and the data that they’re reporting is really just the completeness of the data,” Cahill said. “They’re not reporting the data itself…And they’re also just asking people who tests positive. So, if somebody says positive COVID in California, a contact tracer follows up with that individual and asks them a battery of questions, and among the questions that are asked are SOGI questions.”

As a result of these efforts, Cahill said, California has data on the LGBTQ status of COVID patients, but the data is overwhelmingly more complete for the gender identity of these patients rather than their sexual orientation. As of May 2021, California reported that they had sexual orientation data for 9.5 percent of individuals who had died from COVID and 16 percent of people who tested positive, but for gender identity, the data were 99.5 percent.

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Equality Act, contorted as a danger by anti-LGBTQ forces, is all but dead

No political willpower to force vote or reach a compromise

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Despite having President Biden in the White House and Democratic majorities in both chambers of Congress, efforts to update federal civil rights laws to strengthen the prohibition on discrimination against LGBTQ people by passing the Equality Act are all but dead as opponents of the measure have contorted it beyond recognition.

Political willpower is lacking to find a compromise that would be acceptable to enough Republican senators to end a filibuster on the bill — a tall order in any event — nor is there the willpower to force a vote on the Equality Act as opponents stoke fears about transgender kids in sports and not even unanimity in the Democratic caucus in favor of the bill is present, stakeholders who spoke to the Blade on condition of anonymity said.

In fact, there are no imminent plans to hold a vote on the legislation even though Pride month is days away, which would be an opportune time for Congress to demonstrate solidarity with the LGBTQ community by holding a vote on the legislation.

If the Equality Act were to come up for a Senate vote in the next month, it would not have the support to pass. Continued assurances that bipartisan talks are continuing on the legislation have yielded no evidence of additional support, let alone the 10 Republicans needed to end a filibuster.

“I haven’t really heard an update either way, which is usually not good,” one Democratic insider said. “My understanding is that our side was entrenched in a no-compromise mindset and with [Sen. Joe] Manchin saying he didn’t like the bill, it doomed it this Congress. And the bullying of hundreds of trans athletes derailed our message and our arguments of why it was broadly needed.”

The only thing keeping the final nail from being hammered into the Equality Act’s coffin is the unwillingness of its supporters to admit defeat. Other stakeholders who spoke to the Blade continued to assert bipartisan talks are ongoing, strongly pushing back on any conclusion the legislation is dead.

Alphonso David, president of the Human Rights Campaign, said the Equality Act is “alive and well,” citing widespread public support he said includes “the majority of Democrats, Republicans and independents and a growing number of communities across the country engaging and mobilizing every day in support of the legislation.”

“They understand the urgent need to pass this bill and stand up for LGBTQ people across our country,” David added. “As we engage with elected officials, we have confidence that Congress will listen to the voices of their constituents and continue fighting for the Equality Act through the lengthy legislative process.  We will also continue our unprecedented campaign to grow the already-high public support for a popular bill that will save lives and make our country fairer and more equal for all. We will not stop until the Equality Act is passed.”

Sen. Jeff Merkley (D-Ore.), chief sponsor of the Equality Act in the Senate, also signaled through a spokesperson work continues on the legislation, refusing to give up on expectations the legislation would soon become law.

“Sen. Merkley and his staff are in active discussions with colleagues on both sides of the aisle to try to get this done,” McLennan said. “We definitely see it as a key priority that we expect to become law.”

A spokesperson Senate Majority Leader Charles Schumer (D-N.Y.), who had promised to force a vote on the Equality Act in the Senate on the day the U.S. House approved it earlier this year, pointed to a March 25 “Dear Colleague” letter in which he identified the Equality Act as one of several bills he’d bring up for a vote.

Despite any assurances, the hold up on the bill is apparent. Although the U.S. House approved the legislation earlier this year, the Senate Judiciary Committee hasn’t even reported out the bill yet to the floor in the aftermath of the first-ever Senate hearing on the bill in March. A Senate Judiciary Committee Democratic aide, however, disputed that inaction as evidence the Equality Act is dead in its tracks: “Bipartisan efforts on a path forward are ongoing.”

Democrats are quick to blame Republicans for inaction on the Equality Act, but with Manchin withholding his support for the legislation they can’t even count on the entirety of their caucus to vote “yes” if it came to the floor. Progressives continue to advocate an end to the filibuster to advance legislation Biden has promised as part of his agenda, but even if they were to overcome headwinds and dismantle the institution needing 60 votes to advance legislation, the Equality Act would likely not have majority support to win approval in the Senate with a 50-50 party split.

The office of Manchin, who has previously said he couldn’t support the Equality Act over concerns about public schools having to implement the transgender protections applying to sports and bathrooms, hasn’t responded to multiple requests this year from the Blade on the legislation and didn’t respond to a request to comment for this article.

Meanwhile, Sen. Susan Collins (R-Maine), who declined to co-sponsor the Equality Act this year after having signed onto the legislation in the previous Congress, insisted through a spokesperson talks are still happening across the aisle despite the appearances the legislation is dead.

“There continues to be bipartisan support for passing a law that protects the civil rights of Americans, regardless of their sexual orientation or gender identity,” said Annie Clark, a Collins spokesperson. “The Equality Act was a starting point for negotiations, and in its current form, it cannot pass. That’s why there are ongoing discussions among senators and stakeholders about a path forward.”

Let’s face it: Anti-LGBTQ forces have railroaded the debate by making the Equality Act about an end to women’s sports by allowing transgender athletes and danger to women in sex-segregated places like bathrooms and prisons. That doesn’t even get into resolving the issue on drawing the line between civil rights for LGBTQ people and religious freedom, which continues to be litigated in the courts as the U.S. Supreme Court is expected any day now to issue a ruling in Fulton v. City of Philadelphia to determine if foster care agencies can reject same-sex couples over religious objections.

For transgender Americans, who continue to report discrimination and violence at high rates, the absence of the Equality Act may be most keenly felt.

Mara Keisling, outgoing executive director of the National Center for Transgender Equality, disputed any notion the Equality Act is dead and insisted the legislation is “very much alive.”

“We remain optimistic despite misinformation from the opposition,” Keisling said. “NCTE and our movement partners are still working fruitfully on the Equality Act with senators. In fact, we are gaining momentum with all the field organizing we’re doing, like phone banking constituents to call their senators. Legislating takes time. Nothing ever gets through Congress quickly. We expect to see a vote during this Congress, and we are hopeful we can win.”

But one Democratic source said calls to members of Congress against the Equality Act, apparently coordinated by groups like the Heritage Foundation, have has outnumbered calls in favor of it by a substantial margin, with a particular emphasis on Manchin.

No stories are present in the media about same-sex couples being kicked out of a restaurant for holding hands or transgender people for using the restroom consistent with their gender identity, which would be perfectly legal in 25 states thanks to the patchwork of civil rights laws throughout the United States and inadequate protections under federal law.

Tyler Deaton, senior adviser for the American Unity Fund, which has bolstered the Republican-led Fairness for All Act as an alternative to the Equality Act, said he continues to believe the votes are present for a compromise form of the bill.

“I know for a fact there is a supermajority level of support in the Senate for a version of the Equality Act that is fully protective of both LGBTQ civil rights and religious freedom,” Deaton said. “There is interest on both sides of the aisle in getting something done this Congress.”

Deaton, however, didn’t respond to a follow-up inquiry on what evidence exists of agreeing on this compromise.

Biden has already missed the goal he campaigned on in the 2020 election to sign the Equality Act into law within his first 100 days in office. Although Biden renewed his call to pass the legislation in his speech to Congress last month, as things stand now that appears to be a goal he won’t realize for the remainder of this Congress.

Nor has the Biden administration made the Equality Act an issue for top officials within the administration as it pushes for an infrastructure package as a top priority. One Democratic insider said Louisa Terrell, legislative affairs director for the White House, delegated work on the Equality Act to a deputy as opposed to handling it herself.

To be sure, Biden has demonstrated support for the LGBTQ community through executive action at an unprecedented rate, signing an executive order on day one ordering federal agencies to implement the U.S. Supreme Court’s decision last year in Bostock v. Clayton County to the fullest extent possible and dismantling former President Trump’s transgender military ban. Biden also made historic LGBTQ appointments with the confirmation of Transportation Secretary Pete Buttigieg and Rachel Levine as assistant secretary of health.

A White House spokesperson insisted Biden’s team across the board remains committed to the Equality Act, pointing to his remarks to Congress.

“President Biden has urged Congress to get the Equality Act to his desk so he can sign it into law and provide long overdue civil rights protections to LGBTQ+ Americans, and he remains committed to seeing this legislation passed as quickly as possible,” the spokesperson said. “The White House and its entire legislative team remains in ongoing and close coordination with organizations, leaders, members of Congress, including the Equality Caucus, and staff to ensure we are working across the aisle to push the Equality Act forward.”

But at least in the near-term, that progress will fall short of fulfilling the promise of updating federal civil rights law with the Equality Act, which will mean LGBTQ people won’t be able to rely on those protections when faced with discrimination based on sexual orientation or gender identity.

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