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LGBTQIA disparities amid COVID-19

Pandemic has disproportionately impacted vulnerable groups

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COVID-19 vaccine, gay news, Washington Blade

The COVID-19 pandemic has highlighted the importance of meeting the needs of diverse communities and minorities when facing emergencies such as COVID-19. But more importantly, it highlighted their vulnerability, since they are considered much more prone populations. COVID-19 has made it even more evident the disproportionate burden vulnerable populations bear and the weakness of our health system.

Minorities who are members of racial/ethnic groups are disproportionately affected and often exposed to higher illness rates and have substantially higher mortality and morbidity rates than the general population. For example, people vulnerable to HIV infection usually belong to socially, economically disadvantaged and discriminated groups. The Human Rights Campaign presented an investigative report on how the community faces unique challenges due to their economic situations and access to healthcare. According to HRC, LGBTQIA Americans are more likely than the general population to live in poverty and lack access to adequate health care, paid sick leave and basic needs during the pandemic. The Centers for Disease Control and Prevention states in one of its reports that the LGBTQIA community experiences stigma and discrimination in their lives that “… can increase vulnerabilities to illness and limit the means to achieving optimal health and well-being…” For example, discrimination and violence against LGBTQIA persons have been associated with high rates of psychiatric disorders, substance abuse, suicide and have long-lasting effects on the individuals. Furthermore, LGBTQIA mental health and personal safety are also affected when they go through the process of personal, family and social acceptance of their sexual orientation, gender identity and gender expression.

According to the Williams Institute, the leading research center on rights based on sexual orientation and gender identity, one in 10 LGBTQIA people is unemployed and more likely to live in poverty than heterosexual people, so they cannot always pay for proper medical care or preventive health measures. Also, approximately one in five LGBTQ + adults in the United States (22 percent) lives below the poverty line, compared to an estimated 16 percent poverty rate among heterosexuals. This data is much worse when we look closely at the trans population with 29 percent and LGBTQIA Latinos with 45 percent. These disparities are even more evident when we see that 17 percent of LGBTQIA adults do not have any medical health coverage compared to the 12 percent of the heterosexual population. That 17 percent increases with the LGBTQIA Black adults with 23 percent, trans adults with 22 percent, and trans Black adults with 32 percent who do not have any health coverage, compared to 12 percent of the heterosexual population that does not possess health coverage. The Office of Disease Prevention and Health Promotion statistics reflect that the LGBTQIA community is more likely to attempt suicide, be overweight or obese, have mental health problems, and less likely to receive cancer treatment.

According to several health organizations led by the National LGBT Cancer Network, the LGBTQIA population still faces great social and economic disparities compared to the heterosexual community, so they are more likely to get infected by COVID-19. The report summarizes how COVID-19 negatively affects the lives and livelihoods of the LGBTQIA community at disproportionate levels. The older generations of LGBTQIA encounter additional health barriers in the face of COVID-19 due to isolation, discrimination in the provision of services, and the lack of competent social services. The LGBTQIA community uses tobacco at rates that are 50 percent higher than the general population, and COVID-19 is a respiratory illness that has proven particularly harmful to smokers. In addition, the LGBTQIA population has higher rates of HIV and cancer, which means a more significant number may have compromised immune systems, leaving us more vulnerable to COVID-19 infections. LGBTQIA communities also face additional risks related to conditions that are often associated with complications from COVID-19. One in five LGBTQIA adults aged 50 and above has diabetes, a factor that raises the risk of complications for individuals diagnosed with COVID-19.

A Kaiser Family Foundation research finds that a larger share of LGBTQIA adults has experienced COVID-19 era job loss than heterosexuals adults (56 percent vs. 44 percent). Furthermore, the limited anti-discrimination protections from the LGBTQIA community also make them more vulnerable to joblessness due to an economic downturn resulting from COVID-19’s spread. Since February 2020, 56 percent of LGBTQIA people report that they or another adult in their household have lost a job, been placed on furloughs, or had their income or hours reduced because of the coronavirus outbreak, compared to 44 percent of non-LGBTQIA people.

In addition, recent data show that LGBTQIA respondents were more likely than non-LGBTQIA respondents to be laid off (12.4 percent vs. 7.8 percent) or furloughed from their jobs (14.1 percent vs. 9.7 percent), report problems affording essential household goods (23.5 percent vs. 16.8 percent), and report having problems paying their rent or mortgage (19.9 percent v. 11.7 percent). The research also shows that three-fourths of LGBTQIA people (74 percent) say worry and stress from the pandemic have had a negative impact on their mental health, compared to 49 percent of those, not LGBTQIA. A recent study from the William Institute also found that LGBTQIA people of color were twice as likely as white non-LGBTQIA people to test positive for COVID-19. According to the Williams Institute, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) represented a direct benefit for the LGBTQIA community amid the pandemic. However, LGBT people have still experienced the COVID-19 pandemic differently than heterosexuals, including being harder hit in some areas. The challenges presented by COVID-19 have exacerbated the stigma and discrimination to access to healthcare, social services, and basic legal protections for the LGBTQIA community. It is not the first time the LGBTQIA confronts the stigma and discrimination amid a pandemic. Since the HIV/AIDS pandemic from the 80s until now, the LGBTQIA community has developed an extraordinary resilience over decades, and pushing back against stigma and making claims for basic human dignity and equality

The World Health Organization recognizes that “vulnerable and marginalized groups in societies often have to bear an excessive share of health problems and are less likely to enjoy the right to health…” For this reason, the WHO recognizes the need for more aggressive regulations and laws that promote equality in services for these vulnerable groups to eliminate those current statutes that aggravate marginalization and hinder gradually, and even more so, access to health services, prevention, and care. National policies and state regulations must address the needs of LGBTQIA populations, with particular attention to black LGBTQIA and the absence of standardized protections against discrimination by healthcare providers. Although there have been substantial advances for the LGBTQIA population over the last decade, legal protections remain uneven, including those jurisdictions that do not expressly prohibit discrimination based on sexual orientation, gender identity, or/and gender expression. Eliminating LGBTQIA health disparities and enhancing efforts to improve their health are necessary to reduce disparities and increase longevity. Furthermore, under the context of COVID-19, researchers have found that the intersection of race with sexual orientation and gender identity is essential to understand pandemic’s impact. For example, data collection efforts related to COVID-19 must immediately add sexual orientation and gender identity questions. Collecting sexual orientation and gender identity data will improve knowledge about disparities from sexual minorities, enhance cultural competence among health providers, help implement anti-bullying policies, and reduce suicide and homelessness among youth, among others.

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Opinions

Supreme Court ruling on trans athletes is a public health story

Justices label an entire group as ‘lesser’

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(Washington Blade file photo by Michael Key)

On June 30, the Supreme Court ruled, 6-3 that states may bar transgender girls and women from girls’ and women’s sports teams. Justice Brett Kavanaugh wrote that states may keep these teams for “biological females” and set eligibility by “biological sex.” The country will now spend days arguing about fairness on the field. We’ll debate race times, records, and who has earned a place on the roster.

I want to redirect this conversation, because I study something different and because the frame we’ve settled on misses the something important. 

I’m a public health researcher. My work focuses on how the conditions people live under get into the body and influence health over a lifetime. I’m talking about conditions such as laws, policies, and the everyday climate of acceptance or rejection. 

Two features of this ruling deserve more attention than the sports fight is giving them: the lifelong costs even a “narrow” decision sets in motion, and the question the Court declined to decide.

Start with how a ruling like this reaches the body, because that pathway is what makes this a public health story. My area of research has a name for what laws like this do: structural stigma. It’s the way statutes and court rulings can mark an entire group as lesser, and in doing so become a chronic stressor for every member of that group. 

The overwhelming majority of transgender kids will never compete for a state title. They still learned, from the highest court in the country, that their belonging is conditional. The stress that follows from that lesson is associated with higher rates of depression, anxiety, and poorer health across LGBTQ populations. A consistent finding in this literature is that social acceptance can disrupt such harmful trajectories. But this ruling pushes the country the other way.

I want to emphasize that the question of fairness is important, and the girls and women who raise it deserve to be heard. But the ruling does not resolve this question. It flattens it.

The science on athletic performance and gender transition is truly complicated and individual. It varies by sport, by person, by age, and by life circumstance. The Court grounded its decision in biological sex and then declined to reckon with what biology shows. The West Virginia teenager at the center of the case has been on puberty blockers since before male puberty began. The advantage the law claims to police never developed in her. A rule that treats her like an adult athlete disregards biology.

Here is the part a policy-minded reader should pay attention to. For decades, the central legal question about transgender Americans has been this: When the government treats transgender people differently, how good does its reason have to be? Courts don’t judge all discrimination in the same way. If a law sorts people by race or sex, the state must provide a strong justification, and many such laws fail. But if a law tries to draw an ordinary distinction, like who qualifies for a license, judges tend to wave it through as long as there’s a reasonable purpose. Whether a law singling out transgender people gets the skeptical look (what lawyers call heightened scrutiny) or the easy pass has not been settled. And this ruling, despite its subject, still did not settle it.  

How did the Court avoid the question its own case raised? Following last year’s decision in Skrmetti (the gender-affirming care case), the Court described these laws as drawing lines by biological sex, not transgender status. Courts endorsed sex-separated teams long ago; separate teams are the reason girls’ sports exist. So a law framed as a “sex” line lands on ground the courts have already approved, while a “transgender” line would have forced the choice between the skeptical look and the easy pass. The Court chose the frame that let it stay silent.

That silence creates exposure for transgender people – and I mean that word the way my field of public health uses it, for a condition that puts a whole population at risk. The same unanswered question now hangs over health care, employment, identification documents, public accommodations, and every domain where the level of scrutiny is the whole ballgame. And the Court read Title IX, the federal law banning sex discrimination in schools, through the same lens: “biological sex,” full stop. Advocates are right to see protections far beyond sports as newly vulnerable.

This is where my own research makes me most uneasy. I study LGBTQ adults in their 60s, 70s, and 80s, who came of age in a far more hostile America. Their lives show that the cost of stigma accumulates. Chronic stress works its way under the skin and surfaces years and decades later. Researchers see these deleterious outcomes in mental health, in physical health, and in emerging research like my own that explores the aging brain. So we should understand this decision for what it is: a long-term health decision the country is making on behalf of a generation of children.

Practically, the ruling compels no state to do anything. It tells the more than two dozen states that have passed these bans that they stand on solid ground, and it sends the rest of the fight back to statehouses and school boards, where trans youth and their families often hold little power. The ruling arrives just over a year after the Court let states ban the medical care many of these same young people depend on. Each law is a single stressor. Together they are a dangerous environment.

We know what protects these children. Acceptance, inclusion, and the dignity of being treated as though they belong. The Court made all three harder to offer, and left open the question that determines how much harder it can get. It is the children who needed those protections who will bear the cost, this sports season and for the rest of their lives. 


Harry Barbee, Ph.D., is an assistant professor at the Johns Hopkins Bloomberg School of Public Health where they study LGBTQ health, aging, and public policy.

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Opinions

It’s good to see some justices standing up to Trump

But expanding the court is necessary to save our democracy

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(Photo by Fred Schilling; courtesy Supreme Court of the U.S.)

It was shocking to see some of the MAGA-loving majority on the Supreme Court actually voted against the felon in the White House a couple of times. Not surprisingly, Samuel Alito and Clarence Thomas were steadfast in their ultra-MAGA, outrageous views. They just want to help make Republican doctrine, which today means helping to make Project 2025 a reality, a success. They couldn’t care less about the Constitution. We can just imagine how they voted on the E. Jean Carroll case, where Trump has been trying to weasel out of his obligation to pay the woman he was convicted of committing sexual assault against. But we won’t know for sure since the Court simply denied hearing the case, so there was no recorded vote or dissent. 

On what was a simple case, the constitutional principle of birthright citizenship, Chief Justice John Roberts, Amy Coney Barrett, and Brett Kavanaugh, actually voted to uphold the Constitution along with the three liberal justices, Sonia Sotomayor, Elena Kagan, and Ketanji Brown Jackson. But even then, Kavanaugh was only halfway there. But as could have been predicted, Alito and Thomas voted the other way, and this time were joined by Neil Gorsuch. Then on the question of trans women playing sports on a women’s team, the vote was 6-3 against, and you can figure out who the three were who went against the felon, and supported the women. 

Interestingly, in the case of Mississippi and mail-in ballots, allowing those mail-in ballots to be counted up to five days after the election if they were postmarked by Election Day, Roberts and Coney Barrett went with the liberals. Once again, you knew before the vote where Alito and Thomas were, and in this case, they were joined by Kavanaugh and Gorsuch, trying to help Republicans steal the next election.

I have no love for Roberts, but it seems every so often he is trying to save his own reputation since all this is the Roberts court, as he is the chief justice. I have never known what to make of Coney Barrett, who has occasionally sided with the more liberal justices, to the consternation of Trump, who believed when he nominated her, she would always be with him. She mostly has, and he can be thankful she voted with the other slime bags, and granted him total immunity as president in the 2024 decision. In essence, placing him above the law. In so many ways the felon has acted using that immunity. We now see a blatant case of this with the release of his new financials, and his $2 billion windfall with crypto.  

Roberts nearly always votes with the Trump judges, but if there is a decision that is so obviously a gift to the felon, Roberts every once in a while could go with the liberal wing of the court. We need to remember he was appointed by George W. Bush. But again, this court will always be known as the Roberts court, the one that bowed down to the felon in the White House, and his fascist aids like Stephen Miller, and the author of Project 2025, Russell Vought, at OMB. 

So, what can we do to change this, and to fight back? The first thing is to elect a Democratic Congress in 2026, and then a Democratic president in 2028. Then those we elect will have to decide how to proceed. One answer to that question is simple. Vote to add more justices to the Supreme Court. That simply requires a bill to pass with a majority in both houses of Congress, and the president’s signature. To the surprise of many it has been done seven times since the court was created in 1789. There is no number of justices for the court stipulated in the Constitution. Yet it has remained at nine since 1869. Although that fix may sound easy if Democrats take over Congress and the White House, we must remember, Franklin Roosevelt tried in 1937 to expand the court by six justices to protect his New Deal programs. After a fight that lasted 168 days, the bill to do this was defeated. I fear any proposal to expand the court today, may actually have the same fate. There will be those who say it will divide the nation even further, and there will be a constant tit-for-tat on everything. The only way to win such a vote will be if enough people are convinced the felon and his gang of thieves, have so destroyed our democracy, that changing the court is a necessity if we are to save our democracy for the next 250 years. 


Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.

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Commentary

When a church fears the rainbow

Puerto Rico pastor objected to Pride symbols outside congregation

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(Washington Blade photo by Michael Key)

There are moments when an incident stops being merely a local story and begins to reveal something much deeper. What happened on June 28 outside One Church, in Comerío, Puerto Rico, belongs in that category.

I do not know who painted the rainbow colors on the asphalt and on a roadside guardrail. I do not know what motivated them, and it is not my place to justify their actions. If someone believes a law was broken, there are authorities and legal mechanisms to address that. That is not the point of this reflection.

The point is the words that followed.

Hours after those colors appeared, Pastor Jorge J. Santiago Reyes went live on social media. He said he felt threatened. He described what happened as a physical attack against his church. He appeared angry and disappointed. He called those who painted the rainbow “cowards” and “charlatans.” He expressed frustration with the support that, according to him, the municipal government of Comerío has shown toward the LGBTQ community, and with those who support posts related to that community. He repeated several times that the people responsible had “crossed the line.” He ended his message by saying, “These charlatans have to be stopped.”

As I listened to his words, I stopped thinking about the paint.

I began thinking about fear.

There is one phrase the pastor repeated again and again: “They crossed the line.” Yet he never explained what that line was. If he was referring to a possible violation of the law, that is for the authorities to determine. If he meant respect for property, there are also procedures to deal with that. But when that line remains undefined and the message begins to associate a rainbow with a threat, the question changes. It is no longer only about a guardrail or a road. It becomes a question about what boundary, in the pastor’s view, was actually crossed.

Paint can be erased.

A brush can cover the asphalt and return a guardrail to its original color.

What does not disappear so easily is the meaning of those colors.

And perhaps that is where the real conflict begins.

It is significant that this happened precisely on June 28, the day when the LGBTQ community remembers a history marked by exclusion, violence, and the struggle for dignity. What represents memory, hope, and the possibility of living without hiding for millions of people was presented by others as a threat.

I do not know why someone painted that rainbow. I do not need to know in order to ask whether those were the words society should expect from a pastor.

A religious leader may feel hurt, frustrated, or angry. What he cannot forget is the responsibility that comes with every public expression. His words do not end when a livestream ends. They move beyond the space of his church, reach people who may never share his faith, and help shape the way others see those who think differently. When a pastor calls other people “charlatans” and “cowards,” says they “have to be stopped,” and turns a rainbow into evidence of an attack, he is no longer speaking only from frustration. He begins to build a discourse that can feed rejection toward a community far larger than the people responsible for that act.

There was another moment in the livestream that caught my attention. The pastor reminded viewers how much he has served Comerío, how much he has accompanied his community, and how much he has worked for it. I have no reason to question that service. I am sure many people can testify to the good he has done.

That is precisely why it was difficult to hear.

Pastoral vocation is not about reminding a town of everything one has done for it when conflict appears. Service does not lose its value when it goes unrecognized; it loses something when it becomes an argument to claim a moral position from which to speak down to others. A person who serves does so because that is the nature of the calling, not because that service grants authority to discredit those who think differently.

As a pastor, that part of the message left me deeply uneasy. Not because I expect ministers of God to be perfect. We are not. But because our words carry weight, we are called to speak with greater responsibility. Some expressions build bridges. Others raise walls. Some words invite encounter. Others end up justifying rejection.

The paint will disappear. A brush will be enough to cover the asphalt and return the guardrail to its original color.

The words will not disappear as easily.

They will remain recorded in a video, shared again and again on social media, and remembered by those who heard them. They will remain long after the last trace of paint has been erased.

When this episode is remembered, it probably will not be because of the rainbow that appeared outside One Church, in Comerío, Puerto Rico.

It will be because of the words a pastor chose to use when speaking about it.

And that difference changes everything.

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