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Rachel Levine in ‘rewarding’ visit speaks with trans youth at D.C. health clinic

Hospital an oasis of support amid attacks from states

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Dr. Rachel Levine, assistant secretary for health. (Washington Blade photo by Michael Key)

Itā€™s not unusual for Rachel Levine as assistant secretary for health to visit medical facilities on behalf of the Department of Health & Human Services. But her visit last week to the LGBTQ youth clinic at the Childrenā€™s National Hospital was special because she was able to meet with transgender youth as an openly transgender presidential appointee.

The visit on Thursday by Levine at the D.C.-based hospital comes not long after the U.S. Senate approved her appointment, making her the first openly transgender presidential appointee to win a Senate-confirmed position. As such, her visit to the LGBTQ youth clinic, where transgender kids come for transition-related care and health services, held particular significance for the patients.

Levine, speaking with the Washington Blade at the end of her visit, said having the opportunity to speak with both transgender youth and medical professionals testing them was ā€œtremendously, tremendously rewardingā€

ā€œItā€™s tremendously gratifying to be able to speak to the medical professionals and the clinic personnel,Ā but particularly to the youth and their families from my experience,ā€ Levine added. ā€œSo I have two aspects of that. One is that I’m a pediatrician and adolescent medicine specialist. So I’ve been teaching to children and their families my entire career, but the other is coming from my lived experience as an openly transgender woman, and so I find it tremendously rewarding.ā€

The warm environment of the hospital for children is readily apparent upon entering the main atrium of the building. Lights dressed up as hot air balloons fill the tall ceiling while a nearby TV shows music videos consisting of squares of kids’ faces singing, followed by easy-listening country music and Asian K-pop. Children and their parents await their appointments seated in comfy plush red chairs before white blocks meant for use as tables.

Key to Levineā€™s visit was taking part in a discussion at the hospital auditorium with three transgender youth and their families who obtain services at the clinic. During the question-and-answer period, Levine shared her experience as a transgender person who underwent transition later in life and went on to tremendous success as a high-ranking presidential appointee.

For the transgender youth, Levineā€™s presence at the hospital ā€” at a time when state legislatures are busy enacting bills to restrict their access to medical care and school activities ā€” serves as a reminder that barriers based on gender identity are breaking down and the skyā€™s the limit for their future.

After the question-and-answer session, Levine told the Blade she ā€œlearned a lotā€ about Childrenā€™s National, which she called ā€œa world-renowned children’s hospital and academic medical center.ā€

ā€œIā€™ve known about it before,ā€ Levine added. ā€œIā€™m a pediatrician, adolescent medicine specialist, but I learned more about what they’re doing. And I learned specifically about their gender clinic, where they take care of transgender and gender non-conforming youth and got to meet some of the staff as well as the kids and their families.ā€

The Youth Pride Clinic, which opened in 2015, is one of the few clinics in the nation to provide primary care and mental health services to LGBTQ youth from ages 12 to 22. Among the services offered are hormone replacement therapy, STP/STI treatment and PrEP services as well as individual and family therapy for transgender youth.

Among the transgender youth patients at the clinic who spoke to the Washington Blade was Amir, a 15-year-old Georgia native whose last name as a minor is being withheld for confidentiality purposes.

ā€œI started out in fifth grade coming out as lesbian,ā€ Amir said. ā€œI didn’t even really know, but when I came out to my grandma in Georgia, where I’m from, I still didn’t feel like myself. So then, later on, me and my friend researched, and next thing you know we came across the term transgender, and I was like, ‘This is who I am. This is me.’ā€

Amir said he began taking shots as part of care regimen in January. Being able to receive care from the Youth Pride Clinic, Amir said, means a lot because he has an opportunity not available to other transgender youths, who face challenges and even hostility as they make the journey to transition. The staffers at the Youth Pride Clinic, Amir said, are ā€œlike a second familyā€ who work hard to provide the services they offer.

Sonia Murphy, Amirā€™s aunt who became his legal guardian, said when she began reaching out for medical help for Amir she found a two- or three-year wait list to get access to treatment, which she said makes her “saddened” such care isnā€™t widely available.

ā€œThereā€™s a population of kids and parents out there who need the services and just can’t access it because there’s not enough bandwidth, not enough manpower,ā€ Murphy said.

Amir said heā€™s getting other avenues of support from his two cousins, one who is older at age 18 and one who is younger at age 12. ā€œThey’re like sisters to me, so I call them my sisters,ā€ Amir said. Amir also identified two other male cousins as well as his uncles and his aunt.

ā€œThey’re all very supportive of me,ā€ Amir said. ā€œMy auntie Tonya, for example, Pride month came up, first day, she sent me a paragraph, saying, ā€˜Iā€™m glad you’re yourself and you’re open to who you are and things like that,ā€ and that I’m not afraid to be who I am around anybody. Itā€™s just things like that. And for my birthday, I had tons of Pride shirts, and I got a rainbow shirt with the fist in the middle for Black Lives Matter, and it was a ton of different things.ā€

Lawrence Dā€™Angelo, director of the Youth Pride Clinic and an occupational health adolescent medicine specialist, told the Blade being able to start the facility in 2015 in and of itself was one of the key victories for the initiative, although he said the Childrenā€™s National has been providing transition-related care since 1998.

ā€œWhen we started itā€¦we thought that we were going to be running a PrEP clinic, that we were going to be providing preventive services to LGBTQ kids,ā€ Dā€™Angelo said. ā€œThe first day, the first patient actually came in and asked for PrEP, and the other six patients that were scheduled that day all wanted transgender services. So, suddenly, it became obvious what we were going to be spending 90 percent of our time doing, which is exactly what we think we should be doing, because that’s where the need is the greatest.ā€

Despite the advantages of having access to the Youth Pride Clinic, transgender youth have clear challenges and face hostility based simply on their gender identity, especially in a year when state legislatures have in an unprecedented manner enacted legislation against them. The Youth Pride Clinic, in many ways, is an oasis of support.

Arkansas, for example, enacted a measure that would make criminal the kind of services provided at the clinic. Other states have enacted measures prohibiting ā€œbiological boysā€ from participating in sports, which essentially bars transgender girls from participating in sporting events.

While anti-trans measures aren’t being enacted in D.C. or any nearby states, the advancement of anti-trans legislation in states has had a negative effect on transgender patients at the Youth Pride Clinic.

Dā€™Angelo, based on conversations he’s had with the patients, said theyā€™re aware of the wave of legislation, which he said has led to fear, anger and being ā€œunable to understand what is happening and why it’s happening.”

Amir said watching states enact legislation against transgender youth ā€œmakes me feel some type of weight,ā€ pointing specifically to the anti-trans sports measures because he said heā€™d welcome the opportunity to participate in athletics.

ā€œIā€™m athletic,ā€ Amir said. ā€œI do all types of sports. I play basketball, soccer, I’m going to do boxingā€¦With sports and stuff, I just feel like I want to be able to do everything, just as a regular cisgender person will be able to do,ā€

Amir, despite the enactment of anti-trans laws, has an optimistic outlook and said the enactment of state measures against transgender youth demonstrates theyā€™re now ā€œon the radarā€ of the social conservative movement.

ā€œI feel like if everybody who’s a part of LGBTQ and trans together, we can stand up and we can overcome this because the thing is, there are so many people out there who don’t understand what we do, and the thing is that they’re noticing us, so that’s a start to something big.ā€

Amir (Blade photo by Michael Key)

With many states hostile to transgender youth, others are looking to the federal government for support under the Biden administration. On his first day in office, Biden signed an executive order directing federal agencies to implement the U.S. Supreme Courtā€™s decision against anti-LGBTQ discrimination to the fullest extent possible.

Levine cited an announcement from HHS that resulted from this order on implementing regulations prohibiting anti-LGBTQ discrimination in medical care, reversing a policy under the Trump administration that green lighted discrimination, as one of the ways it has answered that call and helped families like the Youth Pride Clinic.

ā€œSo the Affordable Care Act says that you cannot discriminate based upon sex,” Levine said. “The Department Health & Human Services and the Office of Civil Rights has interpreted sex to include sexual and gender minorities, to include sexual orientation and gender identity, which means LGBTQ individuals under that. So we need to look at all aspects of the Affordable Care Act, and to work to implement that interpretation of the statute. That was only done a month or so ago, so we’re going to be working on that now.ā€

Is there anything more the federal government can do to support the clinic? Dā€™Angelo cited a number of key things already secured, including the hospital being able to offer insurance to patients and the affirmation from HHS against anti-LGBTQ discrimination. More research dollars and greater focus from the National Institutes of Health on gender diverse and sexual minority individuals, Dā€™Angelo said, would also be welcome.

ā€œThere are things out there that the federal government can do, but I thinkā€¦there are limitations of what they can do,” Dā€™Angelo said. “They can’t, unfortunately, effect what’s going on in individual states, which is, in some cases draconian. That’s an awful thought if we were practicing medicine in Arkansas, we could be in jail.ā€

Meanwhile, Levine said the Biden administration, including Secretary of Health & Human Services Xavier Becerra, is working on both internal and external policies to facilities like the Youth Pride Clinic to help them secure their place in the health system and reach transgender youth.

ā€œThe secretary and I will be doing everything we can to advocate for the LGBTQ community,ā€ Levine said. ā€œSo I think we’re going to be working externally, in terms of advocacy, and then we’re going to be working internally in terms of policy.ā€

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U.S. Supreme Court

Supreme Court declines to hear case over drag show at Texas university

Students argue First Amendment protects performance

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The U.S. Supreme Court justices on June 30, 2022. ((Photo by Fred Schilling of the U.S. Supreme Court)

The U.S. Supreme Court on Friday declined to hear a First Amendment case over a public university president’s refusal to allow an LGBTQ student group to host a drag show on campus.

The group’s application was denied without the justices providing their reasoning or issuing dissenting opinions, as is custom for such requests for emergency review.

When plaintiffs sought to organize the drag performance to raise money for suicide prevention in March 2023, West Texas A&M University President Walter Wendler cancelled the event, citing the Bible and other religious texts.

The students sued, arguing the move constituted prior restraint and viewpoint-based discrimination, in violation of the First Amendment. Wendler had called drag shows ā€œderisive, divisive and demoralizing misogyny,” adding that “a harmless drag show” was “not possible.”

The notoriously conservative Judge Matthew Kacsmaryk, who former President Donald Trump appointed to the U.S. District Court for the Northern District of Texas, ruled against the plaintiffs in September, writing that ā€œit is not clearly established that all drag shows are inherently expressive.”

Kacsmaryk further argued that the High Court’s precedent-setting opinions protecting stage performances and establishing that “speech may not be banned on the ground that it expresses ideas that offend” was inconsistent with constitutional interpretation based on ā€œtext, history and tradition.”

Plaintiffs appealed to the 5th U.S. Circuit Court of Appeals, which is by far the most conservative of the nation’s 12 appellate circuit courts. They sought emergency review by the Supreme Court because the 5th Circuit refused to fast-track their case, so arguments were scheduled to begin after the date of their drag show.

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Federal Government

EXCLUSIVE: USAID LGBTQ coordinator visits Uganda

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

US sanctioned Ugandan officials over Anti-Homosexuality Act

The U.SĀ imposed visa restrictionsĀ on Ugandan officials shortly after Museveni signed the law. The World Bank Group later announcedĀ the suspension of new loansĀ to Uganda.

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

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

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

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

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

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

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

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

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

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

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

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Texas

Pornhub blocks Texas accessing site over age verification law

Court battle forced statute to take effect

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Washingtonporn Blade graphic

Aylo (formerly MindGeek) the largest global adult online entertainment conglomerate, owned by Canadian private equity firm Ethical Capital Partners, has restricted access to its platforms including its flagship Pornhub in Texas after a court battle forces the state’s age verification law to take effect.

Texas Republican Attorney General Ken Paxton had appealed a U.S. District Court decision that enjoined him from enforcing House Bill 1181. Paxton and others argued that purveyors of obscene materials online needed to institute reasonable age-verification measures to safeguard children from pornography.Ā 

A week ago the 5th U.S. Circuit Court of Appeals partially vacated the original injunction, ruling that the age verification requirements are constitutional.Ā 

ā€œApplying rational-basis review, the age-verification requirement is rationally related to the governmentā€™s legitimate interest in preventing minorsā€™ access to pornography,ā€ the three judge panel of the 5th Circuit explained. ā€œTherefore, the age-verification requirement does not violate the First Amendment.ā€

While the court vacated the injunction against the age-verification requirement of the statute, it upheld the lower courtā€™s injunction against a separate section of the law that would require pornography websites to display a health warning on their landing page and all advertisements. 

Texas users are greeted with this notice.

The Houston Chronicle reported people who go to the site are now greeted with a long message from the company railing against the legal change as ā€œineffective, haphazard, and dangerous.ā€ The company calls for age verification by the makers of devices that let people on the internet, instead of individual websites.

Age verification legislation was enacted in several states in 2023 in addition to Texas, including North Carolina, Montana, Arkansas, Louisiana, Mississippi, Utah and Virginia.

The new laws require users to provide digital confirmation via a certified approved third party vendor like London-based digital identity company Yoti. The other possibility would be a state approved digital ID such as the California DMVā€™s Wallet app, which contains a mobile driverā€™s license.

Users accessing Pornhub from within Louisiana are presented with a different webpage that directs them to verify their age with the stateā€™s digital ID system, known as LA Wallet. The law passed in 2022 subjects adult websites to damage lawsuits and state civil penalties as high as $5,000 a day if they fail to verify that users are at least 18 years old by requiring the use of digitized, state-issued driverā€™s licenses or other methods.

The Associated Press reported this past October that an adult entertainment groupā€™s lawsuit against a Louisiana law requiring sexually explicit websites to verify the ages of their viewers was dismissed by U.S. District Judge Susie Morgan in New Orleans.

Texas users are greeted with this notice.

Potential or existing Pornhub users in North Carolina and Montana are directed to a video that features adult film star Cherie DeVille, who recites a message also written under the video.

ā€œAs you may know, your elected officials in your state are requiring us to verify your age before allowing you access to our website. While safety and compliance are at the forefront of our mission, giving your ID card every time you want to visit an adult platform is not the most effective solution for protecting our users and in fact, will put children and your privacy at risk.ā€

ā€œMandating age verification without proper enforcement gives platforms the opportunity to choose whether or not to comply,ā€ the statement continues. ā€œAs weā€™ve seen in other states, this just drives traffic to sites with far fewer safety measures in place.ā€

ā€œUntil a real solution is offered, we have made the difficult decision to completely disable access to our website in [the aforementioned locales]ā€ the message ends with.

The company previously blocked Utah on May 7, 2023. CNN reported at the time:

Affected users are shown a message expressing opposition toĀ Senate Bill 287, the Utah law signed by Gov. Spencer Cox in March that creates liability for porn sites that make their content available to people below the age of 18.

ā€œAs you may know, your elected officials in Utah are requiring us to verify your age before allowing you access to our website,ā€ the message said. ā€œWhile safety and compliance are at the forefront of our mission, giving your ID card every time you want to visit an adult platform is not the most effective solution for protecting our users, and in fact, will put children and your privacy at risk.ā€

Courthouse News reportedĀ that after Virginiaā€™s bill was passed in June, state Sen. L. Louise Lucas, a Democrat, criticized the state for not creating a system for age verification, and instead leaving it up to websites to manage the process, citing security risks.Ā Ā 

ā€œWe passed a bill during this session to protect children from online porn. However the executive branch had an obligation to create a system for age verification,ā€Ā Lucas saidĀ on X, formerly Twitter. ā€œWe will continue our work to keep pornography out of the hands of minors ā€¦ but we will also work to ensure that this Governorā€™s error does not put the privacy of Virginians at further risk.ā€

Beyond the U.S. in the European Union, Pornhub and two more of the worldā€™s biggest porn websites face new requirements in the European Union that include verifying the ages of users, under the EUā€™s Digital Services Act.

According to a December 20 report from the Associated Press, Pornhub, XVideos and Stripchat have now been classed as ā€œvery large online platformsā€ subject to more stringent controls under the Digital Services Act because they each have 45 million average monthly users, according to the European Commission, the EUā€™s executive branch.

They are the first porn sites to be targeted by the sweeping Digital Services Act, which imposes tough obligations to keep users safe from illegal content and dodgy products, the Associated Press reported last month.

In addition to the adult entertainment websites, any violations are punishable by fines of up to 6% of global revenue or even a ban on operating in the EU. Some 19 online platforms and search engines have already been identified for stricter scrutiny under the DSA, including TikTok, Amazon, Facebook, Instagram, Google and more.

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