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The LGBTQ+ community, telehealth, and rural broadband access

Congress must act to preserve lifeline of remote healthcare

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The LGBTQ+ community has come to rely more and more on remote general and specialized healthcare as the pandemic continues to limit access to in-person services. This lifeline is in danger of going away unless Congress acts, delivering a serious blow to the diverse community of people who struggle to access care in-person in their communities. 

Telehealth allows doctors and other providers to provide care without an in-person visit. More specifically, telehealth refers to the health care services accessible through telecommunications services, including via audio and video (either real time or asynchronous). These services are best delivered via high-speed broadband services. Medical care appointments, consultations, prescriptions, follow-up visits, and more can be done safely and virtually. 

Telehealth is a modern necessity made even more relevant due to the ongoing COVID-19 pandemic, and demand for these resources is growing. The LGBTQ+ community in particular is experiencing a significant need for improved telehealth provisions and access. Recent relaxations of telehealth regulations have expanded the reach of telehealth and positively impacted marginalized communities including the LGBTQ+ community, especially in rural and remote areas. Effective and reliable broadband access is instrumental for telehealth services and as telehealth expands, advancements to universal broadband access will be critical to reach these communities.

Telehealth and the LGBTQ+ community

More than 18 million Americans identify as lesbian, gay, bisexual, transgender, queer, questioning, or intersex (LGBTQ+), and more younger Americans than ever before are identifying as LGBTQ+. The health concerns of these individuals deserve utmost respect and care, demonstrable through high-quality health care both in person and online. Telehealth plays an important role in connecting the LGBTQ+ community with competent and affirming health care providers and services. The LGBTQ+ community has always been more heavily reliant on internet connectivity, and healthcare is no different, with 81% of LGBTQ+ youth reportedly using the internet to search for health information.

LGBTQ+ communities face many of the same healthcare concerts as non-LGBTQ+ communities, though there are differences in rates of some chronic conditions including cancer, diabetes, obesity, HIV/AIDS and other sexually transmitted infections (STIs), and tobacco-related health conditions. LGBTQ+ individuals have higher rates of mental and physical disability, and the impact of loneliness on health quality is experienced at higher rates by LGBTQ+ individuals in both urban and rural settings. Routine healthcare for these conditions improves quality of life, but LGBTQ+ individuals often report high cost as a deterrent from going to the doctor. Telehealth provides an affordable avenue to routine health care.

Many individuals in the LGBTQ+ community report a history of medical trauma as a barrier to receiving healthcare. Gender-affirming health care is one major motivator for telehealth access in the LGBTQ+ community. Nearly one-fifth of transgender individuals have been refused healthcare due to their gender identity. Online servers such as Folx Health, Plume, and QueerDoc provide gender-affirming care including hormone therapy, mental health, and documents for gender marker change. Telehealth allows users to bypass the barrier of proximity to medical care and to access providers who are informed on medical concerns and considerations that uniquely impact the LGBTQ+ community. 

Regulations that previously restricted the delivery of telehealth have been eased since the onset of the COVID-19 pandemic. Specifically, rules previously limited telehealth to rural areas received in a clinical setting. The new rules allow urban and suburban patients to access telehealth from their home or other convenient setting. This makes sense as many urban areas lack convenient access to physicians and other providers. Individuals across America have benefitted from the ability to access basic health services at home, but those whose care has been most significantly enhanced are poor, elderly, members of marginalized communities such as the LGBTQ+ community, and/or those who live in remote areas of the country. For example, the total number of telehealth visits in Medicare increased from less than 1 million to more than 50 million during COVID. 

There are currently hundreds of proposals pending before state and federal legislatures that address extending or expanding telehealth beyond the pandemic’s public health emergency. Current changes to telehealth regulations include loosened restrictions around telephone-based check-ins and the allowance for telehealth visits between providers and persons across state borders. Before the pandemic, patients filled a prescription after first meeting with a doctor in-person, but telehealth expansion has eliminated the required in-person appointment. Telehealth treatment for addiction is also on the rise, with addiction-specific treatments available online. General mental health resources are also increasingly accessible virtually and by phone. Now that these practices are commonplace, regulators are looking to pass legislation that will maintain this ease of service.

The expansion of telehealth has proven especially effective for the LGBTQ+ community. Easing accessibility of telehealth and prescriptions reduces the cost of care for routine medicines and check-ups for conditions that disproportionately affect the LGBTQ+ community, such as HIV. Increased availability of telehealth mental resources is critical for all youth, but especially for those in the marginalized LGBTQ+ community. Through online resources, transgender adults can safely and reliably access gender-affirming healthcare including hormone replacement therapy and counseling with specialized professionals. Additionally, telehealth access can reduce or eliminate the stigma and discrimination that LGBTQ+ individuals face daily when selecting providers, especially in remote or rural areas where there may be few providers to choose from and even fewer knowledgeable about and sympathetic to the special health care needs of LGBTQ+ individuals.   Making permanent the COVID-19 exemptions currently in place that regulate telehealth services will have far-reaching, positive impacts for the LGBTQ+ community.

Rural need for telehealth

An estimated 2.9 to 3.8 million Americans living in rural and remote parts of the country identify as LGBTQ+ and deserve high-quality and informed healthcare. Accessing a healthcare provider is, in general, more challenging in rural areas. Consider, for example, costs associated with distance. To add insult to injury, where providers are available in rural communities, the potential for discrimination against LGBTQ+ individuals and misdiagnosis of medical conditions is prevalent. Lack of access to sympathetic providers or specialized providers makes telehealth a crucial tool for the rural LGBTQ+ community. 

Given the need for broadband access to ensure quality telehealth services (to access video consultations, for example), the quality of an individual’s access to broadband services will directly affect their health care experience. Rural Americans are routinely left behind in broadband deployment, contributing to the digital divide, or the gap in use of online resources. Improvements to broadband access is key for expanding the reach of telehealth services across the country, especially in rural America. The recently enacted infrastructure law includes $65 billion in new broadband funding. It must be rolled out quickly to ensure marginalized communities in rural areas gain from improvements to broadband access and the telehealth resources that come along with it. 

Telehealth has become a critical tool to expand access for all patients, but especially the LGBTQ+ community. Marginalized individuals benefit the most from increased telehealth access and those living in rural areas may be the most significantly impacted. Telehealth offers a number of benefits including facilitating community health and social wellness, the delivery of gender-affirming medical care, accessible mental health care, and ease of prescription access.

Recently relaxed regulations around telehealth delivery have increased the reach of these services and provided healthcare to individuals who may have gone without care. Rural and remote marginalized communities, such as the LGBTQ+ community, will experience an especially positive impact from telehealth, and increasing rural broadband access is critical to expanding high-quality, informed healthcare to LGBTQ+ individuals across America.  Crucially, Congress can permanently expand telehealth services and capitalize on the recent infrastructure law to roll out high-speed broadband that facilitates telehealth in areas with limited internet access.  Without congressional action, many of the benefits marginalized communities have experienced from telehealth services will expire thereby reducing or eliminating supportive and specialized care options for these communities.  

For more information visit www.LGBTQ+tech.org/telehealth.

Carlos Gutierrez is deputy director and general counsel for the LGBT Technology Partnership & Institute, which works to improve access, increase inclusion, ensure safety and empower entrepreneurship for LGBTQ+ communities around technology.

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Opinions

Thank you, Mayor Bowser

An impressive record of accomplishment for D.C.

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D.C. Mayor Muriel Bowser (Washington Blade photo by Michael Key)

Thank you, Mayor Muriel Bowser, for all you have done for our beautiful city. I am proud to say I have been a supporter of yours since you first announced your run for City Council in Ward 4, when you took some of my suggestions for your first speech. I have known since then what an amazing woman, politician, leader, and now mother, you are. You have moved our city forward in so many ways no one could have anticipated when you were first elected.

You have always proven your mettle, and your ability to rise above the chaos, and done the right thing for all the people of the District. Whether it was during economic uncertainty created by others, the pandemic, the backlash against police after the murder of George Floyd, during the first Trump administration, or the ongoing crisis, continuing today after the felon was elected for a second time. This time, contrary to his first term, he has even more venal people around him. They are acting out their fascist beliefs, and directing him, as he threatens the very basis of home rule. You have stood your ground, and done it with grace and smarts. You managed to work through the budget crisis, and Congress’s attempt to derail all the progress you have made, by not letting us spend a billion dollars of our own money. You have been walking a tightrope, and managing to keep our city from falling into his hands.  Not everyone has understood how difficult that has been. 

Then you managed to get James Comer (R-Ken.), chair of the House Oversight Committee, to support your efforts to have 180 acres of valuable land, the RFK site, turned over to the District for redevelopment. After that, you achieved your goal of getting the Commanders to agree to move back to D.C.; in the process securing the largest private investment ever for the District, the $3.7 billion the team’s owners agreed to pay to build a new domed stadium. That being only the catalyst for an entire new community with 6,000 units of housing, including affordable housing, a supermarket, hotel, sports complex for students in D.C., parks, nature trails, and more. 

While balancing budgets and fighting crime, you have had to deal with the felon in the White House every day. Some accused you of acquiescing to the felon when what you were actually doing was saving our city from the even worse disasters he could visit upon us.

You understood to rebuild the economy Trump and the pandemic worked to destroy, you needed to look at other options. You rightly determined part of what D.C. needed to grow was a sports economy. When Monumental Sports owner Ted Leonsis was trying to move the Capitals and his business out of the District for pure greed; you worked behind the scenes and successfully kept them here. Prior to that you engineered a public/private partnership between the city, and DC United, to get Audi field built. 

Then besides sports you have worked with the private sector to begin the work of converting empty office buildings in the downtown area, into apartments, which will generate new needed taxes for the District. You oversaw the reconstruction of the Frederick Douglass Memorial Bridge, and the redevelopment of the South Capitol Street corridor. Along with all this you have overseen the rebuilding of schools, sports fields, recreation centers, and libraries across the city. In the past five years you have added nearly 10,000 affordable housing units in the District, built new shelters for the homeless, and a new hospital in Southeast D.C. 

You have fought for fairness and equality for the LGBTQ community. You didn’t just walk in our parades, but worked to make them successful. You added budget money to build a new LGBTQ community center, and money to support WorldPride, while the felon’s policies threatened it in every way.  After years of many of us trying to get the city to take responsibility, and fund, the annual High Heel Race, you were the mayor who finally agreed to do it. You have always stood proudly with the LGBTQ community that I am a part of, in large and small ways, both in public and privately. 

You now have one more year to serve as mayor, and I can’t wait to see what you will yet accomplish. It will not be an easy time, as we saw the day after you announced you would not run again. You, and we, faced the tragic shooting of the two National Guard members from West Virginia, who walked our streets at the felon’s orders. But I am confident your energy and drive, your smarts, and understanding of people, will allow you to deal with this and won’t let you stop working for us until the minute the next mayor of the District of Columbia is sworn in at noon, Jan. 1, 2027. 

It is clear to all of us, that person, he, or she, will have very large shoes to fill. Mayor Bowser, we all owe you a debt of gratitude for all you have done for D.C. I for one look forward to all you will do in the future; in whatever area you choose to work. I know your work is far from done.


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

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Commentary

Stand with displaced queer people living with HIV

Dec. 1 is World AIDS Day

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(Bigstock photo)

Today, on World AIDS Day, we honor the resilience, courage, and dignity of people living with HIV everywhere especially refugees, asylum seekers, and queer displaced communities across East Africa and the world.

For many, living with HIV is not just a health journey it is a journey of navigating stigma, borders, laws, discrimination, and survival.

Yet even in the face of displacement, uncertainty, and exclusion, queer people living with HIV continue to rise, thrive, advocate, and build community against all odds.

To every displaced person living with HIV:

• Your strength inspires us.

• Your story matters.

• You are worthy of safety, compassion, and the full right to health.

• You deserve a world where borders do not determine access to treatment, where identity does not determine dignity, and where your existence is celebrated not criminalized.

Let today be a reminder that:

• HIV is not a crime.

• Queer identity is not a crime.

• Seeking safety is not a crime.

• Stigma has no place in our communities.

• Access to treatment, care, and protection is a human right.

As we reflect, we must recommit ourselves to building systems that protect not punish displaced queer people living with HIV. We must amplify their voices, invest in inclusive healthcare, and fight the inequalities that fuel vulnerability.

Hope is stronger when we build it together.

Let’s continue to uplift, empower, and walk alongside those whose journeys are too often unheard.

Today we remember.

Today we stand together.

Today we renew hope.

Abraham Junior lives in the Gorom Refugee Settlement in South Sudan.

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Perfection is a lie and vulnerability is the new strength

Rebuilding life and business after profound struggles

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(Photo by Orhan/Bigstock)

I grew up an overweight, gay Black boy in West Baltimore, so I know what it feels like not to fit into a world that was not really made for you. When I was 18, my mother passed from congestive heart failure, and fitness became a sanctuary for my mental health rather than just a place to build my body. That is the line I open most speeches with when people ask who I am and why I started SWEAT DC.

The truth is that little boy never really left me.

Even now, at 42 years old, standing 6 feet 3 inches and 225 pounds as a fitness business owner, I still carry the fears, judgments, and insecurities of that broken kid. Many of us do. We grow into new seasons of life, but the messages we absorbed when we were young linger and shape the stories we tell ourselves. My lack of confidence growing up pushed me to chase perfection as I aged. So, of course, I ended up in Washington, D.C., which I lovingly call the most perfection obsessed city in the world.

Chances are that if you are reading this, you feel some of that too.

D.C. is a place where your resume walks through the door before you do, where degrees, salaries, and the perfect body feel like unspoken expectations. In the age of social media, the pressure is even louder. We are all scrolling through each other’s highlight reels, comparing our behind the scenes to someone else’s curated moment. And I am not above it. I have posted the perfect photo with the inspirational “God did it again” caption when I am feeling great and then gone completely quiet when life feels heavy. I am guilty of loving being the strong friend while hating to admit that sometimes I am the friend who needs support.

We are all caught in a system that teaches us perfection or nothing at all. But what I know for sure now is this: Perfection is a lie and vulnerability is the new strength.

When I first stepped into leadership, trying to be the perfect CEO, I found Brené Brown’s book, “Daring Greatly” and immediately grabbed onto the idea that vulnerability is strength. I wanted to create a community at SWEAT where people felt safe enough to be real. Staff, members, partners, everyone. “Welcome Home” became our motto for a reason. Our mission is to create a world where everyone feels confident in their skin.

But in my effort to build that world for others, I forgot to build it for myself.

Since launching SWEAT as a pop up fundraiser in 2015, opening our first brick and mortar in 2017, surviving COVID, reemerging and scaling, and now preparing to open our fifth location in Shaw in February 2026, life has been full. Along the way, I went from having a tight trainer six pack to gaining nearly 50 pounds as a stressed out entrepreneur. I lost my father. I underwent hip replacement surgery. I left a relationship that looked fine on paper but was not right. I took on extra jobs to keep the business alive. I battled alcoholism. I faced depression and loneliness. There are more stories than I can fit in one piece.

But the hardest battle was the one in my head. I judged myself for not having the body I once had. I asked myself how I could lead a fitness company if I was not in perfect shape. I asked myself how I could be a gay man in this city and not look the way I used to.

Then came the healing.

A fraternity brother said to me on the phone, “G, you have to forgive yourself.” It stopped me in my tracks. I had never considered forgiving myself. I only knew how to push harder, chase more, and hide the cracks. When we hung up, I cried. That moment opened something in me. I realized I had not neglected my body. I had held my life and my business together the best way I knew how through unimaginable seasons.

I stopped shaming myself for not looking like my past. I started honoring the new ways I had proven I was strong.

So here is what I want to offer anyone who is in that dark space now. Give yourself the same grace you give everyone else. Love yourself through every phase, not just the shiny ones. Recognize growth even when growth simply means you are still here.

When I created SWEAT, I hoped to build a home where people felt worthy just as they are, mostly because I needed that home too. My mission now is to carry that message beyond our walls and into the city I love. To build a STRONGER DC.

Because strength is not perfection. Strength is learning to love an imperfect you.

With love and gratitude, Coach G.


Gerard Burley, also known as Coach G, is a D.C.-based fitness entrepreneur.

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