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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), andĀ 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.Ā 

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.Ā 

Given the need for broadband access to ensure quality telehealth services (to access video consultations, for example), the quality of an individualā€™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 GutierrezĀ is deputy director and general counselĀ for the LGBT Technology Partnership & Institute,Ā whichĀ works to improve access, increase inclusion, ensure safety and empower entrepreneurship for LGBTQ+ communities around technology.

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Opinions

Attacking Jews is latest Trump outrage

Anyone who supports equality and peace must vote for Biden

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(Washington Blade file photo by Christopher Kane)

Calling out the Jewish community in the United States as Trump did, is both dumb, and anti-Semitic. The Jewish community has been a Democratic constituency for many years, and attacking them wonā€™t get them to vote for him.

It is a difficult time for many Jews in the world today. I being one of them. I am a strong supporter of Israel, but support Sen. Chuck Schumer (D-N.Y.), who believes there will never be peace in the Middle East as long as Netanyahu and his government are in control. Israel cannot keep annexing West Bank land, which should be part of a Palestinian state if we can get to a two-state solution. In fact, they must draw back the settlements now there. At the same time, like Schumer, I believe both Netanyahu and Hamas have to go. Being anti-Netanyahu is not being anti-Israel, just as being anti-Trump is not being anti-United States, or wanting Hamas to go, is not being anti-Palestinian. 

Attacking Jews is just one more outrageous thing coming out of Trumpā€™s mouth. He is a notorious sexist, racist, homophobic, pig. He is an old man who canā€™t control his mouth and continues to spout nonsense. His apparently limited brain power is tied up in disgusting views of the world and individuals. He mocks those with disabilities like he did to a New York Times reporter, and mocks President Biden for his stutter. There was a recent column in the Washington Post reminding people Trumpā€™s father had Alzheimerā€™s. I think we may be seeing the disease manifest itself in Trump. 

I have written this election is between two older men. I myself am older, and understand one often forgets a name, a date, or an event. Having just written a memoir, which I hope will be published in May, in its preface I say ā€œthese are dates and events as I remember them.ā€ But as neuroscientist Charan Ranganath recently wrote in the Washington Post, that in no way limits how a person can understand complex issues, or in my case work as a consultant and research and write weekly columns. For a president, especially one who is older, it is important for us to know who is surrounding him or her. I am definitely more secure knowing those who will be around and advising President Biden, versus those around Trump. No one person alone, whatever their age, can handle all the issues facing a president.

Whether you are a Jew supporting Israel, a Muslim supporting the Palestinian people, or someone like me supporting both, you are better off with President Biden. If you support the Palestinian people having their freedom, then Trump must strike fear in your heart, after all, he is the one who moved the American embassy to Jerusalem. 

The idea of electing a man convicted of fraud in his business dealings, found liable for sexually mistreating a woman, and who faces another 88 criminal counts, is ludicrous. It actually says as much about the people who would vote for him, as it does about Trump. A man who brags about taking away the right of women to control their own body, and healthcare, doesnā€™t deserve the vote of any woman. A man who opposes equal rights, affirmative action, and saw good people on both sides in Charlottesville, doesnā€™t deserve the vote of any Black American. A man who opposes any forgiveness of student loans, denies climate change, opposes making community college free, doesnā€™t deserve the vote of any young person. 

It amazes me when people compare how things were four years ago to today, and say they were better then. A time you couldnā€™t find toilet paper on grocery shelves, 1,000 people a day were dying of COVID, the Dow Jones was at 19,000 and today itā€™s at 39,000. The country was hemorrhaging jobs and in the last three years 13 million have been created. Wages are higher and unemployment lower. 

Of course, as President Biden says, we need to do more. He is doing it, Trump didnā€™t. Trump gave a $2 trillion tax cut to the wealthy, increasing the national debt. He pledges to do it again. Biden passed a massive infrastructure bill, now creating thousands of jobs building and repairing bridges and roads, in every state. He passed the Chips and Science Act, recently announcing new chip factories in four states, creating thousands of new construction and manufacturing jobs. Those factories will change the U.S. from an importing country, to a producing one. That is some of the real change Biden has brought about. 

Trump talks big, but never produced; Biden is producing for the American people, and will continue to do so.

Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist. He writes regularly for the Blade.

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Letter-to-the-Editor

Banning the Rainbow Flag: the latest act of GOP madness

Prohibition included in government spending bill the president signed

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The Progress Pride flag flies in front of the U.S. Embassy in Berlin on July 22, 2022. (Washington Blade photo by Michael K. Lavers)

The Republican agenda is an obvious one:Ā Distract from real issues by assaulting the most vulnerable. That’s why they have focused their hatred on the LGBTQ+ community. After years of legislating book bans, curriculum censorship, bathroom restrictions and withholding medically needed gender therapy, their latest act is signature Republican cruelty: For a crucial trillion-dollar budget that would prevent a government shutdown, the GOP slipped in a measure to ban the display of Rainbow Flags at U.S. embassies all over the world.

This is not an act of mere symbolism. In too many countries, being queer is punishable by imprisonment or death. Measures like this give a green light to violence and homophobia both at home and abroad. It places more LGBTQ+ people at tangible risk. It is an outrageous abuse of the political process.

This cynical political maneuver is typical of the GOP, the Party of Destruction. But equally egregious is that President Biden and Democrats approved the budget, knowing the poison pill line item that had already been added.

Now, President Biden vows to repeal the embassy flag ban measure. We will hold him to his vow. Will he expend the political capital necessary to make the repeal happens? We must remember that he and the Congress capitulated to a small group of GOP manipulators and, in this instance, saw the global LGBTQ+ community as expendable.

The Democratic Party positions itself as an ally to the LGBTQ+ community. They must hold their ground. They must represent and defend all of us. Otherwise, an emboldened GOP, led by Trump, will only escalate their merciless attacks on our vulnerable communities.”

Charles Beal is president of the Gilbert Baker Foundation and the Save the Rainbow Flag Campaign.

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Commentary

Returning to the kibbutz: A journey of heartbreak and hope

Hamas militants attacked Kfar Aza on Oct. 7

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Kfar Aza, Israel, after Oct. 7, 2023. (Photo courtesy of K.T. Colin)

Editor’s note: WDG, the Washington Blade’s media partner in Israel, originally published this commentary.

BY K.T. COLIN |Ā In 2019, my first encounter with Israel was through the lens of a sponsored Birthright trip. I embarked on a three-week journey, traversing the diverse landscapes from the northern regions to the eastern territories and finally to the arid southern desert. I had the opportunity to visit different communities within Israel and Palestine. Amidst this exploration, I spent an unforgettable three days and two nights in a kibbutz situated near the Gaza border. The memories etched in my heart were ones of unbridled joy, resilience and the harmonious coexistence of the desert dwellers ā€” an emotional tapestry that forever imprinted itself on my soul.Ā Coming from an Iraqi heritage, I viewed these expressions of coexistence through a lens shaped by my own region’s history of conflict and diversity.

As I recall the Shabbat dinner at the kibbutz, the air resonated with the sacred call to prayers (Adhan) from a nearby Bedouin Arab-Muslim town. The juxtaposition of cultures and faiths was a poignant reminder of the shared humanity that bound the Jewish and Arab Israelis in this region. It was a journey that transcended the ordinary, leaving an indelible mark on my consciousness. Filled with memories of peace and unity, I returned, only to confront a reality far removed from my cherished memories.

Fast forward to last month, when I returned to the Negev Desert, specifically to Kfar Aza ā€” one of the 22 kibbutzim targeted by Hamas on that fateful day, Oct. 7, 2023. The once vibrant oasis, brimming with the light of life, now stood shrouded in the darkness of war-induced death and destruction. The very bench where camaraderie blossomed in 2019, while sharing a moment of connection with an Israeli companion, lay reduced to ashes. The thriving pathways, once bustling with life, had metamorphosed into haunting reminders of blood and rubble. The faces that animated Shabbat gatherings, weaving tales of peace advocacy between Palestinians and Israelis, were now conspicuously absent. In the wake of Hamas’s brutality, no entity ā€” be it human, animal or plant ā€” escaped unscathed. The aftermath resembled scenes from an apocalyptic movie, a tableau of sensory deprivation dominated by the stench of death and the echoes of destruction. This destruction, while uniquely harrowing, echoed the all-too-familiar scenes of conflict from my childhood in Iraq, underscoring the universal tragedy of war.

Kfar Aza, Israel (Photo courtesy of K.T. Colin)

While my roots trace back to Iraq, a land marred by wars and the brutality of conflict, the devastation witnessed in Kfar Aza struck a chord that reverberated with the echoes of my past.Ā My personal journey, from witnessing Saddam’s reign of terror to observing the aftermath in Kfar Aza, underscores a broader narrative of resilience and the enduring hope for peace.Ā Born during the Iraqi-Iranian war, my father’s absence for the first six months of my life spoke volumes about the toll of conflict. The invasion of Kuwait and subsequent wars entrenched the narrative of war as an unwelcome companion in our daily lives. Memories of the U.S. invasion in 2003, the ensuing civil war, and the subsequent loss of rights for women, secular individuals and LGBTQ+ members further underscored the harsh reality of conflict.

Yet, Kfar Aza was a unique chapter in my journey, revealing a form of malevolence that transcended my prior experiences. In their assault, Hamas meticulously targeted specifically peace activists who wanted nothing but peace and prosperity between Israelis and Palestinians, sparing no atrocity in their pursuit. This was not just about taking lives; it was a heinous assault on the very prospect of peace. The evil that unfolded reminded me of the forces mentioned in the Quran ā€” Yaajooj and Maajooj ā€” entities of pure malevolence against whom even Alexander the Great erected a wall, according to Muslim prophecy.

My upbringing in Iraq, under the shadow of Saddam Hussein’s dictatorship, fanned the flames of anti-Semitism. A once diverse Iraq, home to 165,000 Iraqi Jews, witnessed their forced exodus through decades of genocide. Subsequently, Christians, Yazidis and Sabbea Mandaeen fell victim to ethnic cleansing orchestrated by dictatorial regimes, Nazi pogroms, Iranian militias and ISIS. The slow erosion of tolerance and coexistence occurred methodically, propelled by hate campaigns championed by Arab nationalists and later fueled by Islamist movements, plunging Iraq into its darkest era.

My school days were marked by compulsory flag-greeting ceremonies, ostensibly patriotic but laden with hate. The chants of “Death to America; Death to the Zionists; Death to the Jews” echoed through the air, fostering a culture of animosity. Arabization and Nationalism classes further fueled this bigotry, leaving an indelible mark on impressionable minds.

The recent horrors in Kfar Aza echoed memories of a similar brand of terror perpetrated by Saddam’s regime ā€” the Fedaeen of Saddam, a precursor to Hamas’s brutality. The parallels were chilling ā€” beheadings, brutal punishments and a reign of terror continued even after the fall of Saddam, as they joined Al-Qaeda, leaving a trail of atrocities in cities like Fallujah and Ramadi.

As I witnessed the devastation in Kfar Aza, the echoes of war in nearby Beit Hanoun, Gaza, resonated hauntingly. The pain echoed from both sides ā€” the Israeli people enduring Hamas rockets since 2015 and the Palestinians suffering daily under the same regime. My heart shattered for the children left orphaned, the LGBTQ+ Gazans now without shelter or life-saving medications and the vulnerable girls and boys exposed to the horrors of Human trafficking and rape. The theft of humanitarian aid by Hamas left many without food and water, and the lip services to Palestinians by Arab and Muslim majority nations, painting a grim picture of a future hanging in uncertainty for those who survived.

Despite the deep scars of conflict, both in my homeland and here, I see glimmers of hope that guide us toward a shared future. I have endured the darkest chapters of conflict in my past, and I hold onto the belief that one day this war will end. I dream of a future where Israelis and Palestinians coexist in shared spaces, attending the same schools, dining at the same restaurants and dancing in the same nightclubs. Having witnessed such unity among Jews, Druze, Muslims and Christians in Israel, I pray for a day when this reality extends to Gazans and Israelis in the Negev Desert. The journey towards peace is arduous, but the human spirit, resilient and compassionate, holds the promise of a brighter tomorrow.

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