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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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Commentary

Underfunded, undermined and unabashedly victorious in Brazil

Country’s LGBTQ politicians are bringing diversity to democracy

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Brazilian Congresswoman-electErika Hilton (Photo courtesy of Erika Hilton's Twitter page)

Imagine a group of 18 winners where you’ll find only one white man. The recent election in Brazil not only brought back former President Lula, but also doubled the numbers of out LGBT+ representatives in both the national and state legislatures. Out of these 18 elected officials; 16 are women, 14 are black and five are trans. There is only one white man in the group.

Women, LGBT+ and Black people have always showcased political leadership in their communities. But the path to occupy a space in Brazilian institutional politics is often violent and expensive. In recent years, many organized social movements have directed their efforts to set the agenda for public debate into the intersectional realm and support community leaders. In a poll VoteLGBT conducted in 2017 during the São Paulo Pride parade, the biggest in the world, only 45 percent of Pride participants surveyed thought that identity matters when choosing a candidate. In 2022, 85 percent believed so.

Despite the many obstacles and violence they face, Brazilian LGBT+ leaders are gaining political power, often being the most voted individuals in their states or cities. Many trans women who won big in their cities in 2020 advanced to higher positions in 2022. Four LGBT+ people (all women) were elected to congress: Three of them Black and two of them trans, a major breakthrough for LGBT+ political participation.

In Brazil, campaigns are publicly funded. Taxpayers’ money goes to parties’ leadership who can pretty much do whatever they want with it. There are rules made to fight the underrepresentation of women and Black population, but they are often corrupted by fraud.

Party leaders are often older rich white cis men who focus their efforts and financial support to old allies. LGBT+ politicians receive an average of 6 percent of the legal limit for what parties can provide to a single candidate. When interviewing 30 of those who ran in 2020, we came across three trans women who didn’t have enough to eat during their campaigns and still won their seats. Our vote is the cheapest in the election market.

Once elected, LGBT+ officials often face discrimination from their peers in the chambers, many times from their own parties. In a poll we did in 2021 we found that more than half of LGBT party members reported facing discrimination. And those who decided to report it found that there’s no accountability for LGBTphobia inside the parties.

Not to mention the constant death threats that (especially) Black and (especially) trans women face when elected or running for office. City Counselor Benny Brioly, who is Black and trans, had to flee the country in 2020 after public security forces refused to offer her protection, which was her legal right. In 2022 she kept getting death threats from a congressman, from his official Cabinet’s email. Erika Hilton and Duda Salabert, the first trans women elected for congress in 2022, had to conduct campaign activities with armed security and bulletproof vests.

It seems like the world is looking for the tools we are developing to fight extremism and LGBTphobia. International organizations have long supported many of those initiatives. The partnership and support from organizations like the National Democratic Institute and the LGBT Victory Institute have been fundamental to promote a comprehensive approach to such a complex issue.

VoteLGBT’s innovative research strategies have a political and historical importance due to the lack of official data about the LGBT+ population in Brazil. Research has been fundamental for us, not only to give visibility to our issues and set the agenda for public debate, but also to better strategize where to allocate resources. Since 2021 we have been investigating the parties, conducting in-depth interviews with candidates and LGBT caucus. We’ve produced a list of 327 out LGBT candidates in the 2022 election cycle with their racial and LGBT+ identity self declared. That had never been done before.

We’ve offered direct support through organizing a series of webinars, creating downloadable toolkits, conducting pressure campaigns on parties, lobbying the Supreme Electoral Court for them to produce official data on our leadership, creating a gallery with over 300 LGBT+ candidates and their priorities, and offering confidential psychological support, especially after such a violent campaign.

It would be dishonest, though, to claim any part of such astounding victories. Each of those candidates struggled to run their underfinanced and understaffed campaign, and still created strategies to reach and amplify their audience brilliantly. Also, we are not the only ones on the task. There are other organizations who are great examples and partners.

Brazil’s recent election results show us that an intersectional approach to the issue of political representation is not only possible, but potent. LGBT+ candidates earned over 3.5 million votes. Of those votes, a third went to trans women. Seven in 10 went to a Black candidate. Brazilian voters are showing us what kind of democracy they are willing to fight for. Without diversity there is no democracy.

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Opinions

‘Queer’ evolves from hateful epithet to expression of pride

NYT criticizes HRC’s Robinson for use of term

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It hit me one morning this fall as I woke up: I’ve turned 70.

As I’ve been celebrating this milestone, I’ve marveled at the changes that have occurred for our LGBTQ community during my lifetime.

Marriage equality, Pete Buttigieg (or any LGBTQ person) running for president and/or the fab queer rom-com “Bros” would have been unimaginable when I began coming out 50 years ago.

Then, just three years after the Stonewall uprising, I and many other LGBTQ folk felt far more shame than pride about our queerness.

Most of us in that era wouldn’t have dreamed that, decades later, not only LGBTQ teens, but queer people our age would have marched, out and proud, in Pride parades. We’d never have thought that in the 21st century any of us would ever proudly say, shout or chant “we’re queer!”

Nothing is more emblematic to me of the progress made in LGBTQ rights from Stonewall to today than the evolution of the word “queer” from a hateful epithet to an expression of pride.

Today, the term “queer” can be found everywhere from news outlets (including NPR, the Blade, the New York Times and the Washington Post) to museum exhibits such as “Queering the Crip, Cripping the Queer” at the Schwules Museum Berlin through the end of January and “Queer Creativity Through the Ages: Artwork from the Center on Colfax Open Art Studio” at the Denver Art Museum through Dec. 31.

I can’t think of any of my under 60 friends, hetero or LGBTQ who don’t use the word “queer.” Sometimes they’re proudly writing it on Pride parade signs. Often, they use it as a neutral adjective. The way you’d say “they’re from Boston” or “he’s about six-feet tall.”

Many of my over-60 pals are beginning to use the word “queer.” If they’re not comfortable using it about themselves, they’re increasingly comfortable with others using it. My 70-something hetero cousins, who are LGBTQ allies, no longer feel I’m putting myself down when I say I’m queer.

Given that “queer” is so often used as an affirmation of identity or neutral descriptor, I was surprised when New York Times columnist Pamela Paul recently lamented the popularity of the “q-word.”

I’m an avid reader of Paul’s column. Paul, a former editor of the New York Times Book Review, is, like many writers, obsessed about language. She’s an astute observer of the culture and of how we use words.

Yet, I can’t help but wonder what Paul was thinking. “Language is always changing – but it shouldn’t become inflexible,” she wrote, “especially when new terminologies, in the name of inclusion, sometimes wind up making others feel excluded.”

Paul, who is hetero, worried that the widespread use of “queer” excludes LGBTQ people who don’t identify as queer. She was upset that so many Gen-Zers identify as queer, and annoyed that “gays and lesbians can feel crowded out” under the LGBTQ umbrella.

Paul chided new Human Rights Campaign president Kelley Robinson for using the word “queer,” and not saying the words “gay,” “lesbian” or “bisexual” in a video where she introduced herself.

People at HRC do say “gay,” “lesbian” “bisexual” “transgender” and “nonbinary,” Robinson wrote in response to Paul’s column in a letter to the Times.

“I identify as a Black queer woman,” Robinson wrote, “and when I say ‘queer,’ it’s to be as inclusive as possible, to re-center those at the margins, to embrace our differences and to embrace our power, too.”

Robinson nailed what attracts so many of us to the word “queer.”

Of course, many LGBTQ boomers and Gen-Xers vividly recall when “queer” was a homophobic slur.

A hetero friend remembers when she was seven riding on a school bus. “I was mad at a kid,” she told me, “I wanted to call him something mean. So I said he was ‘queer.’”

“My sister told me not to say that again,” my pal added, “She said it was too horrible to tell me what it meant.”

But in recent decades (starting with AIDS activists), we’ve reclaimed the word “queer.” We’ve taken away its sting: transformed it from a hate-mongering, othering slur to a source of power.
It’s hard to think of a more inclusive word than queer. It includes and values all LGBTQ folk. In the wake of the Colorado Springs LGBTQ club shooting, it’s more important than ever to be proudly queer.

Kathi Wolfe, a writer and a poet, is a regular contributor to the Blade.

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Opinions

As a gay Jewish man, I will never let Trump win

My parents escaped Hitler for an America that we must save

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Former President Donald Trump (Washington Blade file photo by Michael Key)

Donald Trump and his friends are scary, but I will not sit back and let them win. My parents escaped Hitler, coming to the United States for a better life. My father’s parents were killed in Auschwitz. Until Trump became president, I never believed anything like that could happen here. While I still don’t, I now know it will take everyone speaking out and not acquiescing to him and his acolytes. 

It is not only Jews and the LGBTQ community who are threatened. In the United States today all minorities and women are coming under fire. Our response must be not to only speak out, refuting hate every day, but working to see it doesn’t continue to threaten our lives. We must vote to ensure those who threaten our way of life never gain control.

Trump is a sexist, homophobic, racist pig. For four years he held a megaphone as president spreading hatred and enabling his followers to spread theirs in the public square. He capped four years with an attempted coup. He was stopped, but today he is trying to once again regain that megaphone. We cannot let him or anyone who supports him have it.

We must call out Trump and every one of his acolytes every time they do something like sit down to dinner with anti-Semites like Kanye West and his friend Nick Fuentes. Fuentes, a white supremacist and Holocaust denier, is a political commentator and live streamer banned from YouTube for his views. We cannot accept any excuses for such behavior. We must also call out those with the power to reach people like that, who don’t speak out. Those like Ivanka Trump and Jared Kushner. They are Jews, bringing their children up in the Jewish faith. Where are their voices? They must realize they and their children will not be spared if the likes of West and Fuentes take over our country. 

There needs to be the outcry like there was when West first iterated his diatribe against the Jews forcing Adidas and others to cut their business ties with him. 

Today we see movies and plays opening that speak to the horrors of racism and anti-Semitism. Movies like “Till,” about racism, and “Fabelmans,” the Steven Spielberg autobiographical movie about him facing anti-Semitism and bullying and the new Tom Stoppard play on Broadway, “Leopoldstadt.” Every day, and in every way, decent Americans must speak out and fight back; not with guns but with words, actions, and votes. 

We are seeing gun violence climb in the United States, often based on hate. We shouldn’t be surprised with the easy access to guns, nearly 440 million in the hands of Americans, when someone’s hatred results in violent attacks on churches, synagogues, schools, movie theaters, or just on the streets in our neighborhoods. We see anger much too easily escalate into violence.

Again, whereas sexism, racism, homophobia are not new to American society, we worked for many years, and until Trump, managed to keep them somewhat under control. It was getting to a point where they were not acceptable to be spoken in the public square. Trump changed that. While we can fight the policies he proposed, like lowering taxes on the rich, or refusing to recognize climate change, the cultural changes he wrought will take decades to change. Putting the genie of hate back in the bottle will not be easy as we see in our country today.  From his announcement for president to his comments on Charlottesville, where he said he could see good on both sides; one side being white supremacists and neo-Nazis, the other being those who opposed them, he allowed hatred to become acceptable. 

Today we have not only Trump but the mini-Trumps who want to take over from him like Ron DeSantis in Florida and Glenn Youngkin in Virginia — those who cover their disgusting thoughts in a more acceptable public veneer, but who nonetheless end up working to advance the same goals as Trump, namely to marginalize every minority and allow them to be continuously threatened into submission. 

But they will learn we will not be threatened without a response. We will not sit idly by while they ruin the country my parents, and so many others, came to seeking asylum and safety. We will fight for the country whose Declaration of Independence states: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty, and the pursuit of happiness.” We will continue to fight to include women in those beautiful words.

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

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