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Rachel Levine tackles bad information on COVID, gender-affirming care

Assistant health secretary is highest ranking transgender person in Biden administration

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Assistant Secretary of Health Rachel Levine (Washington Blade photo by Michael Key)

In a visit to one of Americaā€™s most prestigious institutions of higher learning, Adm. Rachel Levine answered questions and offered insight about two of the most controversial healthcare issues of this decade, long COVID-19 and gender-affirming care.

Long COVID is the mysterious phenomenon in which patients endure debilitating, long-term effects from being infected by the coronavirus and gender-affirming care, treatments for transgender youth that are being targeted by lawmakers nationwide.

ā€œLong COVID is real,ā€ said Levine, the assistant secretary for health at the U.S. Department of Health and Human Services, and the highest-ranking transgender official in the Biden administration. ā€œWe heard from patients who have suffered heart issues, lung issues, issues of fatigue and brain fog, after their COVID-19 infection. And we heard from providers at Yale who are forming a multidisciplinary clinic in order to evaluate and treat these patients.ā€ 

In a public session held Monday at the Yale Law School, four of these ā€œlong haulersā€ shared their challenges with the admiral: Shortness of breath, pulmonary disorders, lifestyle and work limitations and disabilities that are hidden to most observers.

ā€œHearing the patients tell their stories is so meaningful,ā€ she said, calling it a privilege to better understand the challenges they face.

ā€œThat helps us drive policy as well as research,ā€ Levine said. 

ā€œI was very active,ā€ said Hannah Hurtenbach of Wethersfield, Conn., a 30-year-old registered nurse who was diagnosed with post-COVID cardiomyopathy, cognitive brain fog and pulmonary issues. ā€œI loved hiking and being outside. I was constantly on the move and now I barely leave my couch. I barely leave my house and I can’t really handle even a part time job now when I used to work full time. So that has been really difficult at age 30 to be facing those sorts of issues that I never really anticipated feeling.ā€

Hurtenbach told the Washington Blade she appreciated Levineā€™s visit.

ā€œSharing my experience today with the admiral was probably one of the more highlight moments of this experience,ā€ she said. ā€œKnowing that the federal government is taking action, is paying attention, and listening to these stories means more to me than anything else, and especially knowing that what I’ve gone through over the last couple of years can be led and used into the future research and help others just like myself.ā€

A woman named Christine told the Blade that even though she is so impacted by long COVID that she needs assistance to walk and has to pause as she speaks because of her shortness of breath, she felt attending this event was worth all the struggle to get there.

ā€œIā€™m so glad I came. I learned a lot from hearing from the others,ā€ she said, who like her are trying to recover from long COVID.

Levine told the Blade that so far, she herself has not contracted COVID, and that she is double-vaccinated and double-boosted. With the president announcing the end of emergency COVID declarations on May 11, she said the administration is pushing Congress to approve extra funding for long COVID and other related needs. But how can she expect to get that through a House of Representatives full of anti-vaxxers, anti-maskers and COVID-deniers, including in GOP leadership?

ā€œLong COVID is real and we hear you,ā€ she said. ā€œWe plan to engage Congress to talk about the funding that we need. And we’ll continue to work. We do have to get past misinformation in this country, but we are here to give the correct information about COVID-19 and long COVID, and we’ll continue to engage Congress on that.ā€

Hurtenbach expressed disappointment in those colleagues in healthcare who came out publicly in opposing vaccines and mask mandates.

ā€œI just wish they had paid better attention in school and learned more of the science,ā€ the nurse said. ā€œI wish they would trust the science that they are supposed to be promoting for their patients as well.ā€ 

Following Monday morningā€™s public meeting, Levine held a private session with long COVID patients and Yale doctors, researchers, counselors, physical therapists and other providers. Then in the afternoon, the admiral spoke at another event, held at Yale Medical School: ā€œA Conversation on LGBTQI+ Health and Gender-Affirming Care.ā€ Although it was closed to press, Yale Asstistant Professor of Medicine Diane Bruessow attended the event and shared with the Blade what Levine told those gathered, which is that she remains positive and optimistic. 

ā€œI think over time, things will change, and things will get better,ā€ said Levine, adding the caveats, ā€œI donā€™t know if they will get better everywhere in the United States. I also donā€™t know if itā€™s going to be quick. I think the next two years will be really, really hard.ā€ Especially with more than 270 anti-trans pieces of legislation moving their way through state legislatures.

ā€œBut I am going to stay positive. Iā€™m going to think that over time, things will improve,ā€ Levine said, pledging that both she and the Biden administration would do everything they can to help families with trans kids. ā€œI think the tide will turn.ā€

Levine: Long COVID is real

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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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Federal Government

VA expands IVF to cover same-sex couples, single veterans

DoD also broadens IVF access for active-duty troops

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U.S. Department of Veterans Affairs Secretary Denis McDonough (Screen capture/YouTube)

The U.S. Department of Veterans Affairs will cover in-vitro fertilization treatments for same-sex couples and single veterans, the agency announced on Monday ā€” a move that comes after lawsuits last year claiming that its policy of only treating legally married partners who could produce their own eggs and sperm was discriminatory.

The department said the change is expected to take effect in coming weeks, with Secretary Denis McDonough pledging to implement the new policy as soon as possible.

ā€œRaising a family is a wonderful thing, and Iā€™m proud that VA will soon help more veterans have that opportunity,ā€ he said. ā€œThis expansion of care has long been a priority for us, and we are working urgently to make sure that eligible unmarried veterans, veterans in same-sex marriages and veterans who need donors will have access to IVF in every part of the country as soon as possible.ā€

Out in National Security, a nonprofit dedicated to serving and empowering queer national security professionals, celebrated the VA’s announcement in a press release proclaiming that “five years of ONS efforts have delivered.”

The group noted that about 2 million LGBTQ veterans are served by the VA, a number that is expected to “substantially increase in this decade.”

Also on Monday, the Defense Department announced its expansion of IVF eligibility requirements, which will now cover assisted reproductive technology for active-duty troops and their spouses, partners, or surrogates.

DoD will allow these service members to “use donor gametes (sperm, egg, or both) and embryos when procured at their own expense.”   

“We continue to identify ways to lean forward as much as we can in support of equity of access to reproductive health care for our service members,” said Kimberly Lahm, a program director in the Office of the Deputy Assistant Secretary of Defense for Health Affairs for Health Services Policy and Oversight.

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New HHS smoking cessation framework is focused on ‘most vulnerable’ populations

Smoking rates are higher for LGBTQ youth and adults

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U.S. Department of Health and Human Services Secretary Xavier Becerra at 2023 HHS Pride Summit (Screen capture/YouTube)

The U.S. Department of Health and Human Services introduced a new 28-page Framework to Support and Accelerate Smoking Cessation on Friday, an effort to support the Biden-Harris administration’s Cancer Moonshot, which aims to cut cancer-related deaths by at least 50 percent over 25 years.

ā€œThis framework focuses on advancing equity, engaging communities, and coordinating, collaborating, and integrating evidence-based approaches across every facet of our government and society,” HHS Secretary Xavier Becerra said in a press release.

“The Biden-Harris Administration will continue these efforts,” he said, “until smoking is no longer the leading cause of preventable death in the United States, and the communities that remain the most vulnerable get the help they need.”

The department’s assistant secretary for health, Adm. Rachel Levine, said, ā€œTodayā€™s announcement marks an important milestone reaffirming our commitment to helping people whoĀ smokeĀ to quit by working to maximize their access to and awareness of evidence-based interventions and programs.ā€

According to the Centers for Disease Control and Prevention, which is a division of HHS, about 15.3 percent of lesbian, gay, and bisexual adults smoke cigarettes, a figure that is “much higher” than the 11.4 percent of heterosexual adults who do. Lesbian, gay, and bisexual middle and high school aged youth are also likelier to smoke than their straight counterparts.

Additionally, a 2017 study in the American Journal of Preventative Medicine found that 39.7 percent of transgender adults reported using cigarettes, cigars, or e-cigarette products in the last 30 days, and use of e-cigarettes is four times higher compared to use by cisgender adults.

As a result, the CDC reports that LGBTQ people “have more risk factors for cardiovascular (heart and blood vessel) disease ā€“ like high blood pressure ā€“ than straight adults.”

The agency warns that “if you are part of the LGBTQ+ community, you likely have seen tobacco ads in magazines, newspapers, and websites directed at you” because “Tobacco companies are focusing their advertising on your communities.”

Evidence suggests LGBTQ smokers may also be less likely to call tobacco quitlines, and fewer are using counseling or smoking-cessation medications.

HHS’s framework document also notes the disparities in cigarette smoking among LGBTQ adults, along with other populations who are likelier to smoke including Black men, blue collar or service industry workers, and adults living in rural areas.

The authors also highlight, in a list of existing HHS programs and activities for smoking cessation, the CDC’s National Networks Driving Action: Preventing Tobacco- and Cancer-Related Health Disparities by Building Equitable Communities.

The program “funds a consortium of national networks to advance the prevention of commercial tobacco use and cancer in populations experiencing tobacco- and cancer-related health disparities” and lists LGBTQ people among the “focus population groups.”

According to the HHS press release, “The Framework is organized around six goals that serve as a foundation for long-standing HHS efforts to support and promote smoking cessation”:

  1. Reduce smoking- and cessation-related disparities.
  2. Increase awareness and knowledge related to smoking and cessation.
  3. Strengthen, expand, and sustain cessation services and supports.
  4. Increase access to and coverage of comprehensive, evidence-based cessation treatment.
  5. Advance, expand, and sustain surveillance and strengthen performance measurement and evaluation.
  6. Promote ongoing and innovative research to support and accelerate smoking cessation.

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