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Rachel Levine and AVP on approaching anti-LGBTQ hate as ‘public health threat’

White House LGBTQI+ Safety Partnership ‘ramping up’

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Beverly Tillery, executive director of the New York City Anti-Violence Project. (Photo by Eduardo Munoz Alvarez; courtesy The Raben Group)

Admiral Rachel Levine, assistant secretary for health at the U.S. Department of Health and Human Services, told the Washington Blade in a statement: “We know that hate — whether fueled by homophobia, transphobia, or racism — is a public health threat.”

“I look forward to a day in the future where hate-fueled violence, is an unwelcome memory of the past and no longer incites fear amongst LGBTQI+ people, and all people who live in America,” she said, adding, “We all deserve to live in communities safe from violence.”

A pediatrician and four-star officer who serves as the highest-ranking openly transgender official in U.S. history, Levine’s statement came in response to an inquiry about her meeting on Thursday with New York City Anti-Violence Project (AVP) Executive Director Beverly Tillery.

Also in attendance were the assistant secretary’s senior adviser on LGBTQI+ health equity, Adrian Shanker, and Lynn Rosenthal, director of Sexual and Gender-based Violence at the agency.

“We talked about some of the recommendations we have developed specifically for HHS,” Tillery told the Blade during a phone interview on Friday.

These focused on three areas, she said: “more work that will approach hate violence as a public health issue”; incorporating this approach and addressing “the needs of safe spaces on the ground” when implementing the White House LGBTQI+ Community Safety Partnership; and exploring “opportunities for funding and technical assistance for safe spaces.”

Tillery said that “it was a real honor to be able to have a conversation directly with” Levine, adding that during their meeting, the assistant secretary explained she had made a point of visiting LGBTQ spaces in person.

HHS understands that these groups provide and administer the services it funds, like legal aid and referrals to affirming healthcare providers, she said.

The agency “prioritizes those spaces,” with the knowledge that “we’re talking about a really critical infrastructure in our community,” a network of organizations that “holds our community together in terms of physical and mental health,” Tillery said.

Noting the escalation of violence encountered by LGBTQ individuals and spaces, the White House in June announced plans to create an LGBTQI+ Community Safety Partnership led by the U.S. Department of Homeland Security in coordination with the U.S. Department of Justice and HHS.

“We are now looking to the beginning of next year, kind of having a plan in place for what we think needs to be happening for next Pride season, really early, and also thinking about the election,” Tillery said. “This is a really critical time where we need to make sure that we get as much information and resources and boots on the ground so they can be actively thinking about safety in a bunch of different ways.”

The White House explained the Partnership will “Provide dedicated safety trainings for LGBTQI+ community organizations and increase federal threat briefings for LGBTQI+ organizations,” “protect health care providers who serve the LGBTQI+ community,” and “support LGBTQI+ communities to report hate crimes and build cross-community partnerships to address hate-fueled violence” — all while working “to build trust between LGBTQI+ organizations and federal law enforcement agencies.”

So far, Tillery said, “the bulk of the work right now that has been done rests in” the Department of Homeland Security, but “I do feel like, right now, they’re ramping up and figuring out [questions like] ‘who is going to be responsible for this thing and what is it going to look like?'”

She added that during Thursday’s meeting, “One of the things that we asked HHS to think about and help us think about is, ‘could there be some very public, regular cadence of meetings between organizations and the agencies specifically about this Partnership'” such that the public might be kept apprised of its progress?

“We are really hoping,” Tillery said, “to make sure that there’s a process for AVP and other organizations to be in regular communication with [the agencies] involved in the White House Community Safety Partnership.”

Tillery said she also talked with Levine and the other officials about ways that HHS, which unlike DHS and DOJ does not represent law enforcement, can contribute — such as by “having them play a role in data collection,” especially provided how the agency is already “paying attention to” data on sexual orientation and gender identity “across the board” and is well positioned to identify gaps.

The full spectrum of hate incidents targeting all types and sizes of LGBTQ spaces

For the past few months, Tillery has met with the White House, HHS, and members of Congress to discuss the first of its kind survey conducted by AVP and its corresponding report published in July, “Under Attack: 2022 LGBTQ+ Safe Spaces National Needs Assessment.”

The document contains feedback from LGBTQ groups of all types and sizes from all 50 states on the hate incidents they have experienced and “the critical needs they have for future safety.”

AVP discovered that nearly nine in 10 LGBTQ community centers experienced hate incidents in person or over the phone. The findings are consistent with the increase, from 2021 to 2022, in hate crimes motivated by bias against the victim’s sexual orientation and, especially, gender identity that were reported by the FBI on Oct. 16.

What distinguishes AVP’s report, Tillery told the Blade during a previous interview on Sept. 13, is that “nobody had really looked at this issue of what’s exactly happening with [LGBTQ] spaces across the country.”

She noted the importance of broadening the focus on anti-LGBTQ hate incidents to include not just acts of violence like last year’s the mass shooting at Club Q, but the full range of ways in which LGBTQ people are targeted or made to feel unsafe, and in all types of community spaces from book stores to bars and beyond.

When discussing the report and its findings in meetings on Capitol Hill, Tillery said “people are surprised” to learn the extent of anti-LGBTQ violence as well as “the range of different kinds of incidents that are happening across the country” and “the way these attacks are happening.”

About half of the surveyed LGBTQ groups said they did not report hate incidents to the police, with many respondents explaining that when their spaces were targeted with anti-LGBTQ protests led by white nationalist groups like the Proud Boys, they felt local law enforcement was more closely allied with or sympathetic to the extremists, Tillery said.

She noted the “overlay of gun violence with this as well,” especially in communities that do not have strong gun safety laws; places where, in many cases, anti-LGBTQ protesters showed up heavily armed.

Understanding intimate partner violence within the LGBTQ community

Tillery said she was encouraged by how much of her conversation with Levine, Shanker, and Rosenthal concerned issues of intimate partner violence within the LGBTQ community within the context of anti-LGBTQ violence more broadly.

She explained that victims are often made vulnerable by their sexual orientation, gender identity, or HIV status, and targeted not just with physical violence but also other forms of intimate partner abuse such as forced “outing,” blocking access to medication, or isolation from community and support networks.

The problem was exacerbated by the Covid pandemic, Tillery said, which caused many people to be “stuck at home with people who might be causing them harm.” Likewise, she said, LGBTQ youth who do not live in affirming, supportive homes in many cases “had to relive some of the homophobia and transphobia while they were in isolation with family members.”

The conversation about intimate partner violence dovetailed into other matters Tillery discussed with HHS, such as areas in which there is a deficit in data collection, she said.

For example, she pointed to the results of the Centers for Disease Control and Prevention’s 2021 Youth Risk Behavior Survey that were published in April, which had “great data” about experiences with intimate partner violence among gay and bisexual men and women but very little with respect to transgender and gender nonconforming respondents, Tillery said.

Tillery added that strong data is crucial for the Partnership’s work and beyond, carrying implications “down the road for funding and resources and congressional action.”

Looking ahead to prepare for next year’s Pride and election seasons

Another topic addressed on Thursday, Tillery said, was how best to “get out in front” with the work that must be done on matters of community safety and securing LGBTQ spaces ahead of not just the next Pride season but also the 2024 elections.

She said AVP will continue working with the Biden-Harris administration and other partners on implementing measures to protect the various groups, activists, organizers, and volunteers who will be running voter registration programs, participating in “get out the vote” efforts, and campaigning on behalf of candidates.

“We are now looking to the beginning of next year, kind of having a plan in place for what we think needs to be happening for next Pride season, really early, and also thinking about the election,” Tillery said.

“This is a really critical time where we need to make sure that we get as much information and resources and boots on the ground so they can be actively thinking about safety in a bunch of different ways,” she said.

Tillery added, “Hopefully we can get out in front of it, so that we can provide some groups with some resources and tools before they start doing a lot of those activities as the election season heats up,” she said.

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Federal Government

Adm. Levine, Admin. Guzman visit LGBTQ-owned dental and medical practices

Officials talked with the Blade about supporting small businesses

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Second from left, Dr. Robert McKernan, co-founder of Big Gay Smiles, U.S. Small Business Administration Administrator Isabel Guzman, HHS Assistant Secretary for Health Adm. Rachel Levine, Big Gay Smiles Co-Founder Tyler Dougherty, and SBA Washington Metropolitan Area District Director Larry Webb. (Washington Blade photo by Christopher Kane)

The Washington Blade joined Assistant Secretary for Health Adm. Rachel Levine of the U.S. Department of Health and Human Services and Administrator Isabel Guzman of the U.S. Small Business Administration as they toured two LGBTQ-owned small businesses on Tuesday in Washington, D.C. — Big Gay Smiles and Price Medical.

The event provided an “amazing opportunity” to “talk about the different synergies in terms of small businesses and the SBA, and health equity for many communities,” including the LGBTQ community, Levine told the Blade.

Representation matters, she said, adding, “that’s true in dental care and medical care,” where there is a tremendous need to push for improvements in health equity — which represents a major focus for HHS under her and Secretary Xavier Becerra’s leadership, and in the Biden-Harris administration across the board.

“Small businesses identify needs in communities,” Guzman said. With Big Gay Smiles, Dr. Robert McKernan and his husband Tyler Dougherty “have clearly identified a need” for “dentistry that is inclusive and that is respectful of the LGBTQIA community in particular.”

She added, “now that they’re a newly established business, part of the small business boom in the Biden-Harris administration, to see their growth and trajectory, it’s wonderful to know that there are going to be providers out there providing that missing support.”

The practice, founded in 2021, “is so affirming for the LGBTQIA community and we certainly wish them luck with their venture and they seem to have a great start,” Levine said. “They’re really dedicated to ending the HIV epidemic, providing excellent dental care, as well as oral cancer screenings, which are so important, and they’re really providing a real service to the community.”

Big Gay Smiles donates 10 percent of its revenue to national and local HIV/AIDS nonprofits. McKernan and Dougherty stressed that their business is committed to combatting homophobia and anti-LGBTQ attitudes and practices within the dental field more broadly.

“We try to align our practices here within this dental office to align with the strategic initiatives being able to help reduce HIV transmission, reduce stigma, and help to ensure people have the knowledge and [are] empowered to ensure that they’re safe,” Dougherty said.

McKernan added, “With the Academy of General Dentistry, we’ve done a lot of discussions around intersex, around trans affirming care, in order to help educate our fellow dental providers. It’s very important that every dentist here in the [D.C. area] provide trans affirming care and gender affirming care because it’s very important that someone who comes to a medical provider not be deadnamed, not get misnamed, and have an affirming environment.”

Trans and gender expansive communities face barriers to accessing care and are at higher risk for oral cancer, depression, and dental neglect. Levine, who is the country’s highest-ranking transgender government official, shared that she has encountered discrimination in dental offices.

After touring the office, Levine and McKernan discussed the persistence of discrimination against patients living with HIV/AIDS by dental practices, despite the fact that this conduct is illegal.

“I’ve traveled around the country,” the assistant health secretary told the Blade. “We have seen that many FQHCs [federally qualified health centers] or community health centers as well as LGBTQIA community health centers have had dentists, like Whitman-Walker, to provide that care because many people with HIV and in our broader community have faced stigma and have not been able to access very, very important dental care.”

Prior to opening his practice, McKernan practiced dentistry at Whitman-Walker, the D.C. nonprofit community health center that has expertise in treating LGBTQ patients and those living with HIV/AIDS. Big Gay Smiles is a red ribbon sponsor for the organization’s Walk & 5K to End HIV.

After their visit with Big Gay Smiles, Levine and Guzman headed to Price Medical, a practice whose focus areas include internal medicine/primary care, HIV specialty care, immunizations, infectious disease treatment, and aesthetics like Botox.

There, the officials talked with Dr. Timothy Price about his office’s work advancing health equity and serving LGBTQ patients including those living with HIV/AIDS, as well as the ways in which small businesses like his have benefitted from access to electronic health records and telemedicine.

Levine, Dr. Timothy Price of Price Medical, and Guzman 

“People being able to access medical care from the comfort of their home or workplace can be very important,” Price said, with technology providing the means by which they can “ask questions and get an answer and have access to a health care provider.”

Often, LGBTQ patients will have concerns, including sexual health concerns, that need urgent attention, he said. For instance, “we’ve had patients need to access us for post-exposure prophylaxis for HIV,” in some cases when “people are vacationing and they have something that might be related to their health and they can reach us [via telemedicine] so that’s the way it’s really helped us and helped the patients.”

Access to technology for small businesses is an area in which the SBA can play a valuable role, Guzman noted.

“The Biden-Harris administration has focused on a whole-of-government approach to making sure we can support the community, and that includes in entrepreneurship,” she told the Blade.

“There’s a surge in [small] businesses starting and that includes” those founded by members of the LGBTQ community “and so you see that there’s products and services that need to be offered,” and the administration is “committed to making sure that we can fund those great ideas.”

Guzman said she sees opportunities for future collaboration between her agency and HHS to help encourage and facilitate innovation in the healthcare space. “Small businesses are innovators creating the future of health tech,” she said.

Levine agreed, noting “we have been talking about that, about different ways that we can work together, because as we think about the social determinants of health and those other social factors that impact health, well, economic opportunity is absolutely a social determinant of health,” and small businesses are certainly a critical way to broaden economic opportunity.

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EXCLUSIVE: Becerra, Levine plan to expand health equity in a second Biden-Harris administration

Officials spoke exclusively with the Blade on Monday

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HHS Assistant Health Secretary Adm. Rachel Levine, U.S. Rep. Mark Takano (D-Calif.), and HHS Secretary Xavier Becerra (Washington Blade photo by Christopher Kane)

Speaking with the Washington Blade on Monday, U.S. Department of Health and Human Services Secretary Xavier Becerra and Assistant Health Secretary Adm. Rachel Levine detailed plans to expand health equity initiatives under a second Biden-Harris administration.

The conversation came shortly after the agency held a Progress Pride flag-raising ceremony, where U.S. Rep. Mark Takano (D-Calif.), delivered opening remarks alongside the top HHS officials who also spoke at the department’s second annual Pride Summit later on Monday.

Levine highlighted a slate of recent actions and goals on which to build in a second term: The issuance in April of a final rule clarifying that discrimination on the basis of sexual orientation and gender identity is prohibited under the Affordable Care Act; a demographic data collection plan on sexual orientation and gender identity metrics; the pursuit of regulations and litigation (coordinated with the Justice Department) to combat healthcare restrictions, including those which target LGBTQ communities; and the agency’s commitments to diversity, equity, inclusion, and accessibility.

“To put an exclamation point behind some of that,” Becerra said, “on SOGI, we think it’s important to gather the data that lets us figure out where to go next, or where you have issues” in “getting access to the care that you need.”

“And we know we’re going to end up in court with a lot of the rules that we’ve enacted,” added the secretary, who previously served as attorney general of California, “but we’re ready for that — they’ll get tested, and we’re ready to defend [them].”

Becerra added that along with the initiatives outlined by Levine, HHS is looking to expand efforts in the behavioral health space to maximize opportunities to match patients with providers who have shared backgrounds, identities, and lived experiences.

That way, he said, “chances are that individual in need of care is going to open up faster. So we’re going to try to move quicker towards providing, in the behavioral health setting, people with lived experiences who can speak to what this individual is hurting from, is suffering from, so we can try to help them with their behavioral health challenges.”

The secretary praised the Biden-Harris administration’s pro-equality record, noting, “the fact that we’re the first department to fly the Pride flag, I think it shows that we’re out front, and we are very intent on making sure everyone has access to the care that they need.”

“And to do that, you’re going to find yourself in court,” Becerra said. “To do that, you need to do an aggressive job of collecting data. To do that, you have to show people that you can approach them with someone who’s experienced in what they’re going through. And so all of those things have to be amped up if we’re going to make further progress in the next administration’s four years.”

Levine repeatedly credited the secretary’s leadership as well as President Joe Biden’s work advancing equity throughout his administration, including through executive orders, when discussing HHS’s efforts to expand healthcare access and improve health outcomes for diverse populations including the LGBTQ community.

“One of the highlights, I think, of the Biden-Harris administration and Secretary Becerra’s leadership is the the emphasis on building representation in Washington that looks like the people of our country,” said Levine, who became the highest-ranking transgender government official with her appointment as assistant health secretary in 2021.

“Whether it is communities of color, whether it is the LGBTQI+ community, young people, seniors, I mean, we really want the the people who work for the people of our country to look like them and to represent them,” she said.

She also highlighted the extent to which her and Becerra’s work on this front has involved putting boots on the ground. “I’ve been to Austin. I’ve been to Dallas. I’ve been to Nashville. I’m going to Jacksonville. We tried to get to Idaho to Boise, but we got snowed out.”

“We are everywhere,” Levine said, adding that she likes to say the secretary has been doing “everything, everywhere, all at once,” (the title of a critically acclaimed film that won the Academy Award for Best Picture in 2023.)

In a Pride month press release shared by the agency on Monday evening, Becerra said in a statement, “HHS works every day to build an America where LGBTQI+ Americans have access to quality, affordable health care and can go to the doctor without fear of stigma or discrimination. Where the state you live in doesn’t determine whether you can access lifesaving, gender-affirming care. And where more communities embrace the diversity that has always strengthened our national character.”

“Pride reminds us that we are a strong, resilient, and powerful community that fights hate with love,” Levine said. “As we celebrate Pride Month, we should recognize how far we have come, even as we take stock of the challenges that we face. Everything we do at HHS emphasizes health equity and this pride month, we are making a focused effort to address and eliminate the health disparities within the LGBTQI+ community.”

She added, “We are focused on our efforts to end the HIV epidemic in the U.S., prevent syphilis and congenital syphilis, and promote access to care for LGBTQI+ people across America. Together, we can work to support healthy people, healthy communities, and a healthy nation for all. I am a positive and optimistic person, and I believe that working together, we can create a healthier, better future for all people living in the United States.”

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National Park Service clarifies uniform policy

Announcement has implications for Pride

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National Park Service rangers from the Stonewall National Monument march in the 2021 New York City Pride parade. (Photo courtesy of the National Park Service’s Facebook page)

BY ERIN REED | The National Park Service on May 17 clarified its policy on employees wearing official uniforms to non-sanctioned events, which has implications for Pride events.

It’s unclear what triggered the clarification. A source at the National Park Service told the Blade in a statement that the uniform policy “has not changed,” but some LGBTQ employees report feeling betrayed and note that official Pride participation in major cities is uncertain as applications to participate in parades remain unprocessed.

The clarification comes amid increasing crackdowns on Pride flags and LGBTQ people nationwide.

The announcement was first disclosed in a memo to park service employees that did not directly address Pride but stated that “requests from employees asking to participate in uniform in a variety of events and activities, including events not organized by the NPS” conflict with park service policy.

The specific provision cited states that park service employees cannot wear the uniform to events that would construe support for “a particular issue, position, or political party.” Applying this provision to bar Pride participation drew ire from some LGBTQ employees who assert that LGBTQ Pride is not about an “issue, position, or political party,” but about identity and diversity. The employees, who spoke on condition of anonymity, also pointed out that the internal ERG guide allowed for participation in Pride events and that park employees had participated in Pride events with approval for years under the current set of rules.

In a follow-up, the park service stated that the ERG resource known as the “OUTsiders Guide to Pride” conflicts with its policy and that it is in discussion with ERG leaders to review it and similar documents.

Meanwhile, it stated that park service participation in Pride “could imply agency support … on a particular issue of public concern,” essentially stating that celebrations of LGBTQ employees would be considered an “issue of public concern” rather than a non-political celebration of diversity. As such, they determined that park service official participation in parades “should be extremely limited.”

Concern spread among some park service employees . They noted that the park service has participated in Pride parades across the United States for years under the same set of rules, including during the Trump administration, which notably cracked down on LGBTQ Pride in government agencies, such as at embassies abroad.

They also noted that Stonewall National Monument is run by the park service. Importantly, Stonewall National Monument’s founding documents state, “The purpose of Stonewall National Monument is to preserve and protect Christopher Park and the historic resources associated with it and to interpret the Stonewall National Historic Landmark’s resources and values related to the lesbian, gay, bisexual, and transgender civil rights movement.”

One park service employee, speaking on condition of anonymity, stated that multiple Pride parade requests are currently sitting on desks “collecting dust” for participation and representation in major city Pride festivities. When asked about the determination that Pride festivals are an “issue of public concern,” they said, “Pride is not political, it’s not a cause, you just are LGBTQ+. It’s a celebration of who we are.” They added, “Morale is just so low right now. There’s not a lot of fight left in us.”

The Blade reached out to a park service spokesperson to ask about Pride parades in major cities and whether the park service would continue participating this year as they have in previous years. The spokesperson stated that the policy “had not changed” and that “Previous interpretations of the uniform policy were inconsistent and, as you can imagine, approving participation in some events and not others could be seen as discrimination based on viewpoint.” They added that in-park Pride events have not been canceled and that community events outside of the parks that “directly relate to a park’s mission” could be approved. However, they did not indicate whether these events would include continued contingents in major U.S. city Pride parades and celebrations and could not be reached for a follow-up on this question.

Park service resources currently live on the site call for people to “Celebrate Pride,” citing Stonewall National Monument to state that “The LGBTQ experience is a vital facet of America’s rich and diverse past.” This resource emphasizes the importance of not rendering LGBTQ people invisible, stating, “By recovering the voices that have been erased and marginalized, the NPS embarks on an important project to capture and celebrate our multi-vocal past.”

Park Service employees have marched in uniform for years. According to the Bay Area Reporter, in 2014, Christine Lenhertz of the park service requested that a group of LGBTQ park service employees be allowed to wear their uniforms in the Pride parade. They were initially barred from doing so, prompting the group to file a complaint. She then sought a ruling from the Office of the Solicitor for the Department of the Interior, who ruled that there was no reason to bar her and other LGBTQ people from participating in uniform. Since then, many park service contingents have participated in Pride events.

The future of Pride parade participation with in-uniform park service employees is uncertain. While it appears that there will be some Pride events in certain national parks, such as Stonewall, external participation in major city Pride events seems to be on hold in at least some major American cities.

You can see the full response to the request for comment from a park service spokesperson here:

The NPS uniform policy has not changed. There are no restrictions on wearing of uniforms in NPS-organized in-park events. There has been no directive to cancel NPS-organized in-park events. Superintendents have discretion to approve park-organized events, which support park purpose and mission, and departmental mission, initiatives, and priorities (e.g., diversity, inclusion, climate change, and tribal engagement.) This would include many of the events planned to celebrate Pride month. 

Official NPS participation in community events that directly relate to a park’s mission can be approved by the park superintendent, provided it is consistent with applicable laws, rules, regulations, and NPS policies.

Last week, the service sent out a reminder about the uniform policy — specifically because there has been an in-flux of requests from folks asking to wear their uniforms for non-park service events. These requests run the gamut of topics, but could include weekend, off duty events that folks are of course able to do in their personal capacity, but not while wearing a uniform representing the federal government. Previous interpretations of the uniform policy were inconsistent and as you can imagine, approving participation in some events and not others could be seen as discrimination based on viewpoint. 

NPS employees represent a diversity of identities, cultures, and experiences, and we are committed to supporting all of our workforce. Like any large organization, we have a diverse workforce supporting myriad causes, and we welcome employees to express their personal support for various issues, positions, and political parties, provided they do not imply their presence or endorsement constitutes official NPS support for the same.  And, also like other large organizations, there are limits to what employees can do while on-duty and in uniform and seen as communicating on behalf of the NPS.

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Erin Reed is a transgender woman (she/her pronouns) and researcher who tracks anti-LGBTQ+ legislation around the world and helps people become better advocates for their queer family, friends, colleagues, and community. Reed also is a social media consultant and public speaker.

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The preceding article was first published at Erin In The Morning and is republished with permission.

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