Federal Government
Adm. Levine celebrates trans joy on Transgender Day of Visibility
‘We continue to live a life of joy in the face of adversity’
The day after Sunday’s Transgender Day of Visibility observance, the Washington Blade connected with Adm. Rachel Levine, a pediatrician serving as assistant secretary of health at the U.S. Department of Health and Human Services.
“Trans joy means authenticity and being comfortable in your own skin and being able to be who you are,” said Levine, who is the highest-ranking transgender official in U.S. history.
“With my transition, I was able to be my authentic self,” she remembers. “At that time, I was still a professor at the Penn State College of Medicine, and an attending physician at the Penn State Hershey Medical Center in pediatrics and adolescent medicine, but then I had this unique opportunity to become the physician general of Pennsylvania for then-Gov. Tom Wolf, and then two and a half years later to become the Secretary of Health.”
“So it has been a tremendous journey, which has been very rewarding,” Levine said, adding that it has been “an honor” to work for the Biden-Harris administration under HHS Secretary Xavier Becerra ā all allies of trans, nonbinary, and gender expansive folks and of the LGBTQ community more broadly.
Levine recounted how Transportation Secretary Pete Buttigieg, himself the first openly gay Senate-confirmed Cabinet secretary, had singled her out as one of the administration’s other high-ranking LGBTQ appointees during a 2021 Pride celebration at the White House.
At that moment, President Joe Biden “looked me in the eye and, you know, kind of gestured for me to stand up for the applause,” she remembered, and “I thought that that was just truly meaningful and shows his compassion and his attention to the people working for him and his administration.”
At the same time, Levine’s tenure has, unfortunately, come with bigoted attacks from the likes of U.S. Rep. Marjorie Taylor Greene (R-Ga.), but she said part of trans joy means “we fight hate with love, and we continue to live a life of joy in the face of adversity.”
“For me personally, I am able to compartmentalize those attacks,” she said. “You know, and I’ve learned this in my clinical work as a pediatrician, where, if you are in the emergency department or in the office or in the hospital and you have a very sick patient in front of you, you have to be able to function as a professional and compartmentalize your feelings and then be able to bring them out later and process them.”
Levine explained, “And so it’s the same thing so that if I am attacked, I’m able to compartmentalize any emotions about that and then I work that through with my friends and my family.”
“In addition, though, I’ve also learned the art of sublimation where, you know, the more people attack me, then I’m able to turn that around and it serves as motivation for me to work harder and advocate more.”
Rather than herself, Levine said, “What I worry about are the most vulnerable in our community, who I think it can be very challenging for, particularly in these times, to vulnerable transgender and nonbinary youth, their families, and even their medical providers in many states across the country.”
Levine shared her thoughts about the public’s eroding faith in science, medicine, and institutional expertise ā themes that often arise in the context of debates over gender affirming healthcare, as guideline-directed and medically necessary interventions that are supported by every mainstream medical society have come under fire from right-wing politicians.
“There is a lot of misinformation and overt disinformation about transgender medicine,” she said. “You know, transgender medicine is an evidence-based standard of care, which continues to benefit from continued research and evolution from, you know, standards 10 or more years ago to the current standards now published.”
Levine added, “Transgender medicine is absolutely necessary for transgender and gender diverse people including youth ā and transgender medicine is medical care, but it’s also mental health care, and it’s literally suicide prevention care” that has “been shown in study after study to improve the quality of life and can literally save lives.”
Transgender medicine “for young people [is often] conducted at many of our nation’s expert children’s hospitals,” Levine said. “Let me put it this way: if you have a child with a fever, you would take your child, perhaps, to a pediatrician. If they had severe diabetes, you would take them to a pediatric endocrinologist. If they had a mental health condition, you might take them to a child psychiatrist or psychologist.”
“So,” she said, “if you have a child with gender questions or gender issues then you’re going to take them to the pediatric and adolescent gender specialist, and it’s often a team ā including the same endocrinologist and it might be the same psychiatrist or psychologist.”
“You’re not going to think, ‘oh, I’m going to call my state legislator.'”
Nevertheless, Levine said, “These issues have been politicized for political and ideological reasons” over the objections of physicians like Jesse Ehrenfeld, president of the American Medical Association, who during a panel discussion with Levine for the PFLAG National convention in November, agreed that politicians should not get between patients, their families, and their healthcare providers.
“We see other areas where there’s misinformation and disinformation,” Levine said, perhaps partly a consequence of the politicization of the public health response to the COVID pandemic, which has led to vaccine hesitancy for COVID as well as childhood immunizations.
Ultimately, she said, “physicians and other medical and public health professionals are trying to help people,” which is “what I tried to do when I was in academic medicine” where “I really worked to help people, the patients and families that I saw as well as teaching as well as clinical research ā and I think, overall, that’s what most physicians and medical professionals and public health professionals are doing.”
Exciting work ahead at HHS
When it comes to the work in which her agency is engaged, Levine said “health equity is fundamental to everything that we’re doing at HHS under Secretary Becerra and so many of our key policy initiatives relate to health equity.”
“So,” she said, “that includes health equity for the LGBTQI+ community, working to end the HIV epidemic in the United States with a focus on health equity, working to safeguard LGBTQI+ youth from the harms of conversion therapy, promoting data equity for our community, SAMHSA’s work on on conversion therapy, ARC’s work in terms of a sample patient intake form to improve the patient care experience for LGBTQI+ people, and more.”
“We have an office of climate change and health equity with a sister office of environmental justice,” Levine added. “We’re working on health equity in terms of reproductive health and reproductive rights, in the face of the Dobbs decision,” which revoked the constitutional right to abortion.
“We’re working in terms of health equity in regards to food and nutrition,” she said, “in terms of long COVID, and more.”
As with many initiatives under Biden’s presidency, “There is a tremendous emphasis on breaking down silos within divisions at HHS and between departments,” Levine said.
She shared a few examples: “One is our work on long COVID. We have an office of long COVID research and practice, which is really working across the administration with that whole of government approach. Another is in terms of our work on climate change and health equity with the EPA, and the White House Climate Council.”
“And then another actually would be our work on syphilis,” Levine said. “We run ā and I chair ā a syphilis and congenital syphilis federal government task force, which includes all the divisions at HHS, but also includes the VA and the Department of Defense, trying to address the significant increases in syphilis and congenital syphilis that we’ve seen the United States.”
And then, “Another example within the LGBTQ space is a global interagency action plan about conversion therapy, which includes HHS, the Department of State, the Department of the Treasury, and USAID.”
Federal Government
GLAAD catalogues LGBTQ-inclusive pages on White House and federal agency websites
Trump-Vance administration to take office Monday
GLAAD has identified and catalogued LGBTQ-inclusive content or references to HIV that appear on WhiteHouse.gov and the websites for several federal government agencies, anticipating that these pages might be deleted, archived, or otherwise changed shortly after the incoming administration takes over on Monday.
The organization found a total of 54 links on WhiteHouse.gov and provided the Washington Blade with a non-exhaustive list of the “major pages” on websites for the Departments of Defense (12), Justice (three), State (12), Education (15), Health and Human Services (10), and Labor (14), along with the U.S. Equal Employment Opportunity Commission (10).
The White House web pages compiled by GLAAD range from the transcript of a seven-minute speech delivered by President Joe Biden to mark the opening of the Stonewall National Monument Visitor Center to a readout of a roundtable with leaders in the LGBTQ and gun violence prevention movements and the White House Office of National Drug Control Policy’s 338-page FY2024 budget summary, which contains at least a dozen references to LGBTQ-focused health equity initiatives and programs administered by agencies like the Substance Abuse and Mental Health Services Administration.
Just days after Trump took office in his first term, news outlets reported that LGBTQ related content had disappeared from WhiteHouse.gov and websites for multiple federal agencies.
Chad Griffin, who was then president of the Human Rights Campaign, accused the Trump-Pence administration of “systematically scrubbing the progress made for LGBTQ people from official websites,” raising specific objection to the State Department’s removal of an official apology for the Lavender Scare by the outgoing secretary, John Kerry, in January 2017.
Acknowledging the harm caused by the department’s dismissal of at least 1,000 employees for suspected homosexuality during the 1950s and 60s “set the right tone for the State Department, he said, adding, āIt is outrageous that the new administration would attempt to erase from the record this historic apology for witch hunts that destroyed the lives of innocent Americans.”
In response to an inquiry from NBC News into why LGBTQ content was removed and whether the pages would return, a spokesperson said “As per standard practice, the secretary’s remarks have been archived.” However, NBC noted that “a search of the State Department’s website reveals not much else has changed.”
Federal Government
HIV positive patients can now receive organs from HIV positive donors
New HHS rule applies to liver and kidney transplants
A new rule announced Tuesday by the U.S. Department of Health and Human Services will allow HIV positive patients to receive organs from HIV positive donors, a move that will expand the pool of available organs and reduce wait times.
āThis rule removes unnecessary barriers to kidney and liver transplants, expanding the organ donor pool and improving outcomes for transplant recipients with HIV,” said HHS Secretary Xavier Becerra in a statement.
The agency noted that the final rule also aims to combat stigma and health inequities associated with HIV.
āResearch shows that kidney and liver transplants between donors and recipients with HIV can be performed safely and effectively,ā Assistant Secretary for Health Rachel Levine added. āThis policy change reflects our commitment to following the evidence and updating our approaches as we learn more. By removing research requirements where they are no longer needed, we can help more people with HIV access life-saving transplants.ā
HHS notes that the rule applies to kidney and liver transplants, which correspond with the areas in which the evidence from biomedical research is the most “robust.”
Federal Government
LGBTQ federal workers face tough decisions, big worries amid Trump transition
‘I plan to leave after the inauguration’
Donald Trump’s return to the White House promises to shake up Washington in ways not seen even during the norm-shattering Trump 1.0 years: on the table are blueprints for radically reforming the federal civil service into a more partisan institution where loyalty is prized at the expense of expertise and competence; off the table, among other things, are anti-discrimination protections that had long bolstered the rights and welfare of LGBTQ federal government employees.
Washington proudly boasts, per-capita, the highest LGBTQ population of any city in any state in America. Ninety-two percent of the city’s 678,000+ residents voted for Vice President Kamala Harris. So, according to exit polls, did 86 percent of LGBTQ voters.
Many of D.C.’s LGBTQ residents who work for the federal government find themselves, now, at an unenviable crossroads. Some stood to lose their jobs regardless of who won in November because they serve in higher-ranking “political” roles that typically turn over administration-to-administration, but more are “career” employees with experience serving with both parties in charge of the White House.
Many find themselves choosing whether to wade into a hyperlocal job market that is, at the moment, competitive for job seekers ā or continue, if they can, working under institutions run by Republicans who have vowed to destroy them (or at least shake them up, whatever that will mean).
The Washington Blade has spoken with LGBTQ employees in the federal government who worry about the welfare of gay, queer, and trans colleagues they plan to leave behind for jobs in the private sector. They share a deep concern, too, for the LGBTQ Americans who, they believe, will suffer harmful consequences of policy and governance under the incoming administration.
A lesbian attorney for the U.S. Department of Justice and a gay senior official for the U.S. Department of Commerce spoke anonymously with the Blade to share experiences and observations at their respective agencies.
Do you expect to be working elsewhere when Trump 2.0 begins in January
[Justice Department]: I plan to leave shortly after the inauguration.
[Commerce Department]: I hope to be working elsewhere by the next term. The job market is incredibly competitive, but thatās because the Biden administration hired the best and brightest public servants that represent every community in America. Itās particularly important that companies and nonprofits seek out the great early/mid-career staff from the administration. Many finished college remotely during the pandemic, to then immediately serve their country. They have exceptional work experience, but can be at a hiring disadvantage behind their classmates who immediately entered the workforce.
Would you be (or might you be) allowed to continue in your role under the next administration if you wished to do so?
[Justice]: Probably not.
Under the next administration, if you were allowed to continue in your role or serve in a different position at your agency or perhaps work elsewhere in the federal government, would you? Why or why not?
[Justice]: Noārisk of doxing is too high; did it once before and not interested in doing it again.
[Commerce]: I would not work in the Trump administration, even if allowed. To work for someone who believes in retribution over public service would violate the oath I took to my country and the Constitution he refuses to respect. I look forward to doing what queer people have done for all of American history: shining brightly in the face of hate and being a success in spite of every attempt to shame.
What can you tell me about the post-election turnover at your agency that youāve seen so far or expect to see in the coming months, as compared to that which you might have experienced during previous transitions?
[Justice]: I expect to see many more people leave than in any previous admin change.
[Commerce]: Experienced career staff who survived the first Trump years are burned out and leaving. This is a horrible loss for the American people who are losing the dedicated subject matter experts who do the hard work of making their lives easier, safer, and healthier. So many of them work for the federal government because of how it can be used to help people in big ways. Theyāre horrified to think of all the people, especially minorities, women, and queer people, will, instead, be targeted. They donāt want to be a part of that. They canāt live with that.
Are any of your LGBTQ colleagues staying in their jobs? If so, what can you share about the reasons youāve heard for their decision to stay?
[Justice]: Yes; many will stay because they donāt have the luxury of leaving without a job lined up.Ā
What are some of your biggest concerns specific to how your agency might be run under the Trump 2.0 regime?
[Justice]: They will dismantle the civil rights division at DOJ or completely shift its focus.Ā
[Commerce]: I’m horrified at how data may be weaponized against vulnerable people. So much work has been done to help communities by building close-knit relationships with leaders across the countries. Will all these programs focused on supporting the most vulnerable and underserved among us be turned on them to identify easy targets to victimize?
Broadly speaking, what concerns do you have about the rights, safety, and wellbeing of LGBTQ folks who will remain in the civil service post-January, or those who might join the federal governmentās civilian workforce after Trump takes over?
[Justice]: LGBTQ+ people will be at greater risk of doxing; bathroom flexibilities will disappear; harassment will go unchecked.
[Commerce]: We are barely out of the shadow of the Lavender Scare, where thousands of queer American public servants were harassed, humiliated, and often fired in shame. It starts with removing Pride flags, then the photos of our partners on our desks, and then weāre escorted from the building for being security risks. LGBTQ Americans are the soldiers, and scientists, and civil servants and should never, ever have to worry if their mere existence could suddenly cost them their security clearance, their career path, or their safety.
How do you think staff turnover at your agency will impact its work under the next administration?
[Justice]: Staff turnover will severely undermine DOJās work and protecting the rule of law.Ā
If, ultimately, a disproportionate number of LGBTQ workers leave for jobs in the private sector, are you concerned about harms that might result from the loss of voices representing the community in the federal government and/or in your agency specifically?
[Justice]: Re: loss of voices, yes. The federal government cannot function as effectively when it doesnāt reflect the public it serves.
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