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Rachel Levine in ‘rewarding’ visit speaks with trans youth at D.C. health clinic

Hospital an oasis of support amid attacks from states

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Dr. Rachel Levine, assistant secretary for health. (Washington Blade photo by Michael Key)

It’s not unusual for Rachel Levine as assistant secretary for health to visit medical facilities on behalf of the Department of Health & Human Services. But her visit last week to the LGBTQ youth clinic at the Children’s National Hospital was special because she was able to meet with transgender youth as an openly transgender presidential appointee.

The visit on Thursday by Levine at the D.C.-based hospital comes not long after the U.S. Senate approved her appointment, making her the first openly transgender presidential appointee to win a Senate-confirmed position. As such, her visit to the LGBTQ youth clinic, where transgender kids come for transition-related care and health services, held particular significance for the patients.

Levine, speaking with the Washington Blade at the end of her visit, said having the opportunity to speak with both transgender youth and medical professionals testing them was “tremendously, tremendously rewarding”

“It’s tremendously gratifying to be able to speak to the medical professionals and the clinic personnel, but particularly to the youth and their families from my experience,” Levine added. “So I have two aspects of that. One is that I’m a pediatrician and adolescent medicine specialist. So I’ve been teaching to children and their families my entire career, but the other is coming from my lived experience as an openly transgender woman, and so I find it tremendously rewarding.”

The warm environment of the hospital for children is readily apparent upon entering the main atrium of the building. Lights dressed up as hot air balloons fill the tall ceiling while a nearby TV shows music videos consisting of squares of kids’ faces singing, followed by easy-listening country music and Asian K-pop. Children and their parents await their appointments seated in comfy plush red chairs before white blocks meant for use as tables.

Key to Levine’s visit was taking part in a discussion at the hospital auditorium with three transgender youth and their families who obtain services at the clinic. During the question-and-answer period, Levine shared her experience as a transgender person who underwent transition later in life and went on to tremendous success as a high-ranking presidential appointee.

For the transgender youth, Levine’s presence at the hospital — at a time when state legislatures are busy enacting bills to restrict their access to medical care and school activities — serves as a reminder that barriers based on gender identity are breaking down and the sky’s the limit for their future.

After the question-and-answer session, Levine told the Blade she “learned a lot” about Children’s National, which she called “a world-renowned children’s hospital and academic medical center.”

“I’ve known about it before,” Levine added. “I’m a pediatrician, adolescent medicine specialist, but I learned more about what they’re doing. And I learned specifically about their gender clinic, where they take care of transgender and gender non-conforming youth and got to meet some of the staff as well as the kids and their families.”

The Youth Pride Clinic, which opened in 2015, is one of the few clinics in the nation to provide primary care and mental health services to LGBTQ youth from ages 12 to 22. Among the services offered are hormone replacement therapy, STP/STI treatment and PrEP services as well as individual and family therapy for transgender youth.

Among the transgender youth patients at the clinic who spoke to the Washington Blade was Amir, a 15-year-old Georgia native whose last name as a minor is being withheld for confidentiality purposes.

“I started out in fifth grade coming out as lesbian,” Amir said. “I didn’t even really know, but when I came out to my grandma in Georgia, where I’m from, I still didn’t feel like myself. So then, later on, me and my friend researched, and next thing you know we came across the term transgender, and I was like, ‘This is who I am. This is me.’”

Amir said he began taking shots as part of care regimen in January. Being able to receive care from the Youth Pride Clinic, Amir said, means a lot because he has an opportunity not available to other transgender youths, who face challenges and even hostility as they make the journey to transition. The staffers at the Youth Pride Clinic, Amir said, are “like a second family” who work hard to provide the services they offer.

Sonia Murphy, Amir’s aunt who became his legal guardian, said when she began reaching out for medical help for Amir she found a two- or three-year wait list to get access to treatment, which she said makes her “saddened” such care isn’t widely available.

“There’s a population of kids and parents out there who need the services and just can’t access it because there’s not enough bandwidth, not enough manpower,” Murphy said.

Amir said he’s getting other avenues of support from his two cousins, one who is older at age 18 and one who is younger at age 12. “They’re like sisters to me, so I call them my sisters,” Amir said. Amir also identified two other male cousins as well as his uncles and his aunt.

“They’re all very supportive of me,” Amir said. “My auntie Tonya, for example, Pride month came up, first day, she sent me a paragraph, saying, ‘I’m glad you’re yourself and you’re open to who you are and things like that,” and that I’m not afraid to be who I am around anybody. It’s just things like that. And for my birthday, I had tons of Pride shirts, and I got a rainbow shirt with the fist in the middle for Black Lives Matter, and it was a ton of different things.”

Lawrence D’Angelo, director of the Youth Pride Clinic and an occupational health adolescent medicine specialist, told the Blade being able to start the facility in 2015 in and of itself was one of the key victories for the initiative, although he said the Children’s National has been providing transition-related care since 1998.

“When we started it…we thought that we were going to be running a PrEP clinic, that we were going to be providing preventive services to LGBTQ kids,” D’Angelo said. “The first day, the first patient actually came in and asked for PrEP, and the other six patients that were scheduled that day all wanted transgender services. So, suddenly, it became obvious what we were going to be spending 90 percent of our time doing, which is exactly what we think we should be doing, because that’s where the need is the greatest.”

Despite the advantages of having access to the Youth Pride Clinic, transgender youth have clear challenges and face hostility based simply on their gender identity, especially in a year when state legislatures have in an unprecedented manner enacted legislation against them. The Youth Pride Clinic, in many ways, is an oasis of support.

Arkansas, for example, enacted a measure that would make criminal the kind of services provided at the clinic. Other states have enacted measures prohibiting “biological boys” from participating in sports, which essentially bars transgender girls from participating in sporting events.

While anti-trans measures aren’t being enacted in D.C. or any nearby states, the advancement of anti-trans legislation in states has had a negative effect on transgender patients at the Youth Pride Clinic.

D’Angelo, based on conversations he’s had with the patients, said they’re aware of the wave of legislation, which he said has led to fear, anger and being “unable to understand what is happening and why it’s happening.”

Amir said watching states enact legislation against transgender youth “makes me feel some type of weight,” pointing specifically to the anti-trans sports measures because he said he’d welcome the opportunity to participate in athletics.

“I’m athletic,” Amir said. “I do all types of sports. I play basketball, soccer, I’m going to do boxing…With sports and stuff, I just feel like I want to be able to do everything, just as a regular cisgender person will be able to do,”

Amir, despite the enactment of anti-trans laws, has an optimistic outlook and said the enactment of state measures against transgender youth demonstrates they’re now “on the radar” of the social conservative movement.

“I feel like if everybody who’s a part of LGBTQ and trans together, we can stand up and we can overcome this because the thing is, there are so many people out there who don’t understand what we do, and the thing is that they’re noticing us, so that’s a start to something big.”

Amir (Blade photo by Michael Key)

With many states hostile to transgender youth, others are looking to the federal government for support under the Biden administration. On his first day in office, Biden signed an executive order directing federal agencies to implement the U.S. Supreme Court’s decision against anti-LGBTQ discrimination to the fullest extent possible.

Levine cited an announcement from HHS that resulted from this order on implementing regulations prohibiting anti-LGBTQ discrimination in medical care, reversing a policy under the Trump administration that green lighted discrimination, as one of the ways it has answered that call and helped families like the Youth Pride Clinic.

“So the Affordable Care Act says that you cannot discriminate based upon sex,” Levine said. “The Department Health & Human Services and the Office of Civil Rights has interpreted sex to include sexual and gender minorities, to include sexual orientation and gender identity, which means LGBTQ individuals under that. So we need to look at all aspects of the Affordable Care Act, and to work to implement that interpretation of the statute. That was only done a month or so ago, so we’re going to be working on that now.”

Is there anything more the federal government can do to support the clinic? D’Angelo cited a number of key things already secured, including the hospital being able to offer insurance to patients and the affirmation from HHS against anti-LGBTQ discrimination. More research dollars and greater focus from the National Institutes of Health on gender diverse and sexual minority individuals, D’Angelo said, would also be welcome.

“There are things out there that the federal government can do, but I think…there are limitations of what they can do,” D’Angelo said. “They can’t, unfortunately, effect what’s going on in individual states, which is, in some cases draconian. That’s an awful thought if we were practicing medicine in Arkansas, we could be in jail.”

Meanwhile, Levine said the Biden administration, including Secretary of Health & Human Services Xavier Becerra, is working on both internal and external policies to facilities like the Youth Pride Clinic to help them secure their place in the health system and reach transgender youth.

“The secretary and I will be doing everything we can to advocate for the LGBTQ community,” Levine said. “So I think we’re going to be working externally, in terms of advocacy, and then we’re going to be working internally in terms of policy.”

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Federal Government

Two very different views of the State of the Union

As Trump delivered his SOTU address inside the Capitol, Democratic lawmakers gathered outside in protest, condemning the administration’s harmful policies.

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President Donald Trump speaks at the State of the Union address at the U.S. Capitol on Feb. 24. (Washington Blade photo by Michael Key)

As President Donald Trump delivered his State of the Union address inside the U.S. Capitol — touting his achievements and targeting political enemies — progressive members of Congress gathered just outside in protest.

Their message was blunt: For many Americans, particularly LGBTQ people, the country is not better off.

Each year, as required by Article II, Section 3 of the Constitution, the president must “give to the Congress Information of the State of the Union.” The annual address is meant to outline accomplishments and preview the year ahead. This year, Trump delivered the longest State of the Union in U.S. history, clocking in at one hour and 48 minutes. He spoke about immigration, his “law and order” domestic agenda, his “peace through strength” foreign policy doctrine, and what he framed as the left’s ‘culture wars’ — especially those involving transgender youth and Christian values.

But one year into what he has called the “Trump 2.0” era, the picture painted outside the Capitol stood in stark contrast to the one described inside.

Transgender youth

In one of the most pointed moments of his speech, Trump spotlighted Sage Blair, using her story to portray gender-affirming care as coercive and dangerous. Framing the issue as one of parental rights and government overreach, he told lawmakers and viewers:

“In the gallery tonight are Sage Blair and her mother, Michelle. In 2021, Sage was 14 when school officials in Virginia sought to socially transition her to a new gender, treating her as a boy and hiding it from her parents. Hard to believe, isn’t it? Before long, a confused Sage ran away from home.

“After she was found in a horrific situation in Maryland, a left-wing judge refused to return Sage to her parents because they did not immediately state that their daughter was their son. Sage was thrown into an all-boys state home and suffered terribly for a long time. But today, all of that is behind them because Sage is a proud and wonderful young woman with a full ride scholarship to Liberty University.

“Sage and Michelle, please stand up. And thank you for your great bravery and who can believe that we’re even speaking about things like this. Fifteen years ago, if somebody was up here and said that, they’d say, what’s wrong with him? But now we have to say it because it’s going on all over, numerous states, without even telling the parents.

“But surely, we can all agree no state can be allowed to rip children from their parents’ arms and transition them to a new gender against the parents’ will. Who would believe that we’ve been talking about that? We must ban it and we must ban it immediately. Look, nobody stands up. These people are crazy. I’m telling you, they’re crazy.”

The story, presented as encapsulation of a national crisis, became the foundation for Trump’s renewed call to ban gender-affirming care. LGBTQ advocates — and those familiar with Blair’s story — argue that the situation was far more complex than described and that using a single anecdote to justify sweeping federal restrictions places transgender people, particularly youth, at greater risk.

Equality Virginia said the president’s remarks were part of a broader effort to strip transgender Americans of access to care. In a statement to the Blade, the group said:

“Tonight, the president is choosing to double down on efforts to disrupt access to evidence-based, lifesaving care.

“Rather than allowing families and doctors to navigate deeply personal medical decisions free from federal interference — or allowing schools to respond with nuance and compassion without putting marginalized children at risk — the president is instead advocating for reckless, one-size-fits-all political control.

“At a time when Virginians are worried about rising costs, economic uncertainty, and aggressive immigration enforcement actions disrupting communities and families, attacking transgender young people is a blatant political distraction from the real challenges facing our nation. Virginia families and health care providers do not need Donald Trump telling them what care they do or do not need.”

For many in the LGBTQ community, the rhetoric inside the chamber echoed actions already taken by the administration.

Earlier this month, the Pride flag was removed from the Stonewall National Monument under a National Park Service directive that came from the top. Community members returned to the site, raised the flag again, and filed suit, arguing the removal violated federal law. To advocates, the move was symbolic — a signal that even the legacy of LGBTQ resistance was not immune.

Immigration and fear

Immigration dominated both events as well.

Inside the chamber, Trump boasted about the hundreds of thousands of immigrants detained in makeshift facilities. Outside, Democratic lawmakers described those same facilities as concentration camps and detailed what they characterized as the human toll of the administration’s enforcement policies.

Sen. Ed Markey (D-Mass.), speaking to the crowd, painted a grim picture of communities living in fear:

“People are vanishing into thin air. Quiet mornings are punctuated by jarring violence. Students are assaulted by ICE agents sitting outside the high school, hard working residents are torn from their vehicles in front of their children. Families, hopelessly search for signs of their loved ones who have stopped answering their phones, stop replying to text… This is un-American, it is illegal, it is unconstitutional, and the people are going to rise up and fight for Gladys Vega and all of those poor people who today need to know that the people’s State of the Union is the beginning of a long fight that is going to result in the end of Republican control of the House of Representatives and the Senate in the United States of America in 2026.”

Speakers emphasized that LGBTQ immigrants are often especially vulnerable — fleeing persecution abroad only to face detention and uncertainty in the United States. For them, the immigration crackdown and the attacks on transgender health care are not separate battles but intertwined fronts in a broader cultural and political war.

Queer leadership

Rep. Robert Garcia (D-Calif.) speaks at the People’s State of the Union on the Mall on Feb. 24. (Photo by Andrei Nasonov)

After delivering remarks alongside Robert Garcia, Kelley Robinson, president of the Human Rights Campaign, took the stage and transformed the freezing crowd’s anger into resolve.

Garcia later told the Blade that visibility matters in moments like this — especially when LGBTQ rights are under direct attack.

“We should be crystal clear about right now what is happening in our country,” Garcia said. “We have a president who is leading the single largest government cover up in modern history, we have the single largest sex trafficking ring in modern history right now being covered up by Donald Trump and Pam Bondi In the Department of Justice. Why are we protecting powerful, wealthy men who have abused and raped women and children in this country? Why is our government protecting these men at this very moment? In my place at the Capitol is a woman named Annie farmer. Annie and her sister Maria, both endured horrific abuse by Jeffrey Epstein and Ghislaine Maxwell. As we move forward in this investigation, always center the survivors; we are going to get justice for the survivors. And Donald Trump may call this investigation a hoax. He may try to deflect our work, but our message to him is very clear that our investigation is just getting started, and we will we will get justice for these survivors.”

He told the Blade afterwards that having queer leaders front and center is itself an act of resistance.

“I obviously was very honored to speak with Kelley,” the California representative said. Kelley is doing a great job…it’s important that there are queer voices, trans voices, gay voices, in protest, and I think she’s a great example of that. It’s important to remind the country that the rights of our community continue to be attacked, and then we’ve got to stand up. Got to stand up for this as well.”

Robinson echoed that call, urging LGBTQ Americans — especially young people — not to lose hope despite the administration’s escalating rhetoric.

“There are hundreds of thousands of people that are standing up for you every single day that will not relent and will not give an inch until every member of our community is protected, especially our kids, especially our trans and queer kids. I just hope that the power of millions of voices drowns out that one loud one, because that’s really what I want folks to see at HRC. We’ve got 3.6 million members that are mobilizing to support our community every single day, 75 million equality voters, people that decide who they’re going to vote for based on issues related to our community. Our job is to make sure that all those people stand up so that those kids can see us and hear our voices, because we’re going to be what stands in the way.”

A boycott — and a warning

The list of Democratic lawmakers who boycotted the State of the Union included Sens. Ruben Gallego, Ed Markey, Jeff Merkley, Chris Murphy, Adam Schiff, Tina Smith, and Chris Van Hollen, along with dozens of House members.

For those gathered outside — and for viewers watching the livestream hosted by MoveOn — the counter-programming was not merely symbolic. It was a warning.

While the president spoke of strength and success inside the chamber, LGBTQ Americans — particularly transgender youth — were once again cast as political targets. And outside the Capitol, lawmakers and advocates made clear that the fight over their rights is far from over.

(Washington Blade photo by Michael Key)
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U.S. Military/Pentagon

4th Circuit rules against discharged service members with HIV

Judges overturned lower court ruling

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The Pentagon (Photo by icholakov/Bigstock)

A federal appeals court on Wednesday reversed a lower court ruling that struck down the Pentagon’s ban on people with HIV enlisting in the military.

The conservative three-judge panel on the 4th U.S. Circuit Court of Appeals overturned a 2024 ruling that had declared the Defense Department and Army policies barring all people living with HIV from military service unconstitutional.

The 4th Circuit, which covers Maryland, North Carolina, South Carolina, Virginia, and West Virginia, held that the military has a “rational basis” for maintaining medical standards that categorically exclude people living with HIV from enlisting, even those with undetectable viral loads — meaning their viral levels are so low that they cannot transmit the virus and can perform all duties without health limitations.

This decision could have implications for other federal circuits dealing with HIV discrimination cases, as well as for nationwide military policy.

The case, Wilkins v. Hegseth, was filed in November 2022 by Lambda Legal and other HIV advocacy groups on behalf of three individual plaintiffs who could not enlist or re-enlist based on their HIV status, as well as the organizational plaintiff Minority Veterans of America.

The plaintiffs include a transgender woman who was honorably discharged from the Army for being HIV-positive, a gay man who was in the Georgia National Guard but cannot join the Army, and a cisgender woman who cannot enlist in the Army because she has HIV, along with the advocacy organization Minority Veterans of America.

Isaiah Wilkins, the gay man, was separated from the Army Reserves and disenrolled from the U.S. Military Academy Preparatory School after testing positive for HIV. His legal counsel argued that the military’s policy violates his equal protection rights under the Fifth Amendment’s Due Process Clause.

In August 2024, a U.S. District Court sided with Wilkins, forcing the military to remove the policy barring all people living with HIV from joining the U.S. Armed Services. The court cited that this policy — and ones like it that discriminate based on HIV status — are “irrational, arbitrary, and capricious” and “contribute to the ongoing stigma surrounding HIV-positive individuals while actively hampering the military’s own recruitment goals.”

The Pentagon appealed the decision, seeking to reinstate the ban, and succeeded with Wednesday’s court ruling.

Judge Paul V. Niemeyer, one of the three-judge panel nominated to the 4th Circuit by President George H. W. Bush, wrote in his judicial opinion that the military is “a specialized society separate from civilian society,” and that the military’s “professional judgments in this case [are] reasonably related to its military mission,” and thus “we conclude that the plaintiffs’ claims fail as a matter of law.”

“We are deeply disappointed that the 4th Circuit has chosen to uphold discrimination over medical reality,” said Gregory Nevins, senior counsel and employment fairness project director for Lambda Legal. “Modern science has unequivocally shown that HIV is a chronic, treatable condition. People with undetectable viral loads can deploy anywhere, perform all duties without limitation, and pose no transmission risk to others. This ruling ignores decades of medical advancement and the proven ability of people living with HIV to serve with distinction.”

“As both the 4th Circuit and the district court previously held, deference to the military does not extend to irrational decision-making,” said Scott Schoettes, who argued the case on appeal. “Today, servicemembers living with HIV are performing all kinds of roles in the military and are fully deployable into combat. Denying others the opportunity to join their ranks is just as irrational as the military’s former policy.”

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New York

Lawsuit to restore Stonewall Pride flag filed

Lambda Legal, Washington Litigation Group brought case in federal court

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The Pride flag in question that once flew at the Stonewall National Monument. (Photo from National Park Service)

Lambda Legal and Washington Litigation Group filed a lawsuit on Tuesday, challenging the Trump-Vance administration’s removal of the Pride flag from the Stonewall National Monument in New York earlier this month.

The suit, filed in the U.S. District Court for the Southern District of New York, asks the court to rule the removal of the Pride flag at the Stonewall National Monument is unconstitutional under the Administrative Procedures Act — and demands it be restored.

The National Park Service issued a memorandum on Jan. 21 restricting the flags that are allowed to fly at National Parks. The directive was signed by Trump-appointed National Park Service Acting Director Jessica Bowron.

“Current Department of the Interior policy provides that the National Park Service may only fly the U.S. flag, Department of the Interior flags, and the Prisoner of War/Missing in Action flag on flagpoles and public display points,” the letter from the National Park Service reads. “The policy allows limited exceptions, permitting non-agency flags when they serve an official purpose.”

That “official purpose” is the grounds on which Lambda Legal and the Washington Litigation Group are hoping a judge will agree with them — that the Pride flag at the Stonewall National Monument, the birthplace of LGBTQ rights movement in the U.S., is justified to fly there.

The plaintiffs include the Gilbert Baker Foundation, Charles Beal, Village Preservation, and Equality New York.

The defendants include Interior Secretary Doug Burgum; Bowron; and Amy Sebring, the Superintendent of Manhattan Sites for the National Park Service.

“The government’s decision is deeply disturbing and is just the latest example of the Trump administration targeting the LGBTQ+ community. The Park Service’s policies permit flying flags that provide historical context at monuments,” said Alexander Kristofcak, a lawyer with the Washington Litigation Group, which is lead counsel for plaintiffs. “That is precisely what the Pride flag does. It provides important context for a monument that honors a watershed moment in LGBTQ+ history. At best, the government misread its regulations. At worst, the government singled out the LGBTQ+ community. Either way, its actions are unlawful.”

“Stonewall is the birthplace of the modern LGBTQ+ rights movement,” said Beal, the president of the Gilbert Baker Foundation. The foundation’s mission is to protect and extend the legacy of Gilbert Baker, the creator of the Pride flag.

“The Pride flag is recognized globally as a symbol of hope and liberation for the LGBTQ+ community, whose efforts and resistance define this monument. Removing it would, in fact, erase its history and the voices Stonewall honors,” Beal added.

The APA was first enacted in 1946 following President Franklin D. Roosevelt’s creation of multiple new government agencies under the New Deal. As these agencies began to find their footing, Congress grew increasingly worried that the expanding powers these autonomous federal agencies possessed might grow too large without regulation.

The 79th Congress passed legislation to minimize the scope of these new agencies — and to give them guardrails for their work. In the APA, there are four outlined goals: 1) to require agencies to keep the public informed of their organization, procedures, and rules; 2) to provide for public participation in the rule-making process, for instance through public commenting; 3) to establish uniform standards for the conduct of formal rule-making and adjudication; and 4) to define the scope of judicial review.

In layman’s terms, the APA was designed “to avoid dictatorship and central planning,” as George Shepherd wrote in the Northwestern Law Review in 1996, explaining its function.

Lambda Legal and the Washington Litigation Group are arguing that not only is the flag justified to fly at the Stonewall National Monument, making the directive obsolete, but also that the National Park Service violated the APA by bypassing the second element outlined in the law.

“The Pride flag at the Stonewall National Monument honors the history of the fight for LGBTQ+ liberation. It is an integral part of the story this site was created to tell,” said Lambda Legal Chief Legal Advocacy Officer Douglas F. Curtis in a statement. “Its removal continues the Trump administration’s disregard for what the law actually requires in their endless campaign to target our community for erasure and we will not let it stand.”

The Washington Blade reached out to the NPS for comment, and received no response.

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