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The LGBTQ+ community, telehealth, and rural broadband access

Congress must act to preserve lifeline of remote healthcare

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The LGBTQ+ community has come to rely more and more on remote general and specialized healthcare as the pandemic continues to limit access to in-person services. This lifeline is in danger of going away unless Congress acts, delivering a serious blow to the diverse community of people who struggle to access care in-person in their communities. 

Telehealth allows doctors and other providers to provide care without an in-person visit. More specifically, telehealth refers to the health care services accessible through telecommunications services, including via audio and video (either real time or asynchronous). These services are best delivered via high-speed broadband services. Medical care appointments, consultations, prescriptions, follow-up visits, and more can be done safely and virtually. 

Telehealth is a modern necessity made even more relevant due to the ongoing COVID-19 pandemic, and demand for these resources is growing. The LGBTQ+ community in particular is experiencing a significant need for improved telehealth provisions and access. Recent relaxations of telehealth regulations have expanded the reach of telehealth and positively impacted marginalized communities including the LGBTQ+ community, especially in rural and remote areas. Effective and reliable broadband access is instrumental for telehealth services and as telehealth expands, advancements to universal broadband access will be critical to reach these communities.

Telehealth and the LGBTQ+ community

More than 18 million Americans identify as lesbian, gay, bisexual, transgender, queer, questioning, or intersex (LGBTQ+), and more younger Americans than ever before are identifying as LGBTQ+. The health concerns of these individuals deserve utmost respect and care, demonstrable through high-quality health care both in person and online. Telehealth plays an important role in connecting the LGBTQ+ community with competent and affirming health care providers and services. The LGBTQ+ community has always been more heavily reliant on internet connectivity, and healthcare is no different, with 81% of LGBTQ+ youth reportedly using the internet to search for health information.

LGBTQ+ communities face many of the same healthcare concerts as non-LGBTQ+ communities, though there are differences in rates of some chronic conditions including cancer, diabetes, obesity, HIV/AIDS and other sexually transmitted infections (STIs), and tobacco-related health conditions. LGBTQ+ individuals have higher rates of mental and physical disability, and the impact of loneliness on health quality is experienced at higher rates by LGBTQ+ individuals in both urban and rural settings. Routine healthcare for these conditions improves quality of life, but LGBTQ+ individuals often report high cost as a deterrent from going to the doctor. Telehealth provides an affordable avenue to routine health care.

Many individuals in the LGBTQ+ community report a history of medical trauma as a barrier to receiving healthcare. Gender-affirming health care is one major motivator for telehealth access in the LGBTQ+ community. Nearly one-fifth of transgender individuals have been refused healthcare due to their gender identity. Online servers such as Folx Health, Plume, and QueerDoc provide gender-affirming care including hormone therapy, mental health, and documents for gender marker change. Telehealth allows users to bypass the barrier of proximity to medical care and to access providers who are informed on medical concerns and considerations that uniquely impact the LGBTQ+ community. 

Regulations that previously restricted the delivery of telehealth have been eased since the onset of the COVID-19 pandemic. Specifically, rules previously limited telehealth to rural areas received in a clinical setting. The new rules allow urban and suburban patients to access telehealth from their home or other convenient setting. This makes sense as many urban areas lack convenient access to physicians and other providers. Individuals across America have benefitted from the ability to access basic health services at home, but those whose care has been most significantly enhanced are poor, elderly, members of marginalized communities such as the LGBTQ+ community, and/or those who live in remote areas of the country. For example, the total number of telehealth visits in Medicare increased from less than 1 million to more than 50 million during COVID. 

There are currently hundreds of proposals pending before state and federal legislatures that address extending or expanding telehealth beyond the pandemic’s public health emergency. Current changes to telehealth regulations include loosened restrictions around telephone-based check-ins and the allowance for telehealth visits between providers and persons across state borders. Before the pandemic, patients filled a prescription after first meeting with a doctor in-person, but telehealth expansion has eliminated the required in-person appointment. Telehealth treatment for addiction is also on the rise, with addiction-specific treatments available online. General mental health resources are also increasingly accessible virtually and by phone. Now that these practices are commonplace, regulators are looking to pass legislation that will maintain this ease of service.

The expansion of telehealth has proven especially effective for the LGBTQ+ community. Easing accessibility of telehealth and prescriptions reduces the cost of care for routine medicines and check-ups for conditions that disproportionately affect the LGBTQ+ community, such as HIV. Increased availability of telehealth mental resources is critical for all youth, but especially for those in the marginalized LGBTQ+ community. Through online resources, transgender adults can safely and reliably access gender-affirming healthcare including hormone replacement therapy and counseling with specialized professionals. Additionally, telehealth access can reduce or eliminate the stigma and discrimination that LGBTQ+ individuals face daily when selecting providers, especially in remote or rural areas where there may be few providers to choose from and even fewer knowledgeable about and sympathetic to the special health care needs of LGBTQ+ individuals.   Making permanent the COVID-19 exemptions currently in place that regulate telehealth services will have far-reaching, positive impacts for the LGBTQ+ community.

Rural need for telehealth

An estimated 2.9 to 3.8 million Americans living in rural and remote parts of the country identify as LGBTQ+ and deserve high-quality and informed healthcare. Accessing a healthcare provider is, in general, more challenging in rural areas. Consider, for example, costs associated with distance. To add insult to injury, where providers are available in rural communities, the potential for discrimination against LGBTQ+ individuals and misdiagnosis of medical conditions is prevalent. Lack of access to sympathetic providers or specialized providers makes telehealth a crucial tool for the rural LGBTQ+ community. 

Given the need for broadband access to ensure quality telehealth services (to access video consultations, for example), the quality of an individual’s access to broadband services will directly affect their health care experience. Rural Americans are routinely left behind in broadband deployment, contributing to the digital divide, or the gap in use of online resources. Improvements to broadband access is key for expanding the reach of telehealth services across the country, especially in rural America. The recently enacted infrastructure law includes $65 billion in new broadband funding. It must be rolled out quickly to ensure marginalized communities in rural areas gain from improvements to broadband access and the telehealth resources that come along with it. 

Telehealth has become a critical tool to expand access for all patients, but especially the LGBTQ+ community. Marginalized individuals benefit the most from increased telehealth access and those living in rural areas may be the most significantly impacted. Telehealth offers a number of benefits including facilitating community health and social wellness, the delivery of gender-affirming medical care, accessible mental health care, and ease of prescription access.

Recently relaxed regulations around telehealth delivery have increased the reach of these services and provided healthcare to individuals who may have gone without care. Rural and remote marginalized communities, such as the LGBTQ+ community, will experience an especially positive impact from telehealth, and increasing rural broadband access is critical to expanding high-quality, informed healthcare to LGBTQ+ individuals across America.  Crucially, Congress can permanently expand telehealth services and capitalize on the recent infrastructure law to roll out high-speed broadband that facilitates telehealth in areas with limited internet access.  Without congressional action, many of the benefits marginalized communities have experienced from telehealth services will expire thereby reducing or eliminating supportive and specialized care options for these communities.  

For more information visit www.LGBTQ+tech.org/telehealth.

Carlos Gutierrez is deputy director and general counsel for the LGBT Technology Partnership & Institute, which works to improve access, increase inclusion, ensure safety and empower entrepreneurship for LGBTQ+ communities around technology.

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Protection should mean protection

Disbelief as court modifies protective order against Pasha

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(Photo by Sergei Gnatuk/Bigstock)

There is a particular kind of disbelief that Black queer women know intimately. It is not always explicit. It shows up in hesitation, in “both sides” framing, and in systems that require us to prove, again and again, that we are worthy of safety. 

We see that disbelief happening now with the temporary protection order (TPO) involving an individual, D. Pasha. He is accused of repeatedly harassing staff, board members, and volunteers at the Capital Pride Alliance, which led the organization to ask the court for protection. 

The Capital Pride Alliance did not seek this order lightly. They spent over a year documenting his harassment, and several witnesses gave almost two hours of testimony about a pattern of behavior that caused real fear. The organization also spent months working out how to legally protect its staff, volunteers, board, and contractors from this individual. 

At first, the Court agreed and issued a stay-away order that included CPA’s office and other locations, setting a clear boundary to protect staff, volunteers, and community members. 

But that protection did not last. 

After the order was issued, Pasha spoke with a reporter from the Washington Blade and learned that CPA shares office space with the DC LGBTQ Center. It is important to note that he didn’t know this detail before. He then sought an emergency hearing, claiming he needed access to “vital services” from the CPA and DC LGBTQ Center shared offices.  

The Court granted it, allowing access with a 24-hour notice to CPA. According to the Court, the modification was based on Mr. Pasha’s claim that denying him entry to the DC Center would prevent him from accessing essential support services provided there. Although CPA objected and highlighted the lack of recent service usage and the availability of alternatives, the Court determined that his stated need for services warranted an exception to the stay-away order. 

Let’s be clear about what this means. 

There is no record of him accessing services or being at the DC LGBTQ Center in over a year. Numerous organizations across DC provide the same services he cited: food, clothing, computers, Wi-Fi, without placing him in proximity to the people who testified against him. 

And yet, the Court modified the order to allow exactly that. 

Then it escalated. Following the modification, he sent more than 20 emails and text messages in attempts to gain access to our office space, triggering another emergency hearing. At that second emergency hearing, the court maintained its previous decision, allowing Mr. Pasha continued access to the location. 

This is not a technicality. This is a failure of real protection. 

The outcome was shaped not just in the courtroom, but in how it was presented afterward. 

Recent coverage centered the acceptance of a less restrictive order, while giving the person at the center of this case a platform to define the narrative in his own words. He was described as an LGBTQ activist, quoted at length, and presented with his name, voice, and image, including statements like “I am happy with what we have accomplished so far,” “even if I lose this case, I am glad that I spoke up,” and that “the truth will come out.” 

That framing does not exist in a vacuum. It omits important context about the pattern of conduct that led to this case, including the history and the events that followed the Court’s initial order. It also gives weight to claims about access to services that are not reflected in actual usage. 

At the same time, the hours of testimony describing a pattern of conduct that caused fear, serious alarm, and emotional distress are reduced to a small part of the story. The individuals who came forward are largely unnamed, unseen, and unheard. The record that was built in court is condensed, while his narrative is expanded. 

When one side is given visibility, voice, and narrative, and the other is reduced to summary, that is not balance. It is distortion. 

We also need to be honest about who is being asked to bear the consequences of that failure. 

Two Black queer women testified. They followed the process. They showed up, told the truth, and trusted the system to do what it is designed to do: protect them. 

Instead, the system created a pathway back to proximity, back to fear. 

That is not a neutral outcome. It is a choice about whose safety matters most and whose safety can be compromised. 

This is not an isolated incident. It reflects a broader pattern in how systems fail Black women, survivors, and LGBTQ+ people, especially at the intersections of those identities. 

According to the Human Rights Campaign, data shows that over 60% of bisexual women and more than 40% of lesbian women experience physical violence or stalking.  

Violence does not start with homicide. It starts with being dismissed, with being minimized, and with systems that do not act fairly or quickly when harm is reported. 

It starts when people question the credibility of Black queer women. 

When access is granted to those who cause fear, instead of protection being fully extended to those who experience it. 

And it continues when we treat these outcomes as unfortunate, rather than unacceptable. 

Capital Pride Alliance believes in access. We invest in it. We help sustain the very services being cited in this case. But access cannot come at the expense of safety, especially when alternatives exist, and risk is known. 

The question here is not complicated: what does protection actually mean, and who deserves it? 

If a court acknowledges harm but still allows proximity, is that protection? 

If Black queer women testify and are still placed within reach of the person they testified against, what message does that send? 

We cannot keep calling these systems fair if they keep putting the same people at risk. 

Courts need to think about safety in a broader sense, one that reflects real life rather than just following procedures. This means looking at not only direct threats, but also ongoing harassment, intimidation, and the real fear survivors feel when they must share space with someone who has harmed them. 

Real changes could include ensuring stay-away orders are enforced even in shared spaces, working with community groups to offer alternative ways to access services, and asking survivors about their safety needs before changing protection orders. Courts should also get training on the experiences of Black queer women and LGBTQ+ survivors, so their voices and realities are at the center of decisions. 

Our community needs to work toward real safety and protection. Because visibility without safety is not liberation. Protection that can be so easily undone is not protection at all. 

May 28 is LGBTQ+ Domestic Violence Awareness Day.  

#SeenAndBelieved is a call to action: recognize the harm, trust survivors, and create systems that truly protect them. 


June Crenshaw is COO of the Capital Pride Alliance.

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Opinions

Barney Frank, a hero of mine

There’s never been a stronger, smarter LGBTQ advocate in Congress

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Barney Frank in 1985. (Washington Blade archive photo by Doug Hinckle)

Barney Frank has always been a hero of mine. We grew up in similar circumstances, he in New Jersey, me in upper Manhattan. Both of us knew at a young age we were gay, though that was not a term used when we were young. It was a time when one definitely couldn’t come ‘out’ if you wanted to go into politics. 

I met Barney when a mutual friend brought him to brunch at my home in D.C. I had moved to D.C. in 1978 to work for the Carter administration, directing the follow-up to the White House Conference on Handicapped Individuals. That is the term we used back then. I never went back to New York. Barney had been elected to Congress when we met. Neither one of us was publicly out. 

Barney Frank is brilliant, and I was honored to meet him. I always enjoy listening to him speak, whether it was at a congressional hearing, or an event we were both attending. Barney was never one for small talk. When we both ended up living in Dupont, he would see me sitting at a coffee shop when he walked by, and simply nod hello, not stopping to chat. If he ever did stop, I always knew it was to suggest something I should be doing, or writing about. Barney has a sparkling wit, when he wants to share it, and knows more about most topics than anyone else. In 2004, 2006, 2008, and 2010, Washingtonian magazine reported that congressional staffers named him the brainiest member of Congress. CBS News reported in 2008 and 2011 that Leslie Stahl and others, referred to him as the smartest guy in Congress. They were right. I had worked for another brilliant member of Congress, Bella S. Abzug (D-N.Y.), but she was out of Congress by the time Barney got there. It would have been fun seeing them work together. I was working for her when she introduced the first Equality Act in 1974. At the time I was deeply closeted.

I ended up coming out in 1984, which was before Barney did. But then I wasn’t running for office. He came out in 1987 and became an even more passionate supporter of the LGBTQ community than he was before. Because now he could make his speeches, and support, more personal. He spoke eloquently trying to pass the Equality Act which didn’t pass the House until after he retired, and then it died in the Senate. I was, and am, a passionate supporter of the Equality Act, and still believe in my lifetime it will pass Congress, and we will have a president who will sign it into law. Hope springs eternal as they say.

Barney is more than just an LGBTQ advocate. He has worked tirelessly on so many issues, in his effort to make life better for all Americans. He recently said the bill he is proudest of, is the Dodd-Frank Wall Street Reform and Consumer Protection Act. It is a sweeping law enacted to overhaul financial regulation following the 2008 financial crisis. Its primary purpose was to end ‘Too big to fail’ bailouts, and protect consumers from abusive financial practices. It was signed into law by President Obama in 2010. 

As it has become public that Barney Frank was entering home hospice, and being cared for by his husband Jim, so many of us are looking back at his amazing career. We are recognizing the giant he is, both during his time in Congress, and during his life before, and after. He is the first member of the LGBTQ community who married while in Congress. He is one of the people in our community who really made a difference, and in doing so made so many of our lives better. 

Barney has said he is in the process of writing another book on politics, and I already look forward to reading it. I keep visualizing Barney as our community’s Art Buchwald. Those of you who are old enough may remember Buchwald. He was an American humorist, best known for his columns in the Washington Post. He also went into hospice care. But in his case, after five months there, and giving many interviews, he left hospice and wrote another book. It was titled ‘Too Soon to Say Goodbye’ about his five months in hospice. Barney, I am praying I will get to hear you, and see you, on that next book tour. 

But if that shouldn’t be, I want to thank you for a life well lived, and all you have done to make my life, the lives of the rest of us in the LGBTQ community, better. We could have never asked for a stronger, or more passionate, advocate.

Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.

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How do you vote a child out of their future?

Students reportedly expelled from Eswatini schools over alleged same-sex relationships

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(Photo by Vladgrin via Bigstock)

There is something deeply unsettling about a society that turns a child’s future into a public referendum. In Eswatini, there were reports that students were expelled from school over alleged same-sex relationships, and that parents were invited to vote on whether those children should remain, forcing us to confront a difficult question on when did education stop being a right and become a favor granted by collective approval? Because this is a non-neutral vote.

A vote reflects power, prejudice and personal beliefs, which are often linked to tradition, culture, politics and religion. It is shaped by fear, by stigma, by long-standing narratives about morality and belonging. To ask parents, many of whom may already hold hostile views about LGBTIQ+ people, to decide the fate of children is not consultation. It is deferring the responsibility and repercussion. It is placing the lives of young people in the hands of those most likely to deny them protection.

And where is the law in all of this?

The Kingdom of Eswatini is not operating in a vacuum. It has a constitution that guarantees the promotion and protection of fundamental rights, including equality before the law, equal protection of the laws, and the right to dignity. The constitution further goes on to protect the rights of the child, including that a child shall not be subjected to abuse, torture or other cruel, inhuman and degrading treatment or punishment.  

The Children’s Protection and Welfare Act of 2012 extends the constitution and international human rights instruments, standards and protocols on the protection, welfare, care and maintenance of children in Eswatini. The Children’s Protection and Welfare Act of 2012 promotes nondiscrimination of any child in Eswatini and says that every child must have psychosocial and mental well-being and be protected from any form of harm. The acts of this very instance place the six students prone to harm and violence. The expulsion goes against one of the mandates of this act, which stipulates that access to education is fundamental to development, therefore, taking students out of school and denying them education contradicts the law.  

Eswatini is a signatory to the United Nations Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child. These are not just commitments made to make our governments look good and appeasing. They are obligations. The Convention on the Rights of the Child is clear regarding all actions concerning children. The best interests of the child MUST be a primary consideration and NOT secondary one. According to the CRC, as indicated in the Declaration of the Rights of the Child, “the child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth.” It is not something to be weighed against public discomfort and popularity.

The African Charter on the Rights and Welfare of the Child reinforces this, grounding rights in non-discrimination (Article 3), privacy (Article 10) and protection from all forms of torture (Article 16). Access to education (Article 11) within these frameworks is not conditional but is a foundational right. It is not something that can be taken away because a child is perceived as falling outside social norms and threatening the moral fabric of society. It is a foundational right and determines one’s ability to participate in civic actions with dignity.

So again, where is the law when children are being expelled?

It is tempting to say the law is silent but that would be too generous. The law is not silent rather, it is being ignored and bypassed in favor of systems of decision-making that make those in power comfortable. When schools and their leadership defer to parental votes rather than legal standards, they are not acting neutrally. Expelling a child from school because of allegations is not a decision to be taken lightly. It disrupts education and limits future opportunities and for children already navigating identity and social pressure, this kind of exclusion can have profound psychological effects. It isolates them. It marks them for potential harm. Imagine being a child whose future is discussed in a room where people debate your worth. That is exposure. That is harm. There is a tendency to justify these actions in the language of culture, tradition, religion and protecting social cohesion. But culture is not static and the practice of Ubuntu values is not an excuse to violate rights. If anything, the principle of Ubuntu demands the opposite of what is happening here.

Ubuntu is not about conformity. It is about recognition and is the understanding that our humanity is bound up in one another. That we are diminished when others are excluded. That care, dignity, respect and compassion are not optional extras but central to how we exist together. Where, then, is Ubuntu in a school where some children are deemed unworthy of access to education?

Why are those entrusted with protecting children are failing to do so?

There is a very loud contradiction at play. On one hand, there is a claim to shared values and to the importance of community. On the other hand, there is a willingness to isolate and exclude those who do not fit within the narrow definition of what is acceptable. You cannot have both. A community that thrives on exclusion is neither cohesive nor safe.

It is worth asking why these decisions are being made in this way. Why not follow the established legal processes? Why not ensure that any disciplinary action within schools aligns with national and international obligations? Why introduce a vote at all? The answer is uncomfortable and lies in legitimacy and accountability. A vote creates the appearance of a collective agreement. But again, I reiterate, it distributes responsibility across many hands, making it hard to hold anyone accountable. It allows the school leadership to say “lesi sincumo sebantfu”(“This is what the community decided, not me”) rather than confronting their own role in human rights violations. If the law is clear and rights, responsibilities and obligations are established, then the question is not what the community feels. The question is why those entrusted with protecting children are failing to do so.

There is also a deeper issue here about whose rights are seen as negotiable. When we talk about children, we often speak of care, of understanding, of protection and safeguarding them because they are the future. But that language becomes selective when it intersects with sexuality, particularly when it involves LGBTIQ+ identities. Suddenly, care, understanding, protection, and safeguarding give way to punishment.

Easy decisions are not always just ones.

If the kingdom is serious about its commitments under its constitution, the Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child, then those commitments must be visible in practice, not just in policy documents. Rather, they must guide decision-making in schools and in communities. That means recognizing that a child’s right to education cannot be overridden by a show of hands. It means ensuring that schools remain spaces of inclusion rather than sites of moral policing. It means holding leaders and institutions accountable when they fail to protect those in their care.

Bradley Fortuin is a consultant at the Southern Africa Litigation Center and a human rights activist.

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