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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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Frank Kameny’s legacy lives on

May 21 marks pioneering activist’s 100th birthday

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May 21 would have been Frank Kameny's 100th birthday. (Washington Blade photo by Michael Key)

A first generation American from Queens, N.Y., Kameny was a decorated WWII veteran. With a prodigious 148 I.Q., he earned a Ph.D. in astronomy from Harvard University. In 1957 he was recruited by the Army Map Service, a pioneering agency in space exploration. 

In 1953 in the wake of McCarthyism, President Eisenhower issued Executive Order 10450 that prohibited homosexuals from military or civilian employment. Having nothing to do with workplace conduct, the Army learned that Kameny might be a homosexual. When confronted, he equivocated and was terminated. Unlike then thousands of other homosexuals terminated from government employment, Kameny fought back.

He took on the military and Civil Service Commission including being the first openly gay man to file an appeal about gay rights to the U.S. Supreme Court. He helped co-found and chair the Mattachine Society of Washington, the first gay rights organization in the nation’s capital.

He wrote letters to, among others, FBI Director J. Edgar Hoover. He founded and chaired the Eastern Conference of Homophile Organization, the nation’s first regional gay organization.

In the 1960s homosexuality, even with a consenting adult in the privacy of one’s bedroom was criminal. The police entrapped and extorted gay men. The American Psychiatric Association classified homosexuality as a mental illness. A bar could lose its license if there was more than one homosexual in their establishment. Homosexuals were considered dangerous, deviant and demented.

Kameny coined the phrase “Gay Is Good.” He organized picketing called Annual Reminders each July 4 from 1965 to 1969 at Independence Hall. The picketers were the first to call for gay equality. The 1965 Annual Reminder had 39 activists making it then the largest demonstration for gay rights. In the mid-1960s the country had an estimated 300 gay and lesbian activists.

He published a newsletter that became the Washington Blade, now the nation’s oldest LGBTQ weekly newspaper. Kameny and Barbara Gittings, the mother of the movement that demonstrated for the right to be heard at the 1971 American Psychiatric Association meeting. Their panel at the 1972 meeting with a masked psychiatrist using a pseudonym and voice modulator was so impactful that the APA created a panel to determine if homosexuality as a mental illness was based on science or discrimination. In 1973, that classification was removed.

He advised gays and lesbians who were the subject of discharge from federal government service. He identified test cases and referred them to the ACLU, Lambda Legal and other counsel. Slowly, but surely those cases began a process for LGBTQ equality.

His efforts led D.C. to be the first city to overturn its sodomy criminal laws. He helped found the first national LGBTQ organization, the North American Conference of Homophile Organizations. His efforts laid the groundwork for HRC and National LGBTQ Task Force.

After Stonewall in June 1969, he chaired a meeting of NY, Philadelphia and D.C. activists that authorized and helped organize to help remember Stonewall the first New York Pride Parade. He believed that Stonewall could be the movement’s Boston Tea Party. He marched in that 1970 parade holding a picket emblazoned with “Gay Is Good.”

He was the first out person to run for Congress as the D.C. delegate. Money left over from his campaign was used to fund the first gay rights television commercial. In July 1975, he was the first to be advised by the Civil Service Commission that it would eliminate homosexuality as a basis for not hiring or for firing a federal civilian employee. In 1977, he attended the White House’s first meeting with gays and lesbians.

Kameny died on Oct. 11, 2011, National Coming Out Day. He lived to see marriage equality approved in several states. He attended the signing by President Obama of the repeal of “Don’t Ask, Don’t Tell,” which enabled gays and lesbians to serve openly in the military. Kameny is buried in the Congressional Cemetery. On his tombstone is inscribed “Gay Is Good.” Over 70,000 of his documents are in the Library of Congress and picket signs from the pioneering demonstrations are housed in the Smithsonian Institution.

On May 21 LGBTQ national organizations gather in front of the Supreme Court. One hundred activists will each hold a candle for his 100th birthday. Fifteen national leaders will engage in picketing similar to the 1965 picketing at the White House and Independence Hall. They will honor Frank Kameny; celebrate the 10th anniversary of marriage equality (Obergefell v Hodges, 2015); and push back on those who would attempt to render us invisible, deny our history and undermine our equality. We will remember the nation’s loss when it fired a Harvard Ph.D. in astronomy because of his status as a homosexual. History repeats itself. This month the U.S. Supreme Court allowed the federal government to terminate transgender servicemembers solely because of their sexual orientation. How far we have come. How much farther we have to travel.

Malcolm Lazin is the national chair, Kameny 100. He is the executive director, LGBT History Month and executive producer of three LGBTQ documentaries including Gay Pioneers. He was an adjunct professor of LGBT History and Rights at New College of Florida. www.kameny100.org

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Returning to Alcatraz: Memory through a queer lens

Trump would like to ‘rebuilt and reopen’ notorious island prison

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Alcatraz Island in San Francisco Bay (Photo courtesy of Estuardo Cifuentes)

When I arrived at Alcatraz Island, what I felt wasn’t curiosity — it was discomfort. Standing before such a photogenic landscape, something felt off. As if the place was trying to erase what it truly was: a mechanism of punishment, a machine built to control and define who should be excluded. I couldn’t walk those corridors without thinking about what this place represents for so many of us: a symbol of how the state has decided, time and again, that some lives matter less.

As a queer person, what struck me wasn’t just the past Alcatraz holds — but how that past is still alive in today’s policies. As I looked into the empty cells, I thought about the many LGBTQIA+ people who have been punished simply for existing. People like Frank Lucas Bolt, the first prisoner of Alcatraz — not convicted for violence, but for “sodomy,” a label the legal system used to persecute gay men.

He was not the only one. For decades, being gay or trans was enough to end up in a federal prison or a psychiatric hospital. Not for a crime, but for defying the norm. The legal and medical systems worked hand in hand to suppress any deviation from prescribed gender and sexuality. In prisons, queer people were subjected to physical punishment, solitary confinement, and even conversion therapy. Alcatraz was not an exception — it was one of the system’s most brutal epicenters.

But the queer memory of this place isn’t found in tourist brochures. To uncover it, you have to read between the lines, search through archives that are never taught in schools, and listen to those who still carry the scars. Walking among those walls, I realized that remembering isn’t enough — we have to contest the meaning of memory itself. What isn’t told, is repeated.

That’s why, when a few weeks ago President Trump said he’d like to “rebuild and reopen Alcatraz,” I didn’t take it as just another symbolic gesture. I took it as a warning. In times of crisis, punishment becomes an easy offer: lock them up, expel them, make them disappear. And in that narrative, queer, migrant, and racialized bodies are always the first to be targeted.

The danger isn’t just in the idea of a reopened prison, but in what it represents: The longing to return to a social order that was already deeply unjust. The nostalgia for “tough-on-crime” prisons is the same one that criminalizes unhoused people, persecutes migrants, and stigmatizes queer and trans youth in public spaces. Anyone who dreams of locking up more people isn’t thinking about justice — they’re thinking about control.

In 1969, a group of Native American activists occupied Alcatraz for over a year. They did it to denounce land theft and the government’s betrayal of treaties. During their occupation, they painted a message on the island’s water tower: “Peace and Freedom. Home of the Free Indian Land.” That gesture was a radical reclamation of space, a way of saying: this island can also be a place of resistance.

Alcatraz holds many layers. It was a high-security prison, yes, but it also became the stage for one of the most powerful acts of civil disobedience in the 20th century. That tension still lingers. The question is not just what happened at Alcatraz, but what we want it to represent today. A renewed model of punishment — or a site of memory that helps us prevent more harm?

As I walked its halls, I couldn’t stop thinking about the migrant detention centers that are still full today. About trans people held in inhumane conditions. About arbitrary detentions. About those of us who, like me, crossed borders just to survive. The distance between that Alcatraz and our present is not as wide as we’d like to believe. The walls may change, but punishment still operates on the same bodies.

Standing before the empty cells, I felt what many must have felt there: the weight of abandonment, the state’s mark upon their body, the feeling that their existence was a problem. But I also felt something else: conviction. The certainty that we will no longer walk into those spaces in silence. That we will not let ourselves be labeled as “mistakes” or “deviants.” That if they try to lock us up again, they will find us organized, with memory, with dignity.

Alcatraz does not need to be rebuilt. It needs to be understood. And we — queer, racialized, migrant communities — need to transform that understanding into action: to push back against hateful rhetoric, to protect those still living under threat, and to tell our full stories. Let no one be punished again for being who they are. Let history not become a locked cell once more.

The views expressed in this article are solely my own and do not necessarily reflect those of my employer, colleagues, or any affiliated organization. They are shared from a personal perspective shaped by lived experience and advocacy work.

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Antipathy toward queer workers

Employers just don’t like non-passing trans people

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(Photo by Rawpixel .com via Bigstock)

Lately I’ve sensed a deep seated antipathy in the queer population toward fixing systemic issues that sabotage the wellbeing of the queer population. Much of this antipathy is centered around race: wealthy cisgender (and mostly white) gay men feel that much of their needs are taken care of, with the exception of the Trump administration potentially taking away their right to marry. Then, all of a sudden, when reports come out that gay marriage is in jeopardy, these wealthy gay men rally around the flag and start to care. But for the most part, they are busy with their well-off lives renting penthouses in Logan Circle or Dupont, going to mostly all-white gay toga parties, finding casual hookups on Grindr. Their lives are not entirely full of discrimination. They work in offices that celebrate, or at least tolerate, their identity. Because to these office places, a capable, well-dressed, cisgender gay man who knows his business field and can present tidily well is no threat to their corporate good or corporate advance. 

White cis gay men who come from lower socioeconomic backgrounds face a larger struggle: They might not be able to afford the wardrobe that fits an elite corporate culture; some middle or lower class folks can’t fit this mold. Moreover, they might not harbor the educational background to fit such job titles at Goldman Sachs, after all, Goldman is looking for Harvard MBAs. Indeed, they are looking for top-tier MBAs — a credential that very few queer people live up to. With poverty and lower socioeconomic class pervading the queer community, it’s hard to find gay or lesbian or — god forbid — trans folk who fit McKinsey’s mold and ethos of work. 

Queer people who don’t acquiesce to corporate culture — people who don’t have Ivy League degrees or the best MBA grads from Wharton or Yale or Harvard tend to apply to other jobs. At the lower end of the ladder, queer people who don’t strive to be top tier consultants work barista jobs or retail. I mention “lower end of the ladder” not to deride queer people who choose to be baristas or work in retail — it is their choice, and amazing pro-BLM and pro-Palestine and pro-working class movements originate from these kinds of work places. 

Yet other queer people settle for middle class jobs. Trans men who pass extraordinarily well as men become Realtors or insurance agents. Some even more become entertainers and singers and DJs; there are ample jobs available for trans people. Some drag queens or trans women like Laverne Cox shine bright on the national stage and become actresses that represent gender diverse women. And that is good for them. 

What I’ve found though is much antipathy toward our job struggle. Not necessarily antipathy from the queer population itself, but antipathy from employers who are hesitant to hire a trans man or a trans man who doesn’t pass well. Trans men who don’t pass are an enormous issue to employers. Employers just don’t like non-passing trans people. They pose a liability to them. They make companies feel uncomfortable. It’s going to take years–if not decades–for companies to just “chill” about gender nonconformance. Trans people harbor many excellent minds, be it in mathematics, physics, English, computer science, or the arts. 

It’s time that corporate America take a serious look at their queer workforce. Firing or denying someone employment because they don’t fit a certain gender mold is a cruel act. And this cruel act has gone on for far too long. There are some tales of getting it better. Most notably tech companies like Google or Amazon hiring gender nonconforming computer engineers to get the job done. They enforce an environment of respect and mutual aid. This trend needs to continue and grow. 

If it doesn’t then the trans workforce is left feeling bereft, lost in translation. This can’t continue forever. It’s time for change. 


Isaac Amend is a writer based in the D.C. area. He is a transgender man and was featured in National Geographic’s ‘Gender Revolution’ documentary. He serves on the board of the LGBT Democrats of Virginia. Contact him at [email protected] or on Instagram at @literatipapi 

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