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Rulemaking on Older Americans Act targets seniors who are LGBTQ, living with HIV

Monday was National HIV/AIDS and Aging Awareness Day

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U.S. Department of Health and Human Services Hubert Humphrey Building. (Public domain photo courtesy GSA)

Ahead of Monday’s National HIV/AIDS and Aging Awareness Day, the Washington Blade spoke with Aaron Tax, director of federal government relations for SAGE, to discuss what proposed updates to the Older Americans Act might mean for LGBTQ elders and older adults living with HIV.

The conversation followed the conclusion of the public comment period for a Notice of Proposed Rulemaking filed by the Administration for Community Living, a U.S. Department of Health and Human Services agency that is responsible for administering the statute.

An HHS spokesperson told the Blade a final rule is expected “early next year.”

“We’ve looked at the many challenges facing LGBT older people and older people living with HIV,” said Tax, whose organization, Services and Advocacy for GLBT Elders, is the country’s largest group focused on the needs of LGBTQ seniors.

These populations experience “higher rates of social isolation” and “higher rates of poverty” and are “less likely to be partnered, less likely to have children, [and are] more culturally and socially isolated from mainstream institutions,” he said.

Therefore, they “seem to fit the definition of greatest social need quite well,” Tax said, referring to a distinction in the legislation that SAGE has sought to effectuate for LGBTQ elders and older adults with HIV, coming “quite close” in the law’s 2020 reauthorization.

Tax explained, “what we got at the end of the day is some language that requires every state unit on aging in the country and every area agency on aging in the country — which are basically state departments of aging and local departments of aging — to do three things.

“One,” he said, “engage in outreach to LGBT older people; two, to collect data on their needs; and three, to collect data on whether they are meeting their needs.”

SAGE is now working with these state and local entities to ensure “they’re, in fact, carrying out these requirements” Tax said.

Next year, the Older Americans Act will be up for reauthorization again, so “we will once again be fighting for an explicit greatest social need designation again for LGBT older people and older people living with HIV,” he said, adding, “And we recently introduced legislation with [U.S. Rep.] Suzanne Bonamici [D-Ore.] that would try to accomplish that goal in 2024.”

The legislation, Tax explained, originally “came about in 1965 under Lyndon Johnson’s Great Society as a counterpart to Medicare and Social Security,” which respectively addressed the medical and financial needs of older Americans.

“The Older Americans Act is everything else that should enable you to age in place in your community,” Tax said — and, as such, the statute covers, among other programs, “home and congregate meals and meals at senior centers, Meals on Wheels, transportation assistance, legal assistance, caregiver support, respite, all the things that have enabled people to age in place in their community.”

SAGE’s legislative efforts are coupled with advocacy around the administration and enforcement of the statute by ACL, which prior to the forthcoming rulemaking has not issued new regulations on the Older Americans Act since 1988, Tax said.

“Part of that,” he said, “is because there have been so many legislative changes since the law came about in 1988, so, their goal now is to modernize those regs and recognize the changes to the OAA and also maybe put some additional information in there or some additional guidance in there that might not be captured in the statute.”

SAGE wants the ACL “to be as explicit as possible, as proscriptive as possible, about ensuring that the aging network is meeting the needs of both LGBT older people and older people living with HIV,” Tax said, which informed the organization’s public comment to the agency.

This work is important because there are state-by-state differences in how older LGBTQ adults and seniors with HIV are treated, Tax said.

For instance, the “New York State Office for the Aging is extremely aware of the needs of LGBT older people and older people living with HIV,” he said. “They acknowledge that in the work that they do; they’re very intentional in the work that they do to meet the needs of LGBT folks and older people living with HIV.”

Tax said, “we are working hard at SAGE to make sure that other states first acknowledge that this population, or these populations, even exist, and secondly, [that they] are doing more to make sure that LGBT older people and older people living with HIV have access to the same aging services and supports other older people have access to.”

Politics, unfortunately, can play a role, Tax told the Blade.

“When anti equality forces are in control in the White House, of course, that does have an impact on the types of rules and regulations you see coming out of the administration and its agencies” he said.

By contrast, “it’s pretty clear now with the Biden administration’s focus on equity and its interest in making sure that LGBT folks are treated like everybody else, that we’re seeing regulations or proposed regulations that incorporate those important themes.”

“There are good people in state agencies across the country who want to do the right thing,” Tax said, but “Sometimes they bump up against the political realities of their states.”

“We are working hard at SAGE to make sure people who want to do the right thing regardless of what state they live in have the resources and the information and the tools that they need to take care of all of the older people in their states,” Tax said.

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Federal Government

HRC memo details threats to LGBTQ community in Trump budget

‘It’s a direct attack on LGBTQ+ lives’

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President Donald Trump (Washington Blade photo by Michael Key)

A memo issued Monday by the Human Rights Campaign details threats to LGBTQ people from the “skinny” budget proposal issued by President Donald Trump on May 2.

HRC estimates the total cost of “funding cuts, program eliminations, and policy changes” impacting the community will exceed approximately $2.6 billion.

Matthew Rose, the organization’s senior public policy advocate, said in a statement that “This budget is more than cuts on a page—it’s a direct attack on LGBTQ+ lives.”

“Trump is taking away life-saving healthcare, support for LGBTQ-owned businesses, protections against hate crimes, and even housing help for people living with HIV,” he said. “Stripping away more than $2 billion in support sends one clear message: we don’t matter. But we’ve fought back before, and we’ll do it again—we’re not going anywhere.”

Proposed rollbacks or changes at the U.S. Department of Health and Human Services will target the Ryan White HIV/AIDS Program, other programs related to STI prevention, viral hepatitis, and HIV, initiatives housed under the Substance Abuse and Mental Health Services Administration, and research by the National Institutes of Health and Agency for Healthcare Research and Quality.

Other agencies whose work on behalf of LGBTQ populations would be jeopardized or eliminated under Trump’s budget include the U.S. Department of Housing and Urban Development, the U.S. Department of Justice, the U.S. Small Business Administration, and the U.S. Department of Education.

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Trump admin cancels more than $800 million in LGBTQ health grants

As of early May, half of scrapped NIH grants were LGBTQ focused

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President Donald Trump (Washington Blade photo by Michael Key)

The Trump-Vance administration has cancelled more than $800 million in research into the health of sexual and gender minority groups, according to a report Sunday in The New York Times.

The paper found more than half of the grants through the National Institutes of Health that were scrapped through early May involved the study of cancers and viruses that tend to affect LGBTQ people.

The move goes further than efforts to claw back diversity related programs and gender affirming care for transgender and gender diverse youth, implicating swaths of research by institutions like Johns Hopkins and Columbia along with public universities.

The Times notes that a $41 million cut impacting Florida State University will stall “a major effort to prevent HIV in adolescents and young adults, who experience a fifth of new infections in the United States each year.”

A surge of federal funding for LGBTQ health research began under the Obama-Biden administration and continued since. Under his first term, Trump dedicated substantial resources toward his Ending the HIV Epidemic in the United States initiative.

Cuts administered under the health secretary appointed in his second term, Robert F. Kennedy Jr., have put the future of that program in question.

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RFK Jr.’s HHS report pushes therapy, not medical interventions, for trans youth

‘Discredited junk science’ — GLAAD

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HHS Secretary Robert F. Kennedy Jr. (Washington Blade photo by Michael Key)

A 409-page report released Thursday by the U.S. Department of Health and Human Services challenges the ethics of medical interventions for youth experiencing gender dysphoria, the treatments that are often collectively called gender-affirming care, instead advocating for psychotherapy alone.

The document comes in response to President Donald Trump’s executive order barring the federal government from supporting gender transitions for anyone younger than 19.

“Our duty is to protect our nation’s children — not expose them to unproven and irreversible medical interventions,” National Institutes of Health Director Dr. Jay Bhattacharya said in a statement. “We must follow the gold standard of science, not activist agendas.”

While the report does not constitute clinical guidance, its findings nevertheless conflict with not just the recommendations of LGBTQ advocacy groups but also those issued by organizations with relevant expertise in science and medicine.

The American Medical Association, for instance, notes that “empirical evidence has demonstrated that trans and non-binary gender identities are normal variations of human identity and expression.”

Gender-affirming care for transgender youth under standards widely used in the U.S. includes supportive talk therapy along with — in some but not all cases — puberty blockers or hormone treatment.

“The suggestion that someone’s authentic self and who they are can be ‘changed’ is discredited junk science,” GLAAD President and CEO Sarah Kate Ellis said in a statement. “This so-called guidance is grossly misleading and in direct contrast to the recommendation of every leading health authority in the world. This report amounts to nothing more than forcing the same discredited idea of conversion therapy that ripped families apart and harmed gay, lesbian, and bisexual young people for decades.”

GLAAD further notes that the “government has not released the names of those involved in consulting or authoring this report.”

Janelle Perez, executive director of LPAC, said, “For decades, every major medical association–including the American Medical Association and the American Academy of Pediatrics–have affirmed that medical care is the only safe and effective treatment for transgender youth experiencing gender dysphoria.

“This report is simply promoting conversion therapy by a different name – and the American people know better. We know that conversion therapy isn’t actually therapy – it isolates and harms kids, scapegoats parents, and divides families through blame and rejection. These tactics have been used against gay kids for decades, and now the same people want to use them against transgender youth and their families.

“The end result here will be a devastating denial of essential health care for transgender youth, replaced by a dangerous practice that every major U.S. medical and mental health association agree promotes anxiety, depression, and increased risk of suicidal thoughts and attempts.

“Like being gay or lesbian, being transgender is not a choice, and no amount of pressure can force someone to change who they are. We also know that 98% of people who receive transition-related health care continue to receive that health care throughout their lifetime. Trans health care is health care.”

“Today’s report seeks to erase decades of research and learning, replacing it with propaganda. The claims in today’s report would rip health care away from kids and take decision-making out of the hands of parents,” said Shannon Minter, legal director of NCLR. “It promotes the same kind of conversion therapy long used to shame LGBTQ+ people into hating themselves for being unable to change something they can’t change.”

“Like being gay or lesbian, being transgender is not a choice—it’s rooted in biology and genetics,” Minter said. “No amount or talk or pressure will change that.” 

Human Rights Campaign Chief of Staff Jay Brown released a statement: “Trans people are who we are. We’re born this way. And we deserve to live our best lives and have a fair shot and equal opportunity at living a good life.

“This report misrepresents the science that has led all mainstream American medical and mental health professionals to declare healthcare for transgender youth to be best practice and instead follows a script predetermined not by experts but by Sec. Kennedy and anti-equality politicians.”




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