Tennessee’s decades-old aggravated prostitution statute violates the Americans with Disabilities Act, the U.S. Department of Justice announced Friday after an investigation, warning that the state could face a lawsuit if officials don’t immediately cease enforcement.
Tennessee is the only state in the United States that imposes a lifetime registration as a “violent sex offender” if convicted of engaging in sex work while living with HIV, regardless of whether the person knew they could transmit the disease.
LGBTQ and civil rights advocates have long criticized the measure as discriminatory, making it almost impossible to find housing and employment due to the restrictions for violent sex offenders. Earlier this year, the American Civil Liberties Union and the Transgender Law Center filed a lawsuit seeking to overturn the law in federal court.
The department’s findings on Friday are separate from the ongoing lawsuit.
The department is calling on the state to not only stop enforcing the law, but also remove those convicted under the statute from the sex offender registry and expunge their convictions. The agency also says Gov. Bill Lee should introduce legislation to repeal the law.
The ADA is the landmark 1990 federal law prevents discrimination against disabled people on everything from employment to parking to voting. HIV and AIDS are considered disabilities under the ADA because they substantially hinder life activities.
“Tennessee’s aggravated prostitution law is outdated, has no basis in science, discourages testing and further marginalizes people living with HIV,” said Assistant Attorney General Kristen Clarke, with the Justice Department’s Civil Rights Division, in a statement. “People living with HIV should not be treated as violent sex offenders for the rest of their lives solely because of their HIV status.”
The department’s letter was addressed specifically to Attorney General Jonathan Skrmetti, Tennessee Bureau of Investigation Director David Rausch and Shelby County District Attorney Steven Mulroy.
Shelby County, which encompasses Memphis, was named because DOJ said it’s where the law has been “enforced most frequently.”
Through a spokesperson, Mulroy noted that the allegations stem from cases handled before he took office in September 2022. Mulroy said he agrees with the Justice Department’s findings and his office is fully cooperating.
A spokesperson for the Tennessee investigation bureau said officials were reviewing the letter but had no other response to DOJ’s investigation.
A spokesperson for Skrmetti did not immediately respond to an email requesting comment.
Prostitution has long been criminalized as a misdemeanor in Tennessee. However, in 1991 — as the AIDS epidemic provoked panic and prevalent misinformation over prevention — Tennessee lawmakers enacted an aggravated prostitution statute, which was a felony and applied only to sex workers living with HIV. The law was later reclassified in 2010 as a “violent sexual offense,” requiring those convicted to face lifetime sex offender registration.
Court documents state that more than 80 people are registered for aggravated prostitution in Tennessee.
The DOJ letter details several of the struggles of those with aggravated prostitution convictions. A lifetime sex offender registration can stop people from visiting with their grandchildren, revoke job offers, and severely limit housing options. One person shared that they were barred from taking a course to get a general education diploma because children might be present in the building.
Plaintiffs who had filed a lawsuit seeking to block the aggravated prostitution law in October said the DOJ’s letter only further supports their efforts.
The lawsuit was brought by four unidentified people and OUTMemphis, a nonprofit that serves LGBTQ people.
“OUTMemphis welcomes the DOJ’s findings that, through its outdated and punitive aggravated prostitution law, Tennessee is discriminating against people living with HIV,” said Molly Quinn, executive director, OUTMemphis, in a statement. “We agree, and that’s why we are suing to get the law struck down. Whether this issue is resolved informally or in court, it is long past time to end HIV criminalization.”
The Food and Drug Administration’s first-ever approval of an at-home test for chlamydia and gonorrhea could help drive earlier detection and treatment of these sexually transmitted infections amid a ballooning epidemic in the U.S. But some sexual health advocates worry that the FDA’s proposal to begin stepping up regulation of over-the-counter self-testing of STIs could backfire.
The need for new tools to combat these infections is dire.
Diagnoses of gonorrhea, chlamydia and syphilis have soared in the past two decades. Public health experts argue that this is at least partially driven by woeful long-term flat funding of the Centers for Disease Control and Prevention’s budget to fight the spread of STIs during this period.
Some public health officials and advocates expect that greater FDA oversight will help legitimize home STI testing, making it easier to get insurance coverage and actually expanding its use.
Other home tests for these three bacterial STIs are already available over the counter. But the FDA, which has not previously sought to enforce regulation or require that their manufacturers apply for formal approval, cannot vouch for their accuracy.
A consortium of LGBTQ sexual health advocates has objected to a recent FDA policy proposal that, if enacted, would require the companies already offering at-home medical tests, including for STIs, obtain regulatory approval. A central worry is that the expense of meeting the FDA’s demands could drive some companies out of the STI self-testing market and otherwise drive up the cost of the tests.
There are also concerns that the newly approved test does not cover syphilis and is not well suited to address gay and bisexual men’s needs.
The test kit, called Simple 2, does not screen for syphilis, which typically requires at least a finger-prick blood sample. There were at least 177,000 syphilis cases in 2021, a 74% increase since 2017, according to the CDC. Most concerningly, CDC data shows that rates of syphilis in newborns, which can be fatal, rose more than tenfold in the past decade.
Dr. Boghuma Titanji, an infectious disease specialist at Emory University, said that the inconvenience of having to go into a clinic was a major barrier to getting at-risk people tested for STIs.
“Just remove that requirement, that will make the access better for a lot of patients,” she said.
Dr. Leandro Mena, director of the Division of STD Prevention at the Centers for Disease Control and Prevention, believes the new at-home test’s approval will indeed increase testing for gonorrhea and chlamydia.
Self-testing, he said, provides “a tremendous opportunity to empower people to control when, where and how they get tested, and how they learn about their test result, so they can get appropriate treatment for these STIs.”
Chlamydia and gonorrhea are the most common STIs in the U.S., diagnosed in 1.6 million and 710,000 people respectively in 2021, according to the CDC. They can often be asymptomatic and are easily cured with antibiotics. However, if left untreated, the infections can lead to infertility and can be especially harmful to women, leading, for example, to pelvic inflammatory disease. They spread disproportionately among adolescents and young adults, gay and bi men, and people of color.
Will FDA oversight help or hinder the STI fight?
On Nov. 15, the FDA granted marketing authorization for adults to use the over-the-counter Simple 2 Test for gonorrhea and chlamydia, from the home-testing company LetsGetChecked. The test kit, currently sold for $99 through the company’s website, can be activated online, where the consumer fills out a health questionnaire before shipping in samples to a laboratory.
If the results are positive, the company would then put the individual in contact with a physician.
Previously, HIV was the only other sexually transmitted infection to have an FDA-approved at-home test.
Other at-home STI tests are available through telemedicine companies and major pharmacy chains. However, these tests exist in a legal gray zone. Because they’re based on samples that are not taken in a lab, they don’t qualify for an exemption from requiring FDA approval that the agency grants to so-calledlaboratory-developed tests.
The FDA has generally not sought to exert control over home-based tests. However, on Sept. 29, the agency opened a two-month public comment period on a proposed new plan to require companies offering medical self-testing kits for any purpose to seek formal marketing authorization for their products. The FDA’s move followed reports of faulty self-tests that led to undertreatment or improper treatment for heart disease and cancer.
The goal, according to the FDA, is to “ensure the safety and effectiveness of these tests.”
In response, a group that includes sexual health advocates and owners of gay dating apps that provide free at-home HIV and STI testing, began circulating a petition that calls for the FDA to exempt such public health programs from the proposed new demands. Gaining approval for existing STI tests, the petition states, would involve a “time-consuming and expensive process.”
“Many public health leaders are concerned that new FDA regulations will create additional barriers to public health testing,” said Jen Hecht, director of the consortium Building Healthy Online Communities.
Dr. Matthew Golden, who leads the HIV and STI control program at Seattle’s public health department, said that the FDA is playing catch-up in an effort to enforce regulation of an industry that has grown fast since Covid.
“At some level, the horse has left the barn,” said Golden, noting that self-testing kits have been widely used for years. However, he said that for “some of those tests, how well they perform is not well known. So cleaning this up makes sense.”
A source familiar with FDA policies and practices told NBC News that if the agency decides to demand that self-testing companies obtain regulatory approval, it would not likely interrupt the availability of existing medical self-tests during the application process.
That said, it is likely that once a critical mass of self-testing companies obtained or otherwise sought approval, the agency would go after any laggards.
Gay men’s needs are left out — for now
The Simple 2 Test is effectively geared only toward STI exposures from vaginal intercourse.
The kit can process a urine sample and a swab of the vaginal area. Chlamydia and gonorrhea infections, however, can be localized in the throat, urogenital area or rectum. A urine sample can detect urogenital infections in men and women. For people who may have otherwise been exposed through oral or anal sex, oral and rectal swabs would also be needed.
David Harvey, executive director of the National Coalition of STD Directors, said that public health experts “expect and need” the FDA ultimately to approve at-home tests for syphilis and for oral and rectal gonorrhea and chlamydia infections, “so we’re also reaching others who are at high risk, including gay men.”
The CDC’s Mena said he hoped that the agency and the FDA will confer with LetsGetChecked or other testing companies about pushing for additional approvals.
The FDA’s authorization for the Simple 2 Test was based on data indicating that consumers could successfully use the home tests, understand the results and then take any necessary subsequent action.
It’s unclear whether the test will be available outside LetsGetChecked website or whether $99 kit will be covered by insurance. The company didn’t respond to requests for comment.
Tristan Schukraft, CEO of MISTR, a telehealth company that provides the PrEP HIV prevention pill, is supportive of greater FDA oversight of home tests, but expressed concern that tighter regulation could increase the cost of testing.
“Labs are going to be required to spend additional money and resources on studies, quality systems, reagents and software systems,” Schukraft said.
In addition, MISTR requires that PrEP recipients undergo testing every three months for chlamydia, gonorrhea and syphilis. At least 85% of MISTR customers on PrEP opt for at-home testing. The company advises people who test positive — about 13.5% of the kits detect at least one STI — to seek medical care and provides assistance in connecting people to care for those who need it.
Schukraft suggested that greater regulation could lead companies to pull such tests from the market.
If so, he said, “the FDA would be doing harm to public health.”
As Republican-led legislatures have limited or banned access to gender-affirming care for trans people across the country, states like New Mexico are witnessing a large influx of “gender refugees” seeking healthcare.
Over the past two-plus years, nearly two dozen states have instituted limits or bans on gender-affirming health care for trans youth and adults. While trans people in red states seek out alternative sources of care and places to live, larger states and metropolitan areas like San Francisco and New York can prove prohibitively expensive.
So smaller states like New Mexico, Minnesota, Colorado, Vermont, and Washington, with prohibitions on restricting gender-affirming health care and a lower cost of living, are attracting a crush of trans patients seeking care.
They’re being met with waiting lists.
“I feel really excited and proud to be here in New Mexico, where it’s such a strong stance and such a strong refuge state,” Molly McClain, a family medicine physician and medical director of the Deseo clinic, which serves transgender youth at the University of New Mexico Hospital, told CBS News. “And I also don’t think that that translates to having a lot more care available.”
The strain is affecting new patients and longtime New Mexico residents, as well.
“With the influx of gender refugees, wait times have increased to the point that my doctor and I have planned on bi-yearly exams,” said Felix Wallace, a 30-year-old trans man and longtime resident.
Anne Withrow, a 73-year-old trans woman and Albuquerque resident for over 50 years, sought care from a new provider at the University of New Mexico after her doctor retired.
“They said, ‘We have a waiting list.’ A year later they still had a waiting list.”
A year after that, Withrow managed to get care from a local community-based health center.
As of October, UNM’s Truman Health Services clinic still wasn’t taking new patients.
At the Transgender Resource Center of New Mexico, T. Michael Trimm says the center used to field two or three calls a month from people out-of-state considering a move.
“It has steadily increased to a pace of one or two a week,” he said.
“We’ve had folks from as far away as Florida and Kentucky and West Virginia,” as well as families in Texas “looking to commute here for care, which is a whole other can of worms, trying to access care that’s legal here, but illegal where they live.”
In New Mexico, the problem is compounded by a physician shortage.
A 2022 report revealed New Mexico lost a staggering 30% of its physicians in the previous four years. The state is on track to have the second-largest physician shortage in the country by 2030, with the oldest physician workforce.
Despite the obstacles, Trimm says “trans folks can be very resilient.”
While a waitlist isn’t ideal, he says it’s easier to endure “than the idea that you maybe could never get the care.”
Last September, Riley headed to their clinic at Vanderbilt University Medical Center, which was usually brimming with chatter about the day’s research and patient needs.
But that fall morning, Vanderbilt was thrown into chaos, and the clinic for gender-affirming surgeries, which serviced both trans youth and adults, had been shut down for the day. The health care worker, who is using a pseudonym in fear of retaliation from their employer, said the atmosphere among their colleagues in the trans health clinic was a mix of “fear and concern.”
Riley’s clinic remained open, and their colleagues debated whether they were safe at work or should go home. Riley said local police were lined up outside the medical center’s doors, serving as extra security for employees.
All day people whispered about the social media posts by right-wing blogger Matt Walsh, which had gone viral the day before for claiming that doctors at Vanderbilt’s transgender health clinic “castrate” and “sterilize” children.
At the time, Riley hadn’t heard of Walsh. They didn’t have social media and rarely watched the news.
But over the next year, Riley would witness firsthand — again and again — how misinformation and right-wing attacks on the transgender health clinic severely restricted the kinds of care they could provide at Vanderbilt. In those months,trans Tennesseans have felt more intimidated and desperate than ever, as they have been forced to decide whether to pack up their lives to find a place where they can exist without the fear of the government, or right-wing provocateurs, meddling in their private medical information.
One of the first changes Riley saw was Vanderbilt moving the stand-alone transgender health clinic inside the university’s main campus in Nashville, Tennessee. The clinic also adopted new security measures, including an armed guard behind the desk, and required patients and providers to be buzzed inside.
Riley said the medical center has even canceled appointments for certain surgeries for cisgender youth that currently do not fall into the category of gender-affirmation but that critics could see as “pathways to gender affirmation.”
By the end of September 2022, Tennessee’s attorney general, John Skrmetti, said his office had opened an investigation into Vanderbilt’s transgender health clinic. Over the next few months, Skrmetti broadened the scope, first requesting specific patient medical records, and then information on Vanderbilt employees and volunteers at the transgender health clinic. The following spring, Republican Gov. Bill Lee signed a ban on gender-affirming care for transgender children, effectively suspending all operations at VUMC’s pediatric transgender clinic.
Riley said they were one of more than a dozen clinicians who were told by Skrmetti’s office that their emails could be subpoenaed as part of the investigation.
“It feels like a witch hunt,” Riley told HuffPost. “What are you going to find in my emails? Obviously, there’s not a conspiracy here.”
‘That Is Why I Am Working With Matt Walsh’
In September 2022, Walsh, a prominent Nashville-based right-wing talk show host and blogger, accused Vanderbilt University Medical Center’s transgender health clinic of only existing to turn a profit. He also claimed that Vanderbilt doctors “castrate, sterilize, and mutilate minors.”
In a series of tweets, Walsh argued that the clinic was drugging and sterilizing children, and used language that LGBTQ+ advocates and Vanderbilt employees say grossly distorted the reality of pediatric transgender care. Walsh posted a video of one Vanderbilt doctor ― Dr. Shayne Taylor, who founded the clinic in 2018 ― discussing how gender-affirming surgeries, like double mastectomies and genital surgeries, could bring in “a lot of money” for the medical center. (In this video, Taylor, who did not respond to HuffPost’s request for comment, was mostly referencing surgeries for trans adults, as Vanderbilt never performed genital surgeries for minors.)
In another video Walsh posted, a different doctor cautions that employees who don’t want to treat transgender patients on the grounds of religious objections “probably shouldn’t work at Vanderbilt.” At the end of the thread, Walsh wrote that the clinic’s peer support group, Trans Buddy Program, was in fact a “gang of trans activists” acting as “surveillance in order to force compliance.”
Walsh tweeted later that evening that his “report” was just the beginning. “We are not going to let up,” he wrote. “We will shut this down.”
The next day, Vanderbilt released a statement refuting Walsh’s claims. “Vanderbilt University Medical Center is now the subject of social media posts and a video that misrepresent facts about the care the Medical Center provides to transgender patients,” the statement read. “VUMC began its Transgender Health Clinic because transgender individuals are a high-risk population for mental and physical health issues and have been consistently underserved by the U.S. health system.”
Walsh did not respond to a detailed list of questions for this story.
Even when gender-affirming medical care for minors was legal in Tennessee, the first step was still typically social transition, such as a change in name, pronouns, dress or hairstyle. Once a child hit puberty, their families might begin the long process of consulting with behavioral health specialists, endocrinologists and primary care doctors about taking puberty blockers ― medication to temporarily pause the effects of puberty ― while weighing whether hormone replacement therapy might ease a child’s gender dysphoria later in their teens.
Puberty blockers, which stop the body from making sex hormones, help slow unwanted secondary sex characteristics. They do not, as Walsh suggested, “sterilize” or “castrate” children, though the medication could pose some risks to fertility if they are administered too early in puberty. Studies show the effects are largely reversible, and the World Professional Association of Transgender Health recommends that providers talk with patients and their families about fertility preservation before starting medication.
In the years since VUMC began providing gender-affirming care for transgender youth and adults, it grew into a holistic network of care, not only involving health care providers, but also spiritual care from a staff chaplain, weekly support groups, and insurance specialists, according to a panel of VUMC practitioners at an LGBTQ+ health equity conference this fall.
VUMC performed fewer than a dozen top surgeries, or double mastectomies, each year for transmasculine patients in their late teens, according to Riley. Such surgeries require patients to undergo months of therapy beforehand, and a study published this summer showed that top surgery patients had little to no regrets decades after the operation. Both Riley and a VUMC executive, C. Wright Pinson, said that the hospital never performed “genital procedures” on minors.
But Walsh’s claims caught the eye of Republicans in Tennessee, which, with its Republican-controlled legislature, had become a paragon of a one-party state.
Hours after the tweets, Lee called for a “thorough investigation” into VUMC, and Skrmetti vowed to use the “full scope of his authority” to ensure the medical center was complying with state law.
The investigation appears to have started as early as the following morning, according to emails from Republican state Sen. Jack Johson, which HuffPost obtained through a public records request. “The Governor has already opened an investigation into Vanderbilt and I will be filing legislation to prohibit this when we come back into Session in January,” Johnson wrote to one supporter on Sept. 21, the morning after Walsh’s tweets. (The governor’s office told The Associated Press that day that it had passed along concerns about VUMC to the attorney general. Lee’s office recently told HuffPost over email that the attorney general has the “statutory authority” to open an investigation.)
The following day, Johnson responded to emails from supporters who were shocked by Walsh’s allegations, reassuring them that he was on the case — and had help.
“I absolutely agree that these surgeries should not be allowed on children,” Johnson wrote to one. “That is why I am working with Matt Walsh to introduce legislation in our upcoming legislative session to ban these transgender surgeries on children in Tennessee.”
Skrmetti’s office has said it began its probe in September 2022 after receiving a report about a Vanderbilt doctor who “publicly described her manipulation of medical billing codes to evade coverage limitations on gender-related treatment,” which raised concerns about possible fraud in the state’s Medicaid plan, TennCare. (The plan specifically excludes “sex change or transformation surgery.”)
In August 2023, a reporter with Nashville’s News Channel 5 interviewed Skrmetti. The segment showed portions of the video that Skrmetti says instigated the report: In it, Taylor discussed how she supports patients whose insurance plans don’t cover transgender health care, including saying she might write that a patient has a hormonal disorder for billing purposes so that she can order lab work for patients.
Skrmetti, in the interview, said it was “very easy” to initiate the investigation because his office was “already aware of the potential billing issues there.” He acknowledged that the probe into medical records is “probably terrifying” for patients but said there is “no political exception to the fraud laws.”
When reached for comment, Skrmetti’s office referred HuffPost to the interview with News Channel 5 and did not respond to other questions for this story.
As the investigation went on, Skrmetti requested the private medical records of more than 150 Vanderbilt patients who used TennCare. John Howser, a Vanderbilt spokesperson, said the clinic was “compelled” to produce copies of the records, while also complying with state and federal law including HIPAA. However, many LGBTQ+ and privacy advocates across the state and country signaled they were upset that VUMC didn’t fight harder to prevent turning over patient information in the investigation.
Riley said they were “flabbergasted” to learn about the attorney general’s inquiry into the center’s billing process. “There’s so many levels of oversight and protection from that kind of false billing,” they said. “It doesn’t pass the test of reason. Providers don’t do the billing. There’s a whole department of people that review the documentation and the code.”
Patients were not told until June of this year that their records had been turned over to the attorney general. Skrmetti’s office had said it kept its “run-of-the-mill” investigation private in an attempt to avoid a “media circus” — even as it continued to broaden the scope. The attorney general requested additional patient and employee data, including the names of patients who had been referred to VUMC’s trans clinic but did not seek treatment there; information on insurance claims to TennCare; employee tax forms and emails about gender-affirming care, as well as employees’ resumes and employment contracts; and information about the clinic’s Trans Buddy volunteers.
Skrmetti’s investigation and Vanderbilt’s release of records have been criticized as an egregious overstep, and the latest ― and largest ― use of data requests by a state to undermine access to gender-affirming care.
“Trust between patients and their doctors is essential to quality care, and we regret any concern this may have caused for our patients,” Howser said in a statement to HuffPost.
In the past year, as Republican-led states have increasingly passed anti-trans legislation, GOP officials nationwide have leveraged data requests about transgender residents as one of their many tools to restrict access to medical care. In Missouri, the attorney general requested and failed to obtain medical records on trans youth, while in Florida, Gov. Ron DeSantis probed state universities for data on how many students sought out gender-affirming care on campus clinics. More recently, 19 Republican attorneys general ― including Skrmetti ― signed a letter pushing back against a federal rule that would shield states from requesting data on patients seeking abortion out of state.
Many trans health advocates inside and outside the state said Walsh’s posts about Vanderbilt not only seemed to provide pretext for the probe and ban on gender-affirming care, but that his inflammatory language and framing took the doctors’ words out of context and grossly mischaracterized the kinds of care that minors were receiving at the clinic.
“The biggest thing I’ve seen is just the sheer amount of terror of families of trans youth. People are really terrified that the state is going to either try to take away their children from them or put them on some kind of watch list or try to invade their privacy. There’s just a lot of fear in Tennessee right now with families,” Lucas Cameron-Vaughn, a staff attorney at the ACLU of Tennessee, told HuffPost in July.
Cameron-Vaughn is one of the attorneys representing the families of trans kids in L.W. v. Skrmetti, the American Civil Liberties Union’s ongoing lawsuit against the state’s ban on gender-affirming care for transgender youth. The ban was recently upheld by a federal appeals court ruling.
“It may sound extreme to you when I say that we’re living in a totalitarian state,” Democratic state Sen. Heidi Campbell told HuffPost. “Before I became a state senator I don’t think those words would have come out of my mouth. But it’s really just the truth. There are no checks and balances in this government anymore. We’re seeing that with Skrmetti, who is hired by us to protect the people who live in this state, and is actively attacking our own citizens.”
‘State-Sponsored Intimidation’
On Sept. 21, 2022, just one day after Walsh’s initial “report” about VUMC, he tweeted that he had met with Johnson and Republican state Rep. William Lamberth to work on a bill to end gender-affirming care for youth. A few weeks later, ahead of the state’s midterm election on Nov. 8, Lamberth penned an opinion piece promising he would “partner” with Walsh to halt that care for minors if he were reelected to the House.
Cameron-Vaughn wasn’t surprised that Walsh’s posts lined up neatly ahead of the state’s election. “It seems like this sort of campaign against Vanderbilt was designed to scandalize Vanderbilt University Medical Center’s gender clinic by creating a deliberately false narrative right before the election,” he said.
Lamberth and Johnson both won their bids for reelection, and filed identical bills to ban care for minors months before the start of the 2023 legislative session. In February, as the bill passed swiftly through committee meetings, Walsh attended a House meeting to give an expert testimony.
State Rep. John Ray Clemmons, a Democrat who represents Nashville, was one of few legislators to question Walsh’s expertise and knowledge of best practices for transgender youth during a committee meeting on health.
“What qualifies me is that I am a human being with a brain and common sense and a soul, and therefore I think it’s a really bad idea to chemically castrate children,” Walsh said during questioning.
“You don’t use [your research] to get clicks on your publication?” Clemmons asked.
When the bill passed swiftly through each chamber of Tennessee’s government, it was clear to Clemmons that Walsh was something new. He was the gasoline reigniting an already burning fire in Tennessee. Republicans had long been trying to pass various bans on gender-affirming care, but had been largely unsuccessful. In 2021, Tennessee succeeded in barring doctors from prescribing hormone therapy for prepubescent minors — which in reality, advocates say, was not even happening in the state.
But this opened the door for Lamberth and Johnson to go further. Their legislation allows the state to ban puberty blockers, hormone therapy and gender-affirming surgeries for all transgender minors. Youth who are already receiving care will have to terminate it by March of next year, and providers have already begun weaning adolescents off hormones.
Walsh’s voice had eclipsed the dozens of opponents to the bills ― including transgender youth and their parents, LGBTQ+ advocates, and clinicians ― who showed up each week at the statehouse to share their stories about how access to gender-affirming care was very often the buffer between life and death.
Clemmons said he watched with horror as Walsh and his media outlet, the Daily Wire, helped steer conversations among some of his colleagues.
“Obviously the attorney general in this state is taking marching orders from him, which is embarrassing considering he’s not even elected,” Clemmons told HuffPost, referring to Walsh. “This is a new brand of extremism that’s very dangerous, that openly admits to wanting to burn books on the House floor, that openly admits to wanting to limit people’s rights. It’s scary.”
“This is state-sponsored intimidation and that’s never played out well in history,” he added.
The attorney general’s office declined to comment on its relationship with Walsh.
Lee, the governor, signed the ban into law at the beginning of March.
“This kind of bill had been filed in previous years and did not pass because there were divisions among Republicans on intervening in medical decisions. But there was an almost complete lockstep unanimity that they were going to pass the bill in 2023,” said Chris Sanders, the executive director of the Tennessee Equality Project.
“So Mr. Walsh is the first mover on this in a lot of ways in terms of getting a consensus built in the Republican caucus. He is not the first to think of it, but he’s partly responsible for jelling the consensus in Tennessee.”
By the end of the session in April, Tennessee had also become the first state to pass a ban on drag performances, in addition to enacting laws that defined sex as a person’s “immutable biological sex,” and allowed teachers to misgender students.
Since 2015, Tennessee has enacted 19 anti-LGBTQ+ laws, more than any other state in the country.
‘An Attempted Hostile Takeover’
This all might not have been possible if Walsh’s workplace hadn’t been given a royal welcome to the Volunteer State.
The Daily Wire, a one-stop-shop of conservative entertainment and merch — including original documentaries, TV shows, children’s programming and “woke free” razor blades ― has been likened to the right’s answer to Hollywood with a roster of conservative hosts including Walsh, Candace Owens and Jordan Peterson.
The company, which was co-founded by columnist Ben Shapiro, relocated its headquarters from Los Angeles to Nashville in 2020. The next year, Tennessee state lawmakers passed a resolution to embrace Shapiro and his “truth seekers,” and celebrate their move out of “liberal California.”
“We congratulate Ben Shapiro and his associates at The Daily Wire on their relocation to Tennessee and extend to them our best wishes for continued success in discovering and disseminating the truth,” the resolution stated.
Campbell is highly critical of how her colleagues rolled out the welcome mat for the conservative company. “This is an attempted hostile takeover of Nashville because they really want Nashville to be their first right-wing big city,” she said.
By the time Walsh moved his family to Nashville, he was already practiced in “exposing” the ills of same-sex marriage and laws that protected transgender Americans’ rights to use the bathroom that aligns with their gender.
“Millions of Americans have lost their grip on reality,” he wrote in a 2014 blog post arguing that trans people don’t exist. “This is the real crisis, and it’s far more urgent than most of what they’re talking about on the news right now.”
In the past few years, however, Walsh has turned toward a “just asking questions”-style attack on trans people. He built up mainstream notoriety and a career of lecturing at colleges after the release of his 2022 documentary, “What is A Woman,” which also sows doubt about the existence of transgender people. A self-described “theocratic fascist,” Walsh has also argued that trans people are “groomers” and part of a cult, and made posts mocking immigrants and Black people.
And last August, Walsh responded after the right-wing account LibsofTikTok posted a barrage of false claims about the care Boston Children’s Hospital provides. He called on his followers for “an organized effort to fight back against the drugging and mutilating of children.” Then the hospital, which is the country’s first pediatric transgender health program, received twoseparatebomb threats. Walsh brushed off the threats as a “leftist hoax.”
Tennessee Republicans have echoed similar anti-trans rhetoric.
At the end of 2022, the Tennessee Republican Caucus sent out a survey, asking constituents for their opinions about a number of issues including abortion and parental rights in schools. In a section called “protecting children,” the survey asks conservatives if they favor policies preventing “minors from cutting off healthy body parts in order to change their gender identity.” There weren’t any questions about guns or firearm reform in the survey, even though the Tennessee Department of Health found that the leading cause of death for children in the state was homicide, 86% of which were due to gun violence.
Late last October, Nashvillians had a glimpse of what Walsh’s version of the Music City might look like when he held his “Rally to End Child Mutilation” at the state Capitol, which garnered around 1,500 protesters, including some Proud Boys.
There was Walsh, the bespectacled and bearded 37-year-old, standing on stage alongside Johnson and Lamberth, as well as other conservative figures including Sen. Marsha Blackburn (R-Tenn.) and former Rep. Tulsi Gabbard (Hawaii), who announced that she was leaving the Democratic Party last year. Other right-wing media stars, including Chloe Cole, an 18-year-old detransitioner who has testified across the country in support of bans on transition care for minors, also took the stage to speak.
“We are all here today because of this information that Matt brought forward and showed what was taking place just down the street right here in Nashville, and showing how the radical left is trying to put their woke agenda on every single family in this country,” Blackburn told the crowd.
State Sen. Janice Bowling (R) was also present, passing out fliers with what she called “graphic” photos of genital reconstruction surgeries some transgender people may choose to undergo. After the event, she wrote to Johnson that many of the rally’s attendees didn’t know “about the assaults these surgeries are on the bodies of these children,” according to emails obtained by HuffPost. (Two Vanderbilt employees have confirmed to HuffPost that the center never performed genital surgeries on children, as is standard among clinicians of trans care.)
“Upon looking at the photos, their resolve to ‘stay the course in our opposition’ was magnified,” Bowling wrote. “A picture is truly worth a thousand words.”
‘Misinformation Is Like A Snake’
Patients were shocked to find out that their personal medical information had been shared with the attorney general — and some experienced emotional whiplash when they learned they might have been misinformed about their records being turned over. One family of a trans teen who spoke to HuffPost was first notified in June that Vanderbilt had turned over the teen’s records; two months later, the medical center told the family the teen’s records weren’t among those given to Skrmetti.
By then, the family, which requested to remain anonymous due to concerns for their safety, had already driven hundreds of miles to North Carolina to make sure their child could continue hormone therapy.
“We depend on our care providers to be honest with us,” the mother told HuffPost. “They have precious lives in their hands. I don’t know whether to believe this or not.”
In early September this year, a spokesperson at Vanderbilt confirmed that not all of the 150 records that were originally requested by Skrmetti were shared with his office.
“We have since confirmed that records for only 82 of these patients were provided to the Attorney General’s office,” said Howser, the spokesperson for VUMC, in an emailed statement to HuffPost. “After learning of this, we notified the remaining patients, whose records were requested but not provided, that their records have not been produced to the Attorney General’s office.”
Howser did not respond to further questions about why only 82 records were shared and whether the records of the remaining patients could be shared with the attorney general in the future.
“Obviously the attorney general in this state is taking marching orders from [Walsh], which is embarrassing considering he’s not even elected.”
– Democratic state Rep. John Ray Clemmons
The chaos, fear and lack of clarity surrounding the investigation has affected how VUMC operated over the last year. In addition to changes in health care offered, the medical center has removed some information about gender-affirming care from its website.
Riley said they can understand why Vanderbilt did what it could to avoid unwanted attention ― but said such changes did a disservice to those who might look to the clinic as a resource.
“Because of people like Matt Walsh, it forces that whole practice into the shadows, which has a negative impact on patients in that now they may not know about the practice because there’s no media presence about it,” Riley said.
Even with multiple statements rejecting Walsh’s claims, it has been an uphill battle to dispel the factual errors about the clinic. “Misinformation is like a snake,” Riley said. “It just moves and shifts and you can say anything you want about facts and have all the patients that have had excellent outcomes…but it doesn’t make a bit of difference to the attorney general.”
Though the clinic can no longer provide gender-affirming medical treatment for youth, Riley said they and their colleagues are “more in it than ever before” as they continue to service trans adults.
“We’re more supportive even if we’re not able to do all the things we were able to before. It kind of galvanizes a community of people to say, ‘This is wrong. We’re going to keep doing the right thing,’” they said, emphasizing that the care they provide complies within the bounds of the state’s law.
Clemmons believes that Skrmetti is “abusing his discovery powers that require no judicial oversight,” and the state’s actions are ushering in “a whole new day of invasion of privacy.” But he is hopeful that the time will come, not too far down the line, when the flames fan out.
The results of the national midterm elections showed that running on anti-LGBTQ+ rhetoric has been a losing battle for Republicans.
Still, right-wing media continues to influence voters in a way that has shifted their political ideology to further extremes ― and now politicians are trying to play catch-up.
Ari Drennen, the LGBTQ program director at Media Matters, who has spent much of her time tracking Walsh’s rise, said Walsh was able to capitalize on his boost in followers after the Boston Children’s Hospital incident and translate that into a similar push of vitriol in his home state.
“I think part of the dynamic is that many Republican politicians, including in the presidential race, are competing in a field of voters who’ve been radicalized by personalities like Matt Walsh and who are expecting to hear the same rhetoric from politicians that they’re hearing in podcasts and on YouTube,” she said. “And so I would say that it’s a case of politicians chasing Walsh’s audience more than the other way around.”
“Nashville has fought hard to be a community that welcomes everyone, and Matt Walsh has just come in and disregarded that by homogenizing the politics in the city.”
– Roberto Che Espinoza, a trans divinity scholar and Baptist clergyperson
The impact of Walsh’s rhetoric ― and Skrmetti’s ongoing investigation ― could not be any more palpable than in the stories of transgender youth and adults who are trying to find the ways to relocate to more trans-friendly states or venture on long journeys to receive medical care elsewhere.
The Tennessee family of a trans teen said their out-of-state trip was only possible with the help of a $500 grant from a nonprofit. They worry about future appointments, which will be expensive and are increasingly challenging to find. States across the South — including North Carolina, which had for many been a safe haven in the region — are banning transition care for youth.
“We’ll probably have to shuffle some things around to pay for it,” the mother said. “We will still have electricity and running water and a house to live in. There may not be as many fun or extra things going on.”
Vanderbilt is now the subject of a larger federal investigation by the Department of Human Health Services for its allegedly “unauthorized” release of medical records. And in July, two former Vanderbilt patients filed a class-action lawsuit against the medical center, alleging it had violated their privacy by turning their records to Skrmetti. The suit is ongoing but VUMC’s attorney has filed motions to ask the judge to dismiss the case.
Howser, the Vanderbilt spokesperson, declined to comment on the federal investigation or the class-action suit.
‘Weaponization Of Religion’
For some Tennesseans, the only path forward is to leave.
Roberto Che Espinoza, a trans divinity scholar and Baptist clergyperson, left the state last month after learning his medical records had been shared with the attorney general. (Espinoza, who is in his 40s, has not received an update about his records from Vanderbilt.)
Espinoza lived in Nashville for six years. He was active in the local LGBTQ+ community and often participated in social justice movements across the South, including protesting against white supremacists at the “Unite the Right” rally in Charlottesville, Virginia, in 2017.
When Espinoza saw Walsh’s posts about Vanderbilt, he went on Twitter to speak up about what he saw as a hateful distortion of Christianity.
“I was really vocal about the weaponization of religion and the dehumanization that the extreme right is peddling,” he told HuffPost. “I just tried to do my part as both a Christian minister and for my fellow trans comrades who are just trying to live their fucking lives.”
After that, Espinoza said he started getting harassed on Twitter.
“Nashville has fought hard to be a community that welcomes everyone, and Matt Walsh has just come in and disregarded that by homogenizing the politics in the city,” he said.
The week before he was set to receive gender-affirming surgery at Vanderbilt, Espinoza said the Proud Boys targeted him on Telegram. His wife told him, “I don’t know how much longer I have with you.”
Espinoza said he went from being active in Nashville’s queer religious community to feeling like a prisoner in his own home: “It was a very scary time and no way to live.”
The release of his medical records this summer was the last straw. Espinoza crowdfunded $12,000 to leave the South.
He and his wife have been building a new community in the woods. Espinoza has been enjoying grilling outside and lifting weights, and is grateful for the mundane moments of life. “I am sleeping at night and eating three meals a day,” he said. “I am able to leave my house without anxiety. It’s wonderful.”
At certain times of day, Espinoza cannot help but feel those twitches of grief. He never wanted to leave the South. He misses the “slow time.” He misses porch visits. But he would rather be “exiled” in the north than feel the weight of fear and anxiety he shouldered not too long ago.
Riley, however, is determined to remain in Tennessee, even as they worry that they and their colleagues will one day be pushed out of the state because of fear for their own personal and professional safety.
“I think the right thing to do is to stay,” they said. “If we all leave, then that’s exactly what they want. It just becomes one homogenous place.”
On November 12, Paul Glass and Charles D. Evans of Falmouth were honored with this year’s AARP Andrus Award for Community Service. It’s AARP’s most prestigious and visible state volunteer award for community service. They are the first married and Black gay couple in AARP’s history to receive the award.
AARP, formerly the American Association of Retired Persons, is one of the largest organizations in the country. With a membership of over 38 million members as of 2018, it focuses on issues affecting Americans over the age of fifty. The AARP Andrus Award for Community Service is an annual awards program developed to honor individuals whose service is a unique and valuable contribution to their community and society, reflecting AARP’s vision and mission.
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“I am beyond honored and grateful for this recognition. I feel we are not put on this earth to exist but to be of service to others and our community,” Evans told LGBTQ Nation.
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When AARP Massachusetts was looking to honor the state’s top volunteer, Glass and Evans’s names rose to the top. They have made a difference in the lives around them, sharing their knowledge, experience, talent, and skills to enrich the lives of our community. Since childhood, their indefatigable spirit to give back to their community was ingrained in them.
“Paul and Charles have channeled the many negative experiences they endured into positive, healing, and inspiring volunteer work and leadership,” wrote Barrie Atkin of Swampscott, who nominated the couple.
“Their signature work co-founding LGBTQ+ Elders of Color in 2013 in Massachusetts was innovative, unusual, and courageous. No such organization existed at that time. In collaboration with the LGBTQ+ Aging Project, they identified the need and turned the need into a reality. They didn’t just co-found the organization along with others. Their continued leadership inspires many others to be involved.”
People of color are underrepresented and underserved when it comes to aging services and resources. Paul and Charles understand the intersectional challenges and complexities of growing older as African-American gay men.
LGBTQ+ senior communities with multiple identities confront multiple challenges. Their organization, LGBTQ+ Elders of Color, fills the gap missed by Massachusetts LGBTQ+ organizations and local, state, and federal public health systems. Outreach is essential because the challenges facing Black LGBTQ+ seniors intensify with age.
According to Services and Advocacy for GLBT Elders (Sage) and the Movement Advancement Project (MAP), approximately one-third of LGBTQ+ elders live at or below 200 percent of the federal poverty level, with 40 percent being Black.
These seniors often feel more vulnerable, invisible, and isolated by retirement. Historical and ongoing discrimination has created significant lifelong challenges for this demographic: limited wealth and savings, low wages, few labor protections, housing instability, food insecurity, stigma, immigration, HIV status, and higher mortality from treatable conditions. All have contributed to a lack of well-being and a lower quality of life.
By 2050, POC seniors will comprise over 40 percent of the elderly population, and approximately 3 million seniors will identify as LGBTQ+. With this projection, specific cultural and linguistic competence training and nondiscrimination policies are needed to support a rapidly growing demographic group that has experienced a lifetime of health, educational, and economic disparities.
In 2018, Massachusetts legislators passed “An Act Relative to LGBT Awareness Training for Aging Services Providers” mandating LGBTQ+ cultural awareness training for all state-funded and licensed aging service providers within 12 months of employment.
The challenges experienced by aging LGBTQ+ people of color can only be remedied by policymakers and aggressive programs invested in expanding care and services specifically targeted to these racially, ethnically, and culturally diverse communities.
These Dapper Dans, as I fondly dubbed them, provide unique and invaluable resources for LGBTQ+ elders of color. Their impact reverberates throughout the Bay State.
“Since relocating to Massachusetts on Cape Cod in 2002 and our subsequent retirement, we have enriched our lives with stronger connections to the community through outreach and advocacy,” Glass told the audience at the award ceremony. “To some, retirement may mean the opportunity to relax and take it easy. To us, retirement has provided an opportunity to find new ways to help others.”
Without the foundation people like Paul and Charles have laid for LGBTQ+ elders of color, we wouldn’t be the vibrant, visible, and growing community that we are.
The nation’s largest LGBTQ rights group released its latest data on fatal attacks on transgender and gender-nonconforming people, describing an “epidemic of violence” targeting the community, especially young Black trans women.
The Human Rights Campaign found that at least 33 transgender and gender-nonconforming people have been killed in the United States since November last year. Of those deaths, 26 have been recorded so far this year, following a total of 41 recorded deaths last year. The annual report was released Monday to mark Transgender Day of Remembrance.
“The epidemic of violence against transgender and gender non-conforming people is a national embarrassment,” Human Rights Campaign President Kelley Robinson wrote in the report. “Each of these lives taken is a tragedy — the result of a society that demeans and devalues anyone who dares challenge the gender binary.”
People of color have made up the largest share of trans and gender-nonconforming victims of fatal violence since the group began tracking such data in 2013. This year, 69% of all victims were Black, and 51% were Black trans women, according to the report. Hispanic people were the second largest group of victims, making up 21% of all deaths. White people made up 9% of the deaths.
The data also showed that most of the victims were under the age of 35. In the past year, the average age of victims was 28, according to the report.
Human Rights Campaign has identified at least 335 transgender and gender-nonconforming people killed in the past decade. The past four years have been especially fatal for the community, with 171 recorded deaths. In 2021, the number of deaths recorded by the rights group in a single year peaked at 59.
The report emphasized that their numbers are likely an undercount, because “data collection is often incomplete or unreliable when it comes to violent and fatal crimes against trans and gender-nonconforming people.”
It also included a call for lawmakers to take action to address violence toward LGBTQ people by passing legislation such as the Equality Act, which would prohibit discrimination based on sexual orientation and gender identity in numerous arenas, including employment, housing and education. The bill passed a House vote in 2021 but has not seen movement in the Senate.
Human Rights Campaign declared a national state of emergency for LGBTQ people earlier this year in response to growing numbers of anti-LGBTQ bills introduced nationwide. The majority of the bills target transgender people, according to the rights group, and aim to limit their use of bathrooms, access to gender-affirming care and participation in sports.
n the wake of numerous discussions, panels, and speeches at PFLAG’s National Convention in Arlington, VA. last month, a notable conversation took place to illuminate the shadows cast by disinformation on trans healthcare.
The ambiance within the Crystal Ballroom at DoubleTree Crystal City was anything but cold as attendees gathered for a crucial dialogue on trans healthcare. The session, “Courageous Love in Trans Healthcare,” moderated by writer and activist Charlotte Clymer, featured a panel of health experts, including Admiral Rachel L. Levine, the assistant secretary for health in the U.S. Department of Health and Human Services, and Dr. Jesse M. Ehrenfeld, the president of the American Medical Association. The focus was clear — to dismantle the towering wall of disinformation encircling trans healthcare and foster a narrative grounded in facts and empathy.
Levine, who is trans, wasted no time in addressing one of the frequently misunderstood aspects of trans healthcare — the use of puberty blockers.
She explained, “Puberty blockers have been used for a long time. They’re used for a condition called precocious puberty or early puberty, and there was a protocol developed first in the Netherlands probably 15 to 20 years ago, where transgender children could get blockers as they continue to be with their family and to work with their therapists and their physician.” Her words emphasized the long-standing medical practice and the familial and medical support integral to the protocol.
Ehrenfeld, an out gay man whose husband and four-year-old son were also in attendance, brought to light a grave concern — a lawsuit challenging the abortion drug mifepristone that threatens to unravel the FDA’s approval process for certain medications, including puberty blockers.
He stressed, “…if this is going to go to the Supreme Court [and] if the Supreme Court decides that the FDA regulatory process for how we approve drugs and medications and biologics in this country doesn’t work or isn’t appropriate, it will cause chaos because there is a whole list of other medications, puberty blockers included, that will suddenly be challenged.” He outlined this could spawn a cascade of challenges against numerous medications, fuelled by disinformation and devoid of scientific basis.
The conversation also touched upon false narratives emerging from certain European countries re-evaluating gender-affirming care for youth.
Ehrenfeld clarified, “We evaluate our policies all the time because we want to make sure that whatever the science and evidence it is, we’re holding it up… based on what we have today, we have a clear policy that makes sense.”
He underscored the unwavering commitment to evidence-based policies amidst a swirl of misinformation.
Engaging the community emerged as a pivotal theme.
“We know that public perceptions change when you know someone who’s in the community… we can only help educate those in the community if we’re out there having those conversations,” Levine said.
Her call to action resonated as a reminder of the power of personal interactions in altering misconceptions.
According to a survey by The 19thThe 19th, 67 percent of those who know someone who is transgender support gender-affirming care for adults, while 48 percent support it for minors. However, 48 percent support gender-affirming care for those who don’t know transgender people personally, and 33 percent support it for them. For those who identify as LGBTQ+, 84 percent favor gender-affirming care for adults, and 70 percent favor it for minors.
Furthermore, the panel delved into the imperative of medical education and fostering diversity within healthcare. They advocated for an environment where all individuals, irrespective of their gender identity, are welcomed and respected.
“Diversity brings in all sorts of different experiences and different cultures and different perceptions, and it enhances any organization,” Levine said.
As the dialogue neared its conclusion, the unwavering resolve to challenge disinformation and advocate for an inclusive, evidence-based approach to trans healthcare was evident. Levine and Ehrenfeld’s potent blend of facts, empathy, and advocacy painted a hopeful picture of the road ahead.
This enlightening Saturday afternoon conversation was vital to PFLAG’s National Convention from Thursday to Sunday. On Friday, First Lady Jill Biden spoke in support of the families and friends of LGBTQ+ individuals for their unwavering advocacy for marginalized communities. Following Biden’s address, MSNBC’s Ali Velshi took the helm, moderating a panel discussion concerning book bans, sharing the stage with the president of the American Library Association, among other panelists.
Indianapolis high school senior Caston Peters had used they and them or he and him pronouns at school for three years without a problem, but they came home a few days into this school year and told their mother that the situation had changed.
Peters, 18 and nonbinary, heard from a teacher that a new state law meant they wouldn’t be able to use those pronouns, or the first name they’ve used for years, without explicit permission from a parent because the pronouns and name don’t correspond with their sex assigned at birth.
This was news to Caston’s mother, Kim Michaelis-Peters, who immediately sent teachers, a counselor and the principal an email asking them to comply with Caston’s wishes, and the school staff did. But even though her own child’s wishes are being respected, Michaelis-Peters said she has deep concerns about what Indiana’s law could mean for students whose parents might not be understanding if they learn from school officials that their child is transgender or nonbinary.
“It makes me feel like there’s going to be a child out there who’s not going to feel safe at home to tell their parents and the school’s going to rat them out for wanting to be called a different name or different pronouns,” she said.
Indiana is among at least 10 states that have enacted laws prohibiting or restricting students from using pronouns or names that don’t match their sex assigned at birth, a restriction that opponents say further marginalizes transgender and nonbinary students. Most of the laws were enacted this year and are part of a historic wave of new restrictions on transgender youth approved by Republican states.
The measures are creating fear for transgender students and sowing confusion for teachers on how to comply but still offer a welcoming environment for everyone in their classes.
“The things that are passing are so vague and so hard to understand that (teachers) don’t know what to do,” said Cheryl Greene, senior director of the Welcoming Schools Program for the Human Rights Campaign Foundation, which advocates for LGBTQ+ rights. “It just creates this ambiguity and fear with educators because it’s not clear.”
Supporters of the laws have argued that parents should have a say if children are using pronouns or names different than those assigned at birth. Republican lawmakers describe it as a parental rights issue alongside efforts to restrict how gender identity is addressed in the classroom or in library materials.
“School districts can’t shut a parent out of their child’s decision about their gender identity because the child objects or because the school believes the parent isn’t supportive enough of an immediate gender transition,” according to a brief signed by nearly two dozen Republican attorneys general and filed in a lawsuit stemming from a California school district’s policy.
Mental health experts and advocates say that requiring parental consent or notification of pronouns forcibly outs trans students, who already face a high risk of bullying and abuse.
Similar restrictions have sparked some opposition in Virginia, where Republican Gov. Glenn Youngkin unveiled new model policies over the summer that include a requirement that minors must be referred to by the names and pronouns in their official records unless a parent approves something else. Some school boards have begun to adopt policies consistent with Youngkin’s guidelines while others have balked.
Some teachers in other states are finding ways around the requirements or defying the restrictions, saying they don’t want to put their students at risk. Since the laws are being enacted in states where teachers have little job protection, few are willing to talk on the record.
Jillian Spain, who teaches social studies at a middle school in Yanceyville, North Carolina, said she’s continued to address her students by the names and pronouns they use. Spain said outing a child, which is what the law would do to transgender and nonbinary students, “is not in the job description.”
Spain said the fear of being outed just adds to the pressures students already face, especially after the COVID-19 pandemic that devastated their well-being and academics.
“I am absolutely never, ever, ever going to out a child,” Spain said. “School is supposed to be their safe place. It’s supposed to a place where they can be who they truly are.”
Teachers’ groups say educators have been given little to no guidance on how to comply with the new restrictions, including basic steps like how to get permission from parents of students who use pronouns or names not listed on their birth certificates.
Indiana, like other states, leaves the specifics up to school districts.
The state’s teachers union says Indiana’s new parental notification law, which also bars teachers from providing instruction on human sexuality to students from pre-K through the third grade, is aimed at a problem that doesn’t exist.
“We have heard concerns anecdotally about the potential impact of this law,” Indiana State Teachers Association President Keith Gambill said in a statement. “Teachers are worried that it will create confusion and additional administrative burdens in an already demanding educational environment.”
Kentucky’s new law says teachers and school staff cannot be compelled to use a student’s pronouns if they don’t “conform to the student’s biological sex.”
The law, which includes other provisions dealing with student bathroom assignment and parental consent, has prompted confusion among educators, said Chris Hartman, director of the Fairness Campaign, the state’s highest-profile LGBTQ+ advocacy group. Hartman said it allows educators to ignore students’ wishes about pronouns even if their parents have asked the district not to let it happen.
“The mental health impact on trans kids being willfully misgendered by the adults in the room is disastrous,” Hartman said. He said supportive adults are crucial to keeping transgender students from slipping into depression and considering suicide.
Jefferson County Schools, the state’s largest district with 90,000 students, struggled to comply with the new state law. After a third try, the school board in Louisville adopted a policy that includes giving students with gender dysphoria an exception for bathroom accommodations and adds potential punishment for teachers and staff who willfully and repeatedly misgender a student.
A group of parents and students in Lexington have sued over the Kentucky law. One of the families alleges a school office employee intentionally refused to use their child’s name and pronouns while speaking with them in April. The parents, who are identified by a pseudonym, decided to legally change the child’s name after that encounter, according to the lawsuit, which was filed in late September. The suit asks a judge to declare Kentucky’s new law unconstitutional.
In Indiana, Caston Peters said they think other students will suffer because of that state’s law.
“School is supposed to be a safe spot for us where we can be ourselves without having to deal with being called out, without being bullied or name-called or anything like that,” they said. “And I think for some of us being able to be called the name or pronouns that we prefer it’s something we need. And if we can’t get that at home then having it in another safe place like school — if that’s the only place we can get it — well now it’s being taken away from us.”
Gay, lesbian, and bisexual young people are more likely to use alcohol, e-cigarettes, cannabis, and tobacco than their heterosexual peers, a new study has found. Researchers say that stress from sexual orientation-based discrimination is to blame.
The study — published this autumn in the American Medical Association’s open-access medical journal, JAMA Network Open — looked at data on the habits of 28,291 middle and high school students taken from the Centers for Disease Control and Prevention’s (CDC) 2022 National Youth Tobacco Survey.
About 4.5% of student respondents self-identified as gay or lesbian, and 11.8% self-identified as bisexual. These percentages represent about 4,611 of the respondents.
Researchers found that 29.3% of non-heterosexual youths had used alcohol in the last 30 days, compared to 21.6% of heterosexual youth. About 25.6% of non-hetero youth self-reported cannabis use over the last 30 days, compared to 14% of heterosexual youth. Approximately 26.2% of non-hetero youth self-reported e-cigarette use, compared to 16.4% of hetero youth. Lastly, 9.1% of non-hetero youth self-reported cannabis use over the last 30 days, compared to 4.6% of heterosexual youth
Researchers found that bisexual youths were especially more likely to have vaped cannabis oil and e-cigarettes than their gay and heterosexual counterparts.
“It is well-documented that minority stress (eg, stress from sexual orientation-based discrimination) is associated with youth substance use, which may be consistent with vaping cannabis,” the study’s authors wrote. “Preliminary evidence from this study may inform future prevention strategies directed at reducing substance use disparities among sexual minority youth.”
The study’s findings reflect similar findings from past studies. A 2018 surveyfrom the Ohio Department of Health showed that LGBTQ+ teens were more likely to have vaped or smoked in the last 30 days compared to their straight counterparts.
A 2017 CDC study found that LGBTQ+ people were twice as likely to smoke than straight and cisgender people. Another study from the same year found that queer youth were more likely to smoke than straight and cis youth. One studyfound that LGBTQ+ people spend about $7.9 billion on cigarettes each year.
The act of ‘coming out’ is often done in steps and, for many, can be an ongoing process. For myself, I came out in stages, first to a small group of select friends in 1991, then to family in 1993. Over the following years, I came out to more and more of my friends. However, it wasn’t until many years later — in 1998 — that I came out at work.
When I did, the CFO in our Corporate & Investment Bank — someone I’d worked with for years — said to me: “What could I have done better over these years to have made it easier for you?”
This is what we need now more than ever: people proactively asking these types of questions to the colleagues around them. Unfortunately, so many are unsure where to begin or how to advance their allyship. And, while many may think of themselves as allies, few realize that allyship is not a label, it requires action. We all have the power to create positive change when it comes to our colleagues feeling like they belong — no matter how they identify or what differences they bring to the table — by fueling inclusion and promoting safe and accepting environments.
A 2023 survey by the Human Rights Campaign Foundation found that 84 percent of LGBTQ+ workers are out to at least one person in their current job — substantially higher than in 2018, when only 54 percent of LGBTQ+ workers were out to at least one person at work. However, LGBTQ+ workers, on average, are half as likely to be out to their Human Resources department than to coworkers on their team, suggesting a potential lack of trust, or lack of opportunity to report. While we recognize the advancements that have been made to protect LGBTQ+ employees in the United States — in June 2020, the United States Supreme Court affirmed that LGBTQ+ workers are protected from discrimination under the Civil Rights Act of 1964 — recent rulings against the transgender and nonbinary community, as an example, have shown that we still have a long way to go.
It’s also critically important for us to recognize that allyship is not just an action for cisgender, straight people. While allies must come from outside, they must also come from within the community. The LGBTQ+ community is not a monolith, it’s a vast community of diverse identities and orientations, all of which are not equal. LGBTQ+ community members from other marginalized groups, such as women and ethnic minorities, face more barriers. And as LGBTQ+ people around the world are fighting for basic rights and safety in courtrooms and on the streets, members of our transgender and gender expansive community are the most marginalized and at risk. When we look at our workplaces, these groups have even fewer opportunities to grow and thrive.
The allyship we called upon in the past remains essential, but it’s insufficient for today’s needs. We can no longer make meaningful progress with “allies on the sidelines.” It is no longer sufficient for allies to just “stand” with us, we need them to stand up for — and stand in front of — the LGBTQ+ community. The more visible and engaged allies there are, the easier it will be for all people to bring their full authentic selves to work every day.
To help inform our employees of what this might look like in practice, this year, we completed the global roll out of our LGBTQ+ Ally Journey program. Underpinning this program is the idea that allyship is not a label, it’s a series of intentional actions. The actions people can take range from small acts to larger displays of support, including displaying pronouns in email signatures, attending LGBTQ+ trainings, vocalizing support for LGBTQ+ issues, speaking up against harmful or offensive language, and even just talking openly and honestly with LGBTQ+ colleagues or loved ones about their lives.
At JPMorgan Chase, we are leading programming to engage, educate and empower our more than 300,000 global employees to make the pathway to active allyship more accessible. Our digitized Ally Journeys provide this type of direction and support, as well as tangible tools and resources for allies to chart their own path to be able to advocate for LGBTQ+ people around the globe.
Since JPMorgan Chase established the Office of LGBTQ+ Affairs, in 2021, we’ve seen our impact amplified and our progress accelerate. For example, the number of employees self-identifying as LGBTQ+ has grown by 35% year-over-year in 2022, following 50% year-over-year growth in 2021. I can confidently say this progress would not be possible without a commitment from our global allies to making JPMorgan Chase an environment where all employees feel welcomed, equal and included.
Right now, we need everyone, from inside and outside our community, to use their privilege, influence, and/or positions of power to support all members of the LGBTQ+ community, especially those most marginalized — our transgender and nonbinary colleagues, friends and family. So, think about your allyship and potential allies in your organizations, consider how you could be helping employees at every level, and identify specific ways you can take action and have meaningful impact. Together, we can all thrive and ensure that we’re leaving no one behind.
Learn more about how JPMorgan Chase is dedicated to advancing equity and inclusion for the LGBTQ+ community here.
Brad Baumoel is head of JPMorgan Chase’s Office of LGBTQ+ Affairs.