Teen girls in the United States experienced record high levels of violence, sadness and suicide risk in recent years, amid “significant” and “heartbreaking” declines in youth health and well-being overall, according to data published Monday by the US Centers for Disease Control and Prevention.
Responses for the CDC’s bi-annual Youth Risk Behavior Survey were collected in the fall of 2021, offering the first look at trends since the start of the Covid-19 pandemic.
“Many measures were moving in the wrong direction before the pandemic. These data show the mental health crisis among young people continues,” Kathleen Ethier, director of the CDC’s division of adolescent and school health, said at a media briefing. The findings are “alarming,” she said.
The survey found increasing mental health challenges, experiences of violence, and suicidal thoughts and behavior among all teens. More than 40% of high school students said that feelings of sadness or hopelessness prevented them from engaging in their regular activities for at least two weeks of the year.
Girls broadly fared worse than boys, and there is “ongoing and extreme distress” among teens who identify as lesbian, gay, bisexual or questioning (LGBQ+).
Most teen girls (57%) felt persistently sad or hopeless in 2021, double the rate for teen boys (29%). Nearly one in three teen girls seriously considered attempting suicide. Both rates “increased dramatically” over the past decade, according to the CDC.
Most LGBQ+ students (52%) have also recently experienced poor mental health and more than one in five attempted suicide in the past year.
“These data show a distressing picture,” said Dr. Debra Houry, CDC’s chief medical officer and deputy director for program and science. “America’s teen girls are engulfed in a growing wave of sadness, violence and trauma.”
Few measures of adolescent health and well-being showed continued improvement, including declines in risky sexual behavior, substance use and bullying at school. But most other indicators “worsened significantly,” according to the CDC report.
The latest data show increases in the proportion of youth who did not go to school because of safety concerns. There were also increases in teen girls experiencing sexual violence and teen boys experiencing electronic bullying.
Nearly one in five teen girls (18%) had experienced sexual violence in the past year and about one in seven (14%) had ever been forced to have sex.
“These data are clear: our young people are in crisis,” Ethier said.
CDC leaders, along with National PTA President Anna King, emphasized the important role schools play.
“Schools are on the front lines of the mental health crisis and they must be equipped with the proven tools that help students thrive,” Houry said.
Among those tools are training for staff to recognize and manage mental health challenges, counseling and mentorship programs and others that encourage connection and intervention.
King called for action from Congress to address the youth mental health crisis and emphasized the importance of regular conversations about mental health.
“It’s critical to talk with our children about what they’re feeling and their concerns,” she said. “I’m urging our families to come together, look for signs, look for ways that you can have these conversations with your children. Get to know them. Have these routine conversations all the time.”
Many of the challenges facing youth health and well-being are “preventable,” Houry said. “When I look toward our young people’s future, I want to be filled with hope, not heartbreak.”
If you are having thoughts of suicide or are concerned that someone you know may be, resources are available to help. The 988 Suicide & Crisis Lifeline at 988 is for people of all ages and identities. Trans Lifeline, designed for transgender or gender-nonconforming people, can be reached at (877) 565-8860. The lifeline also provides resources to help with other crises, such as domestic violence situations. The Trevor Project Lifeline, for LGBTQ+ youth (ages 24 and younger), can be reached at (866) 488-7386. Users can also access chat services at TheTrevorProject.org/Help or text START to 678678.
Tensions run high in this groundbreaking drama by Lorraine Hansberry.
Set in the 1950’s, three generations of a Black working-class family fail to thrive in a cramped apartment on Chicago’s Southside. A widow and her two grown children eagerly await an insurance payout they see as a means to escape their plight and achieve the American dream.Only each has their own idea of what that is and how to use the money to achieve it.
Lorraine Hansberry wrote this Pulitzer Prize-winning play, her first, at age 27. Her’s was the first play by a Black female to be produced on Broadway.She was also the first Black playwright to receive both the Drama Desk Award and the Critics’ Circle award for Best Play.
A Raisin in the Sun is a character driven play that, for the first time on Broadway, depicted Black Americans as realistic, complex individuals. This is a play for everyone. It is an important part of our history, and…it is theatre at its best. You’ll leave 6th Street Playhouse enriched by this classic American play.
A Raisin in the Sun
The American Classic of a Family’s ‘Dream Deferred.’written by Lorraine Hansberrydirected by Leontyne Mbele-Mbong
March 2-19, 2023
Opening Night features a champagne reception to celebrate the show with your friends, the cast and artistic team. Post-show Discussions Friday, Mar 10, Thursday Mar 16 & Sunday Mar 19 where you can learn more and discuss your thoughts with the cast and director.
In a visit to one of America’s most prestigious institutions of higher learning, Adm. Rachel Levine answered questions and offered insight about two of the most controversial healthcare issues of this decade, long COVID-19 and gender-affirming care.
Long COVID is the mysterious phenomenon in which patients endure debilitating, long-term effects from being infected by the coronavirus and gender-affirming care, treatments for transgender youth that are being targeted by lawmakers nationwide.
“Long COVID is real,” said Levine, the assistant secretary for health at the U.S. Department of Health and Human Services, and the highest-ranking transgender official in the Biden administration. “We heard from patients who have suffered heart issues, lung issues, issues of fatigue and brain fog, after their COVID-19 infection. And we heard from providers at Yale who are forming a multidisciplinary clinic in order to evaluate and treat these patients.”
In a public session held Monday at the Yale Law School, four of these “long haulers” shared their challenges with the admiral: Shortness of breath, pulmonary disorders, lifestyle and work limitations and disabilities that are hidden to most observers.
“Hearing the patients tell their stories is so meaningful,” she said, calling it a privilege to better understand the challenges they face.
“That helps us drive policy as well as research,” Levine said.
“I was very active,” said Hannah Hurtenbach of Wethersfield, Conn., a 30-year-old registered nurse who was diagnosed with post-COVID cardiomyopathy, cognitive brain fog and pulmonary issues. “I loved hiking and being outside. I was constantly on the move and now I barely leave my couch. I barely leave my house and I can’t really handle even a part time job now when I used to work full time. So that has been really difficult at age 30 to be facing those sorts of issues that I never really anticipated feeling.”
Hurtenbach told the Washington Blade she appreciated Levine’s visit.
“Sharing my experience today with the admiral was probably one of the more highlight moments of this experience,” she said. “Knowing that the federal government is taking action, is paying attention, and listening to these stories means more to me than anything else, and especially knowing that what I’ve gone through over the last couple of years can be led and used into the future research and help others just like myself.”
A woman named Christine told the Blade that even though she is so impacted by long COVID that she needs assistance to walk and has to pause as she speaks because of her shortness of breath, she felt attending this event was worth all the struggle to get there.
“I’m so glad I came. I learned a lot from hearing from the others,” she said, who like her are trying to recover from long COVID.
Levine told the Blade that so far, she herself has not contracted COVID, and that she is double-vaccinated and double-boosted. With the president announcing the end of emergency COVID declarations on May 11, she said the administration is pushing Congress to approve extra funding for long COVID and other related needs. But how can she expect to get that through a House of Representatives full of anti-vaxxers, anti-maskers and COVID-deniers, including in GOP leadership?
“Long COVID is real and we hear you,” she said. “We plan to engage Congress to talk about the funding that we need. And we’ll continue to work. We do have to get past misinformation in this country, but we are here to give the correct information about COVID-19 and long COVID, and we’ll continue to engage Congress on that.”
Hurtenbach expressed disappointment in those colleagues in healthcare who came out publicly in opposing vaccines and mask mandates.
“I just wish they had paid better attention in school and learned more of the science,” the nurse said. “I wish they would trust the science that they are supposed to be promoting for their patients as well.”
Following Monday morning’s public meeting, Levine held a private session with long COVID patients and Yale doctors, researchers, counselors, physical therapists and other providers. Then in the afternoon, the admiral spoke at another event, held at Yale Medical School: “A Conversation on LGBTQI+ Health and Gender-Affirming Care.” Although it was closed to press, Yale Asstistant Professor of Medicine Diane Bruessow attended the event and shared with the Blade what Levine told those gathered, which is that she remains positive and optimistic.
“I think over time, things will change, and things will get better,” said Levine, adding the caveats, “I don’t know if they will get better everywhere in the United States. I also don’t know if it’s going to be quick. I think the next two years will be really, really hard.” Especially with more than 270 anti-trans pieces of legislation moving their way through state legislatures.
“But I am going to stay positive. I’m going to think that over time, things will improve,” Levine said, pledging that both she and the Biden administration would do everything they can to help families with trans kids. “I think the tide will turn.”
Fifteen years after the opening of Hollywood’s Triangle Square Apartments, the nation’s largest LGBTQ-affirming affordable housing complex for seniors, the Los Angeles LGBT Center has spearheaded a historic partnership with April Housing to transfer the building’s ownership to the Center. The transfer, which ensures that the building will be preserved as affordable housing for current and future residents, was commemorated with a reverse ribbon cutting ceremony on Thursday, Jan. 26.
“Today serves as an important reminder that the best way to combat homelessness is by providing the housing, services, and care that so many need,” said Los Angeles County Supervisor Lindsey P. Horvath. “Together, the Los Angeles LGBT Center and April Housing have transformed a building into a community, and I look forward to a long and meaningful relationship, with more projects like this to come.”
The 104-unit building opened in 2007, becoming the first affordable housing complex in the nation to specifically address the needs of LGBTQ+ elderly adults, who often struggle to afford housing and are less likely to have children or grandchildren to support them. In addition to housing, Triangle Square residents have access to the full range of services and support provided by the Center, including case management; home-delivered meals; in-home care and benefits assistance; connection to health and mental health care; HIV support and wellness; counseling and support groups; and more than 75 monthly activities and events provided for free or at low-cost.
“Senior Services is one of the brightest jewels in the Center’s crown, and April Housing has made that jewel shine even brighter by agreeing to sell us this historic building that houses our elders,” said Los Angeles LGBT Center CEO Joe Hollendoner. “This sale is going to greatly improve the Center’s ability to help our clients and to further prove to Los Angeles, the LGBTQ+ community, and the nation that we must stop leaving our elders behind.”
“April Housing is proud to transfer ownership of Triangle Square to the Los Angeles LGBT Center,” added Alice Carr, CEO of April Housing, ownership partner of Triangle Square Apartments. “This truly groundbreaking affordable community was created to be a safe, healthy and affordable environment friendly to LGBT seniors, where they can live, thrive and age with respect and dignity. April Housing is thrilled to support the Los Angeles LGBT Center and the important work they do.”
Ginger Beavers is back! See the Gingersnaps (Ginger, Cindy Brillhart-True & Bonnie Jean Shelton), plus Joey Favalora, Ezra Hernandez and Alanna Weatherby. Join us for a night of superb musical numbers from shows past and present. A Stage Left Studio production.
Elected officials, nonprofits, activists, and community leaders are pushing forward the idea of safe consumption sites in San Francisco, in order to prevent overdose deaths, improve the health of people who use drugs, and reduce outdoor and public substance use. Safe consumption sites and services are a well-accepted and effective public health intervention that exist in hundreds of cities around the world, but are slow to gain acceptance and be implemented in the U.S.
To gain traction and momentum for safe consumption services in San Francisco, in January Supervisor Hillary Ronen, from San Francisco District 9, organized a panel discussion with a group of experts to share their thoughts on the issue. The event was moderated by Heather Knight from the San Francisco Chronicle, and included Tyler TerMeer, PhD, CEO of San Francisco AIDS Foundation, Alex Kral, PhD, epidemiologist from RTI, Supervisor Matt Dorsey, Dr. Leslie Suen from UCSF, and Sam Rivera, the executive director of OnPoint NYC.
From what I’ve seen, the idea of supervised consumption services can provoke ire from people who don’t know much about the services, how they work, and how they improve the communities in which they exist. People may incorrectly assume they operate as free-for-all, legally-sanctioned, disorganized places that encourage and entice people to use drugs, or maybe enable people in their drug use. This couldn’t be further from the truth.
These are, of course, fears that are based on centuries-old stigma around illicit substance use and addiction, rather than the ample data we now have available from hundreds of sites around the world. The benefits of safe consumption sites are clear: The National Institute of Health shares that safe consumption sites “are associated with lower overdose mortality, 67% fewer ambulance calls for treating overdoses, and a decrease in HIV infections.” We know that safe consumption services increase use of social services–including addiction treatment–and reduce things like public drug use, improper syringe disposal and litter, and public costs spent on HIV/hepatitis C infections, emergency room visits, and overdose.
It was fascinating to hear from Sam Rivera, who is the executive director of OnPoint NYC–the nation’s first supervised consumption centers.
He shared how prior to OnPoint NYC’s opening, the business across from one site had been collecting around 13,000 syringes per month on their own from the surrounding streets. A month after OnPoint opened, that needle waste plummeted to only 1,000 syringes picked up off nearby streets. The site prevented public drug use in the area, which meant far fewer improperly discarded syringes.
NYC’s two sites have also successfully reversed hundreds of overdoses. Rivera talked about how sometimes the percentage of fentanyl in their attendees’ drug-of-choice was so high, people turned blue and started overdosing before they could even complete their injection. Having professionally trained staff on deck to jump in in this crisis situation was essential to saving their lives.
However, if I had to pinpoint the thing that was most notable to me from this panel discussion, it would be something a little less definable, something that doesn’t fit neatly onto a chart or graph to convince funders and politicians of its worthiness. That “X factor” was the unconditional love that was apparent in the way Rivera spoke about people visiting these sites.
As the panel discussion began, Rivera shared a story of a large, six-foot-four man who had come in for injection support. Rivera addressed him by name, and suddenly the man started crying. Rivera, assuming he had used the wrong name or somehow triggered this man’s trauma, apologized profusely. The man explained that Rivera did nothing wrong, he had just not been addressed by his name in such a long time. It was as if hearing his name had, in some inexplicable way, restored a part of his humanity that the streets–and those who so ruthlessly police them–had taken away.
“Just love people,” Rivera explained.
We could feel the authenticity of what Rivera was asserting. “Just love people,” he repeated. Rivera went on to discuss how these sites had unintentionally become a site of bonding–of remembering. “It’s hard to be in those rooms and not get emotional,” he shared. He described how many of the folks working these sites have their own lived experience around substance use, and how their success stories (which include continued use in addition to recovery) serve as a beacon of hope. “We are you,” Rivera said, recalling speaking to a client.
Rivera explained that for some people, safe consumption sites become a place where people explore reducing or ending their substance use. Staff at the site don’t need to constantly ask people about recovery, reducing use, or medication-assisted treatment, Rivera said. Most often, it’s the participants themselves who talk about drug treatment and changing their substance use. As staff get to know the clients who come in, they get to talking. They talk about their interests and their lives. “What we see happen,” Rivera shared, describing these contextual and peripheral conversations while the person is using, “is an [overall] reduction in drug use.”
At the end of the panel discussion, the moderator opened the conversation to audience questions. There were some community members who had shown up in opposition, or at least with extreme doubt in their hearts. They expressed fears that opening a site in San Francisco would attract people who use drugs across the Bay Area, like a lighthouse, cutting through Karl the Fog.
Rivera disputed this idea, sharing that in the year or so they’ve been open, they have not found this to be the case. “Drug users use where they purchase,” Rivera responded, reminding the audience that oftentimes people have an urgency to use, both chemically and also for fear of legal retribution. In NYC, there has been no influx from other areas. He went on to describe how these sites had actually improved relations with local police forces: officers who once indiscriminately arrested people using drugs publicly were now coming to OnPoint NYC in droves to observe and, ultimately, it became evident, to learn.
The question remaining in some audience members’ minds was along the lines of, “What’s your proof that this will work here, in San Francisco, like it has in New York City?” Of course, we won’t actually have definitive proof that it will until we’re able to open a site and measure its impact. But Rivera shared his hope and optimism that San Francisco will be able to implement these life-changing services. “Just be San Francisco,” he said. There was a beat of silence in the room. “Be San Francisco,” he reasserted. “San Francisco always had the gall to step up and do things really radical, really righteous.”
Can we move forward, San Francisco?
Nonprofits across the city are ready to step up and implement these services with City and San Francisco Department of Public health support, something San Francisco AIDS Foundation CEO Dr. Tyler TerMeer emphasized during the panel discussion.
Rivera’s plea to San Franciscans, to remember who we are (or at least once were), reminds me of a segment of the environmental protection movement known as “rewilding.” This form of ecological preservation aims to restore an area’s natural–wild–state. San Francisco has led the nation in many radical movements towards justice–towards love–most notably the gay liberation movement. Perhaps it is time that San Franciscans “rewild” ourselves, restoring our natural, radical roots to effectively address crushing social inequities.
We live in an age in which there is an observable, systemic, systematic callousness towards people who use drugs who may not have housing. The way our society treats folks who use drugs is causing nothing but pain and suffering. Public drug use is at an all-time-high, fatal overdose death rates are through the roof, and incarceration as a response has not worked to solve the issue in any meaningful way. It is time we abandon “tough love” approaches and shift towards something warm. Something radical. Something wild, unimaginable, and powerful. Something loving. We can choose to meet people where they are at–with openness, without judgment, and with unconditional love. Or we can continue down the grim path we’ve been on for decades. We do have a choice.
A new ad for Rihanna’s Fenty beauty brand features Mariana Varela and Fabiola Valentin, newlyweds who fell in love while competing as Miss Argentina and Miss Puerto Rico.
The ad is for Fenty eau de parfum and depicts the couple telling their love story while embracing, holding hands, and enjoying the scent.
They tell the story of how they met at a pageant in Thailand and immediately became inseparable.
“The details, like how we like our coffee, everything kept flowing,” they say.
They call theirs a story of “beautiful friendship” and add that it has been “magical” to find one another.
“What a special it was to work for the fenty eau de perfum fragance [sic],” Varela wrote on Instagram, adding “It’s beautiful when two bodies come together with love.”
The happy couple announced their marriage in October 2022 in a joint Instagram post featuring photos and video clips of their relationship.
“After deciding to keep our relationship private, we opened the doors to it on a special day. 28/10/22,” the post’s caption reads.
One clip shows the moment the couple got engaged, with “Marry Me?” spelled out in gold and silver balloons as Valentin slips a ring on Varela’s finger. Another shows the pair wearing white on the steps in front of the Marriage Bureau in San Juan where they were reportedly married.
Varela and Valentin met while competing in the 2020 Miss Grand International pageant, where they were both among the top 10 finalists. They’ve posted frequently about their close friendship, but as they noted in their post had chosen to keep their romantic relationship private until now.
Tiffany Najberg, a Louisiana doctor who is transgender, said three insurance companies refused to reimburse her since she legally changed her name nearly two years ago.
The companies have since come to agreements with her and her Shreveport clinic, UrgentEMS, but not until after she started a petition that has garnered nearly 12,000 signatures and received news media attention about her cause, including inquiries from NBC News.
While the three insurers have agreed to update her name in their records and pay back claims, Najberg and her clinic have yet to receive any checks. In the meantime, she has spent her life savings — about $200,000 — to sustain her clinic, where she provides both primary and urgent care, including to more than 100 transgender patients, some of whom come from Alabama and Tennessee, two states that have passed restrictions on gender-affirming medical care for minors.
After Najberg changed her name in April 2021, she said, she updated it with all the necessary government offices and with databases from which most insurance companies pull information about providers.
She said Medicare, Medicaid, Blue Cross Blue Shield and United all updated the information and continued to reimburse her for the care she provided to her patients. But she said Aetna, Cigna and Humana had repeatedly denied her claims and refused to reimburse her.
“They were flagging each claim and rejecting it because of a name incompatibility with their internal database. They did not change my deadname,” she said, referring to the name she used prior to her transition.
She said all three companies told her that they don’t source information from the same database used by the government, Blue Cross and United. When she asked which database they use so that she could go through whatever steps necessary to update it, she said they wouldn’t tell her what it was. Even after her office sent the companies the court order granting her name change and copies of her updated IDs, they still wouldn’t update her name, she said.
Last March, Najberg began posting videos about the reimbursement denials on her TikTok account, where she has more than 150,000 followers. Last month, she also started a petition demanding that the three companies change her name and pay all of the back claims — something she said she did “out of sheer desperation because nothing else worked.”
“I’ve run through every dime I’ve ever had,” Najberg said. “I don’t have three to seven years for a court fight. I’ve got to make a living now. I have hundreds of patients, and most of them are in vulnerable populations. I want to keep taking care of them.”
Najberg said the situation has also had an impact on her mental health, because every time she would reach out to the three companies, their representatives would use her deadname, which at the time was still in their databases.
English Perez, who since 1998 has done medical credentialing — including helping hundreds of medical providers update their credentials following a name change after marriage or divorce, or an error in their name — said she has never encountered a problem like the one Najberg has been facing.
“That’s why I volunteered to help her,” Perez said, adding that she came across Najberg’s story on TikTok. “This needs to stop for her, for the next person that becomes their true self and lives in their authentic self — they should never have to incur this type of embarrassment.”
Perez added that Najberg’s relevant medical identification numbers and tax ID number all reflect her legal name change.
“That’s why I said it’s more about the transition, less about a name change,” Perez speculated.
By mid-January, after Najberg’s petition received more than 10,000 signatures and her story was covered by local news outlets, the three companies reached out, but they did not immediately agree to pay the back claims, she said.
As of Jan. 23, Aetna created a new contract with Najberg and agreed to process all of the back claims. Humana and Cigna had not agreed to anything at that point, she said.
NBC News reached out to all three companies on Jan. 24 for comment regarding Najberg’s reimbursement denials, their processes for updating medical provider names in their systems and Najberg’s allegations that company representatives repeatedly misgendered her. All three responded the following day, though none responded to specific questions regarding Najberg’s allegations.
A spokesperson for Aetna said, “We value our relationship with our providers and strive to resolve any issues they may experience as quickly as possible.”
Cigna’s spokesperson said name changes “have no impact on our payments to doctors or other health care providers; and we are committed to fair and prompt payment for both in- and out-of-network clinicians.”
Humana shared its first on-the-record response Jan. 27, with a spokesperson telling NBC News in an email that, “We are glad to have Dr. Tiffany Najberg as a provider in Humana’s network, and we look forward to continuing to partner with her and her office.”
The day prior, Humana had informed Najberg that the company would pay all of the back claims with interest and would create an immediately effective updated contract that puts her in their network.
On Monday, Jan. 30, Najberg said Cigna tentatively accepted her terms, and that she and her clinic now have agreements with all three insurance companies.
Perez, who noted that two of the three insurance companies did not help Najberg find a solution until they received an inquiry from NBC News, said, “We can’t relax and breathe until those checks start coming in the door.”
There is little available data on how many openly transgender medical providers there are and whether others have had issues similar to Najberg’s. Of 15,794 entering medical students surveyed by the Association of American Medical Colleges last year, 1.4% reported that their gender identity is different from their sex assigned at birth — up from 1.2% in 2021 and 0.8% in 2020.
Najberg said that she hasn’t had to stop seeing any patients as a result of the three companies denying claims for nearly two years now, but her practice has had to postpone plans to expand its telehealth services to Texas, Mississippi, Alabama and Florida, because she cannot afford the malpractice insurance in those states right now. She said she’s had more than 100 requests from residents in those states regarding telehealth care.
She said that she has been living off of Go Fund Me fundraisers for about eight months and that if she doesn’t start receiving reimbursements from the insurance companies soon, she could lose both her business and her home. She has dropped both her dental and health insurance and has eliminated all nonessential medications.
“I am literally in survival mode right now,” she said.
She said her goal isn’t to attack any of the insurance companies — but to draw attention to what has happened so that it doesn’t happen again.
“I’m not asking for anything special,” she said. “I just want to be an equal.”
When Constance Zhou got to college, they noticed that their queer friends were struggling with mental health. But they were also struggling to find providers well-versed in sexual and gender minorities or the complicated intersection of identities that often brought both discrimination and unique therapy needs.
At the same time, Zhou was working at a national suicide hotline, where many of the callers identified as LGBTQ+.
“I was getting people in Texas, in the Midwest, and in the South who really didn’t have access to resources,” Zhou said. “I began to appreciate how important it is to have access to mental health care and that it isn’t one size fits all.”
LGBTQ+ people face unique medical challenges related to sexuality and gender diversity. From experiencing higher rates of mental health stress and substance abuse to requiring gender-affirming care and treatment and prevention of HIV, needs stem from an array of factors related to how the healthcare industry and mainstream culture define identity. The criminalization of gender-affirming care in some states, as well as sports, bathroom, and book bans, contribute to the anguish faced by many in the queer community.
Medical understanding of the needs of queer people has come a long way since 1973 when activists successfully lobbied for the American Psychiatric Association to declassify homosexuality as a mental disorder. Indeed, advancements in health care have been hard fought by the community, often in the face of neglect and hostility by the medical establishment.
The federal government’s failure to respond to the HIV/AIDS crisis in the 1980s and ’90s further galvanized the queer community to take health care into its own hands. Gay Men’s Health Crisis (founded in 1982), the American Foundation for AIDS Research (1985), and ACT UP (1987) were among the early organizations to demand research, innovation, and medical access — efforts that drastically reduced HIV infections and eventually led to effective treatments and medications to prevent the spread of the virus.
That practice of forcing the medical establishment to address the health needs of the increasingly diverse community is underscored today by efforts to improve gender-affirming care for trans and non-binary people, a movement under attack with 11 states introducing bills to restrict gender-affirming health care access.
“There’s been an enormous amount of harm done to queer people in health care environments,” said David Baker-Hargrove, co-founder and former CEO of 26Health, an LGBTQ+ health care center in Orlando, Florida. “Sometimes, it’s out of willful discrimination, but it’s also from ignorance about how our needs differ and how to interact with and provide services to members of our community.”
Many such issues are systemic, as is the lack of culturally competent care to address the needs of LGBTQ+ people. Demographic differences among queer people also play a determining role in health risks and outcomes, reflecting entrenched social inequalities.
“There are disparities in our community — notably race, ethnicity, and class — that may not be sexuality specific and that drive unequal access to care and prevention services,” Gregg Gonsalves, an early member of ACT UP and today associate professor of epidemiology at Yale School of Public Health, told LGBTQ Nation.
Sexuality and gender identity are among the many considerations included in what the World Health Organization calls social determinants of health — non-medical factors, including economic means and access to education, that impact health risks and outcomes. Such factors account for up to 50 percent of variations in health outcomes in the U.S.
“Addressing social determinants of health is as important as medical interventions,” said Gonsalves, which means addressing factors like access to care is as necessary as developing effective treatment.
That’s where advocates like Zhou come in, with hopes of changing the system for the better. They are determined to help push for care that meets the community’s complex needs by working inside and outside the system for change.
“We’re survivors,” Baker-Hargrove said. “We know how to get along outside of existing systems, and it’s made us strong.”
LGBTQ Nation spoke to a range of queer people who were inspired by their personal experiences to become healthcare advocates and providers.
Constance Zhou co-founded the Weill Cornell Medicine Wellness Qlinic. José Romero advocates for people like themselves who are living with HIV to be part of the solution to ending the epidemic. Dr. Marci Bowers is a pioneering transgender surgeon whose personal experience transitioning informs both her push for innovation and sensitivity toward patients. And Anthony Sorensen was inspired by his own sobriety journey to found Transitional Recovery in Minnesota, which provides LGBTQ+ people in recovery with a supportive living environment.
Constance Zhou: creating new spaces for mental health
Growing up in Charlotte, North Carolina, Constance Zhou, 26, thought mental health was a storm that people weathered on their own.
That changed when Zhou got to college, where they grew comfortable identifying as queer and recognized that many queer people struggle with mental health and seek care, not only for anxiety or depression but for help developing a sense of self and to combat feelings of loneliness.
As a student, Zhou recognized the need for queer-affirming mental health care among their friends, as well as the LGBTQ+ people from around the country who called the suicide hotline where they worked. That led to Zhou’s decision to attend medical school to pursue psychiatry.
Zhou witnessed firsthand the disproportionate mental health stress that young queer people face and the need for more culturally sensitive and affirming providers to meet the demand.
“The issue became very personal to me, being part of the LGBTQ+ community,” Zhou told LGBTQ Nation. “I’m Asian American, queer, and trans. I also identify as nonbinary and use they/them pronouns. And within both the Asian American community and the LGBTQ+ community, there’s a lot of stigma surrounding mental health.”
Parental pressures to succeed in academics, pressure to live up to the “model minority” stereotype, and racial and cultural discrimination are some of the stressors cited in a University of Maryland School of Public Health study. Still, the stigma Zhou mentioned is often a deterrent to seeking help.
Motivated to improve the situation, Zhou decided to specialize in mental health at medical school but said that as a student, they “see that a lot of curricula in medical school really don’t focus on LGBTQ issues.”
Zhou, an M.D./Ph.D. candidate at Weill Cornell Medical College in New York City, co-founded with a classmate the Weill Cornell Medicine Wellness Qlinic, a student-run resource that provides mental health care to queer people while serving as a training ground for the next generation of practitioners.
“I see a lot of patients who are going through feelings and experiences that I have had before,” Zhou said. “Knowing that I can use my own background in understanding and helping them has been very rewarding.”
Co-founding the Wellness Qlinic within the first week of school was transformative. “I never really thought that the work that I did would be meaningful to my queer or trans identity,” Zhou said.
The Wellness Qlinic received immediate support from faculty and administration. “A lot of people went out of their way to make sure that we felt empowered to do what we needed to do,” Zhou said. The clinic, which opened in 2019 and has expanded to include 20 students on the board, functions as a resource for the patients it serves and those who run it.
“Part of the mission of the Wellness Qlinic is to provide free and culturally competent mental health care to queer and trans folks,” Zhou said.
Those services include patient evaluations, individual and group psychotherapy, and medication management. But the clinic also serves as an essential training ground for medical students, residents, and volunteers “to give them the skills they can use later on in their own practice.”
The Wellness Qlinic follows a pattern of similar organizations around the country offering mental health care specifically to queer people. Indeed, the number of clinics offering services specially tailored to LGBTQ+ people decreased by an average of 10 percent each year from 2014 to 2018. As of 2018, about one in five mental health clinics offer services specifically geared toward queer patients.
Nonprofit organizations like Queer LifeSpace, founded in 2011 to offer mental health services to people in the Bay Area regardless of ability to pay, have sprouted up to meet the need. Queer LifeSpace also offers a 12-month clinical training program to help foster the next generation of queer therapists. There are dozens of such clinics around the country. More are necessary to increase access to services for minority populations.
Educating providers is key to improving and expanding health care because, Baker-Hargrove noted, “most health care training programs, no matter the discipline, don’t have a lot of specific training geared towards LGBTQ+ competencies.”
Building community around HIV
José Romero has also experienced the power of community. As a public health advocate, Romero believes in building networks of mutual support in which people look out for one another. It’s a perspective rooted in personal history and informed by their experience living with HIV and pushing for greater accessibility and education around treatment and prevention.
“I’ve always been around people who have had to find ways to care for each other,” Romero, 30, said. Romero’s family emigrated from an impoverished part of Mexico to rural Washington State, where they worked as farm laborers. The nearest hospital to their small town was such a long drive that Romero’s mother nearly gave birth to them in the car. “I feel like I’ve been mobilizing for health care ever since,” Romero told LGBTQ Nation.
Romero’s first awareness he had been exposed to HIV was a phone call from a doctor.
“I had gone in feeling sick, and he asked me, ‘Do you have sex with men?’ When I said yes, he just immediately shut off to me,” recalled Romero, who identifies as non-binary. “He told me I had been diagnosed with HIV, and I should probably get a follow-up.” Romero made an appointment with another doctor, who was much more supportive.
Romero didn’t share their diagnosis for another five years when they started working as an organizer. “It’s taken other advocates and people who have lived experience supporting me to get to this point in my life where I’m using my diagnosis for good,” Romero said.
Today, they serve as director of community advocacy, research, and education at Pride Foundation, which gives scholarships to students and funds community organizations serving queer people throughout the Northwest. Pride Foundation was founded in 1985 out of a desire from people dying from HIV/AIDS to leave their money and legacies to benefit the community. Pride Foundation has distributed more than $74 million in grants to queer people and organizations advocating for equity and justice in the decades since.
Since the height of the HIV/AIDS epidemic in the mid-1980s, annual infections in the United States have dropped by more than two-thirds, according to the Centers for Disease Control and Prevention. New HIV infections in the U.S. fell 8 percent from 2015 to 2019. The U.S. Department of Health and Human Services has set a goal of ending the HIV epidemic by 2030, and a number of city-based initiatives with similar aims are underway, including in former epicenters San Francisco and New York.
But men who have sex with men account for about 66 percent of new infections each year, despite being only 2 percent of the population, with Black and Latino MSM being affected disproportionately. Each group accounted for around a quarter of new HIV diagnoses among MSM in 2020.
Contributing factors to the high prevalence are intersectional and include racial discrimination, lack of access to resources, language barriers, and stigma. “It’s been really important for me to focus on this big issue by working in coalition and step-by-step,” Romero said. Since they grew up speaking Spanish, Romero recognized language as one of the biggest barriers to healthcare access. They have worked as a translator, interpreter, and advocate for hospitals to provide multilingual materials.
Though medical interventions for the treatment and prevention of HIV, such as antiretrovirals and PrEP, have extended lives and lowered infection rates, advocates are working to improve access for those who need it most, including racial minorities and trans people, who have been underserved by prevention efforts. “It wasn’t until recently that we’ve seen people who are not white or cisgender represented in media around HIV prevention and care,” Romero said.
The medications themselves aren’t enough, Romero said.“We need a social and cultural approach, and that means meaningful involvement of people living with HIV.”
Many factors put people at greater risk of negative health outcomes from HIV, including substance use, mental health, and access to stable housing. Social and political solutions that address these conditions are as important as medical innovations in the fight to end the epidemic.
“Structural interventions in the context of HIV prevention and care are going to need policy-level, community-wide solutions,” Gonsalves said. “This takes us back to the old days of LGBTQ+ advocacy — working to change the sort of environment in which we live to make it easier for us to keep ourselves healthy and safe.”
Half of all new HIV infections are located in the South, where Morris A. Singletary has been working as a peer educator to connect young men of color with care. Based in Atlanta, Singletary, 45, runs the HIV prevention and education initiative PoZitive2PoSitive, offering support and mentorship informed by his lived experience with HIV.
Singletary knows the stakes firsthand. He was near death when he received his HIV diagnosis in 2006, having not understood that he was at risk. And he struggled with the emotional fallout and with adhering to treatment for the next ten years. He also knows the shame, stigma, and lack of awareness that keep men from pursuing care.
“We have to be more intentional,” Singletary said. “We tell people to go to the doctor and get tested, but we don’t say what happens next. We need to show the cycle of care,” he added, including the patient’s role in communicating openly with providers who are trained to show support. Singletary noted that everyone involved in the healthcare process, from researchers and providers to peer educators like himself, has an integral role to play.
“Storytelling is an amazing tool,” Singletary said of the connections he’s forged through sharing his lived experience and encouraging others to seek HIV treatment and prevention.
Romero agrees that people living with HIV should be integral to the path forward, and encourages outreach organizations to hire them to reach others at risk or in need of care. “We need to invest in people to be the solution to the problems that we’re facing,” Romero said. “When we are provided with the resources and opportunity to help each other, we do.”
Dr. Marci Bowers: pioneering gender-affirming healthcare
Dr. Marci Bowers has devoted much of her history-making career as a surgeon treating transgender people, whose access to essential medical care has come under attack in recent years. Bowers, 64, has performed more than 2,000 vaginoplasties, or bottom surgeries, for trans women and is one of few surgical providers to have undergone the process herself.
“Everyone deserves access to gender-affirming care,” said Bowers, whose medical practice is based in Burlingame, California.
Growing up, Bowers knew she wasn’t comfortable with the gender identity she was assigned at birth, though it was a feeling she couldn’t describe. “I didn’t really have words for what it was to be trans,” Bowers said of the era when there were fewer role models and information. She wound up pursuing medicine, getting married, and having children, playing the role she felt was expected.
“I felt like I could displace my feminine feelings by being a woman’s health care provider,” Bowers said of her decision to become an OB-GYN. It was after Bowers transitioned, at age 37, that she considered pursuing a career in gender-affirmation surgery. “I was responding to an obvious need within the community for more providers,” Bowers said.
Insights gleaned by going through surgery herself have informed her sensitivity toward patients, “not just in the technical aspects of giving them what they want, but recognizing the struggle that they’d already been through being trans.”
Trans people experience disproportionately high rates of anxiety and depression and are about six times as likely as the general population to be hospitalized for a suicide attempt. Recentstudies have shown that gender-affirming care, including puberty blockers for trans adolescents, hormone therapy, and potential surgical interventions where necessary, significantly improve mental health and save lives. The latest guidelines from the World Professional Association for Transgender Health advised that hormone treatments can start from age 14.
“It’s an overwhelming, established fact that gender-affirming treatment is effective and greatly enhances psychosocial functioning and reduces suicidality,” Bowers said. “It’s about people improving their lives by assuming the identity that they feel most comfortable with.”
Even as the evidence of efficacy becomes ever more clear, gender-affirming care is being targeted across the country. As of March 2022, 15 states have restricted access to gender-affirming care or are considering laws that would do so. The consequences for people who need care are dire, cutting off access to treatment proven to improve well-being and reduce suicidality.
At the same time, the demand for gender-affirming care is growing, as is the corresponding need for more providers. “It’s growing because people are more comfortable being themselves,” said Bowers, who also helped establish the Transgender Surgical Fellowship Program at Mount Sinai Hospital in New York City to help train more doctors to care for trans people. Under the Affordable Care Act, it’s illegal for insurance providers to deny medically necessary transition-related care, and Bowers also accepts Medicaid from her patients.
“People at every socioeconomic level should have access to this care; we’ve always felt strongly about that,” Bowers said. But even for patients who have coverage, there’s a need for more doctors to provide treatment. “We need more clinicians and mental health professionals to help with the care of this population,” she said.
“Gender identity is a very deeply held value,” Bowers said, an indelible one that requires affirmative care. “It weathers any storm.”
Providing homes for recovery
When Anthony Sorensen, 52, was growing up on Long Island, New York, his father — who struggled with alcoholism — would disappear for days at a time. When Sorensen was 16, his father left for good, and Sorensen blamed himself, thinking it was because he is gay. Sorensen had started drinking the year before, blacking out the first time he tried alcohol.
“I wanted to be the bad kid who got in trouble in order to feel cool and accepted by my peers,” Sorensen recalled. “But at the same time, to save myself from the humiliation of being called out as gay, I just wanted to disappear.
“The first time I drank, all those fears and inhibitions of being humiliated went away,” Sorensen said.
Feelings of alienation like those Sorensen described are among the reasons that LGBTQ+ people are more than twice as likely to abuse drugs and alcohol than the general population, according to the National Survey on Drug Use and Health, a trend that’s been exacerbated by the coronavirus pandemic. A variety of factors contribute to the increased likelihood, including concurrent mental health conditions like anxiety, depression, and suicidality, themselves often a result of marginalization, discrimination, and trauma.
Drugs and alcohol have also occupied a historically central role in how queer people relate to each other and form social bonds. “Our community was formed in bars,” Baker-Hargrove said. “It can be hard to think about a life within the community that’s not anchored to alcohol or partying.” That’s one reason substance abuse is sometimes normalized within the community, and it may be easier to overlook when someone is struggling.
Sorensen’s heavy drinking and drug use accelerated when he moved to New York City shortly after coming out at age 19. He was 23 when he attended his first Alcoholics Anonymous meeting, but it wasn’t until he discovered AA meetings that were mainly attended by queer people that he was able to work the program and stay sober for two years.
Sorensen’s first experience with Pride Institute, a treatment and recovery center especially focused on the needs of LGBTQ+ people, was in 1999, at a facility in Belle Mead, New Jersey, that has since closed. He stayed sober for 11 years before he began drinking again, when his career as a hairstylist took precedence over his recovery, Sorensen said.
Sorensen later completed two 30-day courses of inpatient treatment at Pride Institute’s main campus in Eden Prairie, Minnesota.
“Pride 100 percent saved my life,” Sorensen said. “Pride for me was the place where I knew I could authentically be myself without many of the fears that I had carried since I was a kid,” he recalled, noting that he was fortunate to have private insurance and a choice of where to seek treatment. Pride is in-network for most major insurers and works with uninsured patients on lending options to reduce financial barriers to care.
Pride Institute has pioneered a model of treatment specifically tailored to LGBTQ+ people. Since many patients like Sorensen can trace their struggles with addiction back to aspects of their queer identity, centering and affirming those aspects of their lives is essential to effective treatment. “If you can’t totally be yourself, you’re not going to move forward in your recovery,” Sorensen said.
Pride Institute’s affirming environment includes gender-neutral bathrooms and room assignments not based on gender identity assigned at birth, as well as peers and staff with lived experience who embrace and celebrate everyone for who they are. “The counselors are educated in LGBTQ+ issues and addiction and mental illness,” Sorensen said. “They made me sit with my feelings and work through them, rather than escape them” — a process Sorensen called life-changing.
Sorensen also credits the success of his recovery to transitional housing specifically designed for LGBTQ+ people, where those who have completed inpatient programs can live with others in a shared house and offer mutual support. “I saw the success that I had with transitional housing, and I want to be able to reach as many people as possible and give them that same opportunity,” said Sorensen, who ultimately decided to relocate to Minneapolis and dedicate himself to offering queer people in recovery a place to support each other.
A few years into his own recovery, in 2015, Sorensen founded Transitional Recovery in Minnesota (TRIM), which now runs two houses catering to queer people working through addiction. Sorensen works with local outpatient programs, including Pride Institute, which helps subsidize housing costs for patients so that 90 percent of TRIM’s residents have financial support to make the rent accessible.
“When someone comes into the house, they are 100 percent made to feel like they’re at home,” Sorensen said of TRIM, a model of affirmative support that Sorensen experienced at Pride Institute. “Whether a gay man or a transgender woman who walks through those doors, we all have a very unique set of experiences, but we go through similar things being a minority within our society.”
Though LGBTQ+ people face a variety of challenges based on other aspects of identity and social determinants of health, a sense of solidarity continues to be important in pushing for better health outcomes across the board. “We want everybody to survive, thrive, and prosper,” Gonsalves said, “and LGBTQ+ people need to think of activism as a component of fighting for their health and safety.”
Early activism during the AIDS epidemic continues to be the prime example. Gonsalves pointed to the recent Mpox outbreak and the queer community’s response as proof of how effective collective action continues to be, often in the face of a flawed institutional response.
“LGBTQ+ communities were essential over the past year in slowing down and putting the brakes on the epidemic,” Gonsalves said, noting the pressure placed on government leaders for accelerated vaccine access and the spontaneous reduction of sexual activity that slowed the spread. Unequal risk and access, based on factors like race and class, persisted, and policy-level change is necessary to protect the well-being of the queer community.
In the meantime, LGBTQ+ people continue to lead the charge, taking on disparities the community faces in the medical system and revolutionizing how we care for ourselves and each other.
On Tuesday, February 21, 2023, the LGBT National Help Center will officially launched its newest program, the LGBT National Coming Out Support Hotline. The brand-new hotline focuses specifically on the concerns of those who are struggling with coming out issues (regardless of age, or how each person defines that process). All services are free and confidential. Staffed by all LGBTQIA+ volunteers, the dedicated toll-free phone number is 1-888-OUT-LGBT (1-888-688-5428), with a dedicated website at www.LGBTcomingOUT.org.
The new hotline is a program of the LGBT National Help Center, a non-profit organization with a 26-year history of providing coming out services. The LGBT National Coming Out Hotline provides a concentrated, focused and clear way of communicating that coming out, either to one’s self or to others, can be a deeply personal decision, but that it doesn’t mean having to go it alone. While the hotline would never tell a person they MUST come out (as that is a highly personalized decision), the highly-trained, all LGBTQIA+ peer-support volunteers can provide a safe space on the telephone to discuss and consider a person’s physical and mental safety, as well as their options and how they might choose to move forward. Certainly, not every conversation will end with a decision on coming out or not, and that’s to be expected. What matters is that this will provide a safe space for the LGBTQ community to go to when they are considering this decision, and know that they will be heard, affirmed and respected.
“When people in our community are considering one of the most important decisions of their lives, together we can provide critical support and care to those in the LGBTQIA+ community, who are terrified to simply be themselves,” said Executive Director Aaron Almanza.
For more information about the LGBT National Help Center, please visit www.LGBThotline.org.