Have you ever read a short story that could be a book? The hook in the first line is compelling, immediately drawing you in. The characters are fleshed out and well-written within their limited storylines. The plot is unexpected and keeps you guessing, unsure how it could wrap up in the few remaining pages. It’s so finely done that it could go on for a couple hundred more pages, and you would still be satisfied.
That is how every story left me in Ryan Vance’s debut collection, One Man’s Trash.
The uncanny defines these short stories. Each story provides a gripping, disconcerting narrative. From a teenager with an innate power that makes everyone hand all of their belongings over to him, to a seemingly post-apocalyptic world where housemates have to supply a large hermit crab with cowry shells as rent, this collection has a compendium of fantastical short stories that are unsettling and incredibly queer.
Vance has the ability to write about the “odd” in a manner that is simultaneously unnerving, mystifying, and immersive. Generally, short stories do not give a lot of time for the reader to become adjusted to the world of the tale. With fantastical realms, such as Vance’s, this is all the more difficult. Yet, in One Man’s Trash, you cannot help but become immersed in the outlandish domain the author has created.
Take “When All We’ve Lost is Found Again,” where Rob, the story’s neurotic protagonist, copes with recently being ghosted by his longtime boyfriend by obsessing over a newly discovered area in space, where lost items mysteriously turn up. Rob’s infatuation with what has been labeled “Lost Space” slowly takes his boyfriend’s place within his life. As Rob’s boyfriend increasingly distances himself from their relationship, Rob spends more time cataloging the random items floating in space. This is until Rob stumbles upon a cephalopod creature that seems to have slightly moved every time he looks at it. By the end of the story, Rob has let all of his material items go. He leaves them outside his house to either end up in someone else’s home, or in Lost Space, handed over to the cephalopod.
Throughout the story, Vance maintains an eerie yet conversational tone. Rob’s passiveness about everything occurring in his life leads you to just accept it, despite the abnormalities. It is easy to understand how Rob can be so utterly fascinated by the cephalopod because you, as the reader, are itching to know more about it; the reader’s experience parallels Rob’s in this way. Stuck at the same level of comprehension as Rob and learning about Lost Space at the same pace as him, you’re limited to a certain level of understanding. The reader is being kept at a distance from total insight, heightening the disturbing presence of the cephalopod, and rationalizing Rob’s infatuation.
In “Dead Skin” the protagonist, Bruce, keeps the reader at a distance and incapable of knowing every detail. After a complete body transplant in which his head was connected to a new body, Bruce is prohibited from sharing any information regarding the surgery, and thus closes himself off to all people, including the reader, who is treated with the same apprehensiveness. Naturally, Bruce is not comfortable in this new body. Everyone knows who he is, being labeled “The Modern Frankenstein” at the center of documentaries and clickbait articles. Bruce essentially lives his life in isolation, refusing to allow anyone to get close to him. He even works as a bouncer for an LGBT nightclub, literally standing guard in all aspects of his life. Bruce wants to be alone until he meets Gale (using ne/nir/nem pronouns) at the gym.
Gale is an awkward stagehand at a local theater. Ne celebrates nir year anniversary on T and dons costumes from the theater for a date with Bruce. Gale does not understand Bruce’s reluctance to share himself, and Bruce thinks ne is only observing him like “a specimen,” because that’s what everyone else does. Still, Bruce slowly opens himself up to Gale by showing Gale track marks from his procedure and even attempting to dance with nir. When Bruce claims he was “‘not made for dancing,’” Gale comforts him, saying that “‘nobody’s made for anything,’” reminding Bruce of his humanity despite how unnatural he feels.
The nature of humanity is reflected in Vance’s stories. In many of the stories, humans are capable of persevering, despite being physically altered, or living in a world that has changed drastically. We learn Bruce had the transplant procedure performed as a solution to some unspoken terminal illness. Despite the public eye treating Bruce as nothing more than a bizarre experiment, Bruce continues to live his life, albeit a lonely one. Even before Gale, Bruce recognizes he was not ready to die, and if the price to continue living was to have the surgery, he was ready to pay it. Bruce’s nature to persevere and live is relatable and undeniably human, no matter how unusual his situation is.
If you are a fan of the weird fiction genre (think Octavia Butler, Neil Gaiman, or Stephen King), One Man’s Trash is for you. Vance’s debut is a dynamic piece of speculative fiction that artfully jumps from science fiction, telling a tale in which all straight people inexplicably die, to fantasy, with a story in which a Minotaur living in present-day sells ice cream to kids at a skatepark, and even a horror story about a man who creates a rat king out of vengeance. Do not let these peculiar plots scare you away. Underneath the uncanny, Vance’s true understanding of humanity is revealed, through strange situations that ultimately make each story within One Man’s Trash addicting and compelling.
A Virginia school district will pay more than $1.3 million in legal fees to resolve the case of Gavin Grimm, former high school student who challenged its bathroom policy.
The American Civil Liberties Union on Thursday announced in a press release the Gloucester County School Board in a court filing said it would not challenge Grimm’s request to pay the fees and other costs associated with his case.
Grimm was a sophomore at Gloucester County High School in 2015 when he filed a federal lawsuit against the Gloucester County School District’s policy that prohibited students from using bathrooms and locker rooms that did not correspond with their “biological gender.”
Lower courts ruled the policy violated Title IX of the Education Amendments of 1972. The U.S. Supreme Court in June declined to consider the case.
“Rather than allow a child equal access to a safe school environment, the Gloucester School Board decided to fight this child for five years in a costly legal battle that they lost,” said Grimm in the ACLU press release. “I hope that this outcome sends a strong message to other school systems, that discrimination is an expensive losing battle.”
The report, “The State of HIV Stigma 2021,” found that less than half (48 percent) of American adults say they feel knowledgeable about HIV, down from 51 percent last year.
According to the study, which was published by the LGBTQ advocacy group GLAAD and the Southern AIDS Coalition, 64 percent of adults said they’re aware that there are medications that protect against HIV, but only 42 percent knew that someone properly following an antiretroviral drug regimen can’t transmit the virus.
“Fear comes from a lack of knowing. A lack of information drives the stigma, which feeds the feeling you have to hide. It’s a vicious cycle.”
DAFINA WARD, SOUTHERN AIDS COALITION
Gilead Sciences, which funded the study, makes HIV medications like Biktarvy and Atripla and the HIV prevention pills Truvada and Descovy.
Half of respondents (50 percent) said they’d feel uncomfortable with a HIV-positive medical professional, 42 percent were uncomfortable with a hair stylist or a barber living with the virus, and a third (34 percent) said they were uncomfortable with an HIV-positive teacher.
There were some notable differences between LGBTQ and non-LGBTQ respondents: Fifty percent of straight, cisgender respondents said they wouldn’t be comfortable with a partner or spouse with HIV, for example, compared to 38 percent of lesbian, gay, bisexual, transgender and queer respondents.
“There’s a correlation there,” Southern AIDS Coalition Executive Director Dafina Ward said. “Fear comes from a lack of knowing. A lack of information drives the stigma, which feeds the feeling you have to hide. It’s a vicious cycle. People are so afraid of being found out they defer treatment.”
More than 500,000 people live with HIV in the South, according to the coalition, but the region falls behind in quality HIV care and prevention services. Sex education in the South also tends to be abstinence-only, Ward added, “so vital conversations aren’t happening” and students aren’t given comprehensive information about preventing HIV/AIDS.
According to Planned Parenthood, seven Southern states either prohibit sex educators from discussing or answering questions about LGBTQ identities and relationships “or actually require sex educators to frame LGBTQ identities and relationships negatively.” Such laws further stigmatize LGBTQ youths and leave them without the information they need to protect their sexual health, the reproductive health services organization said, putting them at greater risk for sexually transmitted diseases.
Some issues fueling HIV misinformation, like inadequate sex education, have existed since the dawn of the AIDS crisis, Ward said, but new hurdles have emerged in recent years.
“We’ve had so much advancement in treatment and people living longer, healthier lives that we’ve lost the sense of urgency,” she said. “There’s a new generation that’s not hearing about HIV — not in the media, not in schools and not from the government.”
And when they do hear about it, the message is often warped: Hip-hop star DaBaby came under criticism last month for telling fans at the Rolling Loud music festival in Miami to shine their smartphone flashlights if they “didn’t show up today with HIV/AIDS, any of them deadly sexually transmitted diseases that will make you die in two to three weeks,” and made other disparaging remarks about gay men in a viral video.
“Stories and voices of people living with HIV are not prioritized regularly to humanize the epidemic, reduce stigma around it, and illustrate how HIV is preventable.”
SARAH KATE ELLIS, GLAAD
A November 2019 survey from the pharmaceutical company Merck and the Prevention Access Campaign underscored how pervasive stigma and misinformation around HIV are among younger Americans.
More than a quarter (28 percent) of HIV-negative millennials (ages 25 to 36 at the time) said they had avoided hugging, talking to or being friends with someone with the virus, and 30 percent said they’d prefer not to interact socially at all with people with HIV.
Researchers also found that 23 percent of HIV-negative millennials admitted that they were either “not at all” or “only somewhat” informed about the virus. For HIV-negative members of Generation Z (ages 18 to 22), the figure leaped to 41 percent.
Nearly half of all HIV-negative young adults in the 2019 survey believed the virus could be transmitted by someone whose viral load is undetectable, even though the CDC has confirmed that there’s “effectively no risk” of infection if someone’s viral load is undetectable.
“Stories and voices of people living with HIV are not prioritized regularly to humanize the epidemic, reduce stigma around it, and illustrate how HIV is preventable,” GLAAD President Sarah Kate Ellis said in a statement about “The State of HIV Stigma” study. “Their stories must be told to show how people with HIV lead long and healthy lives, and cannot sexually transmit HIV when on proper treatment.”
J. Maurice McCants-Pearsall, director of HIV and health equity at the Human Rights Campaign, an LGBTQ advocacy group, said the report “confirms that HIV stigma permeates throughout our entire society.”
“And as long as HIV is stigmatized, the more it will continue to devastate multiple marginalized communities,” he added.
Last week, the Human Rights Campaign launched the first national in-home HIV testing program, also supported by Gilead Sciences. Partnering with the health equity nonprofit Us Helping Us, the organization has pledged to ship at least 5,000 free at-home HIV testing kits over the next year, focusing on marginalized communities disproportionately affected by the virus, including Black and Latino men who have sex with men, as well as bisexual and transgender women of color.
The kits include an OraQuick oral swab, as well as condoms, lubricants, a card with testing information and a referral to providers of pre-exposure prophylaxis, or PrEP, in their area.
“These in-home self-testing kits empower people to learn their status and take control of their sexual health in the privacy of their own home, helping reduce HIV stigma and fear,” McCants-Pearsall said.
Ending the epidemic
President Joe Biden has made bold promises about fighting HIV/AIDS, starting with a campaign commitment to end the epidemic by 2025, five years earlier than President Donald Trump’s stated goal.
“Updating the nation’s comprehensive HIV/AIDS strategy will aggressively reduce new HIV cases, while increasing access to treatment and eliminating inequitable access to services and supports,” Biden wrote in a 20-page candidate HIV questionnaire submitted by a coalition of AIDS organizations.
The White House requested $670 million from Congress this year to end HIV/AIDs, an increase of more than $267 million from previous budgets. He has also pushed to expand the use of HIV-prevention medication and ensure access to HIV services by minorities.
But ending the stigma surrounding HIV/AIDS will take more than money, said DaShawn Usher, GLAAD’s associate director for communities of color.
“We have to think critically and intentionally about how we truly equip and engage everyday Americans with the facts, resources, and scientific advancements about HIV,” Usher said in a statement. “We must hold the media accountable to the 1.2 million Americans living with HIV who are not seen, represented, or discussed. Their stories matter and are beyond worthy of being told.”
An appellate court deciding Hobby Lobby violated Illinois anti-discrimination law by denying a transgender employee access to the women’s restroom could have nationwide implications, experts say.
Meggan Sommerville, a trans woman who has worked at a Hobby Lobby location in Aurora for more than 20 years, has been denied access to the store’s women’s room since transitioning at work in 2010. As a result, she has had anxiety and recurring nightmares and has been forced to limit her fluid intake, according to filings.
On Friday, the Illinois 2nd District Appellate Court upheld a lower court decision that determined the crafts chain violated the Illinois Human Rights Act both as an employer and as a place of public accommodation.
“Sommerville is female, just like the women who are permitted to use the women’s bathroom,” the three-judge panel said in its decision. “The only reason that Sommerville is barred from using the women’s bathroom is that she is a transgender woman.”
The ruling is one of first impression, meaning it presents a legal issue that has never been decided in the court’s jurisdiction.
“They stuck to the law,” Sommerville, 51, told Forbes. “This is a precedent-setting case in Illinois, because the Human Rights Act has never been tested in this way in Illinois, and actually in the country.”
Jim Bennett, director of the Illinois Department of Human Rights, said the decision underscored that trans people in the state “have strong protection from discrimination.”
“Ms. Sommerville’s experience of discrimination is certainly not unique, as too many of our transgender friends and neighbors continue to face acts of discrimination and hate,” Bennett said in a statement. “With this decision, the IDHR has been given a clear path to enforce the Commission’s orders concerning the rights of trans persons.”
Jacob Meister, who represented Sommerville, went further, telling Bloomberg Law the decision had national implications and will “start the process of courts around the country addressing the issue of bathroom access.”
Camilla Taylor, litigation director for the LGBTQ legal advocacy group Lambda Legal, agrees the ruling could have a broad impact in a variety of areas and jurisdictions.
“I think other states will generally be able cite this ruling, because of how sweeping it is,” Taylor said. “This is not limited to employment. This is the public policy of the state of Illinois. The court went out of its way to knock down every justification for treating trans people differently in public. It made it clear there’s no justification.”
While the Supreme Court’s 2020 decision in Bostock v. Clayton County, Georgia, determined discrimination based on sex includes sexual orientation and gender identity, it didn’t address access to sex-segregated facilities, services or sports teams.
“You can’t argue it’s not sex discrimination to deny someone access to a bathroom or a locker room,” Taylor said.
Not only could the ruling be used by opponents of so-called bathroom bills, she added, it could be relevant to the legal fight against legislation prohibiting transgender girls from playing on female sports teams.
“It will have big ramifications in all kinds of aspects of life — in education, in business, in gyms and sports,” Taylor said. “It’s indicative of applying nondiscrimination principles to sex-segregated areas. It makes clear that gender identity determines sex.”
Hobby Lobby could appeal the ruling to the Illinois Supreme Court and theoretically take it all the way to the U.S. Supreme Court. Attorney Whitman Brisky, who represented the company, did not immediately reply to a request for comment.
The 2021 legislative session has set a record for anti-transgender bills, according the Human Rights Campaign, an LGBTQ advocacy group: Nearly 70 measures were introduced in at least 30 states that would prohibit trans youth from participating in sports consistent with their gender identity, and at least 15 bills were introduced that would bar trans people from accessing the restrooms or locker rooms that align with their gender identity.
The judicial branch, however, has been more supportive: In addition to Bostock, the Supreme Court in June declined to review a 4th U.S. Circuit Court of Appeals decision that ruled transgender student Gavin Grimm had a constitutional right to use the boys’ restroom at his Virginia school.
The lower court ruled that policies barring transgender students from restrooms that match their gender identity violate the equal protection clause of the 14th Amendment and Title IX of the Education Amendments of 1972.
Yorje Pérez Moreno traveled thousands of miles from Venezuela to reach Nuevo Laredo, Mexico, leaving his family, friends and studies, as he fled the violence of state security forces who allegedly persecuted him for participating in anti-government protests.
“My dream was to finish college, but they wouldn’t let me. They beat me, chased me and threatened to imprison me, that’s why I had to leave,” Pérez Moreno, 23, said.
He said that in early August, when he was finally a few miles from the U.S. border, he took a taxi with a friend who accompanied him to request asylum at the border. “You’re not from here. You are Venezuelan and you come to ask for asylum, right?” he said the driver asked, without giving him time to ask for help, locked the car doors and began to drive around the city while making calls to other people and asking for money.
Pérez Moreno said he and his friend panicked and paid more than $600 to be released from the car to avoid being taken and confined to “safe houses” where drug cartels hold people they kidnap at the border. After being extorted, he said, he changed hotels to avoid being found by others looking to exploit migrants.
The next day he crossed the border bridge to request asylum. He said that despite explaining what he suffered, he was returned to Mexico by U.S. immigration authorities. “We live in fear because it is a very corrupt area. All the people tell you that the cartels impose the rules, the narco is the law,” Pérez Moreno said with dismay.
In a new report, the Washington-based organization Human Rights First has registered 6,356 violent attacks against migrants in Mexico since January. These include rape, kidnapping, extortion, human trafficking and other assaults against migrants who were deported to Mexico or people who were prevented from seeking asylum at the U.S. border under Title 42, a health ordinance implemented during the coronavirus pandemic.
An Indigenous man from Honduras reported that he was kidnapped and separated from his 5-year-old son after being expelled to Reynosa, Mexico. A Salvadoran woman and her 7-year-old son were also allegedly kidnapped in Reynosa. A Guatemalan migrant was allegedly raped in Ciudad Juárez, after U.S. authorities returned her to that city with her 5-year-old daughter.
“Since most people do not make complaints to the authorities, we believe that this is a minimal figure of what is happening at the border,” Ana Ortega Villegas, a lawyer and researcher at Human Rights First, said in an interview with Noticias Telemundo.
The report warns that almost 83 percent of asylum-seekers who were returned to Mexico reported having suffered attacks or threats in the last month, according to data from the survey conducted from mid-June to mid-August.
The document is based on interviews with asylum-seekers, surveys applied to migrants, press reports and information provided by lawyers and humanitarian aid groups.
The Mexican interior ministry and Mexico’s National Institute of Immigration did not respond to requests for comment on the report.
According to the researchers, the extensive control exercised by the cartels in vast swaths of the territory and the complicity of the Mexican authorities are evidence that U.S. policies that force asylum-seekers to wait in Mexico or require an initial exemption or other processing there country put migrants, lawyers and humanitarian groups at risk.
In the last two months, Human Rights First helped 69 migrants in Tijuana, in the Mexican state of Baja California, and Piedras Negras, in the state of Coahuila, to apply for humanitarian visas. Sixty-two percent of them reported having been kidnapped in Mexico, and almost 19 percent said they had suffered sexual assaults in those Mexican cities.
Most LGBTQ migrants attacked or threatened
Research data reveals that 89 percent of people from the LGBTQ community who participated in the surveys were attacked or received threats recently.
A Honduran woman, a member of the LGBTQ community, told investigators that she was raped and assaulted in Ciudad Acuña, a Mexican town on the border with Del Rio, Texas. “She had a broken arm, and many bruises on her face and stomach. Something that moved us a lot was that she told us that she never imagined that the violence and discrimination from which she had been fleeing would accompany her to the border,” Ortega said.
In each section of the investigation, there are many complaints from migrants who were alleged victims of cartels and other criminal groups in Mexican cities. In addition, the researchers warn about the increase in the number of people living in makeshift camps in cities such as Tijuana, Matamoros and Reynosa, where a camp in the central square of the city houses thousands of migrants.
At the end of June, the organization published a report in which it registered 3,300 violent incidents, so the new figure shows a 95 percent increase in these attacks.
Eunice Rendón, an academic and international consultant on migration issues, who did not participate in the research, agrees with the report’s findings. She has seen the effects of migrant returns closely because she studies the flow of people in regions such as Ciudad Juárez.
Aside from the violence many migrants experience, what is being experienced in the shelters in Ciudad Juárez is that close to 20 percent of migrants who are being returned to Mexico after they’ve sought asylum or tried to enter the U.S. are infected with Covid-19, she said.
This decision means that U.S. authorities will have to resume the practice of returning asylum-seekers at the border to Mexico, while they wait for their cases to be processed in American immigration courts.
President Joe Biden suspended the Migrant Protection Protocols (the formal name of the program) during his first day in office, and the Department of Homeland Security assured that it would finalize it in June, according to court documents.
Recently, more than 70 organizations from Mexico and the U.S. signed an open letter asking Mexican President Andrés Manuel López Obrador to oppose the reinstatement of that program.
It is estimated that more than 70,000 migrants — mostly Central Americans, but also Cubans, Venezuelans and other nationalities — were returned to Mexico by the Trump administration during the implementation of this program in 2019.
“Like the Title 42 expulsion policy, the ‘Remain in Mexico’ program … cannot be carried out legally or humanely and will only increase the danger to those seeking safety in the United States. That will lead to more kidnappings, assaults, torture and other violent attacks,” said Kennji Kizuka, associate director of research and analysis at Human Rights First.
“I want to live in a place where I don’t feel like my life is in danger. Meanwhile, I have to endure and be patient,” Pérez Moreno said in a shelter in Nuevo Laredo.
A Moscow man was abducted and taken to Chechnya where he was interrogated for information on LGBT+ activists, the Russian LGBT Network reports.
On Wednesday (25 August), the group said that a Dagestan native named Ibragim Selimkhanov was approached by four Chechen-speaking men near a subway station in the city’s Novogireyevo District on 15 May.
The men, who were wearing civilian clothes, forced him into a car and took his passport, phone and apartment keys. He was driven to the airport and ordered onto a plane which took him to the Chechen capital of Grozny.
On arrival he was handed over to the local police, who reportedly threatened and exerted psychological pressure on him while seeking the information about the emergency assistance programme run by the Russian LGBT Network, Radio Free Europe said.
The group provides a vital lifeline to the LGBT+ community in the North Caucasus, a region notorious for persecuting queer people as part of a horrifying “gay purge”.
Chechen officials deny that any LGBT+ people exist there, let alone a gay purge; however, their claims are countered by dozens of harrowing reportsfrom refugees who have been imprisoned, beaten, tortured and seen others killed in gay concentration camps.
After a few days in custody Selimkhanov was freed by his captors and taken to his mother, who lives in Grozy.
He remained under permanent surveillance by Chechen authorities but managed to quietly leave the house and escape to Moscow, where he filed a complaint with police.
According to the Caucasian Knot, a news outlet that covers the Caucasus region, the Investigating Committee of the Russian Federation refused to investigate his complaint.
A similar ordeal was reported in May this year when officials detained and interrogated the family of two gay brothers who fled the region.
20 of the brothers’ relatives were held in the village of Komsomolskoye in the Urus-Martan district of Chechnya and were interrogated for hours about the whereabouts of the men and their parents, according to local media reports.
As the nation battles new variants of the Covid-19 virus, LGBTQ Americans have felt the economic brunt of the pandemic harder than the general public, according to a new report from the U.S. Census Bureau.
It found 19.8 percent of lesbian, gay, bisexual and transgender adults lived in a household where there was a loss of income in the past month, compared to 16.8 percent of non-LGBTQ adults.
Economic disparities between LGBTQ and non-LGBTQ people existed long before the pandemic, says M. V. Lee Badgett, a professor of economics at the University of Massachusetts Amherst, but have grown more pronounced.
A report from the Center for LGBTQ Economic Advancement and Research, for example, indicated that, in 2019, nearly 1 in 5 (19.8 percent) LGBTQ households were unsure they could pay their bills that month, compared to 14 percent of non-LGBTQ households.
But according to the new data, collected from 64,562 households between July 21 and Aug. 2, more than a third (36.6 percent) of LGBTQ people had difficulty paying household bills in the last week, compared to roughly a quarter (26.1 percent) of cisgender heterosexuals.
That growing inequality is evident in other areas, too: Food securityis a reference to the ability to access sufficient, safe and nutritious meals that meet dietary preferences and needs for an active and healthy life.
According to the census survey, LGBTQ households are now nearly twice as likely to experience food insecurity as heterosexual families, 13.1 percent to 7.2 percent.
Williams Institute data from 2014 suggests the difference was much smaller then, with 18 percent of lesbian, gay and bisexual adults reporting that they or someone in their family went without food for an entire day in the past month. That’s compared to 14 percent of all people who were food insecure, according to U.S.Department of Agriculture figures for that year.
“If we’re starting out on unequal footing, it’s just going to get worse with a pandemic. It’s going to reach into economically vulnerable populations and hit them harder,” said Badgett, author of “The Economic Case for LGBT Equality.” “And groups with health disparities, like LGBTQ people, are also going to be hit worse.”
In a statement, Jay Brown, senior vice president for programs, research and training at the Human Rights Campaign, the nation’s largest LGBTQ advocacy group, said the Census Bureau’s findings “highlight what we have long known — LGBTQ+ Americans disproportionately bear the brunt of economic hardships, from food insecurity to unemployment.”
The group’s research shows that, during the current crisis, LGBTQ people, especially queer people of color, are consistently more likely than the general population to have their work hours cut or to face unemployment.
In part, that’s because LGBTQ people are more likely to be employed in the food service industry, hospitals, retail and education: According to a 2020 HRC Foundation brief, 40 percent work in those industries, all significantly impacted by shutdowns and more likely to expose workers to the virus.
There are other factors, including that the LGBTQ population tends to be younger and is less likely to have robust support systems than their cisgender heterosexual counterparts. But Badgett said “we don’t have great data” yet to determine how much of an impact those factors might have.
Badgett underscores the Census Bureau finally incorporating sexual orientation and gender identity on an economic survey is a positive sign.
“Mostly they just appear in health surveys,” she said. “Going forward, this indicates we’ll get richer data on LGBTQ economics.”
The important thing is to ensure assistance programs are available to help everyone, Badgett said, “that LGBTQ people can access [Supplemental Nutrition Assistance Programs] and food banks, and that service providers are fully inclusive and not turning them away, either intentionally or accidentally.”
For three years, Jesse Brace avoided getting care for their seizures after they experienced discrimination at an emergency room near their home in Lawrence, Kansas, in 2017.
They said they told the staff that they are transgender and nonbinary, that their name is different from their legal name and that they use gender-neutral pronouns.
“They refused to even so much as acknowledge this information, and not only did they not use [my pronouns], but they also sent me home without treating me for what I went in for,” said Brace, 25.
When they tried to get care elsewhere after that, they said, they had similar experiences, so they avoided care entirely.
In 2018, they began having seizures every day, so they started living in their car outside the Amazon facility where they were an assistant operations manager, because they couldn’t drive themself to work anymore.
In November 2018, they lost their job. “I lost my car soon after and ended up on the streets in the winter,” they said. “I was having hundreds [of seizures] a day and wasn’t even leaving where I was laying.”
They were homeless, living out of their car or on the streets, for over three years.
Brace’s experience in the ER — and the impact that health care discrimination had on their life — is something many trans people face and fear when they try to get care, according to a report released Wednesday by the Center for American Progress, or CAP, a liberal think tank.
Discrimination, among other factors, prevents trans people from seeking necessary care, which leads to health disparities that can affect many other areas of their lives, the report found.
The authors outline a road map of solutions, including legislative protections for LGBTQ people and better competency training for medical providers.
“The onus should not be on individuals,” said one of the report’s authors, Sharita Gruberg, vice president of the center’s LGBTQ Research and Communications Project. “It really should be on these institutions to do the right thing, and the resources and guidance is out there.”
Forgoing routine care after trauma
CAP’s report found that nearly half of transgender people — and 68 percent of transgender people of color — reported having experienced mistreatment at the hands of a medical provider, including refusal of care and verbal or physical abuse, in the year before the survey, which took place in June 2020.
Discrimination can then prevent people from seeking future care, the survey found: 28 percent of transgender people, including 22 percent of transgender people of color, reported having postponed or not gotten necessary medical care for fear of discrimination.
Brace got another job in May 2019, but they said they weren’t able to get consistent care again until May of this year. They said doctors in the area repeatedly told them that they were unable to take on new patients. It wasn’t until Brace was referred to a doctor who has a transgender child that they were finally able to obtain a primary care physician.
“I get panic attacks just making appointments,” they said. “I have no support whatsoever. Unfortunately, all health care around here is like this. There is no support for trans people, and so most avoid seeking care.”
Dallas Ducar, a psychiatric nurse practitioner, opened Transhealth Northampton, a trans-led organization that provides health care to trans and gender diverse patients in western Massachusetts, in May. Ducar said that as a health care provider and a trans woman, she knows there’s a dearth of affirming care for trans people across the country.
She said many of Transhealth’s patients have gone without medical care for long periods of time. A patient who came in a couple of months ago had abnormal vital signs and had to be quickly taken to an emergency room because they were so sick, she added.
“It’s unfortunately not uncommon to see people who have experienced such high levels of discrimination and then forgo the routine visits, then perhaps even forgo an urgent care visit, which then turns into an emergency care visit,” she said.
The CAP report said harassment and discrimination “contribute to high rates of stress,” and — along with social determinants of health — make trans people “more likely to experience poor health outcomes.”
People will read about health disparities among trans people “and just think of that as something that, horribly, is associated with just like being trans, but actually a lot of these experiences have to do with being trans in a world that is constantly oppressing you and where you’re experiencing discrimination both interpersonally but also institutionally and in these broader systems,” said one of the report’s authors, Caroline Medina, a policy analyst at CAP.
The report cites the 2019 Behavioral Risk Factor Surveillance System data collected by the Centers for Disease Control and Prevention, which found that trans people were more than twice as likely as cisgender adults to be told they had depressive disorders.
Fifty-four percent also reported poor physical health at least one day in the previous month, compared to 36 percent of cisgender respondents, according to the CDC data. Trans people also have an increased likelihood of having asthma and developing cardiovascular disease, according to the CAP report.
The Covid-19 pandemic has also aggravated the health disparities trans people face: 1 in 3 reported having had suicidal thoughts during the pandemic, and 1 in 2 reported that their access to gender-affirming health care was curtailed significantly during the pandemic.
Ducar said barriers to care, particularly gender-affirming care like hormones, is “really, really harmful, and they add to the layers of discrimination that exists within the trans community.”
“On the mental health side, we are seeing folks with really complex issues — tons and tons of trauma — that’s coming to our doorstep,” she said. “We’re just seeing a lot of not only trauma, but complex PTSD specifically. These are people that have just been consistently burdened with the symptoms of PTSD, trauma just recurring. It’s really been terrible.”
A lack of cultural competency
When trans people do try to seek health care, they can face discrimination or outright refusal of care, as CAP found. But even when they don’t experience discrimination, they are likely to see providers who don’t have the cultural competency to provide them with affirming care.
CAP’s survey last year found that 1 in 3 transgender people reported having had to teach their doctors about transgender people to get appropriate care, and 15 percent reported having been asked “invasive or unnecessary questions about being transgender” not related to their reasons for visiting.
The report cited a 2018 brief from the Kaiser Family Foundation that found that more than half of medical school curriculums lack information about unique health issues the LGBTQ community faces and don’t cover treatment beyond HIV prevention and care, “likely contributing to transgender people’s inability to access affirming care,” CAP wrote.
Alex Petrovnia, 24, a writer and scientific researcher living in central Pennsylvania, said that last fall, he had to report a primary care physician after a negative experience.
He was worried about how testosterone would affect a joint problem he was having, and he asked the doctor, who was still a medical resident, whether there was a form of physical therapy to help the problem. After a tense exchange, he said, the doctor told him, “I don’t know anything about this, because I’ve never had a patient like you.”
“I was trying to keep this interaction peaceable, and I replied with: ‘Yeah, I know. It’s really unfortunate that you’re not taught anything about trans people in medical school, and it’s just not a very well-known issue,’” he said. “And she looked me right in the eyes and she said: ‘I don’t think it’s that important. There aren’t many of you.’”
When he left, he tweeted about the visit so other trans people in the area would know not to see that doctor.
The medical practice reached out to him a few days later and asked what it could do better, Petrovnia said. When he returned to see a new, supportive primary care physician, “they told me that they sent the resident back to trans-inclusivity training and that they had instituted that for all of their residents going forward,” he said. “So that was very positive. … Being the squeaky wheel really actually made an impact and actually improved the situation theoretically for others.”
Petrovnia acknowledged that not everyone is able or willing to spark such teachable moments.
Mel Groves, 25, visited a primary care office in Montgomery, Alabama, in January when he had a cough, fever and lower body pains. When he was taken back for a full-body CT scan, he said, he had a decent conversation with the attendant who was pushing his chair. Groves said that when the procedure was over, however, the attendant’s tone changed. The attendant had apparently seen Groves’ chart and made a comment about his genitals, Groves said.
“I was taken aback,” he said. “It was shocking, to say the least.”
Groves said that he wanted to report it but that he was feeling too ill and overwhelmed, as he was working in the area temporarily. “I knew that that’s what I should have done, but at the time, I had a lot of stuff going on,” he said.
The health care system that oversees the primary care office where Groves was treated could not confirm his story, citing patient confidentiality.
‘The role falls on society’
CAP’s report outlines a number of policy recommendations that the authors said would help address health care discrimination against trans people.
One in particular is among the most pressing, the authors said: They recommend that the federal government create a rule to strengthen Section 1557 of the Affordable Care Act, which prohibits discrimination on the basis of sex and has protected trans people from discrimination in federally funded health care facilities.
“The protections in Section 1557 are so critical but are also a floor that we need to firmly establish and strengthen,” said Gruberg of CAP. She said it was great that the Department of Health and Human Services’ Office of Civil Rights had announced that it would enforceSection 1557 to cover sexual orientation and gender identity, “but we’re also very worried about what that looks like, how strong these protections are going to be and the potential for religious exemptions to undermine them.”
U.S. District Judge Reed O’Connor issued a permanent injunction last week against the nondiscrimination protections in the Affordable Care Act, ruling in favor of religious health care providers who said the rules would force them to perform abortions or provide gender-affirming treatment against their religious beliefs. While Gruberg expects the decision to be overturned, she said “that threat is still there.”
The report’s authors also recommended that Congress and state and local governments increase funding for LGBTQ community health centers, which often fill the health care gaps that trans people face.
Groves was connected with an affirming primary care physician through the Knights and Orchids Society, a grassroots organization in Selma, Alabama, led by Black trans people. He drives about 4½ hours from his home in Jackson, Mississippi, to Auburn, Alabama, when he needs care.
Although groups like the Knights and Orchids Society have provided what Groves described as “life-changing” support, he said it’s ultimately up to the medical system and society to address pervasive issues like discrimination.
“We’ve always been here,” he said. “So I think that now the role falls on society and the medical professionals to educate themselves more. If that means more fellowships, more trainings, more professional development … I feel like that is single-handedly the best thing that we can do to foster better health care for trans people, is helping people to understand how to be inclusive, and then going forward from there.”
Vice President Kamala Harris on Thursday met with two LGBTQ rights activists in Vietnam.
Harris’ office said Chu Thanh Hà Ngoc, a transgender activist, and Đoàn Thanh Tùng, an LGBTQ advocate, participated in a “roundtable discussion with the vice president and Vietnamese social advocacy organizations” that took place at the U.S. Chief of Mission’s home in Hanoi, the Vietnamese capital.
“It is critical that if we are to take on the challenges we face that we do it in a way that is collaborative, that we must empower leaders in every sector, including of course government but community leaders, business leaders, civic society if we are to maximize the resources we collectively have,” said Harris.
Harris specifically noted the Vietnamese Health Ministry “helped craft the draft — and draft — the (country’s) transgender rights law” that took effect in 2017.
“Transgender people deserve and need equal access to healthcare services,” she said. “This is an issue that we still face in the United States, and it is an issue here in Vietnam, I know. And we will work together and support you and the work you are doing in that regard.”
Ann Marie Yastishock, the U.S. Agency for International Development’s mission director in Vietnam, moderated the roundtable.
It took place on the last day of Harris’ trip to Southeast Asia that began on Sunday in Singapore, one of the dozens of countries in which consensual same-sex sexual relations remain criminalized. The trip also coincided with growing calls for the U.S. to evacuate LGBTQ Afghans from Afghanistan after the Taliban regained control of the country.
Ted Osius, who co-founded GLIFAA, an association of LGBTQ employees of Foreign Service agencies, was the U.S. ambassador to Vietnam from 2014-2017. The late-U.S. Supreme Court Justice Ruth Bader Ginsburg in 2015 presided over the Hanoi ceremony during which Osius and his husband, Clayton Bond, renewed their wedding vows.
President Biden in February signed a memorandum that committed the U.S. to promoting LGBTQ rights abroad.
Visibles Executive Director Daniel Villatoro and Ingrid Gamboa of the Association of Garifuna Women Living with HIV/AIDS were among the members of Guatemalan civil society who participated in a roundtable with Harris in June when she was in Guatemala City. USAID Administrator Samantha Power also met with LGBTQ activists in Guatemala and El Salvador when she was in the countries at around the same time.
As young people across America prepare to return to class — some in person, some remotely — the Biden administration issued a message for transgender students.
In a joint video Thursday, Suzanne Goldberg, the acting assistant secretary of education for civil rights; Assistant Attorney General Kristen Clarke; and Dr. Rachel Levine, the assistant secretary of health and human services for health, outlined the federal government’s support for transgender students even as their community is under siege on the state level, where more than 130 anti-trans bills in 36 states have been introduced this year alone, according to the Human Rights Campaign.https://iframe.nbcnews.com/UjuZokP
In the video, Goldberg, a lesbian, discussed the concerns many students have about returning to class, from making friends to keeping up with academic demands.
“If you’re a transgender student, perhaps you’re worried about simply being accepted and safe and being treated with respect as you head into the new school year,” she said.
Clarke, the first woman to lead the Justice Department’s Civil Rights Division, praised the work by many teachers and administrators nationwide to create safe and inclusive environments for LGBTQ students.
But, she added, “we also know that’s not the reality for all transgender students, including perhaps some of you.”
“In some places, people in places of authority are putting up obstacles that would keep you from playing on the sports field, accessing the bathroom and receiving the supportive and lifesaving care you may need,” Clarke said. “We’re here to say, ‘That’s wrong — and it’s against the law.’”
In the 2020-21 legislative session, more than 75 bills were introduced that would bar trans students from playing school sports. Such measures have become law in nine states, according to the Movement Advancement Project.
“We know you are resilient,” Goldberg said, “and we hope you will find support where and when you need it. But we also want you to know the Department of Education and the entire federal government stand behind you. Your rights at school matter. You matter.”
Goldberg said trans students who faced discrimination should file complaints with the Education Department’s Office for Civil Rights, and Clarke confirmed that the Justice Department would investigate such allegations.
“We want you to know that we are looking out for you,” Clarke said. “And we’re looking out for your civil rights.”
“It is critical to support trans youth and their parents and families to help them achieve the good health and well-being that everyone deserves,” she said.
It isn’t the first time the White House has reached out to trans youths: In an executive order released on his first day in office, President Joe Biden extended federal nondiscrimination protections to LGBTQ Americans, writing, in part, “Children should be able to learn without worrying about whether they will be denied access to the restroom, the locker room, or school sports.”
In his first address to Congress in April, Biden said, “To all the transgender people at home, especially the young people, I want you to know the president has your back.”
Referring to that “unequivocal message,” Levine said she wanted transgender students to know “that I’ve got your back, too — and I’ll do everything I can to support and advocate for our community.”
Clarke cited the Justice Department’s challenges to bans on transgender girls’ competing in female sports in West Virginia and on gender-confirming treatment for minors in Arkansas, saying, “We stand behind you and are ready to act to defend your rights.”
Rodrigo Heng-Lehtinen, executive director of the National Center for Transgender Equality, praised the video for “sending a strong and meaningful message to transgender students across the country — and especially in places where they have come under attack by politicians.”
“It’s so important for transgender kids to know that they are not alone and that the president of the United States has their back,” Heng-Lehtinen said. “President Biden and his administration are working to make sure transgender youth have an opportunity to be safe, to learn and to be healthy. They are incredible allies.”
Melanie Willingham-Jaggers, interim executive director of GLSEN, a LGBTQ student advocacy nonprofit group, said that she also welcomed such a “bold, affirming message” and that she wanted “further policy action to back up this commitment.”
“The administration must set a clear precedent, not only for federal agencies, but for state and local leaders, and ensure that transgender youth are safe, supported and empowered in our school communities,” Willingham-Jaggers said. “Individual educators and school leaders can step up in the meantime and make thoughtful connections with the transgender students in their schools to show them that they are valued and that they belong.”