The transgender community, which is one of the populations that has been most affected by the coronavirus pandemic, has been explicitly excluded from contingency plans that seek to prevent the virus’ spread.
Sex workers have been left to their own devices during this health crisis and they can practically only count on themselves. Due to confinement, most of them can’t go out to work, and to stop working is not a choice when they live on a day by day basis and the only housing they can afford are “pagadiarios” (places for which they pay by the day.) Some of the sex workers who can’t get enough money to pay them do not have anywhere to stay during the lockdown or, even worse, they have had to live on the streets where they are more prone to get infected with COVID-19.
Different community-based organizations like Calle 7 Colombia and Fundación Red Comunitaria Trans have created initiatives to mitigate the impact of this situation.
Red Comunitaria, for example, created an emergency fund for sex workers during the pandemic. It has given — aside from safety — economic support, food and housing to thousands of trans people. However, individual private donations alone will not be enough to benefit everyone who needs it.
That is not the only problem the trans community is facing. Many different Colombian cities, including Bogotá, from April 13 have implemented “pico y género”, a gender-based measure that allows only men to leave their homes on odd days, only women to leave their homes on even days and trans people to leave their homes on those days based on their gender identity.
Although this decision was taken as a strategy to diminish both the number of people in the streets and to mitigate the spread of COVID-19, this decree makes non-binary or gender non-conforming people and the trans community more prone to violence.
The main concern with the decree is the police become the identity definer and watchdog. Their use of violence and abuse of power has been a historic phenomenon that has served to kill many people.
As of the date of this publication, they have already been numerous physical and verbal assaults against trans and non-hegemonic gender people. These include the case of Joseph, a trans man who was denied the right to enter a supermarket because the employees thought he was not enough of a “man.”
A similar situation happened in Peru, which alongside Panama also applied this measure. The government rescinded the policy after a video posted to social media showed police officers forcing three trans women to squat while they were forced to repeat “I want to be a man.”
It is understandable that a pandemic’s reality requires the adoption of measures for controlling the spread of the virus among citizens and that some of them demand the restrictions of some fundamental rights, such as freedom of movement and association. All of this is aimed to protect public health, but these policies cannot, in any moment, infringe on nondiscrimination rights.
The Colombian government must therefore listen to the voices of the most vulnerable populations during the crisis, who have been forced to endure unfair exclusion and assume the State’s responsibilities. Countries around the world must adopt mechanisms to restrict movement without using criteria that fosters additional risks for populations that already cope with structural exclusion in society because they are constantly criminalized and persecuted.
The Trump administration is moving to scrap an Obama-era policy that protected LGBTQ patients from discrimination, alarming health experts who warn that the regulatory rollback could harm vulnerable people during a pandemic.
The health department is close to finalizing its long-developing rewrite of Obamacare’s Section 1557 provision, which barred health care discrimination based on sex and gender identity. The administration’s final rule on Thursday was circulated at the Justice Department, a step toward publicly releasing the regulation in the coming days, said two people with knowledge of the pending rule.
The White House on Friday morning also updated a regulatory dashboard to indicate that the rule was under review. Advocates fear that it would allow hospitals and health workers to more easily discriminate against patients based on their gender or sexual orientation.
Read the full article. As I’ve previously reported, this change has been long coming. Apparently the Trump administration figures they can finally push it through relatively unnoticed during the relentless pandemic news. They may be right.
The director of the U.S. Centers for Disease Control and Prevention warned that a potential second wave of the novel coronavirus could be far more fatal than the current phase of the pandemic because it may overlap with the beginning of flu season this winter.
Government leaders at all levels must use the months ahead to prepare for such a resurgence even as some states announce plans to resurrect their economies, CDC Director Robert Redfield told The Washington Post in a wide-ranging interview published Tuesday.
“There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through,” Redfield told the Post. “And when I’ve said this to others, they kind of put their head back, they don’t understand what I mean.”
The health official said the virus could be harsher in a second wave because having concurrent outbreaks of the flu and COVID-19, the disease caused by the novel coronavirus, would put immense pressure on the nation’s health care system. Both viruses cause respiratory symptoms and can require similar protective gear and medical equipment.
Redfield also said that government leaders must stress the need to continue social distancing as states lift stay-at-home orders, as well as exponentially scale up each state’s ability to identify infected residents through testing and then trace back others they’d come in contact with.
But Trump just this week dismissed bipartisan concerns about states not having adequate supplies, claiming that the U.S. was testing people “at a number nobody thought possible.”
“Not everybody believes we should do so much testing,” Trump said during Monday’s coronavirus briefing. “You don’t need so much. The reason that the Democrats and some others maybe … they want maximum because they want to be able to criticize, because it’s almost impossible to get to the maximum number, and yet we’ve been able to do it already.”
TRUMP: “Not everybody believes we should do so much testing. You don’t need so much. … Democrats and some others … want maximum because they want to be able to criticize because it’s almost impossible to get to the maximum number and yet we’ve been able to do it already.”94:44 PM – Apr 20, 2020Twitter Ads info and privacy25 people are talking about this
The White House released criteria last week for states to review how to best restore their economies in phases, including being required to first record 14 days of declining cases and to establish strong testing programs. The CDC has also created detailed guidelines for state and local governments on how to ease mitigation efforts to support a safe reopening, which Redfield told the Post will be “in the public domain shortly.”Subscribe to The Morning Email.Wake up to the day’s most important news.
Despite public demands to reopen the economy, a new set of HuffPost/YouGov polling found that the overwhelming majority of Americans support their state’s stay-at-home orders and are making a concerted effort to follow them. The most recent survey, conducted last Friday through Sunday, suggested that 86% of Americans were trying to stay home as much as possible, and about 65% said they would continue to stay home even if their area lifted all restrictions.
Part of the preparation for a potential second wave of COVID-19 includes convincing Americans to get their flu shots in the coming summer months so that public health officials can minimize the number of people hospitalized for one of the two respiratory illnesses. Redfield told the Post that getting vaccinated for the flu “may allow there to be a hospital bed available for your mother or grandmother that may get coronavirus.”
A 37-year-old non-binary person who passed away from coronavirus this week kept a heartbreaking online journal of their experience.
PJ McClelland from Florida, who died on April 11, had gained hundreds of followers as they shared their experience of having COVID-19 through daily Facebook posts.
They were originally screened for coronavirus on March 23 and sent to be tested the next day. A few days later they found out they had a positive test result. They had no underlying health conditions other than a recent diagnosis of sleep apnea.
Their update that day read: “I’m getting sicker by the day. It feels like I have a migraine, bronchitis, and the flu all at once… Don’t worry about me. I’m relatively young and healthy.
“Worry about the people I’ve been around who are EXTREMELY high risk. It breaks my heart to think I may have given this to them.”
PJ McClelland was sent home after being rushed to hospital.
They later began to develop severe chest pain and were taken to hospital by ambulance, then admitted in isolation.
McClelland wrote: “I was their first confirmed case, and I am REALLY f**king worried. NO ONE had proper PPE. They had zero N95 masks.”
However, after their oxygen levels increased to 94 per cent, they were sent home with an inhaler.
By day 10, their symptoms were still worsening, and they wrote: “I’m only sharing this because I think people need to know that not everyone has ‘minor cold symptoms for a few days’.
This is, by far, the sickest I’ve ever been. I’m writing this through tears.
On day 16, McClelland’s symptoms took an even scarier turn. They wrote: “For the last three days I’ve been coughing ridiculously often… but s**t got REAL early this morning.
“For what seemed like an eternity, but was actually a couple of hours, I coughed non-stop. Literally. I couldn’t breathe. Like barely at all. Just a gasp between coughing here and there. I was having a panic attack the entire time.
“My hands were tingling and I lost my peripheral vision. I know you’re wondering why the f**k I didn’t call 911. Idk if it was the lack of oxygen, the fever, exhaustion, or something else, but I was extremely confused/ disoriented.
“I can’t quite articulate how absolutely terrifying this ordeal was. I just wanted to breathe, and I couldn’t. It was, without a doubt, the scariest thing that has ever happened to me.”
Non-binary COVID-19 victim shared final update two days before their death.
On April 9, in what would be their final update, they said: “I can safely say this has been the longest, and some of the worst, three weeks of my life… I know I’ve said this, but it bears repeating: I’m one of the lucky ones. I’m NOT saying I’m out of the woods yet.
“I’ve seen far too many cases of people who were on the mend in the morning and died that night.”
They said they would be getting more blood tests and another chest x-ray that day, and promised to update later.
But the update never came, and McClelland passed away from coronavirus at home two days later.
Their close friend Tim Ross told Fox News: “As a close friend for many years, it was difficult to read. But I feel it was important.
“Everybody who met PJ became a friend, and it’s been evident in the outpouring of support since their passing.
After the Food and Drug Administration changed the rules for blood donations from gay and bisexual men earlier this month, coronavirus survivor Lukus Estok saw an opportunity to help other patients recover from the disease.
For years, the FDA has restricted men who have had sex with men in the preceding year from donating blood, but loosened its rules on April 2 as a way to address a sharp drop in donors during the coronavirus outbreak.
Within days, Estok tried to donate blood plasma for a test program in New York City that treats severely ill COVID-19 patients with plasma from patients who have developed antibodies and recovered from the disease. He said he was turned away after revealing he was gay.
“I was shocked,” said Estok, 36. “I’ve been through a month of hell with this virus. I’m finally recovered. I’ve been through a screening process that tells me I’m a potential candidate to help somebody else and now I’m being told I can’t.”
NBC News found that despite the rule change hundreds of the nation’s blood centers are still unable to accept blood from gay men, even though there’s a desperate need for blood at U.S. hospitals and a desire to get plasma with antibodies from COVID-19 survivors. Both the Red Cross and America’s Blood Centers, which together represent 800 banks nationwide, told NBC News they haven’t been able to accept donations.
Estok and other gay men who have tried to give blood since April 2 have been unable to do so because many blood donation centers have not yet trained staffers or updated their computer systems to accommodate the new rule. It’s also because a trade group to which nearly all U.S. blood banks belong has not yet gotten approval for an important document from the FDA.
A person stands in front of the New York Blood Center on 67th Street in New York on March 22, 2020.Cindy Ord / Getty Images file
In 1985, as a way to block the transmission of HIV, the FDA blockedall men who had had sex with other men after 1977 from donating blood. The rule was changed to sex within the past 12 months in 2015, and then to sex within the past three months on April 2.
Gay and bisexual men began showing up at blood banks to donate immediately, only to be turned away.
Estok was trying to donate his blood plasma as a part of the Mount Sinai hospital system’s blood plasma therapy program. He found out about the program through friends and knew he wanted to donate his plasma to help others who were sick.
“Having gone through a bit of a horrific experience with the virus and feeling pretty grateful to have come out the other side, I reached out to Mount Sinai,” said Estok.
After multiple screenings, Estok said Mount Sinai called him and said his blood had sufficiently high levels of the needed antibodies and that New York Blood Center would be in touch to schedule an appointment. But once he arrived at New York Blood Center, Estok was told he would be unable to donate.
“I was not expecting the reaction I got,” said Estok on when he told the staff he was gay. “It was like I was radioactive.”
In an exchange that Estok recorded on his phone, the NYBC staff explained to him that they had not yet implemented the FDA’s new guidelines and that the process was “complicated.” Estok was forced to go home without donating plasma.
“I was so upset,” said Estok. “I genuinely want to be able to contribute to help somebody and right now they’re basically putting out messages that they need blood that there’s shortage of blood. But at the end of it, they sent me home.”
An NYBC staffer denied that a potential donor would be asked if he were gay, saying the donor would instead be asked about sexual activity with another man during the past 12 months.
Brandon Gunther, 24, of Sacramento, California, had a similar experience. He attempted to donate at a local blood bank, believing he was eligible under the new guidelines, but was turned away after revealing his sexual history.
“I hadn’t had sex in the past three months so figured I was good to go,” said Gunther. “But the computer rejected my eligibility to donate and I was told ‘you have to remain abstinent from male to male sex for at least one year to be eligible to donate.'”
Gunther says the experience felt discriminatory and jarring.
Blood bank representatives told NBC News the experience has also been frustrating for them, especially since they have been pushing for relaxation of the rules for years. The blood centers can’t just flick a switch and change their rules for donation, they say — making such changes can take months.
Vials of blood from a recovered COVID-19 patient drawn at a laboratory in New York on March 30, 2020.Diana Berrent / AFP – Getty Images file
Linda Goelzer, a spokesperson for Carter BloodCare in Dallas, said “tons” of people showed up at their facilities the day after the FDA guidelines were announced, believing they were now eligible to donate. The staff were forced to turn them away.
“They were so angry with us,” said Goelzer. “People were calling and saying ‘You lied to us, you’re not following the FDA,’ and it’s so unfair. Every blood center in the country has been advocating for these changes, but we have to go through some very rigorous protocols to make these changes so that we can still keep safety in the blood supply and in the process.”
“When the FDA says the word ‘immediately’ that means something totally different in our world,” said Goelzer. “It takes about three months to implement this stuff but [the FDA] is relying on us to communicate that to the public.”
Kate Fry, CEO of America’s Blood Centers, said that the language in the FDA’s guidance was intended to mean that blood centers should immediately begin the process of implementation, recognizing that it would take some time.
“The struggle is in the public perception that it’s actually blood centers who are stalling the effort,” said Fry. “And that is just not the case at all. They are 100 percent working on it. It just takes time.”
According to Fry and confirmed by the FDA, the phrase “immediate implementation” as used in the FDA’s April 2 press release did not necessarily mean that blood centers could immediately begin collecting blood and plasma from newly eligible donors.
In a statement, an FDA spokesperson said that the agency understands that blood centers will have to undergo a lengthy implementation process and that they are willing to help blood centers if needed.
“We are hopeful that blood collectors will work expeditiously to make the changes needed to implement the modified recommendations so that they may begin collecting blood and blood products under these recommendations as quickly as possible,” said Michael Felberbaum, an FDA spokesperson. “The FDA is available and willing to work with them as appropriate to assist them.”
The question of a questionnaire
The spokesperson for the New York Blood Center, where Estok tried to donate plasma, told NBC News that the delay in implementation involved the time needed to train staff, but also involved receiving an updated Donor History Questionnaire from AABB, a industry group formerly known as the American Association of Blood Banks. AABB’s has more than 1,400 institutional members, accredits “virtually all” the blood centers in the U.S., according to a spokesperson, and collects the majority of the blood donated in the U.S.
In fact, representatives from all blood centers NBC News contacted said they’re currently waiting on AABB’s updated donor history questionnaire to first be approved by the FDA and then released by the industry group, before they can begin the implementation.
The AABB said it submitted its primary documents, including the donor history questionnaire, to the FDA on April 3 – just one day after the FDA announced new donor guidelines. AABB said it has since sent several documents to the FDA. An AABB spokesperson said that as of Monday it had submitted all of the needed documentation to the FDA, and is in touch with the agency, answering any questions it may have.
The FDA says it is reviewing all COVID-19 related items as quickly as possible, but also noted that the AABB’s member organizations don’t actually have to wait for approval of the AABB questionnaire to move forward. If they submit their own questionnaire to the FDA, they can begin accepting donors immediately.
“As noted in the guidance, while licensed blood establishments may wait to use the revised donor questionnaire and accompanying materials provided by industry associations and found acceptable to the FDA, they may also revise or create their own materials to implement these changes immediately upon receipt of this information by the FDA,” said Felberbaum.
Blood centers say that when they do receive an FDA-approved updated questionnaire from AABB, they will still need to update their computer systems and train their staff on new protocols. A spokesperson for Carter BloodCare said that the staff training would take at least 30 days. The NYBC spokesperson said it hopes to be able to receive newly eligible donors by mid-May.
The Red Cross said it anticipates being able to accept newly eligible donors in June. Kate Fry of America’s Blood Centers said she anticipates her network’s centers will be able to accept newly eligible donors in June or July.
‘The policy remains discriminatory in nature’
Gunther and Estok share in outrage from the LGBT community over what they call a discriminatory experience.
“Not only is it imperative that gay and bisexual men who are now able to donate blood be allowed to do so without delay, the FDA must also lift the 3 month deferral in its entirety,” said Sarah Kate Ellis, CEO of GLAAD, a LGBTQ advocacy organization. “The policy remains discriminatory in nature, unaligned with science, and continues to prevent LGBTQ Americans from saving lives.”
But those who are deferred under the old guidelines will still have to wait. Gunther said he wants to encourage others like him to keep trying to donate and not be discouraged if they are turned away.
“We have perfectly good blood to give, and we want to give it and help.”
Kate Fry advised that those who are newly eligible under the FDA guidelines should keep in touch with their local blood bank to check on when the facility expects to finalize implementation.
“We’re so excited to have these individuals become donors again,” said Fry. “We are absolutely working as fast as we can as an industry. Patience is what we ask for our guests during this time and we’ll get them into the fold as quickly as possible.”
Matthew, 30, keeps an emergency stockpile of his life-saving HIV medication at his home in Sacramento, California. He started building his stash shortly after he was diagnosed six years ago, on the recommendation of people he met through a forum for those living with HIV. Without his once-a-day pill, his viral load would increase and his general health would decline.
Now, over a month after the World Health Organization declared the coronavirus a global pandemic, Matthew hasn’t broken into his stash. But, like many of the 1.1 million HIV-positive people in the United States, he has questions about how the ongoing crisis could affect his access to medication and his chances of contracting the coronavirus, and whether his chronic immune condition could put him at a higher risk of complications due to COVID-19, the disease caused by coronavirus.
“Being positive, it puts it at the forefront of your mind,” Matthew, who requested that his last name not be used to protect his medical privacy, told NBC News. “You have to be present and aware.”
CDC’s recommendations for HIV and COVID-19
There is currently “no specific information” about the risk of COVID-19 in those living with HIV, according to the Centers for Disease Control and Prevention. However, the CDC noted that HIV-positive people who are not receiving treatment (antiretroviral therapy) or still have a weakened immune system despite treatment are at greater risk of “getting very sick,” should they contract the coronavirus. According to a 2017 CDC report, approximately half of HIV-positive Americans do not have the virus under control and would fall into this higher-risk category.
To prevent sickness, the CDC recommends HIV-positive individuals avoid exposure to the virus by using everyday preventive measureslike social distancing and frequent hand washing; maintain a healthy lifestyle by eating right, getting at least eight hours of sleep and reducing stress; and continue HIV treatment.
In addition to what’s recommended for all Americans amid the coronavirus pandemic, the CDC advises those with HIV to have at least a 30-day supply of HIV medicine and any other supplies needed for managing HIV; make sure vaccinations are up-to-date; establish a remote clinical care plan; and maintain a remote social network to stay mentally healthy.
Impact of age, comorbidities and poverty
Dr. Robbie Goldstein, an infectious disease specialist at Massachusetts General Hospital and director of its Transgender Health Program, said the coronavirus is most likely to affect the HIV-positive population through secondary conditions, such as homelessness, incarceration, old age and underlying health problems.
“What I say to my patients is, if you’re taking your medications and your CD4 count is greater than 200, for right now, we believe that it is not your immune system that is going to increase your risk of acquiring COVID,” Goldstein said. “That said, many of my patients and many patients living with HIV have other issues that they’re facing that put them at really high risk.”
One of those issues, according to Goldstein, is age. The CDC has warned that older adults “seem to be at higher risk for developing more serious complications from coronavirus,” with 8 out of 10 people reported dying from COVID-19 complications in the U.S. being 65 and older.
Individuals living with HIV are disproportionately older than the general U.S. population, according to the CDC: While approximately 35 percent of the U.S. population is over 50, nearly half of HIV-positive people are.
Beyond the physical health risks, older people living with HIV are also more likely to experience negative psychological effects as a result of the pandemic, according to Goldstein, who sees HIV-positive patients at his clinic twice a week.
“These are people who watched as all of their young friends died around them” during the AIDS crisis, he said, “and they are once again watching as young people around this country die.”
“We also have to remember that these folks who are now in their 60s and 70s and in some cases in their 80s … are living a life with very few other people around them,” Goldstein said. “They don’t have the same family structure that many other people in their 70s and 80s have. They don’t have kids and friends and partners and parents who can help support them through this.”
People of any age who have “serious underlying medical conditions might be at higher risk for severe illness from COVID-19,” according to the CDC. In its guidance, the CDC specifically mentions chronic lung disease, asthma, serious heart conditions, diabetes, liver disease and severe obesity, among other conditions.
While HIV-positive people who start their medication soon after contracting the virus have about the same life expectancy as the general U.S. population, people with long-lasting infection are still more likely to experience additional health problems later in life, according to Stephen Helmke, a geriatric cardiology researcher at Columbia University who has been living with HIV for 34 years.
For example, HIV-positive people are at least 1.5 times more at risk for heart disease and stroke than the general population, according to the American Heart Association. Helmke said this is often a result of the chronic inflammation HIV causes, specifically for people who began their treatment with less effective drugs. Additionally, those living with HIV are more likely to suffer from liver damage, often because of their medication, and are more at risk for additional infections, like hepatitis and tuberculosis.
After recovering from a mild case of COVID-19, Helmke, 56, said he now has a deeper awareness of how dangerous the virus can be for those who have serious underlying conditions, including untreated HIV.
“There are deaths that are directly able to be tied to lung function, and then there’s folks whose lungs are still at the level of functionality, but their heart is not able to deal with the loss of optimal oxygenation,” Helmke said.
Dr. Revery Barnes, a physician specializing in HIV for Los Angeles County, said her main focus for her HIV patients, many of whom are homeless or in poverty, has been ensuring they have access to their medication, as well as food and housing.
While HIV drugs have remained in stock in the United States thus far, Barnes said she is navigating other barriers, like the skyrocketingunemployment rate, that might prevent her patients from accessing and taking their medicine.
“Poverty has been a huge pandemic going on for a long time,” Barnes said. “When you actually get down to the barriers to people taking their medications, so much of it has to do with the fact that they’re spending all of their time trying to find money, or trying to find housing.”
HIV also disproportionately affects incarcerated populations, which have infection rates three to five times higher than the general population, according to a 2013 report from the National Minority AIDS Council. According to the report, “as many as half” of all HIV-positive inmates released from correctional facilities each year have no home to return to.
Goldstein, the physician from Massachusetts, added that factors like homelessness and incarceration have an inherent physical risk when it comes to suppressing a contagious disease like COVID-19.
“The thing that is unique about all of those people … is the fact that they live in high density settings,” Goldstein said. “It’s really easy to social distance when you live alone in an apartment in New York City. It’s very hard to social distance when you live in a shelter in Boston.”
Surviving a pandemic
Two federal assistance programs for people living with HIV — the Ryan White HIV/AIDS Program and Housing Opportunities for Persons With AIDS — will see millions in additional funding from the$2 trillion stimulus package that was signed into law on March 27.
Jeremiah Johnson, the HIV project director for Treatment Action Group, an HIV/AIDS advocacy organization, called the funds, which total $155 million, “incredibly welcome,” but he said it is crucial for advocates to keep track of how that money is ultimately used and ensure that it’s enough to help those living with HIV weather this storm.
“I think it’s incumbent on us to really start to sit down and do the math as a community,” he said. “We have a lot of landscaping to do in order to understand if this is even close to what we need to take care of these very vulnerable communities.”
Amid this latest public health crisis, Johnson also stressed the importance of keeping focused on the “ultimate end goal of trying to reign in HIV as an epidemic.”
Echoing the CDC’s guidance, Goldstein said it’s important for those living with HIV to establish a strong virtual support network to combat loneliness as they self-isolate during the mitigation phase of the pandemic. Barnes stressed the importance of keeping up with one’s health status — in terms of HIV and beyond.
“Because you know, somebody who’s diabetic and doesn’t know it is also immune compromised,” Barnes said.
Johnson, a longtime HIV activist who has lived with the virus for over a decade, said he sees a silver lining for people living with HIV and other chronic conditions, who are accustomed to navigating health care obstacles.
“I’m incredibly resilient, and I think that that applies to many people living with HIV,” he said. “We’re actually better prepared than a lot of people to deal with this current reality.”
Gay bars have been shuttered by public-place closure orders during the coronavirus pandemic. In March, more than half of U.S. statesissued statewide closure orders for bars and restaurants, decimating the nightlife industry. This has left LGBT people without a place to gather in public and LGBT workers without employment.
But gay bars were already closing their doors before the virus hit. Their decline began sometime around 2002 and has since accelerated. My research shows that as many as 37% of the United States’ gay bars shut down from 2007 to 2019.
In this era of increasing LGBT acceptance, there’s growing competition from straight establishments. “I go wherever I want with my friends,” one former employee of a gay bar told Talking Points Memo in 2015. “Every bar is a gay bar.” In addition, the debut of geolocating smartphone dating and hookup apps like Grindr also heralded an era where cruising for sex – one of bars’ primary offerings – could be conducted anywhere, anytime.
The mainstreaming of LGBT people is a positive sign of progress, but something is lost when gay bars close.
They were once the only places where LGBT people could gather in public. Today, they are often the only place where they regularly do. Going to a gay bar is still a rite of passage for every LGBT person’s coming out.
Big cities have many gay bars and LGBT organizations, but most places only have one or two gay bars. In many smaller municipalities – from McAlester, Oklahoma, to Lima, Ohio, to Dothan, Alabama – the local gay bar is the only public place that caters to an LGBT crowd. When one of them closes, whether it’s due to the coronavirus or an owner’s retirement, entire regions are left without an LGBT community hub.
Grappling with an uncertain future
Some well-known establishments from big cities have responded to the coronavirus closures by moving their programming online.
Gay bars like Stud have moved events online for their housebound patrons. AP Photo/Jeff Chiu
These shows, however, represent a mere fraction of the bars’ regular weekly schedules, and virtual tip jars don’t bring in the same cash as the regular live shows did. Still, it’s something, and for LGBT people with disabilities, these online offerings are often more accessible than the physical places.
But shuttered gay bars outside of big cities don’t have the resources -— nor the national reach —- to move content online or raise money. Because these bars in smaller cities are often the only LGBTQ address for multi-county regions, their temporary closure leaves already-isolated LGBTQ people even more isolated than ever. As one gay bar owner told The Daily Beast, “The vast majority of bars don’t operate with margins to be able to sustain themselves for two weeks, four weeks or eight weeks without cash flow.”
If these temporary closure orders become permanent business failures, bars are unlikely to reopen quickly. Investors are required to open a bar in expensive, gentrified coastal cities. Savvy business owners may be able to declare bankruptcy and eventually reopen, but nearly all gay bars in America’s interior are mom-and-mom and pop-and-pop shops. These owners sometimes commingle personal finances with the professional, and lack the lines of credit to bounce back quickly.
The extent to which the stimulus package will help gay bars remains to be seen – all small businesses are in a state of limbo as they await relief funds. But the pathways for financial support for independent contractors and gig workers are even more cumbersome and convoluted in many states. These are the people not on the payroll who provide the sparkle to LGBT nightlife: the DJs, drag queens, dancers and security guards.
True, gay bars were never all things to all LGBT people. Caring about them means reckoning with their histories of exclusion of women, of transgender people, of people of color. Scholars once described them as the “primary social institution” of gay and lesbian life, but they haven’t been that for years. For many LGBT people they never were, even among the white gay men they primarily served. There are long histories of gay bars excluding those under 21, the undocumented, the disabled and those in addiction recovery.
But only a pessimist would condemn bars for these exclusionary sins, while only a willful optimist would celebrate the closure of what is often the only place for LGBT people to find like-minded others to celebrate in our queer ways.
Whether 37% fewer gay bars is a lot or a little depends on where you stand. True, there are fewer of them now than at any time in the last 40-plus years. There were more gay bars during the depths of the AIDS crisis, even. On the other hand, there are still over 800 across 46 states, with new ones appearing each year. Gay bars may be in trouble, but they’re not disappearing.
Nonetheless, the pandemic threatens the most vulnerable establishments – and their loss affects those of us in the LGBT community who have the least to lose.
Trans people in Pakistan are being deprived of support during the pandemic lockdown, according to alarming reports from the country.
Regions across Pakistan have imposed a lockdown, with the number of confirmed coronavirus cases in the country standing at 5,300.
Pakistani outlet The News reported concerns about the lack of support for trans people – many of whom were living in extreme poverty even before the lockdown, and have been left to fend for themselves as NGOs who previously helped them have stopped working.
Trans people ‘ignored as if we are not humans’.
Shakila, a trans woman from Peshawar, told the newspaper: “We are the most unfortunate human beings on Earth because neither the federal nor the provincial government has bothered to consider our plight.
“The government and the philanthropists are giving relief package to others, but have ignored us as if we are not humans.”
She added: “It hurt us when the federal and provincial governments announced relief packages for industrialists and government servants, but ignored the most neglected section of the society.”
Another trans woman, Nazo, also from Peshawar, told the newspaper that with work dried up and no relief available, trans people are struggling to make ends meet.
She said: “[Before], we were worried about our security, but now we are worried about food, shelter and medicines.”
Transgender people protest in Pakistan in 2019, prior to the lockdown, demanding an end to discrimination (Photo: RIZWAN TABASSUM/AFP via Getty Images)
Iftikhar Shalwani, a commissioner in Pakistan’s largest city, Karachi, previously said that help would be provided for trans people to ensure they would not be left hungry or out on the streets.
He told the Express Tribune: “We are committed to providing them with all possible help.”
Pakistan extended free healthcare to trans people.
Prime minister Imran Khan said that his government was “taking responsibility” for trans people, who are routinely denied treatment and can face harassment or ridicule from hospital staff and patients.
The 2017 national census recorded 10,418 trans people in Pakistan, out of a population 207 million, though charities estimate there are at least 500,000 trans people.
Seven per cent of trans people in Pakistan are HIV-positive, meaning that treatment is vital to their health.
In the year since the Trump administration banned transgender individuals from serving in the military, a number of advocacy groups have challenged the policy and many active service members say they’ve been forced to choose between continued service and their dignity and basic health care needs.
When the administration implemented the ban on April 12, 2019, it ended an Obama-era policy that allowed trans men and women to serve openly and to receive transition-related medical care while enlisted.
“The Trump-Pence administration has shamefully told thousands of qualified transgender military members that we aren’t good enough and our service doesn’t matter.”
ARMY STAFF SGT. PATRICIA KING
The current policy allows service members who received a diagnosis of gender dysphoria prior to April 2019 to continue to serve in their preferred gender. Any currently serving troops diagnosed after that date must serve according to their sex as assigned at birth and are prohibited from seeking transition-related care. Prospective recruits who have received a gender dysphoria diagnosis are barred from enlisting or enrolling in military academies.
The Defense Department stands by the year-old policy, and while it is widely viewed and referred to as a “ban,” the Pentagon insists it is “not a ban on transgender persons.”
“If you are a transgender individual, you are welcome to serve,” Jessica R. Maxwell, a Defense Department spokesperson, said in an email, adding that the policy “actually prohibits discrimination on the basis of gender identity for accession, retention or separation.”
What the policy does, Maxwell added, is end “presumptive accommodations” for people with gender dysphoria, which she referred to as a “serious health condition.”
Ending these “presumptive accommodations,” means transgender individuals would have to forgo gender-affirming health care and serve in the military according to their sex assigned at birth, not their preferred gender, a situation that is untenable for many, if not most, trans people.
Army Staff Sgt. Patricia King, second from right, together with other transgender military members, from left, Army Capt. Alivia Stehlik, Army Capt. Jennifer Peace and Navy Petty Officer Third Class Akira Wyatt, testify about their military service before a House Armed Services Subcommittee on Military Personnel on Feb. 27, 2019.Manuel Balce Ceneta / AP
A number of LGBTQ advocacy groups are challenging the Pentagon’s policy and its justification for restricting the military service of transgender individuals, and five of these challenges are currently in court.
But as these cases slowly advance in the courts, prospective and active trans service members say they are forced to live with the consequences of the policy.
“The Trump-Pence administration has shamefully told thousands of qualified transgender military members that we aren’t good enough and our service doesn’t matter,” Patricia King, the U.S. Army’s first out transgender infantryman, said in a statement shared with NBC News. “Our nation’s brave service members and their families deserve better.”
History of the ban
On July 26, 2017, President Donald Trump tweeted that the U.S. military would no longer “accept or allow transgender individuals to serve in any capacity.”
“Our military must be focused on decisive and overwhelming victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail,” he wrote.
At the time, studies estimated that 2,450 to 15,000 transgender people were serving in the U.S. military, and a 2015 survey of over 27,000 transgender individuals from the National Center for Transgender Equality found trans respondents reported twice the rate of military service as the general population.
In a presidential memo in August 2017, Trump directed the Defense Department to “return to the longstanding policy and practice on military service by transgender individuals that was in place prior to June 2016 until such time as a sufficient basis exists upon which to conclude that terminating that policy and practice would not have the negative effects discussed above.”
The memo allowed currently serving trans members to remain, but ordered the cessation of Defense Department or Homeland Security resources to “fund sex reassignment surgical procedures for military personnel, except to the extent necessary to protect the health of an individual who has already begun a course of treatment to reassign his or her sex.”
Trump’s proposal went against the military’s own recommendations regarding transgender service members, which were arrived at as part of a policy review that began in 2015 by the secretary of defense at the time, Ashton Carter. Under Carter, a Pentagon-commissioned study concluded that there were no reasons to exclude trans individuals from military service. The Obama administration thenlifted the ban on transgender people serving in the military in June 2016, permitting those already in the armed forces to be open about their gender identities and setting a date to allow the recruitment of openly transgender individuals.
Democrats came out against the ban, as did some prominent Republicans, including Sen. John McCain of Arizona, a decorated veteran of the Vietnam war and former POW who said in 2017 that any service member who meets appropriate military standards should be permitted to serve.
“When less than 1 percent of Americans are volunteering to join the military, we should welcome all those who are willing and able to serve our country,” McCain said.
In addition to the five lawsuits that are still working their way through the courts, lawmakers have introduced legislation and attempted to amend the 2020 National Defense Authorization Act to rescind the ban over the past year.
Legal challenges
Several LGBTQ advocacy organizations have filed lawsuits challenging the ban, and four federal courts issued orders forbidding the government to enforce it.
“Taking up resources to discharge someone who has incredible things to contribute makes no sense.”
JENNIFER LEVI, GLBTQ LEGAL ADVOCATES AND DEFENDERS
Kara Ingelhart, an attorney at Lambda Legal working on one of the cases, Karnoski v. Trump, called the Supreme Court decision “disappointing” but said the high court has not yet heard the merits of the case. She pointed to U.S. District Judge Marsha Pechman’s December 2019 ruling requiring the government to turn over some 35,000 documents cited in its decision to ban trans service members. The judge said the plaintiffs were entitled to all the documents and information used to justify the administration’s restrictions on trans service members.
“We are currently in the thick of discovery and moving forward as if we were going to trial,” Ingelhart said.
Jennifer Levi, director of the Transgender Rights Project at GLBTQ Legal Advocates and Defenders, or GLAD, saidshe’s confident the ban will be found unjustifable.
“We anticipate trials where the court will evaluate and see quite clearly the absence of any rational justification or any legitimate justification of the ban,” she told NBC News. “There is no justification for banning a group of people from serving in the military who can meet all the generally applicable standards … It undermines the concerns for the stability and strength of the military.”
Last month, GLAD and the National Center for Lesbian Rights filed anew suit on behalf of a Navy officer who has served two extended tours of duty over nine years and is now facing involuntary discharge because she is transgender. She came out as trans after the ban went into effect in April 2019, and is therefore not protected by the “grandfather clause” that permits those already enlisted to continue to serve. The current policy mandates the discharge of any service member who comes out as transgender and seeks to undergo a gender transition.
“It is just an example of just how irrational the ban is,” Levi said. “Taking up resources to discharge someone who has incredible things to contribute makes no sense.”
Serving under a ‘cloud of otherness’
The transgender military ban affects both active personnel and prospective recruits.
“It’s disheartening that the president of the United States has taken an opinion on my fitness to serve in the military without knowledge about what makes me, and so many other transgender people, just as good candidates to serve in the military,” said Ryan Karnoski, one of the plaintiffs on the suit brought by Lambda Legal.
At 25, Karnoski has an M.A. in social work and is pursuing a Ph.D. in social welfare at the University of California, Berkeley. He hopes to be given the opportunity to apply his skills to a health services career in the military.
“The ban has been frustrating, but I’m refusing to look at it like a setback,” he said.
According to Ingelhart, the ban continues to be a source of concern and frustration for clients like Karnoski.
One of the other plaintiffs in the case with Karnoski is a woman known as Jane Doe, who chose anonymity because she remains in active service. She did not come out as transgender prior to the implementation of the ban last April.
“Because she didn’t do that within the artificially imposed window, she is now prohibited from doing so without the loss of her career,” Ingelhart said. “She is not being able to make that choice for herself without risking her career and the livelihood of her family.”
While there are openly transgender people currently serving in the military, Peter Perkowski, legal director of the Modern Military Association of America, a nonprofit organization advocating for LGBTQ service members and veterans, said, “They are doing it under a cloud of otherness.”
“That’s not healthy for them,” Perkowski said. “Even though they were spared, at least for now, discharge or separation, that doesn’t mean they are not feeling the effects of this ban.”
Perkowsi said these service members are subject to mental health issues as a result, in addition to outright discrimination and even being pressured to leave the military.
Blake Dremann, an active duty lieutenant commander in the Navy and the treasurer of SPART*A, an LGBTQ military group, said those who are grandfathered in are having to deal with a cloud of suspicion as to whether they are fit to serve.
According to the latest Pentagon memo, transgender individuals may seek waivers to be able to enlist or serve in accordance with their gender identity. The waiver process has turned out to be complicated, Dremann said, as one must obtain separate waivers for gender dysphoria, another to serve as one’s preferred gender, and another to receive maintenance hormone therapy. “They take a long time,” Dremann said.
Further, many active service members he has spoken to worry about the consequences of a denial of the waiver.
“What is the course of action then? Does it go back to the member and they could ‘change their mind’ or does that immediately start discharge?” Dremann asked.
The current public health crisis highlights the costs of denying qualified people the ability to serve.
“How many trans people have left the military or chose not to join the military that would have gone into critical health care professions?” said Jennifer Peace, a transgender Army captain who has been serving for over 15 years. “With ‘don’t ask, don’t tell,’ we spent over $300 million from the early ‘90s to its repeal. What money are we spending now? It’s so unfortunate we are making the same mistakes.”
Thousands of military personnel are being called upon to help in the fight against the coronavirus.
“I think about the trans military service members, especially in the medical service corps, that are fighting on the front lines against the coronavirus not just here but overseas as well,” Karnoski said.
“It’s really frustrating that this issue is something they have to be focusing any amount of attention on,” he said of the trans military ban.
Next steps
The policy could be changed through the courts, but the slow nature of litigation and the current composition of the Supreme Court leads some advocates to believe redress is more likely through Congress or the ballot box.
“Our message right now is that the only way this changes is with a change in administration, but that doesn’t stop us from working with our members of Congress,” Dremann said.
Levi said, “The challenge to this military ban has just highlighted how wrong it is to exclude people because of who they are.”
The study’s authors found that transgender and nonbinary youth often lack access to critical support systems to educate them about safer sex practices. The research team conducted three-day focus groups with 30 young people ages 13 to 24 and found that respondents widely lacked “affirmative and culturally competent” resources to understand their sexual health needs.
These resources ranged from a lack of LGBTQ-inclusive sexual education courses to parents who did not affirm the respondent’s gender identity when discussing topics related to sexual and romantic intimacy.
“Youth really need adults to be there for them, to meet their needs, and to be open and respectful of them,” the lead author, Holly Fontenot, a professor at the Boston College School of Nursing, told NBC News. “If youth had adult caregivers, teachers or health care providers that could provide that affirmation, they feel supported and then they might have better overall health outcomes.”
Written by researchers from the Fenway Institute, the University of Chicago, the Centers for Disease Control and Prevention and Boston College, the study notes that trans and nonbinary youth are less likely than their peers to engage in safe sex practices. According to researchers, this group is more “likely than cisgender youth to report first sexual intercourse before age 13 years, intercourse with four or more partners, drinking alcohol or using drugs before intercourse, and not using a condom at last intercourse.”
Fontenot said the research found that one of the roots of these disparities is a widespread feeling among trans and nonbinary youth that they are “isolated and left out of the conversation” about sexual health in classrooms and at home. One participant in the study admitted that they “really don’t know what counts as sex,” because the definition they had been given from parents and educators “is very heteronormative” and “doesn’t apply to LGBT people.”
“When they do ask for help, youth might feel stigmatized, diminished or have negative experiences with the adults in their lives instead of ones that affirm who they are and tell them that they’re loved and supported,” Fontenot said.
Others said they had no one to turn to — even in their own peer group — for advice that’s inclusive of their gender identities. “I don’t really get any support, but I would like support in knowing that it’s OK to question who you want to have sex with, and it’s OK to explore your body,” one member of the focus group is quoted as saying.
The lack of a support network left many of the trans and nonbinary young people surveyed without the basic skills to discuss intimacy and consent with their sexual and romantic partners. The majority of respondents described open communication with potential partners as “challenging,” and many said they struggled “with self-advocacy, particularly when negotiating sexual preferences with cisgender partners.”
“Participants noted that sex requires more communication when experiencing gender dysphoria, and inability to negotiate safe behaviors might lead to feeling ‘abused or taken advantage of,’” the study noted.
Fontenot said these responses show that it’s “really important” for adults to model healthy relationships for trans and nonbinary youth.
“If you’re already feeling different and afraid, then you’re really not going be able to advocate for yourself in terms of safer sex behaviors,” she said. “It goes to that affirmation and support for youth. If they feel they have inherent self-worth and that they’re a member of society that’s loved and respected just like any other person, then they’ll carry that into whatever romantic relationship they may form in the future.”
Sean Cahill, a co-author of the study and the director of health policy research at the Fenway Institute, an LGBTQ-focused research center, said these lessons apply not only to parents and teachers but also health care providers who work with trans and nonbinary young people.
“For example, school nurses can support youth in school but also work with community partners to develop educational resource lists for youth and their parents and guardians,” he said in a statement.
Fontenot said the study suggests several ways in which all adults can be better advocates for trans and nonbinary youth, whether in a professional or personal capacity. For instance, young people who participated in the focus groups expressed a desire for more “coaching and guidance around healthy communication,” and Fontenot encouraged parents to turn to LGBTQ advocacy organizations or resources geared toward LGBTQ youth if they aren’t sure how to have those conversations.
However, Fontenot acknowledged that the availability of “competent sexual health resources that are really medically informed and accurate” remains scarce online, which can be a major barrier to access in rural areas. Only 27 states and Washington, D.C., mandate both sex education and HIV education, according to the Guttmacher Institute, a sexual health research and policy nonprofit.
Five states — Texas, Oklahoma, Mississippi, Louisiana and Alabama — still have “no promo homo” laws on the books, which prohibit sex education and health teachers from discussing LGBTQ people in a positive light, if at all. (South Carolina, Arizona and Utah only recently had such laws repealed or struck down.)
“That’s an area that needs great improvement because I don’t think our country’s in a place where schools across the nation are going to be delivering inclusive sex education,” Fontenot said of LGBTQ-inclusive online sex ed resources. “We have to think about alternative venues to deliver comprehensive sex education that’s inclusive of multiple identities.”
