Today, The Fenway Institute of Fenway Health released a policy brief demonstrating that in 2019, the Trump Administration
dramatically expanded upon discriminatory, anti-LGBT policies
implemented in 2017 and 2018 that are harming the health and well-being
of LGBTQIA+ people in America and around the world.
“During
Donald Trump’s third year as president, we moved from worrying that
anti-LGBT policies would harm people to seeing the damage of these
policies in action,” said Sean Cahill, PhD, Director of Health Policy
Research at The Fenway Institute. “The most dramatic examples have been
the deaths of two transgender women seeking asylum in the United States
who were detained in facilities currently being sued for their alleged
abuse of LGBT migrants. Other moves have made LGBT people and people
living with HIV much more vulnerable to discrimination in health care,
social services, employment, education, and access to basic government
services.”
Much
of the harm LGBT people are now experiencing is the result of
discriminatory actions that target them, such as rolling back sexual
orientation and gender identity nondiscrimination provisions in health
care, employment, and housing while expanding discriminatory religious
refusal policies. But other policies that are not specifically aimed at
LGBT people, such as restricting asylum hearings in the United States
only to people who have been denied asylum in another country, and the
maltreatment of people in border detention facilities, have
disproportionately affected LGBT people from Central America seeking
asylum to escape anti-LGBT violence.
In
June, a transgender woman from El Salvador, who spent six weeks in a
detention center in New Mexico that has been sued by the ACLU for
creating “unconscionable conditions” for LGBT immigrants, died after
being hospitalized for chest pain. The woman, a nurse, had repeatedly
asked for an IV solution or, barring that, water, salt, and sugar so she
could make and administer her own solution, but was denied medical
care.
Two
initiatives by the Trump Administration aimed at improving the
conditions of LGBT people around the world and ending the transmission
of HIV have been undermined by the administration’s own anti-LGBT
policies.
During
his 2019 State of the Union address, President Trump announced the
Ending the HIV Epidemic Initiative, a new plan to end the HIV epidemic
by 2030 with increased investments in outreach and prevention to
communities hit hardest by HIV. But the campaign does little to address
anti-LGBT discrimination and stigma, which are the underlying drivers
behind the HIV epidemic among the most disproportionately affected
populations in this country. Meanwhile, the Trump Administration’s work
to uphold religious refusal protections, repeal nondiscrimination
protections for LGBT Americans, and other such actions may actually
increase discrimination against LGBT people, creating additional
barriers to success for the HIV initiative.
In
February 2019, the Trump Administration announced that it would launch a
global campaign to end the criminalization of homosexuality as it is
still a crime in 70 countries around the world, with 13 of them allowing
for the death penalty. Since the announcement, the Trump Administration
has been inconsistent in implementing its policy. While the US State
Department publicly condemned anti-LGBT laws and actions in Chechnya and
Brunei, it has been silent on similar anti-LGBT actions taken this year
by Saudi Arabia, Qatar, and Kenya. The U.S. Ambassador to Zambia, who
criticized the imprisonment of a gay couple there for 15 years, was told
to leave the country by Zambia’s president, and was recalled by the
U.S. State Department last month.
Other
examples of actions taken by the Trump Administration in 2019 that
undermine the health and well-being of LGBT people and people living
with HIV include:
- Proposing
a new rule to reverse the Obama-era final rule implementing Section
1557 of the Affordable Care Act (ACA), which prohibits discrimination in
the provision of health care. The 2016 Section 1557 rule was
implemented to address anti-LGBT discrimination in health care, which
can range from being verbally or physically harassed to being denied
treatment altogether.
- Proposing
a new rule to remove explicit sexual orientation and gender identity
nondiscrimination provisions from important health care regulations
governing health insurance exchanges, Medicaid regulations, and the
Program of All-Inclusive Care for the Elderly.
- Proposing
a new rule to remove regulatory provisions that explicitly prohibit
organizations that receive HHS grant funding from discriminating on the
basis of sexual orientation, gender identity, sex, and religion. Such a
rule would affect organizations that provide a wide array of health and
social services, including health care at federally funded community
health centers, HIV and STI testing and prevention, refugee
resettlement, elder care programs, childcare and after-school programs,
community meal programs, and adoption and foster care services.
- Nominating
judges for lifetime federal appointments who have expressed anti-LGBT
sentiments and/or have histories of ruling against the interests of LGBT
Americans.
- Arguing
before the U.S. Supreme Court in favor of limiting existing
nondiscrimination provisions under Title VII that have been used to
protect LGBT workers.
- Proposing
an amendment to the Equal Access Rule, which ensures that homeless
shelters do not discriminate based on sexual orientation or gender
identity.
- Amending
the 2019 Notice of Funding Availability Act, administered by the
Department of Housing and Urban Development, to remove a crucial
incentive that encouraged housing providers to support LGBT individuals.
LGBTQ youth and transgender people, especially people of color,
experience disproportionately high rates of homelessness.
- Eliminating
disparate impact civil rights regulations which treat policies that are
neutral on paper but have an unequal impact in practice as forms of
discrimination, even if there was no discriminatory intent.
- Finalizing
a rule that allows healthcare providers to refuse to participate in
medical procedures, such as infertility treatment for same-sex couples,
abortion, and HIV treatment for religious reasons.
- Proposing
a new rule that would remove sexual orientation data collection for
foster youth and foster and adoptive parents in the Adoption and Foster
Care Analysis and Reporting System.
- Implementing
a ban on transgender troops that was first proposed in 2017 and which
puts an estimated 13,600 transgender individuals at risk of being
discharged.
The policy brief, “In its third year in office, the Trump Administration dramatically expanded discriminatory anti-LGBT policies” can be downloaded here.
Since 1971, Fenway Health
has been working to make life healthier for the people in our
neighborhoods, the LGBTQIA+ community, people living with HIV/AIDS and
the broader population. The Fenway Institute at Fenway Health is an
interdisciplinary center for research, training, education and policy
development focusing on national and international health issues.
