“I think some of my most memorable times are when I am in conferences, roundtables, and discussions with transgender children, their families, their health providers, and with trans and non-linear adults,” says United States Assistant Secretary of Health Admiral Rachel Levine.
Our Zoom discussion, held soon after International Transgender Day of Visibility, was both revealing and disconcerting. It made me think of the enormous accomplishments we’ve made as a result of the presence of a dominant transgender advocate for LGBTQ+ rights in the federal government, as well as the never-ending obstacles we encounter every day.
The topics we discussed resonate today on GLSEN’s Day of (No) Silence. The classic Day of Silence, which was started by two college students roughly 30 years ago, demanded that students spend the day not talking, and it eventually led to rallies to promote inclusivity. The group is, however, changing the text and calling for student-led rallies to address the 800+ anti-LGBT+ bills that have been introduced in the last two years.
These bills aren’t anything to scoff at. In Ohio, HB 68 passed and will significantly reduce female-affirming care for minors, along with bathroom restrictions moving through the legislature. Even as we reach the end of legislative sessions for many states across the country, the LGBTQ+ community still faces challenges like Alabama’s HB385, a drag ban, and Kansas’s SB394, an online age verification bill for sites containing 25% or more articles considered “harmful to juveniles,” which under the act refers to “sexual content,” and, in turn, the country’s classification of sexuality.
In theory, elected and appointed government officials should support the interests of the common good. However, as the country becomes more divided, journalists like me are challenged to have an objective and critical eye for decisions that are both popular and unpopular with the general public.
I’ve long been an admirer of Adm. Levine. As a trans woman myself, it’s inspiring to see someone like me in such a prominent position. Watching a trans woman from my home state in her position is nothing short of amazing, especially as I was born in Pennsylvania. With this appreciation, I begin to question and challenge the issues facing our society.
When asked what concrete steps the Department of Health and Human Services (HHS) is implementing to improve transgender care, Adm. Levine responded, “We are working on some key HHS policy initiatives to advance health equity for the LGBTQI+ community. For instance, our efforts to end the HIV epidemic in the United States with a focus on health equity would serve as an example. We have many, many medical advances that we’re working to implement, including PrEP, including ART [antiretroviral treatment] with U=U [undetectable = untransmittable]. However, we are still having a hard time getting these medical advances to the people who need them most. And that is why we must keep doing that.”
She also emphasized how, despite facing many challenges, divisions within HHS have conducted research into the negative effects of conversion therapy, improvements for transgender care, non-discrimination procedures within the HHS, and are attempting to combat sexually transmitted diseases in marginalized communities.
Academics have long been aware of the challenges that face people in getting the care they need. Issues like stigma against HIV care, mental health problems, inability to physically access care, and disparities in Black and Latinx communities all contribute to the difficulty of providing care for those in need.
Not everyone is happy with how well HHS has handled the situation.
HHS relaxed telehealth restrictions across state lines in a bid to maintain continuity of care during the pandemic. The majority of these were left in place after the crisis was over, according to Jessica Kant, a clinical social worker and lecturer at Boston University, in an interview with LGBTQ Nation. There are obvious steps that the federal government could take to expand that access and get support for kids in most of the most impacted regions.” One unexpected outcome of this was that LGBTQ+ youth had a brief window of expanded access to essential care. It’s confusing and quite frustrating to not do so.
Kant also emphasized how this has been discussed and proposed before by politicians like Senator Ed Markey in 2022, referring to the “Drug Enforcement Agency (DEA) to change testosterone’s schedule III status. The classification and regulation of testosterone as a regulated drug, which can present challenges for trans people, are referred to as Schedule III status.
I asked Admiral Levine how she would respond to critics who say that the current administration’s actions aren’t enough. Politicians have publicly criticized the administration for not taking the necessary steps to advance LGBTQ+ rights, claiming that Biden’s 2022 Pride Month order is “a lot less than we need” and that “the pieces seeking to respond to state-sponsored discrimination and its [sic] impacts could have been much more specific, with clear timelines, and also acknowledged that this crisis is inextricably linked to rising violent extremism.”
Adm. Levine thinks that having visibility is a useful tool.
Adm. Levine stated that the Biden-Harris administration will do everything in its power to assist transgender and nonbinary people in our nation. “We are engaged in a variety of activities, including advocacy. I go out and make a point about these issues. I meet with trans youth. I meet with their families. Almost everywhere I go, I meet with their medical professionals.
The Biden-Harris administration will make every effort to assist transgender and nonbinary people in our nation.
American Admiral Rachel Levine, Assistant Secretary of State for Health
But it’s not enough to meet with constituents all over the country and discuss these issues. The Biden-Harris administration has been making strides to protect transgender people for the past three years, but the transgender rights movement is still at its height. Talking to people does not protect the lives of transgender people, despite having the potential to be very impactful and inspiring. Legislation that would significantly alter state laws that violate people’s medical rights and nondiscrimination needs to be passed.
Adm. Levine continued by highlighting her visits to numerous different parts of the nation to speak with constituents, noting that “The Department of Justice has participated in numerous amicus briefs and other briefs in lawsuits.” Within HHS, our Office of Civil Rights is engaged. Additionally, there are rules and regulations that are being passed as well. So we’re going to do everything we can to support these young people, their families, and their medical providers throughout the country”.
In response to specific critics like Tobin, Adm. Levine emphasized her belief that the Biden administration is doing all that it can for the LGBTQ+ community, concluding, “I think that the president, vice president, and the administration have shown their support for our community and will continue to do so”.
However, not everyone agrees that the Biden administration is exerting all of their will. “Biden has continued to claim that he has the backs of transgender people, but he hasn’t really had much of a backbone on issues that affect transgender individuals,” Allison Chapman, legislative researcher, and activist, told LGBTQ Nation.
“While he has done some good things, especially in the past few months with the defeat of the anti-LGBTQ+ riders and his unwavering support during Transgender Day of Visibility, it still remains lacking,” said Chapman. His campaign tends to lean more toward the performative and the easy small victories, not for any real significant change. I and other LGBTQ+ people are unsure whether he really has our backs or just wants our votes as a result of the country’s constant attacks on LGBTQ+ rights.
Nevertheless, there are advocates in favor of Biden’s approach to LGBTQ+ rights. For instance, Rodrigo Heng-Lehtinen, executive director of the National Center for Trans Equality (NCTE) said in a statement, “Without question, the Biden Administration has been the strongest advocate for the needs of transgender Americans of any presidential administration in American history”.
Clearly, reception to the Biden administration within the LGBTQ+ community is mixed at best. The existence of dissatisfied individuals is a sign of the work that needs to be done. To protect librarians and teachers from harmful restrictions like book bans or “Don’t Say Gay” bills, we need stronger protections for gender-affirming care, strong nondiscrimination policies, and national legislation.
This can be especially depressing because the LGBTQ+ community is incredibly threatened throughout the nation. Nearly 500 anti-LGBT bills are currently being introduced in state legislatures, and many more are doing so more quickly, though not as quickly as they were last year. I’m one of the many people who have been forced to live independently in my home state of Ohio.
When asked how to safely and legally continue providing gender-affirming care, Adm. Levine responded, “It’s very difficult for youth to be able to do so in those states where those actions and laws have been passed to ensure that they are able to do so.” Therefore, my heart goes out to them. I believe there are some avenues for telemedicine, as well as the ability to travel to a contiguous state.
Adm. Levine expressed hope that the anti-trans wave will start to take hold in the nation.
“The wheel will change on this. I do recognize and I’ve spoken to many personally, about how challenging it is right now,” she said. And so, in my opinion, we must all keep working on it to ensure that they receive the care they require. Medical refugees who cannot get the care they need in their states are now a reality in the United States. I believe things will improve, but we must acknowledge that because of how difficult it is right now.
“The legal and political climate where people live now is itself now a social determinant of health,” Adm. Levine continued. “The social determinants of health are the different social factors that influence one’s health that aren’t just medical care, including the environment, education, economic opportunity, transportation, housing, nutrition, and others”.
As more anti-LGBT+ laws are introduced and put into place across the nation, it’s likely that the number of medical refugees will rise. The 2024 elections will have a significant impact on how we as a nation react.
In honor of GLSEN’s Day of (No) Silence, let’s continue speaking out and being vocal. There is undoubtedly still work to be done, regardless of whether you are supportive or critical of President Biden. No matter where elected officials are on the political spectrum and in every branch of government, we must hold them accountable.
