It’s even worse than you may realize

BY CONNOR SIMONOFF, TIM WANG, SEAN CAHILL | THE FENWAY INSTITUTE

In 2019, the Trump Administration dramatically expanded upon the discriminatory policies implemented in 2017 and 2018 that are harming the health and well-being of LGBTQIA+ people in America and around the world. It rolled back sexual orientation and gender identity (SOGI) nondiscrimination provisions in health care, employment, and housing, and expanded discriminatory religious refusal policies. It appointed more anti-LGBT federal court judges and further attempted to roll back the collection of sexual orientation and gender identity data that is critical to understanding LGBT health disparities. It also enacted anti-immigration policies that advocates say directly contributed to the deaths of two transgender women seeking asylum3,4 and are also disproportionately affecting LGBT asylum seekers, generally.

The Trump Administration did take some positive actions in its third year in office. It launched the Ending the HIV Epidemic Initiative, an ambitious campaign to end the domestic HIV epidemic. It also launched a global campaign, which President Trump spoke about before the United Nations in September, to advocate for the repeal of 70 laws in other countries that criminalize same-sex sexual behavior. However, ongoing anti-LGBT policies by the Trump Administration threaten to undermine progress made by the Ending the HIV Epidemic Initiative, and global LGBT advocates claim that there is no substance to the decriminalization effort. They also point to other anti-LGBT actions taken by the U.S. State Department and by the Trump Administration.

A new policy brief from The Fenway Institute of Fenway Health demonstrates 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.

You can read the whole report at fenwayhealth.org.