By Kendall Martinez-Wright, Elizabeth Lovinger, and De’Ashia Lee
Many people recognize advances the LGBTQ+ community has made in the United States and other countries, including the freedom to marry their partners, sexual orientation and gender identity protections, and the fact that various states and territories have granted sanctuary status for queer people fleeing oppression elsewhere. Queer visibility in pop culture and media has risen significantly over the past three decades.
Despite these gains, anti-LGBTQ+ bigotry has persisted — and in some places now is on the rise. In the last few years, signs of open anti-LGBTQ+ hatred have intensified. One study showed that in the United States, anti-LGBTQ+ hate crimes rose by 52 percent in 2022.1 In 2023 alone, state legislators have filed over 520 pieces of anti-LGBTQ legislation; 220 of these bills were aimed specifically at the transgender community, ranging from banning gender-affirming health care for minors to laws requiring educators to misgender students.2 These developments threaten the health of queer individuals and communities.
Most obviously, surging homo- and transphobia damages mental health. According to data from The Trevor Project, an estimated 86 percent of transgender youth have been negatively affected by proposals to limit gender-affirming care.3 In a survey of over one hundred clinicians providing gender-affirming care for trans youth, nearly all reported that restrictions on care negatively impacted the mental health of their patients.4 These effects are likely even more dramatic for young queer people of color: one recent study found that Black and Hispanic LGBTQ+ youth had higher rates of depression in states that don’t have laws against conversion therapy or sexual and gender identity-based bullying.5 Psychological distress emanating from anti-queer sentiment is hardly relegated to vulnerable young people; laws and policies reflecting institutional homophobia and transphobia can lead to increased suicidality among LGBTQ+ adults, particularly Black men, who are oppressed in multiple ways by institutional white supremacy.6
It’s become increasingly clear that wielding anti-LGBTQ+ hatred as a political cudgel also has dire negative effects on health education and access to health care. One casualty of anti-queer political backlash has been sexual education, particularly information about HIV. This year in Iowa, Governor Kim Reynolds signed a bill striking down requirements that public schools teach students about HIV.7 This legislation directly bans a critical public health intervention, as HIV education is associated with reduced risky behavior and higher HIV testing rates.8 Gutting sexual health curricula is unacceptable in light of ongoing epidemics of HIV and other sexually transmitted infections (STIs) in the US, particularly as it singles out and stigmatizes health issues that disproportionately affect LGBTQ+ people.
More causes for alarm have emerged from state and local governments, conservative organizations, and other groups. Most recently, the Supreme Court decision in 303 Creative LLC. v Elenis granted small private businesses, including health care providers, the right to deny services to members of the LGBTQ+ community.9 In another troubling trend, private organizations and governments are attempting to limit access to preventive health services, including preexposure prophylaxis (PrEP). For example, a Texas district judge in Braidwood Management vs Becerra struck down the Affordable Care Act requirement to cover PrEP medication for HIV prevention and claimed that this provision violates providers’ religious rights because it “encourages homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.”10 TAG recently signed an amicus brief in support of the defendants prepared by HIV+Hepatitis Policy Institute, arguing that the decision stands to limit access to PrEP for the people who may benefit most.
Earlier in 2023 the Tennessee Department of Health (TDH) under Governor Bill Lee refused to accept federal Centers for Disease Control and Prevention (CDC) funds for HIV prevention and monitoring, a move that severely restricts resources for organizations serving Black and sexual minority communities. Governor Lee later explained the decision, stating, “We think we can do that better than the strings attached with the federal dollars that came our way and that’s why we made the decision.”11 Governor Lee also instructed the TDH to concentrate HIV prevention services on first responders, mothers and children, and victims of human trafficking, groups that together account for only 1 percent of new HIV cases annually.12 Governor Lee’s comments and actions target LGBTQ+ communities by diverting vital CDC HIV prevention funding away from those disproportionately affected, implying that unrelated priority groups are more “deserving” of support, despite being minimally affected by HIV. This refusal creates a harmful precedent of states rejecting federal funding and oversight of public health programs. With nearly 50 percent of current HIV cases located in Southern states with conservative governors and legislatures, the implications for LGBTQ+ public health and human rights are extensive, particularly for Black men and trans people.13
Unfortunately, such anti-LGBTQ rhetoric and policies are not limited to the US. One of the worst examples of global anti-LGBTQ+ policies is the Anti-Homosexuality Act recently passed in the Ugandan legislature and signed into law by President Museveni, assigning stiff criminal penalties — up to death — for homosexual activity. This law has severe ramifications for the fight against HIV in the already struggling country, with citizens afraid to utilize vital services such as HIV diagnosis and treatment. As Uganda is one of the countries The United States President’s Emergency Plan for AIDS Relief (PEPFAR) operates in, the law poses a serious threat to global efforts to end HIV.
Anti-LGBTQ+ legislation casts a shadow over public health, particularly as it relates to HIV prevention and treatment. We must collectively fight back by supporting laws that reflect up-to-date, evidence-informed, and LGBTQ-affirming public health policy, including non-stigmatizing and non-punitive approaches to HIV prevention and care. Public and private funders can dedicate increased funding toward improving the health and well-being of LGBTQ+ people and communities, and local and national LGBTQ+ community organizations can support their people and work in solidarity with public health organizations and providers. In these ways, activists can help ensure that critical health interventions equitably serve all individuals regardless of their sexual orientation or gender identity, in spite of political threats that make that task difficult.
- Astor M. “Report cites more than 350 anti-L.G.B.T.Q. incidents over 11 months.” New York 2023 Jun 22. https://www.nytimes.com/2023/06/22/us/ politics/anti-lgbtq-report-adl-glaad.html
- Peele Roundup of anti-LGBTQ+ legislation advancing in states across the country. Washington, DC: Human Rights Campaign; 2023 May 23. https:// www.hrc.org/press-releases/roundup-of-anti-lgbtq-legislation-advancing-in- states-across-the-country
- The Trevor “New Poll Emphasizes Negative Impacts of Anti-LGBTQ Policies on LGBTQ Youth.” Trevor News [Internet]. 2023 Jan 19. https://www. thetrevorproject.org/blog/new-poll-emphasizes-negative-impacts-of-anti- lgbtq-policies-on-lgbtq-youth/
- Pallarito K. “How anti-LGBTQIA+ legislation harms youth mental health.” Health [Internet]. 2022 Jun https://www.health.com/news/lgbtqia-laws-and- youth-mental-heath
- Murez “Depression rates rise for minority youth in states with anti-LGBT legislation.” HealthDay [Internet]. 2023 Jul 5. https://www.usnews.com/ news/health-news/articles/2023-07-05/depression-rates-rise-for-minority- youth-in-states-with-anti-lgbt-legislation
- English D, Boone CA, Carter JA, Talan AJ, Busby DR, Moody RL, Cunningham DJ, Bowleg L, Rendina Intersecting structural oppression and suicidality among Black sexual minority male adolescents and emerging adults. Journal of Research on Adolescence. 2022. https://doi.org/10.1111/jora.12726
- Gazette-Lee Des Moines Bureau. “Iowa senate passes bill loosening school ” The Gazette [Internet]. 2023 Mar 7. https://www.thegazette.com/state-government/iowa-senate-passes-bill-loosening-school- requirements/
- Phillips G 2nd, McCuskey DJ, Felt D, et Association of HIV education with HIV testing and sexual risk behaviors among US youth, 2009–2017: disparities between sexual minority and sexual majority youth. Prev Sci. 2020 Oct;21(7):898–907. doi: 10.1007/s11121-020-01153-z. PMID: 32804334; PMCID: PMC7470599
- “303 Creative v Elenis: what’s wrong with preemptive litigation of discrimination.” Search eLibrary :: SSRN, 2023 May 3. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4436350
- Richardson, K. “Federal Judge Blocks Obamacare Mandate For HIV Drugs, Other Preventive Services”. Conservative Daily News [Internet]. 2023 May https://www.conservativedailynews.com/2023/03/federal-judge-blocks- obamacare-mandate-for-hiv-drugs-other-preventive-services/.
- “Tennessee rejects federal HIV prevention funds: a looming public health and financial ” Health Affairs [Internet]. 2023 May 8. https://www.healthaffairs.org/content/forefront/tennessee-rejects-federal- hiv-prevention-funds-looming-public-health-and-financial
- Diagnoses of HIV Infection in the United States and Dependent Areas, 2020. HIV Surveillance Report 2021; 33.