Editorial: Becerra's HHS is moving on health equity

  • by BAR Editorial Board
  • Wednesday December 13, 2023
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Health and Human Services Secretary Xavier Becerra. Photo: Rick Gerharter
Health and Human Services Secretary Xavier Becerra. Photo: Rick Gerharter

Earlier this week, Xavier Becerra, the Health and Human Services secretary in the Biden administration, held a meeting with leaders from LGBTQI+ civil rights organizations. He discussed actions the department has taken to advance health equity, increase access to health care, secure non-discrimination protections, and increase access to behavioral health services for the LGBTQ community. Judging from a readout of the meeting, HHS has continued to take proactive steps that benefit the community. Overall, we believe Becerra, a longtime ally and former California attorney general, and Admiral Rachel Levine, the assistant secretary for health and a trans woman who also attended, have worked to make changes within the department since taking over after the Trump administration.

Becerra highlighted the importance of sexual orientation and gender identity data collection, or SOGI, which, as we have been reporting for years, is crucial to determining how many LGBTQs access services, what services they are provided, and where the federal government comes up short in its pursuit of health equity. For example, we know that disparities remain among men who have sex with men in getting on PrEP, an effective HIV prevention medication, particularly gay and bi men of color. And with the recent San Francisco Department of Public Health report showing Latino men have the highest rate of new HIV cases in the city, it's clear that more needs to be done to reach these populations. There's also an effort underway among California health officials to better collect SOGI data after a scathing audit earlier this year found stark deficiencies.

The Healthy People 2030 plan, which contains HHS' goals for identifying disparities in health and human services, was also discussed, Becerra's office stated in a news release. According to its website, it sets data-driven national objectives to improve health and well-being over the next decade. It includes 350 core — or measurable — objectives. Under HIV/AIDS, the goals so far are mixed. The website indicates that there's little to no change in the "Increase knowledge of HIV status," which is key to preventing spread of the disease. (Research has shown that if a person achieves and maintains an undetectable viral load — the amount of HIV in the blood — by taking antiretroviral therapy (ART) daily as prescribed they cannot sexually transmit the virus to others. This is called Undetectable=Untransmittable, or U=U.) On the other hand, the Healthy People 2030 goal to increase linkage to HIV medical care is improving, according to the website.

Becerra also discussed supporting LGBTQI+ youth (ages 10-24), the release noted. The HHS' Office of the Assistant Secretary for Planning and Evaluation has released a new brief titled "Emerging Practices for Supporting LGBTQI+ Young People Across Human Services Programs." Its website notes that five LGBTQI+ young adults served on a steering committee for the project, each with lived experience navigating human services programs. An infographic for the brief showed that services should be centered on LGBTQI+ young people's needs and intersecting identities. That is crucial and something that many providers should strive for. Additionally, the infographic noted the importance of creating safe spaces, including the use of a person's preferred name and pronouns, as well as understanding and strengthening family-youth connections and providing training for staff.

This is a good resource for nonprofit organizations that serve queer youth, and includes a webinar and recording of a panel discussion of youth, and a caregiver of LGBTQI+ young people.

Becerra also discussed how the department has issued multiple landmark proposed regulations to protect LGBTQI+ individuals and families from discrimination. For example, HHS' Office of Civil Rights issued a proposed rule that would protect LGBTQI+ people from discrimination in health and human service programs by clarifying and reaffirming the prohibition on discrimination on the basis of sexual orientation and gender identity in certain statutes. The office also issued a proposed rule that would update implementation of Section 504 of the Rehabilitation Act to protect against discrimination based on an individual's HIV status or diagnosis of gender dysphoria. A proposed rule from HHS' Administration for Children and Families would ensure LGBTQI+ youth in foster care receive safe and appropriate placements, the release stated.

These policies are important because in too many places, people are still discriminated against based on their HIV status. Regarding foster youth, there is an effort underway in some places that put religious beliefs ahead of other considerations. In 2021, the U.S. Supreme Court ruled against the city of Philadelphia, which has an ordinance prohibiting discrimination and wanted to deny an independent contractor providing foster placement services from operating in the city because it had a policy of denying service to same-sex couples. More recently in California, Governor Gavin Newsom earlier this year vetoed a bill that would have required state judges to take into account parental support for their transgender children during custody disputes.

Overall, HHS is continuing to build on the progress it has made on LGBTQI+ issues. It's crucial that the department's personnel continue to support trans youth and their families as hostile laws in red states serve to disrupt their lives by banning gender-affirming care for youth and other prohibitions. National LGBTQ organizations that had representatives at the meeting, such as the Human Rights Campaign, The Trevor Project, and AIDS United, need to work with local LGBTQ nonprofits across the country to help disseminate HHS' various policies so that health equity can be furthered.

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