A new report said to be the first of its kind has documented the needs of the Bay Area's Two-Spirit and Indigiqueer communities. The findings show that an overwhelming majority of respondents are able to access health care but struggle to pay for their everyday needs.
Called "Living in Abundance: Report on the Needs and Strengths of Indigenous 2SLGBTQIA+ Communities in the Greater Bay Area," nearly 30% of the 222 people whose survey responses were used for the needs assessment feel connected to their Indigenous community "all of the time," while 83% said they felt culturally connected to their Indigenous community through dance, ceremonies, spiritual practices, storytelling, food, music, language, arts, and medicinal herbs.
While 1,500 people responded to the survey, only responses from 2SLGBTQIA+ people, with the 2S shorthand for Two-Spirit, living in the nine-county Bay Area could be used for the findings in the report. Conducted by BAAITS, Bay Area American Indian Two-Spirits, it is the first such report the nonprofit has compiled in its 25-year history.
The response, said BAAITS Executive Director Dr. Angel C. Fabian, "reinforced the fact we exist and there is a lot of very beautiful strengths in the community but also a lot of very deep needs."
More than half of respondents were between the ages of 25 and 44, with 50% identifying as male. Three identified as nonbinary and five as Two-Spirit.
Almost 80% were American Indian/Alaska Native or First Nations. The rest were Native Hawaiian/Pacific Islander or Indigenous people from the Americas, according to the report.
"We serve a very particular niche, which are the Two-Spirit and Indigiqueer community. And it is through culture that we are kind of highlighting their role in the community," said Fabian, whose agency annually hosts the biggest powwow gathering for the 2SLGBTQIA+ community, with the next one set for February 1 at Fort Mason in the city's Marina district.
The survey finding that around a quarter of respondents struggle with housing and employment, and that more than 4% are uncomfortable with their use of alcohol and drugs, didn't come as a surprise, Fabian told the Bay Area Reporter during a phone interview on the eve of Native American Heritage Month, which is celebrated in November.
"We knew that by word of mouth. What we were able to do with this particular community assessment is quantify it," said Fabian, 52, who is Two-Spirit and Indigiqueer and was brought in to lead BAAITS close to two years ago.
Fabian was born into the Ben'Zaa or Zapotec Indigenous group of Mexico and grew up in the Central Valley's migrant labor camps. They first came to the Bay Area in 1991 as an undergraduate at Stanford University.
Many 2SLGBTQIA+ Two-Spirits and Indigiqueers move to the Bay Area to find the acceptance they were not receiving in their own nations or the communities they grew up in, said Fabian, who in ceremonial spaces is known as Tlahuizpapalotl, which translates as Butterfly of Light. Others end up coming to the city due to the community resources that are available via different nonprofits or city agencies.
It is captured in the data from the survey responses about feeling a sense of belonging to their Indigenous communities here in the Bay Area, said Fabian.
"What that tells me is that the trajectory of the past 25 years has worked or is working," they said about the various programs BAAITS and other groups have been able to offer. "What that tells me is the labor of love is working."
In terms of medical care, 92.3% of the respondents said they could access the care they need. But 6.7% had problems finding the mental health, medical, or vision care they required.
Survey development
In developing the survey, BAAITS hosted a number of talking circles with a handful of participants at a time who could provide input on what questions to ask. It had selected six people to be community story keepers and lead the discussions.
"The level of openness and vulnerability our community members showed was moving. Some of the preconceived notions I originally held regarding potential need within the community fell short of what the community offered. Their needs were greater, deeper, and often in completely different areas than I imagined," noted Emeryville resident Maritza Castillo, 45, who is Two-Spirit and a detribalized Nahua-Mexica.
One of the story keepers who now works part time for BAAITS as a community wellness ambassador, Castillo was struck by Two-Spirit youth saying they would like to have more "open access" to elders in their Indigenous communities. Meanwhile, they heard from many older LGBT community members that "they don't identify with the younger generation's approach to gender and sexuality," as the report states.
"I think lack of access to elders was something that was repeated over and over again through the process, whether through youth or folks my age," said Castillo.
Consultant Deborah Scott, 72, a straight ally who is Cherokee and president of Sage Associates Inc., said more work is needed to better determine the needs of 2SLGBTQIA+ Two-Spirit and Indigiqueer youth. The survey included responses from just 37 people ages 18 to 24.
"It was a hard group to kind of figure out; that bears some more work," said Scott, who splits her time between Tulsa, Oklahoma and Austin, Texas. "On the whole, I was very pleased with the report and the findings."
She was particularly struck with the findings around people feeling connected to their Indigenous communities. She hopes it sparks an interest in building on that and ensuring people remain connected and have access to community spaces that feel safe and meet their various needs.
"There was a strong feeling of solidarity and alignment," noted Scott. "Even though we have differences internally, there was a strong sense of someone's got my back."
One topic that came up from the talking circles was seeing if people could access the gender-affirming care they needed, which 94.2% said was "accessible." But, as for their friends, 36.5% said they knew someone with no gender-affirming care provider.
In other aspects of health care access, 98.6% of respondents reported having friends in need of assistance. They reported knowing someone who needed help for alcoholism (63.1%); anxiety (50%); depression (47.3%); another mental health condition (19.8%); or pain management for a chronic condition (5%).
"Fortunately, and this is not common in all areas, especially not in rural America, you just have to go down to Fresno or another rural area and know gender-affirming care doesn't exist, we are one of the few urban areas that does have access," said Fabian.
Expecting influx of people
With Republican-led states cracking down on gender-affirming care, and the incoming Trump administration expected to do so as well, Fabian said San Francisco-based agencies are expecting to see even more people from out of state coming to the city for services. They already have been having conversations with their counterparts at other LGBTQ nonprofits about how to handle the influx.
"The impact of anti-LGBT legislation that is happening in all these red states directly impacts what happens in Indian country. Unfortunately, if your gender-affirming care is taken away from you then you are going to go somewhere you can access it," said Fabian.
Although Fabian wouldn't disclose how much the needs assessment cost, it was partly funded via a two-year grant from the San Francisco Human Rights Commission. It had set aside in 2023 $5 million, which was distributed to 13 LGBTQ-serving organizations in awards of up to $750,000.
They are using its findings in their talks with the city's health department on receiving funds to hire a case manager to be on site at BAAITS' offices at 415 Valencia Street it moved into during Pride Month in June. It doesn't provide direct health services but does partner with the Native American Health Center, which provides medical services at its 160 Capp Street location in San Francisco and is in the process of opening a 14,000 square foot community and clinical facility at 3050 International Boulevard in Oakland's Fruitvale neighborhood by winter 2025.
"This also allows us to tap into other funding sources to both elevate and continue elevating the strengths and meeting some of the needs," said Fabian of the people BAAITS serves.
Those needs are only going to grow, predicted Fabian, particularly with Republicans now in control of both the White House and Congress.
"The direct impact of anti-LGBT legislation is that people flee for their lives and end up in urban settings like ours. What that means for us is we have to continue raising those resources to meet the need and telling the story," said Fabian. "Part of the year two process is getting in front of the city agencies and saying this is what the community is telling us and asking how can we partner."
One sentiment expressed by survey participants was that even in San Francisco, Two-Spirits often feel neglected by the larger LGBTQ community. As an example, Fabian pointed to how Two-Spirit is often erased from the acronym or not included along with the transgender and queer communities.
"I believe it is a work in progress," they said, pointing out that the resolution declaring San Francisco to be a sanctuary city for gender-nonconforming people the Board of Supervisors adopted in June specifically identified Two-Spirit people as being covered by it.
The report's accounting of lateral discrimination faced by Two-Spirits, whether within the LGBTQ community or society in general, stood out for Castillo, who grew up in Tucson, Arizona and came out as Two-Spirit 25 years ago. Living in the Bay Area for 19 years, she has only noticed in the past five there being greater recognition of Two-Spirit individuals, specifically within Indigenous communities.
While a good first step was various city and outside groups adopting and reciting land acknowledgements, in which they recognize San Francisco sits on the traditional land of the Ramaytush Ohlone people, other actions are needed to support the local Indigenous community, noted Fabian. They pointed to support for returning access and management of ancestral lands back to Native peoples, and supporting Two-Spirit organizations like BAAITS.
"I would ask your audience what is the action, how are you supporting Indigenous movements," said Fabian, pointing to a saying of the sober community that they have been a part of for 20 years. "Without action it is just words."
To learn more about BAAITS, and to read its assessment report in full, visit its website at baaits.org.
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