Reflections for Pride Month: Gender and Sexual Health Liberation in 2024


Ryan Dougherty, PhD, MSW

Publish date

Reflections for Pride Month: Gender and Sexual Health Liberation in 2024
Tag(s): Editor's pick
Topic(s): Clinical Ethics Health Regulation & Law LGBTQ ethics

Pride is a time for joyous celebration. It’s a time to be in community with friends, watch parades, and dance. It also is a time to honor the countless sacrifices made by lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) people before us who paved the way for the broader cultural acceptance that we enjoy today. Historically, in the United States, many of these battles were directed at reforming the practice of medicine and science. These hard-earned victories resulted in the depathologization of gender, sex, and sexual diversity, and LGBTQIA+ people being able to access life-saving care, often without stigma or hatred. Still, not all LGBTIQIA+ people have fully benefited from these victories, especially those at the intersection of multiple marginalized identities. More troubling, the LGBTQIA+ community stands at a paradoxical crossroads in 2024: while our rights have significantly grown in the last decade, so has a dissenting chorus whose organizing threatens to stop—and even outright reverse—our gains. In the shadow of broader attacks on sexual and reproductive healthcare, bioethicists and healthcare professionals must not only bolster our sexual public health infrastructure but articulate a clear defense to the right of sexual healthcare for the LGBTQIA+ community and others.

A major area of growth pertains to sexual health. Today, people living with HIV have dramatically improved life expectancies thanks to increased access to antiretroviral therapies. People whose viral load is undetectable cannot transmit the virus to their sex partners; a scientific finding summarized in the campaign “Undetectable = Untrasmittable” (U = U), or “treatment as prevention.” Additionally, people living without HIV can take pre-exposure prophylaxis (or, PrEP) which reduces the likelihood of transmission from sex by about 99%. In addition to these advancements, new research supports a new sexual health strategy called doxy-PEP to prevent the transmission of certain bacterial STIs. Overall, these findings portray an optimistic picture on the development and uptake of life-saving sexual health medicine.

Still, research demonstrates major limitations in our capacity to address communicable diseases. For example, in 2022, despite the willingness of gay and bisexual men to take a monkeypox vaccination, research captured frustrations concerning their slow rollout and limited access. In fact, recent data suggests that during the outbreak, many gay and bisexual men altered their sex behaviors, which itself may be the reason a larger pandemic was subverted. As we learned with COVID-19, these issues point to a growing urgency to bolster our public health preparedness for communicable diseases. The LGBTQIA+ community should not have to handle health crises without sufficient, public health support.

Other research demonstrates stark inequities along lines of race, gender, and geographical region in accessing sexual healthcare. Similarly, many populations still cannot access standard of care for HIV prevention and treatment. PrEP remains under-prescribed among Black and Hispanic individuals, and especially women, which is due to both structural barriers (particularly out-of-pocket costs) and social stigma toward these populations. This has resulted in shorter lifespans for these populations living with HIV compared to their white and cis-male counterparts. Access is also frustrated by the imposition of far-right ideology. In 2022, a district court judge in Texas ruled in favor of an employer denying insurance coverage for PrEP because, “compulsory coverage for those services violates their religious beliefs by making them complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman.” Especially in the wake of Dobbs, we cannot remain silent – we must prepare ourselves for continued attacks designed to eliminate access to sexual and reproductive healthcare in the United States.

The assault on LGBTQIA+ rights is also deteriorating relationships between healthcare professionals and their patients. A recent study reported that LGBT adults were twice as likely to report negative experiences with healthcare professionals for any reason. Addressing this requires robust education to prepare healthcare trainees to work across diverse populations. Unfortunately, since 2023, 84 bills have been introduced to restrict or disband Diversity, Equity, and Inclusion (DEI) offices, many of which are hubs for curriculum reform and strategies to diversify faculty recruitment and retention. Such bans go hand-in-hand with broader attacks on LGBTQIA+ visibility in popular media and educational curriculum, including banning discussions of sexuality in public classrooms (so-called “Don’t Say Gay” legislation). The far-right is now setting their sights on LGBTQIA+ studies in undergraduate level curriculum. In addition to the erasure of LGBTQIA+ issues in classrooms, these efforts are direct threats to the well-being of youth and will have downstream consequences for their physical and mental wellbeing for decades to come. Consider that some bills might require teachers to “out” LGBTQIA+ students to their parents and, in some states, even risk their imprisonment for providing support to trans students.

 No other topic in LGBTQIA+ healthcare has received more public attention and attacks in recent years than gender affirming care (GAC) for minors. Twenty-four states have new legislation that limit or outright ban GAC for minors; 22 of which include legal penalties for health care practitioners. These bans ignore the wealth of literature demonstrating the benefits of gender affirming care for minors. Many of these are based in an intentional disinformation campaign on what gender affirming care entails. Now, states are also limiting access to GAC for adults too.

Festering alongside this rampant disinformation are deeper paranoias regarding the role of medicine in society. It is not uncommon to see COVID-19 conspiracy theories alongside disinformation on transgender identities and gender affirming care these days. This kind of discourse should concern us all as it both increases the risks of hate-based violence toward vulnerable populations and marks the injection of paranoid-thinking in American politics and medicine. By drawing from misinformation and hatred, the far-right continues to encourage non-evidence based medical and therapeutic practices to have LGBTQIA+ people confirm to social norms of gender, sex, and sexuality. This includes “conversion therapy” – a range of pseudoscientific attempts at “turning” people heterosexual – and still practiced widely across the United States. Similarly, surgeries to “fix” intersex children (i.e., have their physical characteristics align with the sex binary) are still practiced. Intersex communities across the United States continue to protest these irreversible and non-consensual surgeries, which often do not receive the time and attention that are deserved. More recently, the United Nations passed a resolution to protect the rights of intersex individuals against non-consensual surgeries.

 The LGBTQIA+ issues I’ve highlighted do not encompass the full range of issues our community faces and the uphill challenges before us. Nor do I sufficiently dive into the nuances across lines of nationality, race and ethnicity, and gender, divides that our community must address. Hopefully, though, what I’ve provoked is careful consideration to how LGBTQIA+ issues are, at their core, issues that impact us all. We are all interwoven within social systems of gender, sex, and sexuality, and benefit from having a healthcare system responsive to our needs. We deserve to live without medicine weaponized against human diversity. And we will need everyone, including our allies, to lend a hand in our fight.

Ryan Dougherty, PhD, MSW is an Assistant Professor at Baylor College of Medicine.

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