When we think of danger to LGBTQ+ people, we often think of some sort of looming specter — a violent attacker outside a bar, an angry figure in the dark. But what about the danger present to LGBTQ+ people who cannot access medical care?
Due to stigma, discrimination, and criminalization of LGBTQ+ relationships, individuals in some countries, like Kenya, often shy away from seeking healthcare services — especially sexual and reproductive health services including HIV testing, treatment and care. Yet gay men and transgender women are among the people most at risk of HIV, estimated to be 24 and 49 times more likely to acquire HIV than the general population, respectively. Concerns about safety, coupled with economic constraints, often prevent many LGBTQ+ individuals from seeing a doctor.
Fortunately, Family Health Options Kenya (FHOK), the nation’s oldest public healthcare provider, treats all patients with respect regardless of sexual orientation. For years, FHOK clinicians have proudly provided members of the LGBTQ+ community with comprehensive sexual and reproductive health services, including prenatal and postnatal care, STI screening, and HIV prevention, testing, treatment and care — including post violence care. The clinic provided contraceptives, counseling and education, including affirmative psychological treatment for LGBTQ+ clients. As part of their training, FHOK clinicians visited LGBTQ+ patients in their homes to build clinician-patient relationships based on mutual trust.
On one visit, FHOK trainees met with Lena (to protect her identity, we’re using a pseudonym), a transgender client and sex worker living with HIV who suffered from health complications related to past trauma and sexual violence. Lena spoke frankly to the trainees as she applied her makeup, telling them about her job, experiences and specific healthcare needs. It took courage for her to welcome staff to her home, and trainees left with a clearer perspective on how to respectfully treat LGBTQ+ patients. Visits like those reassured LGBTQ+ patients that they would be safe and welcome at FHOK clinics.
Thanks to a U.S. policy restricting foreign aid, those patients are now in danger. On his first day in office, Donald Trump issued an executive order instituting his “Global Gag Rule.” This harmful policy requires any organization receiving foreign aid from the U.S. government to sign a statement promising not to provide abortion services, refer patients to an abortion services provider, or mention abortion at all. FHOK leaders declined to comply with the policy, citing a responsibility to provide the best care possible to patients. As a result, FHOK forfeited millions in US aid, which had a devastating impact on all their services.
Trump’s Global Gag Rule forced FHOK to cease all community outreach services, including home visits with patients like Lena. FHOK was forced to close multiple clinics, stranding LGBTQ+ people without access to safe, reliable reproductive healthcare. The years providers spent building relationships with patients, the trust those patients placed in staff, the access to lifesaving treatment FHOK provided -- none of these things mattered to Trump.
Trump’s Global Gag Rule went further than past Republican restrictions, cutting off NGOs that did not sign the gag rule from accessing funding from the President's Plan for Emergency Relief for AIDS, or PEPFAR. Recent research found that Trump’s Global Gag Rule has prevented healthcare providers from treating patients for HIV or providing needed contraception — including condoms for HIV prevention — due to funding cuts and other disruptions. NGOs based in sub-Saharan Africa, where HIV rates are among the highest in the world, reported the largest number of disruptions in healthcare services due to Trump’s Global Gag Rule.
Research by Frontline AIDS in Malawi and Cambodia has shown that the closure of outreach services brought about by the gag rule has had a particular impact on men who have sex with men, transgender women, and other marginalized populations like sex workers. The gag rule creates an additional barrier to access to safe treatment and further isolates LGBTQ+ people; it fragments their networks, closing down safe spaces for them to meet and support one another.
During his State of the Union address, Trump told the nation his administration would help end HIV by 2030. This is impossible under the constraints of the gag rule. The policy is a slap in the face for patients like Lena. They didn’t vote for Trump. They have no members of Congress to call in protest. An American foreign policy decision is hurting LGBTQ+ people thousands of miles from the United States — people who cannot go to the ballot box to correct it.
But you can. In February, Rep. Nita Lowey and Senator Jeanne Shaheen re-introduced the Global Health, Empowerment, and Rights (HER) Act, which would permanently rescind Trump’s Global Gag Rule. Voters have rallied in the streets to protest Trump’s anti-LGBTQ+ policies and their impacts on Americans. Take the next step. Take a stand for vulnerable LGBTQ+ people abroad, whose lives were forever changed by a single stroke of Trump’s pen. End Trump’s Global Gag Rule.
Melvine P. Ouyo is former Kibera clinic manager at Family Health Options Kenya. Luisa Orza is the senior gender advisor at Frontline AIDS.