Becoming Whole: A New Era for LGBTQ+ Americans To be LGBTQ+ in America today is to enjoy freedoms hard-won by trailblazers who came before and to feel the urgency of an unfinished promise of full equality under the law. We are here thanks to the struggle of activists like Henry Gerber, Del Martin, and Phyllis Ann Lyon, who founded some of the first LGBTQ+ rights organizations in the country when it was still illegal for LGBTQ+ people to congregate in public or private. Fifty years ago, a resistance at the Stonewall Inn—primarily led by transgender women of color like Marsha P. Johnson and Sylvia Rivera, and lesbian activist Stormé Delarverie— galvanized a movement. As hundreds of thousands of LGBTQ+ people lost their lives to the HIV epidemic, activists and organizations like ACT UP dramatically changed the visibility of the community and fostered positive changes in our health care system that have gone well beyond the treatment of this disease. And leaders like Essex Hemphill, who famously declared in ESSENCE Magazine, “I love myself as a black man and a homosexual,” thereby confronting racism and discrimination across the LGBTQ+ and Black communities head on. LGBTQ+ people haven’t just been present in American history—they have been drivers of it.1 They have pushed our country to be what it has promised to be all along: a more perfect union. As a result of these heroic efforts, the movement for LGBTQ+ equality has made profound strides forward. In the last decade alone, advocates successfully pushed for the repeal of Don’t Ask, Don’t Tell, ending a policy that forced service members to choose between the person they loved and the country they loved and helped make marriage equality the law of the land. We now have medications that make HIV manageable and can help prevent individuals from being infected. Decades ago, there was no place where someone could worship as an openly LGBTQ+ person. Today, many major religions and sects in the United States, representing millions of people, perform LGBTQ+ marriages and majorities of every major religious group support LGBTQ+-inclusive nondiscrimination laws.2,3 Twenty years ago, an awkward teenager at St. Joe High School in South Bend, Indiana, who didn’t know a single out LGBTQ+ student there, never would have imagined how far we would come as a country. But what does our country look like to a teenager in 2019, just starting to realize who they are? What future do they see for themselves? They see an administration that has unacceptably deemed people who risk their lives for their country as unfit for service because they are transgender.4 They see a government that is allowing clinicians to refuse to treat patients who are LGBTQ+.5 They see a President who, when asked about LGBTQ+ rights by a 1 2 Bronski, Michael. “A Queer History of the United States.” Beacon Press. 2012. Riess, Jana. “Same-sex marriage garners support among most American religious groups, study shows” Religious News Service. May 1, 2018. 3 Daniel Greenberg, Maxine Najle, PhD, Oyindamola Bola, Robert P. Jones, Ph.D. “Fifty Years After Stonewall” Public Religion Research Institute. March 26, 2019. 4 5 Chung, Andrew, Jonathan Stempel. “U.S. court lets Trump transgender military ban stand, orders new review.” Reuters. June 15, 2019. Sanger-Katz, Margot. “Trump Administration Strengthens ‘Conscience Rule’ for Health Care Workers.” The New York Times. May 2, 2019. 1 reporter, joked of his Vice President: “Don’t ask that guy—he wants to hang them all!”6,7 They see more states covering gender-affirming procedures, but they also see schools refusing to allow trans students to use the bathroom of their current gender.8 They see people with HIV living vibrant lives, but they also see people who cannot afford the treatment they need. They see gay nightclubs opening up across the country, but they can’t forget Pulse. They see transgender people, primarily Black transgender women, murdered at alarming rates. They see a country where they are still not fully free or safe and one in which they still don’t feel like they fully belong. In the past week alone, four out of five LGBTQ+ youth felt down or depressed, more than two out of three reported feeling worthless, and last night, almost all had trouble sleeping.9 This past year, LGBTQ+ Americans were twice as likely to suffer from mental illness as their straight peers, and almost one in two transgender people considered suicide.10 Across much of our country, discrimination and the ever-present fear of it continue to govern aspects of LGBTQ+ people’s lives. Can I be who I am and keep my job? Can I hold the hand of the person I love in public? Which bathroom can I use safely? Will I be able to raise a family or not be harassed at school? Can I live here and be happy? Will I ever be accepted? When I’m President, I hope these questions will start fading away. We will share solutions big enough to meet the challenges the LGBTQ+ community faces while bringing the American people together to understand that our freedoms are bound up in each other. This starts with an intentional dismantling of the institutionalized discrimination confronting the LGBTQ+ community. I will press for and sign the Equality Act into law as soon as it hits my desk, making anti-discrimination the law of the land. I will deliver quality health care that is affordable, accessible, and equitable for all Americans, regardless of their sexual orientation, gender identity, or race. My Administration will put us on a path to end the HIV/AIDS epidemic—which disproportionately affects gay men and transgender women of color11—by 2030, and ban the dangerous practice known as “conversion therapy” once and for all. I will use more comprehensive strategies to end hate-based violence against LGBTQ+ people, especially Black transgender women; increase access to housing for LGBTQ+ Americans; and strengthen protections for LGBTQ+ immigrants and refugees. For LGBTQ+ people, like for other marginalized groups, the political has always been extremely personal. This is why our policy is inspired by LGBTQ+ people’s stories: by the war that breaks out in the heart of a young person when they realize that a basic fact about them makes them more likely to be feared, and the immense joy that comes with finally knowing with certainty that you belong. Below we share the stories of some of these brave people. 6 Massie, Chris, Andrew Kaczynski. “Trump judicial nominee said transgender children are part of ‘Satan’s plan,’ defended ‘conversion therapy.” CNN. September 20, 2017. 7 8 9 Mayer, Jane. “The danger of President Pence.” The New Yorker. October 16, 2017. Balingit, Moriah. “Education Department no longer investigating transgender bathroom complaints.” The Washington Post. February 12, 2018. Human Rights Campaign. “2018 LGBT Youth Report.” 10 National Alliance on Mental Illness. “LGBTQ.” 11 Gamarel, Kristi E., Kimberly M. Nelson, Rob Stephenson, Olga J. Santiago Rivera, Danielle Chiaramonte, Robin Lin Miller, and Adolescent Medicine Trials Network for HIV/AIDS Interventions. “Anticipated HIV Stigma and Delays in Regular HIV Testing Behaviors Among SexuallyActive Young Gay, Bisexual, and Other Men Who Have Sex with Men and Transgender Women.” AIDS and Behavior 22, no. 2 (June 2017): 522–30. 2 Each of us has our own story. And when I’m President, I will use the power of the presidency to tear down the walls that have excluded far too many LGBTQ+ people for far too long. EQUALITY “They can't fire me now.” That was my first thought upon being selected as the 2015 National Teacher of the Year. After 15 years as an educator, it wasn't until I stood in the Rose Garden at the White House that I finally felt safe enough to do the work I've felt called to do. My career longevity was never something I could count on. Because I'm from the 13th Congressional District in the Texas Panhandle, identified by the Cook Political Report as the reddest in the country, my job wasn't guaranteed to me if someone took issue with me being openly gay. In fact, my home state is one of 28 that will not protect your right to work if you are LGBTQ+. Our LGBTQ+ youth need to know that in addition to the right to marry the person they love, they have the right to do the work they love free from discrimination. This is why I'm committed to being an openly gay teacher and advocate. - Shanna Peeples, Educator, Texas Prohibit discrimination against LGBTQ+ people. 12 13 14 ● Pass the Equality Act. In 29 states, an LGBTQ+ individual can be denied a job or housing based on their sexual orientation or gender identity.12 They can be denied service at a restaurant or hotel.13 No state or community in the United States should be allowed to discriminate and the federal Equality Act would prohibit such discrimination nationwide. Winning passage of this landmark civil rights legislation would be a top priority of a Buttigieg administration. ● Rescind the Trump administration’s efforts to strip protections against discrimination for LGBTQ+ Americans. A Buttigieg administration would immediately restore administrative regulations, guidance, and interpretations of federal civil rights laws that prohibit discrimination based on sex, sexual orientation, and gender identity. This will include ensuring that all shelters receiving federal funding will provide a safe and welcoming environment for homeless or displaced trans persons that aligns with their gender identity. ● Ensure that the freedom of religion is not exploited into a license to discriminate. Freedom of religion is a core American value that is protected by the First Amendment of the Constitution. The First Amendment does not allow institutions to impose their beliefs on others or cause them harm. The Buttigieg administration will conduct a thorough examination of unconstitutional religious exemption policies in the federal government, especially those deployed by the Trump administration to undermine the rights of LGBTQ+ people. This includes refocusing, reassigning, or removing offices that were put in place to enable discrimination, especially, for example, at the Department of Health and Human Services (HHS).14 Public Leadership Institute. “LGBT Fairness Act.” Miller, Susan. “Not just about a cake shop': LGBT people battle bias in everyday routines.” USA Today. January 16, 2018. Abutaleb, Yasmeen. “U.S. health agency finalizes conscience and religious freedom rule.” Reuters. May 2, 2019. 3 ● Ensure that every federal agency identifies discrimination against LGBTQ+ people and vigorously uses all available tools to stop it. All relevant agencies will restore interpretations of federal civil rights laws that prohibit discrimination by federal contractors and by recipients of federal funding based on sex, sexual orientation, and gender identity, and will vigorously prosecute such discrimination. The Buttigieg administration will also propose a budget that provides federal Offices of Civil Rights with the staffing and funding they need to enforce protections for LGBTQ+ people and other marginalized groups. ● Update the U.S. passport program to include a third, non-binary gender option, “X”, for all new U.S. passports. In the last three years, several states have updated their driver’s licenses and other forms of identification (ID) to include a third gender option: X. In that short time, over 7,000 non-binary people have received gender X IDs.15 Non-binary people across the country should be able to join the ranks of other countries such as Australia and Canada and receive passports with accurate gender information that allow them to travel freely as themselves.16 End the blanket ban on blood donation from people including gay and bisexual men and replace it with a science-based approach. Currently, there is a ban on gay and bisexual men giving blood that was put in place in reaction to fear rather than science. A safe and adequate blood supply is essential for all Americans. One study found that if the one-year ban on blood donations was lifted, as a country we would have over 300,000 more pints of blood per year.17 As President, Pete will ensure that all public health decisions and regulations are based on scientific evidence and not fear or stigma, including blood donor deferral guidelines to prevent HIV transmission. He will properly fund the Food and Drug Administration (FDA) to facilitate this approach. Protect and respect the rights of intersex people’s bodily autonomy, bodily integrity, and health. ● Ban medically unnecessary genital surgeries on intersex infants and children. In the United States, 1.7 percent of babies cannot be easily categorized as male or female at birth.18 Some intersex children are subject to medically unnecessary genitalia-altering surgeries that can be so physically and psychologically harmful that the United Nations has deemed them human rights violations.19 15 Lam, Kristin. “More than 7,000 Americans Have Gender X IDs, a Victory for Transgender Rights. Is It a Safety Risk, Too?” USA Today. Gannett Satellite Information Network, August 31, 2019. 16 Allen, Samantha. “Will the State Department Fight Non-Binary Passports?” The Daily Beast, September 27, 2018. 17 Miyashita, Ayako, and Gary J. Gates. “Update: Effects of Lifting Blood Donation Bans on Men Who Have Sex with Men.” The Center for HIV Law and Policy, September 2014. 18 Knight, Kyle. “‘I Want to Be Like Nature Made Me’: Medically Unnecessary Surgeries on Intersex Children in the US.” Human Rights Watch, August 30, 2017. 19 Knight, Kyle. “‘I Want to Be Like Nature Made Me’: Medically Unnecessary Surgeries on Intersex Children in the US.” Human Rights Watch, August 30, 2017. 4 ● Train more doctors and medical professionals on the health needs and human rights of intersex people. More training opportunities will help ensure that medical professionals provide respectful and appropriate information, advice, and care to parents and intersex children. ● Combat discrimination on the basis of intersex characteristics or status. Pete will combat discrimination in a range of settings, including in health care, education, and employment. HEALTH On May 2, 2007, seven days before my 19th birthday, I was diagnosed with having HIV. I thought it was going to be the end of my life and the end of my very fresh military career. I thought it was the end of my life because all I really knew about HIV at the time were the stories of the late 80s and early 90s, where people were only living about two to five years. With Don't Ask, Don't Tell in law at the time, I just knew I was going to get separated from the military for having HIV and being gay. But I was wrong. I was able to find the strength to keep fighting and not let the virus control my life thanks to a support system that continued to let me know that things were going to be okay. It was also thanks to the health care and counseling provided through the military that relieved the burden of worrying about getting treatment for this virus. Since then, I have seen it as a duty to help educate people about HIV and let them know that it is no longer the death sentence that it was once known to be and just being there for people who are diagnosed without a support system. - Taye Wilkinson, Organizer for Pete for America, South Carolina Improve access to and quality of health care for LGBTQ+ people. 20 ● Guarantee that every LGBTQ+ person has access to affordable health coverage through Medicare for All Who Want It. In our country, millions of people are either uninsured or underinsured, and either pay too much for care or do not get the care they need because it’s too expensive.20 LGBTQ+ people are less likely to be insured than their non-LGBTQ+ peers, and as a result, are less likely to access crucial preventive services and more likely to forego care for chronic conditions such as diabetes or heart disease.21 Through Pete’s Medicare for All Who Want It plan, every American will have access to an affordable public plan. ● Eliminate all barriers to medically necessary care for transgender Americans. Transgender Americans require gender-affirming treatments and procedures. Pete will enact policies that not only require coverage of gender-affirming care but also address the shortages of transition-related care that so many transgender Americans face while trying to find a provider who can competently and respectfully deliver their health care. Such medically necessary care should be recognized and paid for by all insurers. Pete will also ensure that trans men have access to safe reproductive health care including routine gynecological health services such as pap smears or breast exams. “Key Facts about the Uninsured Population.” The Henry J. Kaiser Family Foundation, February 7, 2019. 21 Baker, Kellan, and Laura E. Durso. “Why Repealing the ACA is Bad Medicine for the LGBT Community.” Center for American Progress. March 22, 2017. 5 ● Provide targeted approaches within women’s health programs for lesbians and bisexual women. Bisexual women and lesbians continue to experience health disparities and are often overlooked by health care providers and in health care research.22 A Buttigieg administration will increase data collection and prioritize research on the health and well-being of bisexual women and lesbians. ● Ensure LGBTQ+ people receive care from clinicians who are equipped to provide respectful, appropriate, and equitable care. Pete will support a health care delivery infrastructure that is inclusive of and responsive to the needs of LGBTQ+ people, emphasizing provider education on LGBTQ+ health and health care needs. This includes ensuring clinicians understand sexual orientation and gender identity, use inclusive language, understand the unique health needs of the LGBTQ+ community, and know trauma-informed care. Pete will also work to ensure that clinics serving the LGBTQ+ community are part of the care networks created under Pete’s Medicare for All Who Want It public alternative, as well as existing pubic health care plans like Medicaid and Medicare. A Buttigieg administration will also promote culturally, linguistically, and historically respectful provider education and training to address stigma based on multiple identities, particularly important for LGBTQ+ people of color. Reduce disparities in mental health care for LGBTQ+ Americans. ● Ensure access to comprehensive mental health and addiction services for all Americans, including LGBTQ+ people. Pete’s Health and Belonging in America Plan will ensure that every American has access to comprehensive coverage for mental illness and addiction care and reduce stigma by changing the narrative around mental health and addiction. Pete would do this by enforcing mental health parity in health care coverage, empowering communities to address the problem in their own way through annual $10 billion grants that address prevention and care integration, directing more resources to programs that use harm-reduction and trauma-informed care, and dramatically expanding the use of medication-assisted treatment (MAT). ● Pass the LGBTQ+ Suicide Prevention Act, comprehensive legislation that addresses key risk factors for LGBTQ+ deaths by suicide, particularly for LGBTQ+ youth. LGBTQ+ youth are four times more likely than their non-LGBTQ+ peers to attempt suicide.23 More than two in five transgender people attempt suicide.24 These rates are even higher for transgender people who are people of color, have a physical disability, have a mental illness, or have low incomes.25 A Buttigieg administration will work with Congress to pass the LGBTQ+ Suicide Prevention Act, which will launch a LGBTQ+ suicide prevention task force and address key risk 22 Baptiste-Roberts, Kesha, Ebele Oranuba, Niya Werts, and Lorece V. Edwards. “Addressing Health Care Disparities Among Sexual Minorities.” Obstetrics and Gynecology Clinics of North America 44, no. 1 (2017): 71–80. 23 Kann, Laura, Emily O’Malley Olsen, Tim Mcmanus, William A. Harris, Shari L. Shanklin, Katherine H. Flint, Barbara Queen, et al. “Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9–12 — United States and Selected Sites, 2015.” Center for Disease Control Morbidity and Mortality Weekly Report Surveillance Summaries 65, no. 9 (December 2016): 1–202. 24 Haas, Ann P., Philip L. Rodgers, and Jody L. Herman. “Suicide Attempts among Transgender and Gender Non-Conforming Adults.” The Williams Institute, January 2014. 25 Haas, Ann P., Philip L. Rodgers, and Jody L. Herman. “Suicide Attempts among Transgender and Gender Non-Conforming Adults.” The Williams Institute, January 2014. 6 factors for LGBTQ+ deaths by suicide, including bullying, cyber-bullying, stigma, homelessness, and others. ● Increase funding for culturally appropriate mental health and substance use disorder services for LGBTQ+ people. LGBTQ+ individuals are more than twice as likely as nonLGBTQ individuals to suffer from a mental health disorder.26 Despite greater need for mental health and substance use disorder services, many LGBTQ+ individuals receive poor quality care due to insensitivity, lack of provider awareness of the community’s unique needs, and stigma.27 As noted above, Pete will transform the health workforce, health systems, and the institutions that train future clinicians to ensure they are prepared to engage with communities in culturally-, linguistically-, and historically-appropriate ways, and include peer-based interventions. End the HIV/AIDS epidemic by 2030. ● Restore White House leadership on HIV/AIDS. Pete will re-establish the White House Office of National AIDS Policy and, within six months of taking office, update the National HIV/AIDS Strategy to ensure that U=U (Undetectable means Untransmittable) and universal access to PrEP (Pre-Exposure Prophylaxis) in order to end the epidemic by 2030. A Buttigieg administration will also address the continued racial and geographic disparities in the epidemic, especially among transgender women of color and Black and Latino men who have sex with men in the South. ● Guarantee that everyone with HIV is, and remains, in treatment. A Buttigieg administration will achieve this by expanding access to HIV testing in clinical and non-clinical settings, ensuring that everyone living with HIV has access to coverage and affordable health care, and fully funding the Ryan White HIV/AIDS program. ● Ensure access to PrEP for everyone who needs it. PrEP therapies are a critical tool for ending the epidemic, yet less than 10 percent of those for whom PrEP is appropriate are currently using it.28 Moving toward universal insurance coverage with Pete’s Medicare for All Who Want It plan is the first step to improving access. Pete will harness the strong HIV care delivery system already in place to provide culturally competent care to people on or who may benefit from PrEP. Pete will require all insurance plans to cover PrEP and related screening and monitoring services without cost sharing and provide special federal funding to ensure access to PrEP drugs and related services for those who are uninsured and under-insured. We must also address costs. Truvada, the current PrEP drug, costs $1,600 a month in the United States and only $70 a month in some countries.29 And the newly approved PrEP alternative, 26 27 American Psychiatric Association. “Mental Health Disparities: LGBTQ.” 2017. Ibid. 28 Center for Disease Control and Prevention. “HIV prevention pill not reaching most Americans who could benefit – especially people of color.” March 6, 2017. 29 Fitzsimons, Tim. “Generic HIV prevention drug coming in 2020, Gilead says.” NBC News. May 8, 2019. 7 Descovy, is expected to cost $1,800 a month.30 The United States is one of the largest purchasers of PrEP worldwide, and American taxpayers and LGBTQ+ communities were instrumental in funding and participating in trials for the development of PrEP.31 If pharmaceutical companies selling PrEP therapies refuse to ensure affordable access for all Americans, A Buttigieg administration will pursue aggressive price negotiations in line with our broader drug pricing strategies. If those negotiations fail, given the vital public health role of PrEP as an HIV prevention tool, Pete will consider exercising eminent domain on PrEP-related patents as detailed in our drug pricing plan, Affordable Medicine for All. ● Invest in finding a cure for HIV. While we currently have treatment and prevention tools that can dramatically alter the course of the epidemic, we must continue searching for a cure and a preventive vaccine. A Buttigieg administration will commit to restoring funding for domestic HIV/AIDS research, which has been slashed since 2016. ● Guarantee access to prevention services, such as condoms and risk reduction programs. A Buttigieg administration will align existing programming and funds to make condoms and HIV prevention programs broadly available through community organizations, Federally Qualified Health Centers, and school health programs. These will target populations particularly at risk, especially young men who have sex with men, and transgender women. ● Support evidence-based harm reduction, including removing restrictions on syringe services programs and permitting states to develop safe injection sites. With the continued opioid and methamphetamine epidemics, health departments should be encouraged to develop or expand syringe services programs. The federal government should also ensure that federal funds are available for testing safe injection sites and that these sites are not impeded by federal law enforcement policies. ● Decriminalize HIV transmission and reduce stigma related to HIV/AIDS. Stigma based on either gender identity or HIV status increases the risk of acquiring HIV and jeopardizes whether someone gets the care they need.32 Pete’s administration will restore the Affordable Care Act’s civil rights protections to everyone at risk for HIV. ● Resume U.S. leadership in international institutions, partnerships, and programming aimed at ending the HIV/AIDS epidemic globally. Pete will invest in evidence-based programs that prioritize vulnerable populations and promote gender equity, reproductive rights, transparency, and accountability. This means expanding funding for PEPFAR and the Global Fund to projected needs level and rolling back the Mexico City policy. YOUTH & FAMILIES 30 31 32 Fitzsimons, Tim. “FDA approves Gilead's next-generation HIV PrEP pill, Descovy.” NBC News. May 8, 2019. Pebody, Roger. “380,000 people on PrEP globally, mostly in the USA and Africa.” AIDS Map. October 23, 2018. Avert. “HIV Stigma and Discrimination.” 8 I grew up in a conservative town in Minnesota. During my time in school, I was struggling with who I was. Navigating a high school romance that we weren't even sure was real or right, I knew that coming out meant having my community and those closest to me reject me solely on the basis of who I was. During my sophomore year in high school, I was unexpectedly forced out of the closet by my peers and, suddenly, my life was turned upside down. I was constantly harassed, threatened, and ostracized. Over the next year and a half, things became so bad at school and within a family that didn't understand or accept me, that I dropped out of high school and attempted to commit suicide. While I was in recovery, I saw so many other young LGBTQ youth struggling in many of the same ways I was. I found that there were 9 student suicides over the course of a year in my school district; I was one pill away from being the 10th. I firmly believed—and still do—that I had to be here for a reason when so many others weren't. - Kyrstin Schuette, Midwest Organizing Director for Pete for America, Minnesota Protect LGBTQ+ students from bullying and ensure they learn in safe, supportive environments. ● Prohibit violence, bullying, and discrimination based on sexual orientation and gender identity. Schools have a responsibility to ensure the safety and dignity of each student. When LGBTQ+ students feel safe and protected, the overall learning environment becomes more welcoming and inclusive for all students. Research shows that schools which enumerate or list characteristics that are the most frequent targets of harassment not only make marginalized students more visible but reduce the frequency and number of incidents for all groups.33 To this end, Pete will also support the Student Nondiscrimination Act and the Safe Schools Improvement Act, and correctly interpret Title IX to include protection of transgender students. A Buttigieg administration will lead with this clear interpretation in all education policy. ● Provide funding to help states’ education department create more safe and inclusive environments. As President, Pete will provide resources to help school districts develop resources and model training programs for teachers to better support LGBTQ+ students who are facing harassment, lack of acceptance, or discrimination at school, at home, or in their communities. ● Empower the Office of Civil Rights at the federal Department of Education to appropriately investigate complaints of discrimination by LGBTQ+ students and families. No student should feel that their education is limited or denied because of discrimination against their identity. As President, Pete will direct the Office of Civil Rights in the Department of Education to reverse the backsliding under the Trump administration, and make sure LGBTQ+ civil rights cases, and in particular, increase efforts to protect transgender students, who experience greater frequency of gender-based harassment, bullying, and violence, are investigated.34,35 33 Kull, R. M., Greytak, E. A., Kosciw, J. G., & Villenas, C. “Effectiveness of school district antibullying policies in improving LGBT youths’ school climate.” Psychology of Sexual Orientation and Gender Diversity, 3, no. 4 (2016): 407-415. 34 Mirza, Shabab A. and Bewkes, Frank J. “Secretary DeVos is Failing to Protect the Civil Rights of LGBTQ Students.” Center for American Progress, July, 2019. 35 James, Sandy E., Jody L. Herman, Susan Rankin, Mara Keisling, Lisa Mottet, and Ma'ayan Anafi. “The Report of the 2015 U.S. Transgender Survey.” National Center for Transgender Equality, December 2016. 9 ● Increase funding for school-based health centers to provide mental health services. These funds will build and upgrade infrastructure and hire staff to address students’ mental health, physical health, and wellness needs. As shared in Pete’s mental health plan, Pete will also require every school across the country to teach Mental Health First Aid courses. ● Provide LGBTQ+ inclusive lessons and health education. Students deserve to see themselves reflected in our curriculum. Pete will include funding under Title II to support inclusive lessons, such as including LGBTQ+ people in history curricula. End “conversion therapy” nationwide. “Conversion therapy” is currently legal in 31 states (18 states have fully banned the practice).36 An estimated 73,000 young people will receive “conversion therapy” before their 18th birthday.37 Pete will work to pass the Therapeutic Fraud Prevention Act, which will require the Federal Trade Commission to classify, and thereby prohibit, “conversion therapy” as consumer fraud, and end the dangerous practice across the country. Protect the rights of all LGBTQ+ families. ● Prohibit discrimination against potential adoptive or foster parents and children based on sexual orientation or gender identity. Over 400,000 youth are in foster care, 100,000 of whom are eligible for adoption.38 Every year, more than 23,000 young people age out of care without ever being placed with a permanent family.39 Youth of color and LGBTQ+ youth are overrepresented in the foster care system, and LGBTQ+ adults are far more likely than their peers to foster or adopt.4041 To place more children in permanent homes, Pete will end Trump’s “religious freedom waiver” that allows foster care agencies receiving federal dollars to discriminate based on sexual orientation or gender identity, and prohibit them from performing “conversion therapy” on youth in their care. ● Pass the Every Child Deserves a Family Act and the Do No Harm Act. These important pieces of legislation would solidify into law non-discrimination in child welfare based on sexual orientation, gender identity, and religion, and Pete will work with Congress to pass them. ● Pass the FAMILY Act and ensure these protections reach all families who need them. All new parents, regardless of gender, deserve time off from work to take care of a sick loved one or 36 LGBT Movement Advancement Project. “Conversion Therapy Laws.” One state, North Carolina, partially banned conversion therapy for minors. 37 38 39 40 Mallory, Christy, Taylor N.T. Brown, and Kerith J. Conron. “Conversion Therapy and LGBT Youth.” The Williams Institute, June 2019. “About the Children.” AdoptUSKids. Accessed September 30, 2019. “51 Useful Aging Out of Foster Care Statistics: Social Race Media.” National Foster Youth Institute, May 26, 2017. “Same-Sex Parenting in the U.S.” The Williams Institute, August 7, 2019. 41 Children’s Welfare Information Gateway. “Racial Disproportionality and Disparity in Child Welfare.” Children’s Bureau Issue Brief. November 2016. 10 a new baby or child without losing a paycheck or risking their job. Pete will pass the FAMILY Act to ensure that workers have access to 12 weeks of paid family and medical leave and introduce policies that allow benefits to extend to chosen family members. ● Treat same-sex American parents abroad equally. The Trump administration’s State Department created a new requirement that makes it harder for the children born abroad to samesex parents to be considered citizens.42 Pete will clarify State Department guidance so that samesex couples living abroad are spared from additional hoops for their children to gain citizenship. End youth homelessness, which disproportionately affects LGBTQ+ youth. ● End youth homelessness as part of a comprehensive housing agenda. An estimated 40 percent of youth experiencing homelessness identify as LGBTQ+, and 70,000 transgender youth lack access to secure housing.43,44 Pete will increase federal investment in housing and services for youth experiencing homelessness, encourage innovation and flexibility to address communities’ unique needs, and expand federal initiatives to end youth homelessness. As President, Pete will also expand the McKinney-Vento Homeless Assistance Grants and passing the Runaway and Homeless Youth and Trafficking Prevention Act. ● Encourage family acceptance of LGBTQ+ youth. Family rejection is one of the leading causes of LGBTQ+ youth homelessness.45 Pete will support culturally respectful public health campaigns emphasizing the importance of family acceptance and its positive impact on the mental health of LGBTQ+ youth. COMMUNITY I am a bisexual mom raising a lesbian daughter and a questioning child. I feel like bold leaders fought for me and my family knowing that we would need the space to exist as a queer family. I need, and my children need, to exist openly and to be celebrated. I am also a minister and a veteran, and these are also important areas in which people have fought for me and my family to embody a much wider representation of family values. And now it's my generation's turn to fight for the next generation. I know I wouldn't be here, my family would not be here if it wasn't for people like Marsha P. Johnson, Sylvia Rivera, and Brenda Howard. We need to step up like the previous generation for the next generation so that my children's children can also live and love openly, be celebrated for who they are, as they were made by God. A lot of people need to see that being all of who you are is not contrary to being a faithful person. My family exists today because of people who fought for me, and I am here fighting so that all of us can be free to love and create families in many different ways! 42 Mervosh, Sarah. “Gay U.S. Couple Sues State Dept. for Denying Their Baby Citizenship.” The New York Times. The New York Times, July 23, 2019. 43 Durso, L.E., & Gates, G.J. (2012). Serving Our Youth: Findings from a National Survey of Service Providers Working with Lesbian, Gay, Bisexual, and Transgender Youth who are Homeless or At Risk of Becoming Homeless. Los Angeles: The Williams Institute with True Colors Fund and The Palette Fund. 44 Murray, Laura Rena. “Trans, Teens, and Homeless: America’s Most Vulnerable Population” Rolling Stone. September 26, 2017. 45 Durso, L.E., & Gates, G.J. (2012). Serving Our Youth: Findings from a National Survey of Service Providers Working with Lesbian, Gay, Bisexual, and Transgender Youth who are Homeless or At Risk of Becoming Homeless. Los Angeles: The Williams Institute with True Colors Fund and The Palette Fund. 11 -Shawna Foster, Faith Engagement Director at Pete for America, Colorado Launch the We Belong National Mentorship Program for LGBTQ+ youth. Despite the immense strides we’ve made towards LGBTQ+ equality, it is still easy for an LGBTQ+ person to feel more shame than pride over who they are and who they love. We must begin to change this culture. Knowing one accepting adult lowers the risk of suicide for an LGBTQ person by 40 percent.46 Learning from initiatives like the My Brother’s Keeper Program launched by President Barack Obama, the We Belong National Mentorship Program will call on leaders in the public and private sectors to mentor LGBTQ+ youth and strengthen the resources, self-love, and sense of belonging they need to thrive. Increase funding for community-based programs that support the LGBTQ+ community. ● Provide federal funding for LGBTQ+ community centers. Community centers across the country are often the heart of local LGBTQ+ communities. Pete will ensure that these community centers are aware of and have access to federal funding and technical assistance for community and economic development, health and social services, housing, education, and other programs. ● Establish funding for workforce training and apprenticeship programs that expand opportunities for LGBTQ+ people, especially LGBTQ+ youth. Pete will also ensure that existing Department of Labor programs adhere to LGBTQ+-inclusive nondiscrimination policies. This could include incentives for programs to partner with local LGBTQ+ organizations in outreach. ● Advance initiatives that support LGBTQ+-owned businesses and entrepreneurs. Pete’s Walker-Lewis Initiative, part of his Douglass Plan, aims to triple the number of entrepreneurs from underrepresented backgrounds within 10 years. ● Shift federal funds to support the provision of comprehensive sexual health education in schools and to the public instead of funding abstinence-only programs. This means providing education that is age-appropriate and shares medically accurate sexual and reproductive health information.47 ● Give the White House Office of Faith-Based and Community Partnerships a mandate to work with faith and community leaders who support LGBTQ+ people to provide services and ensure LGBTQ+ representation in the overall mission of the office. JUSTICE 46 Reynolds, Daniel. “Just One Accepting Adult Can Save an LGBTQ Young Person’s Life.” The Advocate. June 27, 2019. 47 Hall, Kelli Stidham, Jessica McDermott Sales, Kelli A Komro, and John Santelli. “The State of Sex Education in the United States.” The Journal of Adolescent Health. U.S. National Library of Medicine, June 2016. 12 STORY FORTHCOMING Ensure the safety of all LGBTQ+ people, especially transgender women of color. ● Vigorously enforce the Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act. So far this year, at least 18 transgender individuals have been murdered, including 17 Black trans women.48 In 2018, 26 transgender Americans were murdered, and the majority of these individuals were Black trans women.49 Trans women are justifiably afraid.50 In 2017, nearly onefifth of hate crimes were committed out of sexual orientation or gender identity bias, making it more likely to be targeted as a member, or perceived member, of the LGBTQ+ community than any other marginalized group.51 There is a clear link between misogyny and violence, and police should be trained on this connection, as outlined in Pete’s Guns and Hate Action Plan. Pete will incentivize states to abolish the so-called gay panic defense so that hate and fear can never justify violence.52 We also will support law enforcement and community policing strategies to investigate and prosecute these crimes in a manner that ensures justice to trans women and their families, while protecting the trans community. ● Train law enforcement and require reporting on issues specific to LGBTQ+ people. Pete will train law enforcement to treat LGBTQ+ people in a culturally respectful way. Pete will also incentivize proper collection and reporting of hate crimes statistics against LGBTQ+ individuals and, as in Pete’s Douglass Plan, data collection of officer-involved violence against LGBTQ+ people. Finally, a Buttigieg administration will promote training on LGBTQ+ domestic violence, which often goes under-reported and under-enforced. Address the high rates of criminalization and abuse of LGBTQ+ people in our criminal justice system. ● 48 49 Reduce incarceration by 50 percent nationwide. The United States has the highest incarceration rate in the world.53 Lesbian, gay, or bisexual people are incarcerated at three times the rate of straight people,54 and over 40 percent of incarcerated women are sexual minorities.55 These individuals are more likely to be survivors of abuse, placed in solitary confinement or other “Violence Against the Transgender Community in 2019.” Human Rights Campaign. Accessed September 30, 2019. Ibid. 50 Rojas, Rick, and Vanessa Swales. “18 Transgender Killings This Year Raise Fears of an 'Epidemic'.” The New York Times. The New York Times, September 27, 2019. 51 Romero, Adam P., Ari M. Shaw, and Kerith J. Conron. “Gun Violence Against Sexual and Gender Minorities in the United States: A Review of Research Findings and Needs.” The Williams Institute, April 2019. 52 53 Avery, Dan. “Get Away With Murder: It's Legal in 47 States to Use the Gay and Trans Panic Defense.” LOGO News, December 11, 2018. “Highest to Lowest - Prison Population Rate.” World Prison Brief. Accessed September 30, 2019. 54 Meyer, Ilan H., Andrew R. Flores, Lara Stemple, Adam P. Romero, Bianca D.M. Wilson, and Jody L. Herman. “Incarceration Rates and Traits of Sexual Minorities in the United States: National Inmate Survey, 2011-2012.” The Williams Institute, February 2017. 55 Meyer, Ilan H., Andrew R. Flores, Lara Stemple, Adam P. Romero, Bianca D.M. Wilson, and Jody L. Herman. “Incarceration Rates and Traits of Sexual Minorities in the United States: National Inmate Survey, 2011-2012.” The Williams Institute, February 2017. 13 traumatizing conditions of incarceration, and sexually assaulted while incarcerated.56 Studies show that we are incarcerating people with no public safety justification;57 instead of incarceration, Pete will promote diversion programs, sentence reforms, and expand treatment and rehabilitation options, as laid out in Pete’s Douglass Plan. ● Ensure that all correctional and detention facilities provide medically necessary treatment and appropriate detention conditions. The Buttigieg administration will put the full force of the federal government behind ensuring that transgender people are appropriately placed in the correctional facilities that align with their gender identity. The federal government will provide guidance to state and local facilities on how to best ensure the safety of trans and gender nonconforming individuals in their facilities, without relying on solitary confinement or administrative segregation as a form of protection. Pete will also make sure that incarcerated people diagnosed with or living with HIV have access to high-quality and evidence-based treatment, and that incarcerated transgender people are provided medically necessary care as defined by the World Professional Association of Transgender Health, including psychotherapy, hormone therapy, and gender-affirming surgeries. ● Reform and strengthen the Prison Rape Elimination Act. LGBTQ+ people who are incarcerated are more likely to be victims of sexual assault while in prison, but they are also more likely to be punished for consensual sex while incarcerated.58 We need to reform the Prison Rape Elimination Act to prevent these assaults and stop these unjust punishments and ensure that facilities are meeting their obligations under the Department of Justice’s National Standards to Prevent, Detect, and Respond to Prison Rape. HONOR Following in the footsteps of my grandfather, and in a shared sense of service, I enlisted in the U.S. Army in 2008. As a transgender woman, a condition of my service was hiding my gender identity. After leaving the military in 2014 and beginning my transition, I was encouraged to see steps towards equality in our military taken, including the monumental decision by the DoD to lift its ban on transgender service members in 2016. This meant that people like me can serve without hiding, making for stronger, happier soldiers. It is disheartening that this progress has been destroyed by a reflexive, transphobic action under the guise of “enhancing military readiness." No evidence supports such an action; in reality, unit cohesion has nothing to do with gender identity. Standing shoulder-toshoulder, I couldn’t care less about the gender of the person beside me, instead knowing that they, too, answered the call to service to protect this country. It breaks my heart that although progress has been made, in my true self I couldn’t serve then and I couldn’t serve now. - R. Charlotte Ishida, Student, Connecticut Honor the contributions of LGBTQ+ veterans and service members. 56 Meyer, Ilan H., Andrew R. Flores, Lara Stemple, Adam P. Romero, Bianca D.M. Wilson, and Jody L. Herman. “Incarceration Rates and Traits of Sexual Minorities in the United States: National Inmate Survey, 2011-2012.” The Williams Institute, February 2017. 57 Austin, James, Ph. D., Lauren-Brooke Eisen, J.D., James Cullen, B.A., and Jonathan Frank, J.D. “How Many Americans Are Unnecessarily Incarcerated?” Brennan Center For Justice. 2016. 58 Borchert, Jay W. “Controlling Consensual Sex Among Prisoners.” Law & Social Inquiry 41, no. 03 (2016): 595–615. 14 ● Rescind the transgender military ban. Although its harms can never be fully undone, Pete will immediately repeal the ban on military service for transgender Americans and allow our transgender troops to serve openly. We give every service member discharged because of their gender identity the opportunity to re-enlist, re-commission, or access resources. ● Review and grant honorable discharges and appropriate benefits to the over 13,000 veterans discharged solely based on being LGBTQ+.59 LGBTQ+ Americans have always played a role in the defense of our country, and we must recognize those who chose to serve in spite of policies like Don’t Ask, Don’t Tell that sought to suppress their identities. ● Rescind the exclusion of coverage for surgical treatment of gender dysphoria currently in place at the Veterans Health Administration. This policy blocks critical health care for transgender veterans even if a provider deems treatment a medical necessity.60 ● Rescind restrictions on military service by people living with HIV. These exclusionary, outdated policies do not reflect our advances in medical treatment, reinforce stigma and shame, and harm our service members and civilians alike who are living with HIV. Respect and honor LGBTQ+ seniors. ● Ensure that LGBTQ+ seniors have equal access to long-term care and facilities. Many LGBTQ+ seniors are socially isolated, some from losing partners and friends to HIV/AIDS, and lack family caregivers. Pete will provide them with culturally respectful care and ensure that prohibitions against discrimination apply to them, too. ● Review federal retirement benefits to ensure equity for survivors of long-time LGBTQ+ couples who were prohibited from civil marriage. Before the U.S. Supreme Court legalized same-sex marriage in 2013, federal employees and retirees in same-sex relationships were not eligible or recognized for pensions, health care coverage, and other benefits. Pete will review claims by long-time LGBTQ+ couples and survivors and seek Congressional authorization to remedy this historical injustice and provide dignity and security to these LGBTQ+ seniors. Celebrate LGBTQ+ history and culture. ● 59 Increase funding to help document and celebrate LGBTQ+ history and culture. Provide funding and promote special exhibits and other activities to document and celebrate LGBTQ+ history and the contributions of LGBTQ+ individuals and communities. Barnes, Julian E. “Military curbs ‘Don’t Ask, Don’t Tell” policy on gays.’ Los Angeles Times. March 26, 2010. 60 Kuzon, William M., Emily Sluiter, and Katherine M. Gast. “Exclusion of Medically Necessary Gender-Affirming Surgery for Americas Armed Services Veterans.” AMA Journal of Ethics 20, no. 4 (January 2018): 403–13. 15 ● Increase funding for arts and culture grants that are LGBTQ+-inclusive. This will include supporting LGBTQ+ artists and culture by supporting the National Endowment for the Arts, National Endowment for the Humanities, and the Corporation for Public Broadcasting. ● Expand the representation of LGBTQ+ people and history in our National Parks System. Pete will build on the designation of the Stonewall Inn as a National Monument to include the varied history and contributions of the LGBTQ+ community in our national story, such as San Francisco’s Black Cat Tavern and Women’s Building; the former site of the UpStairs Lounge in New Orleans; the Matthew Shepard Memorial Bench in Laramie, Wyoming; the Julius Bar in New York City; and historic LGBTQ+ community centers across the country. LEADERSHIP On Tuesday, September 20, 2011, I stood at the Pentagon press podium before a packed audience of journalists, military officials, and my press office staff, to introduce then-Defense Secretary Leon Panetta and then-Chairman of the Joint Chiefs of Staff Admiral Mike Mullen, who would shortly announce the official end to the Don’t Ask, Don’t Tell (DADT) policy that had kept thousands of LGBT troops around the world from serving their country as whole human beings. My own personal journey to that podium had been a long and unexpected one: from a kid in Tucson, Arizona, who had planned to please his loving parents by becoming a lawyer, getting married and presenting them with grandchildren to ending up as Assistant Secretary of Defense for Public Affairs and the first openly-gay individual to be Senate confirmed to a senior Pentagon position. -Doug Wilson, former Obama Department of Defense official, Delaware Become a global leader on LGBTQ+ rights, including by strengthening protections for LGBTQ+ immigrants and refugees. ● Protect LGBTQ+ refugees and asylees. Pete will protect and welcome as refugees and asylees people persecuted for being LGBTQ+ in their home countries. Pete will also dramatically reduce the number of all immigrants in detention, particularly for LGBTQ+ individuals and others for whom detention poses a particular risk of harm, and create a presumption that all immigrants may be released while their cases are proceeding. ● Ensure that the refugee resettlement program is inclusive of the needs of LGBTQ+ people and that LGBTQ+ refugees are placed in welcoming communities. This includes making grant funds available to community-based organizations that are equipped to effectively and respectfully work with LGBTQ+ people and their families. ● Pass legislation that recognizes same-sex relationships from countries where civil marriage is not available or accessible for same-sex couples. We support passing the Greater Leadership Overseas for the Benefit of Equality (GLOBE) Act in Congress. In the meantime, Pete will exercise administrative discretion to recognize such relationships in visa applications, through humanitarian parole, and in deportation proceedings to avoid the involuntary separation of such couples. 16 ● Lead against persecution and discrimination of LGBTQ+ people on the global stage and encourage our ambassadors to ensure LGBTQ+ rights as human rights. Pete will also advocate strongly for LGBTQ+ rights worldwide, particularly in contributing to the movement to remove homophobic and transphobic laws that prevent people from living safe and open lives in their countries, so that people will not be forced to flee their native countries. Pete will document persecution and discrimination against LGBTQ+ individuals and organizations in countries around the world.61 U.S. embassies and consulates should be safe and welcoming spaces for local LGBTQ+ individuals and organizations. Our ambassadors and U.S. representatives at the United Nations and other international organizations should provide leadership in speaking out and supporting policies that reflect our American values of diversity and inclusion of all people. ● Support LGBTQ+ foreign service officials and their families. Ensure that all benefits and privileges are available to same-sex couples and LGBTQ+ families. Create a White House and administration that reflects the diversity of America, including LGBTQ+ Americans. 61 ● Appoint officials who reflect the diversity of America. Diverse voices including LGBTQ+ people will be nominated to serve in important positions in the Executive and Judicial Branches. A Buttigieg administration will also identify and implement opportunities to better serve LGBTQ+ Americans through every federal department and agency. ● Work with the LGBTQ+ community to identify appropriate vehicles to collect greater and more useful data about sexual orientation and gender identity. In consultation with experts and the LGBTQ+ community, Pete will direct all federal agencies to identify an ethical and acceptable process through which they will add sexual orientation and gender identity questions across federal survey and data collection instruments. In addition, his administration will reinvigorate the empirical study of the experiences and needs of LGBTQ+ people across federal agencies. ● Increase funding for federal research about LGBTQ+ individuals, families, and communities. These funds will be especially geared towards identifying and lifting up the most impactful protective factors and sources of resilience, health and well-being, healing, and belonging for LGBTQ+ individuals, families, and communities. ● Honor LGBTQ+ Pride Month every year. A Buttigieg administration will celebrate the LGBTQ+ community during Pride Month, honor how they have helped make us a more perfect union, and recognize the immense contributions they make to our society. Lavers, Michael K. “State Department Releases Annual Human Rights Report.” Washington Blade, March 15, 2019. 17