Rolling back transgender protections would endanger patients, experts say

Alex Keuroghlian, MD, MPH
Alex Keuroghlian

A federal policy that rolls back protections for transgender people would endanger their access to appropriate health care, experts said.

In a joint statement, the heads of the Infectious Diseases Society of America and HIV Medicine Association said the groups oppose a reported plan by the Trump administration to redefine gender based entirely on a person’s genitalia at birth, saying it “disregards not only current biologic science but also established, prevailing medical and legal standards, while re-enforcing stigma and discrimination against transgender people.”

“These policies harm individual and public health by impeding access to personal medical care while further challenging responses to the HIV and sexually transmitted infection epidemics in the U.S.,” IDSA president Cynthia L. Sears, MD, FIDSA, and HIVMA chair David Hardy, MD, said.

According to a report by The New York Times, HHS is “spearheading” an effort to establish a legal definition of sex under Title IX, the federal civil rights law that bans gender discrimination in educational programs getting federal assistance. According to the report, the agency has privately argued that the term “sex” was not meant to include gender identity or homosexuality and that the Obama administration’s loosening of the legal concept of gender in federal programs extended civil rights protections to people who should not have them.

In a memo obtained by the Times, HHS proposed that “Sex means a person’s status as male or female based on immutable biological traits identifiable by or before birth,” according to the report.

Alex Keuroghlian, MD, MPH, director of the National LGBT Health Education Center at the Fenway Institute in Boston and psychiatrist at Massachusetts General Hospital, said it is “critical” that a patient’s sex assigned at birth and current gender identity both be recognized, especially within health care.

“It’s important to know both a patient’s sex assigned at birth and current gender identity in order for an electronic health record to work properly, to generate appropriate clinical decision support for the care team, to have an anatomical inventory of retained organs in the electronic health records,” Keuroghlian told Infectious Disease News. “We run into all kinds of health risks if we’re not distinguishing these two within health care.”

Currently, all 1,500 federally qualified health centers in the United States are required to collect data on gender identity for all patients, as mandated by the Bureau of Primary Health Care, according to Keuroghlian. Additionally, EHR systems already have built-in — or are building in — gender identity features, he said.

“This proposed change would be out of step with the direction health care and electronic health care records have already moved in,” Keuroghlian said.

According to HHS, the broad definition of “sex” by the Obama administration was “enjoined by a federal court” in December 2016 and the decision was not appealed.

“That court found that the Obama administration regulation was overbroad and inconsistent with the text of the 1972 Title IX law prohibiting discrimination on the basis of sex,” Caitlin B. Oakley, national spokesperson and senior advisor at HHS, told Infectious Disease News. “The court order remains in full force and effect today and HHS is bound by it as we continue to review the issue.”

Oakley said discrimination in health care based on race, color, religion, national origin, sex, age and disability is prohibited and “all laws as written and passed by Congress” will be enforced by the agency’s Office for Civil Rights.

“Everyone deserves to be treated with respect,” she said.

In their statement, Hardy and Sears called stigma and discrimination “two of the most significant barriers that transgender people face when trying to access health care and other basic services, resulting in serious health disparities and poor health outcomes.”

“Without strong non-discrimination protections for the most basic rights to services, the health of the more than 1.4 million transgender Americans will remain at high risk,” they said. “We strongly urge the Trump administration to recognize and respect the standards set by the legal and medical communities and withdraw ill-advised proposals that will only serve to marginalize and deny civil rights to transgender individuals.” – by Marley Ghizzone

References:

The New York Times. ‘Transgender’ could be defined out of existence Under Trump Administration. https://www.nytimes.com/2018/10/21/us/politics/transgender-trump-administration-sex-definition.html. Accessed October 23, 2018.

IDSA. Policies Marginalizing transgender people run counter to science, public health. https://www.idsociety.org/news--publications-new/articles/2018/policies-marginalizing-transgender-people-run-counter-to-science-public-health/. Accessed October 23, 2018.

Bureau of Primary Healthcare. Uniform data system reporting instructions for 2018 Health Center data tables. https://bphc.hrsa.gov/datareporting/reporting/2018-uds-tables.pdf. Accessed October 24, 2018.

Disclosures: Keuroghlian reports no relevant financial disclosures. Oakley works for HHS. Sears is president of IDSA. Hardy is the chair of HIVMA

Alex Keuroghlian, MD, MPH
Alex Keuroghlian

A federal policy that rolls back protections for transgender people would endanger their access to appropriate health care, experts said.

In a joint statement, the heads of the Infectious Diseases Society of America and HIV Medicine Association said the groups oppose a reported plan by the Trump administration to redefine gender based entirely on a person’s genitalia at birth, saying it “disregards not only current biologic science but also established, prevailing medical and legal standards, while re-enforcing stigma and discrimination against transgender people.”

“These policies harm individual and public health by impeding access to personal medical care while further challenging responses to the HIV and sexually transmitted infection epidemics in the U.S.,” IDSA president Cynthia L. Sears, MD, FIDSA, and HIVMA chair David Hardy, MD, said.

According to a report by The New York Times, HHS is “spearheading” an effort to establish a legal definition of sex under Title IX, the federal civil rights law that bans gender discrimination in educational programs getting federal assistance. According to the report, the agency has privately argued that the term “sex” was not meant to include gender identity or homosexuality and that the Obama administration’s loosening of the legal concept of gender in federal programs extended civil rights protections to people who should not have them.

In a memo obtained by the Times, HHS proposed that “Sex means a person’s status as male or female based on immutable biological traits identifiable by or before birth,” according to the report.

Alex Keuroghlian, MD, MPH, director of the National LGBT Health Education Center at the Fenway Institute in Boston and psychiatrist at Massachusetts General Hospital, said it is “critical” that a patient’s sex assigned at birth and current gender identity both be recognized, especially within health care.

“It’s important to know both a patient’s sex assigned at birth and current gender identity in order for an electronic health record to work properly, to generate appropriate clinical decision support for the care team, to have an anatomical inventory of retained organs in the electronic health records,” Keuroghlian told Infectious Disease News. “We run into all kinds of health risks if we’re not distinguishing these two within health care.”

Currently, all 1,500 federally qualified health centers in the United States are required to collect data on gender identity for all patients, as mandated by the Bureau of Primary Health Care, according to Keuroghlian. Additionally, EHR systems already have built-in — or are building in — gender identity features, he said.

“This proposed change would be out of step with the direction health care and electronic health care records have already moved in,” Keuroghlian said.

According to HHS, the broad definition of “sex” by the Obama administration was “enjoined by a federal court” in December 2016 and the decision was not appealed.

“That court found that the Obama administration regulation was overbroad and inconsistent with the text of the 1972 Title IX law prohibiting discrimination on the basis of sex,” Caitlin B. Oakley, national spokesperson and senior advisor at HHS, told Infectious Disease News. “The court order remains in full force and effect today and HHS is bound by it as we continue to review the issue.”

Oakley said discrimination in health care based on race, color, religion, national origin, sex, age and disability is prohibited and “all laws as written and passed by Congress” will be enforced by the agency’s Office for Civil Rights.

“Everyone deserves to be treated with respect,” she said.

In their statement, Hardy and Sears called stigma and discrimination “two of the most significant barriers that transgender people face when trying to access health care and other basic services, resulting in serious health disparities and poor health outcomes.”

“Without strong non-discrimination protections for the most basic rights to services, the health of the more than 1.4 million transgender Americans will remain at high risk,” they said. “We strongly urge the Trump administration to recognize and respect the standards set by the legal and medical communities and withdraw ill-advised proposals that will only serve to marginalize and deny civil rights to transgender individuals.” – by Marley Ghizzone

References:

The New York Times. ‘Transgender’ could be defined out of existence Under Trump Administration. https://www.nytimes.com/2018/10/21/us/politics/transgender-trump-administration-sex-definition.html. Accessed October 23, 2018.

IDSA. Policies Marginalizing transgender people run counter to science, public health. https://www.idsociety.org/news--publications-new/articles/2018/policies-marginalizing-transgender-people-run-counter-to-science-public-health/. Accessed October 23, 2018.

Bureau of Primary Healthcare. Uniform data system reporting instructions for 2018 Health Center data tables. https://bphc.hrsa.gov/datareporting/reporting/2018-uds-tables.pdf. Accessed October 24, 2018.

Disclosures: Keuroghlian reports no relevant financial disclosures. Oakley works for HHS. Sears is president of IDSA. Hardy is the chair of HIVMA