Trump Empathy Deficit – LGBT Lives at Risk

It’s happened yet again. The latest anti-LGBT action by a Trump cabinet appointee is a proposed rule allowing hiring decisions by federal contractors based on religious beliefs, and it was announced by the Labor Department on August 14, 2019 (1). As of July 2019, seven legal actions promoting discrimination against transgender people by the Trump Administration were implemented; more than 30 such actions have been taken since Trump assumed the role of President (2).

Previously this year – on May 24, 2019 – the DHHS formally proposed a rule to shrink the scope of federal healthcare anti-discrimination law by removing transgender people from its inclusion target groups; this rule paves the way for doctors and hospitals to legally refuse to provide healthcare services to transgender people. In May of 2019, Trump also expressed his opposition to the House-passed Equality Act (H.R. 5) that confirmed basic civil rights protections for LGBT people.

(As a reminder, Trump pledged as a presidential candidate at the Republican National Convention in Cleveland, Ohio in 2016 to protect LGBT Americans [3]).

These are the real-world consequences of his administration’s rules changes:

New Barriers, More Fear

Increased obstacles and decreased quality of life are the result of Trump Administration policies toward LGBT people. Under Trump’s leadership, fatal attacks against transgender people in the US have reached their highest recorded level (4). Indeed, the public health reality is that consequent to Trump’s policies, health risks – and death risks – for LGBT people are increasing in the US and worldwide.

Focus on Four Societal Problem Arenas in the US Affecting the LGBT Population

Four of the myriad societal problem arenas where health-impacting disparities have been documented between LGBT and non-LGBT people are discussed below. These four arenas have a significant impact on health and well-being – both in the US and in other nations. Additionally described are Trump actions that are specifically furthering an anti-LGBT agenda across the globe. 

Societal Problem 1: Homelessness as a Public Health Issue for LGBT People

A research study conducted by the US Office of Housing and Urban Development (HUD) (point-in-time study) concluded that 552,830 people in the US in 2018 experienced homelessness (5). Meanwhile, an article in 2019 in the International Journal of Environmental Research and Public Health reported that LGBT people represent 20-40 percent of the homeless population (6).

The Fenway Institute’s National LGBT Health Education Center in 2016 reported that around 3.5 percent of the US population identifies as LGBT, and that homelessness is significantly higher among LGBT youth than non-LGBT youth (7). As well-recognized by the Centers for Disease Control (CDC), homelessness is strongly linked to poor overall health status (8).

Family and Local Community Ostracism Link:

Family and local community ostracism is a major reason that LGBT adolescents and young adults end up homeless, but homeless shelters often leave LGBT residents vulnerable to physical abuse by other residents. Study findings published in 2016 in the Journal of Urban Health revealed that 17 percent of their sexual minority male research subjects had been forced to move from a family or friend’s home due to their sexual identity (9).

Rather than provide increased protection for LGBT homeless individuals, HUD under Secretary Ben Carson in May 2019 proposed a rule enabling homeless shelters to deny shelter to LGBT people (10).

Societal Problem 2: Suicide as a Public Health Issue for LGBT People

The suicide attempt rate among lesbian, gay, and bisexual youth is nearly five-fold higher than among non-LGBT youth (11). Meanwhile, 40 percent of transgender adults have attempted suicide (12). Based on findings of the National Transgender Discrimination Survey (NTDS), the American Foundation for Suicide Prevention in 2014 concluded in a report that the most striking finding was the exceptionally high prevalence of lifetime suicide attempts (13).

In a systematic review of the literature in 2017 in Issues in Mental Health Nursing, the authors described 14 suicide-related risk factors in men who have sex with men. These included homelessness, bullying and victimization, parental abuse, fear of community violence, and substance use/abuse (14).

People who have attempted suicide – whether LGBT or not – often suffer from long-term health consequences (and especially if self-poisoning was utilized as the suicide attempt method). According to an article in JAMA Psychiatry in 2015, self-poisoning is the leading attempted suicide method in the US (15).

Societal Problem 3: Poverty as a Public Health Issue for LGBT People

In 2018, a report of the City University of New York’s Graduate Center Social Justice Sexuality Project described a huge poverty disparity between the LGBT population in the US as compared to the non-LGBT population (with the greatest disparity between the non-LGBT population and LGBT people of color) (16).

This report also noted transgender people as four times more likely to have an annual income under $10,000 than non-transgender people. As widely recognized, the report also noted an especially high rate of difficulty experienced in accessing healthcare by impoverished LGBT people of color.

Military Service and Trump’s Anti-LGBT Efforts:

Serving in the US military has been a longstanding path to economic security for young adults in low-income families (and especially for those of color). According to the independent, nonpartisan Council on Foreign Relations, 43 percent of male (and 56 percent of female) military service members are “racial minorities” (17).

Besides fostering increased bullying of active service transgender (and gender nonconforming) people, another impact of Trump’s ban on transgender people from serving in the military – that was upheld by the US Supreme Court in 2019 – is that a path toward economic security for low-income transgender people has been blocked.

Societal Problem 4: Substance Abuse as a Public Health Issue for LGBT People

 An annual cost of $740 B in the US is attributable to substance abuse, per the National Institute on Drug Abuse (NIDA) (18). Meanwhile, an article in 2018 in Drug and Alcohol Dependence reported sexual minorities experience elevated rates of substance use behaviors as compared to heterosexuals (19).

As noted by an article in the Annals of the New York Academy of Sciences, stress is a well-known risk factor for the subsequent development of addiction (20). Meanwhile, anxiety and depression fostered by social rejection and stigmatization is widely recognized. An article in 2016 in the Annual Review of Clinical Psychology described stressors related to victimization, prejudice, and discrimination as contributing to minority mental health disparities (e.g., anxiety and depression) (21).

Addiction consequent to self-medicating with alcohol and/or drugs to relieve anxiety and depression is a US societal problem disproportionately affecting marginalized people – such as LGBT people. In turn, alcohol and/or drug addiction has been linked to an increased likelihood of engagement in risky sexual behaviors (promoting STD transmission) (22).

Global Anti-LGBT Legal Actions and Activities in the Trump Era

The global movement toward increased LGBT human rights has met resistance under President Trump’s guidance. Currently, 70 countries criminalize same-sex attraction, with the death penalty imposed in 13 countries (23). Besides disregarding the historical role of the US as a global human rights advocate, the US – under Trump – has demonstrated that no negative US foreign policy repercussions will occur consequent to cruelty aimed at LGBT people.

In 2018, Jair Bolsonaro – an admirer of President Trump – was elected Brazil’s president (24); Bolsonaro has expressed his ardent opposition to LGBT human rights (25). In a speech to the American Farm Bureau following Bolsonaro’s victory, Trump stated, “They say he’s the Donald Trump of South America”, and also that he liked Bolsonaro (26).

In Russia, President Vladimir Putin – who Trump has often praised – signed a law in 2013 banning the provision of a positive LGBT educational message to LGBT youth via the Internet newspapers, magazines, radio and/or television (27). This has stifled access to LGBT-inclusive education and support services – as well as contributing to violence aimed at LGBT youth and anyone supporting LGBT human rights throughout the Russian republic (28).

Trump’s anti-LGBT policies have been most clearly demonstrated on a global level by Trump’s nomination in 2018 of Samuel Brownback – despite Brownback’s opposition to LGBT civil rights – as the State Department’s Ambassador at Large for International Religious Freedom. Consequently, it is no wonder that so many nations (especially in Africa and the Middle East) continue to both foster societal violence and enact harsh criminal penalties against LGBT people.

Concluding Thoughts – Trump’s Authoritarian Strategy

Divide and conquer has been the strategy of authoritarian leaders throughout the world, and their first targets have been LGBT people and other vulnerable internal subpopulations. The targeting of LGBT people (and other subpopulations in the US) has been a strategy utilized by President Trump to distract from his failures. Furthermore, Trump’s successful nomination of two Supreme Court Justices who favor religious freedom over civil rights suggests difficult times for LGBT people in the coming decades.

As a member of the LGBT community, the usurpation of religious freedom as justification for oppressing other subpopulations in the US (including LGBT people) is just plain scary.

Three years into his presidency, Donald Trump has shown only a desire for increased personal power; his empathy deficit is similar to other dictators throughout recorded history. No more and no less.

References:

  1. Scheiber, Noam. (August 15, 2019). Labor Dept. Moves to Expand Religion Exemption for Hiring and Firing. New York Times Webpage: https://www.nytimes.com/2019/08/15/business/economy/religion-exemption-hiring-firing.html?action=click&module=Well&pgtype=Homepage&section=Business
  2. National Center for Transgender Equality. The Discrimination Administration. Webpage: https://transequality.org/the-discrimination-administration
  3. Keller, Jared. (June 12, 2019). For Trump, LGBT Rights are Foreign Policy, Not a Domestic Concern. Pacific Standard Webpage: https://psmag.com/ideas/for-trump-lgbt-rights-are-foreign-policy-not-a-domestic-concern
  4. Human Rights Campaign. Violence Against the Transgender Community in 2018. Webpage: https://www.hrc.org/resources/violence-against-the-transgender-community-in-2018
  5. US Office of Housing and Urban Development (HUD). (December 2018). The 2018 Annual Homeless Assessment Report (AHAR) to Congress. Webpage: https://files.hudexchange.info/resources/documents/2018-AHAR-Part-1.pdf
  6. Fraser B, Pierse N, Chisholm E, et al. (2019). LGBTIQ+ Homelessness: A Review of the Literature. International Journal of Environmental Research and Public Health 16(15): 2677. Webpage: https://www.mdpi.com/1660-4601/16/15/2677/htm
  7. National LGBT Health Education Center [Fenway Institute]. (March 2016). Understanding the Health Needs of LGBT People. Webpage: https://www.lgbthealtheducation.org/wp-content/uploads/LGBTHealthDisparitiesMar2016.pdf
  8. Center for Disease Control (CDC). [Transcript of Podcast; Speaker: Samantha Williams] Public Health and Homelessness. Webpage: https://www2c.cdc.gov/podcasts/media/pdf/HIV_Homeless.pdf
  9. Krause KD, Kapadia F, Ompad D, et al. (2016). Early Life Psychosocial Stressors and Housing Instability among Young Sexual Minority Men: The P18 Cohort Study. Journal of Urban Health 93(3): 511-525. Webpage: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899333/#__ffn_sectitle
  10. Stracqualursi, Veronica. (May 24, 2019). HUD proposes rule that would roll back protections for transgender homeless. CNN Politics Webpage: https://www.cnn.com/2019/05/23/politics/hud-rule-transgender-homeless-shelters-ben-carson/index.html
  11. The Trevor Project. Facts About Suicide. Webpage: https://www.thetrevorproject.org/resources/preventing-suicide/facts-about-suicide/
  12. The Trevor Project. Facts About Suicide. Webpage: https://www.thetrevorproject.org/resources/preventing-suicide/facts-about-suicide/
  13. The American Foundation for Suicide Prevention, and The Williams Institute, UCLA School of Law. (January, 2014). Suicide Attempts among Transgender and Gender Non-Conforming Adults: Findings of the National Transgender Discrimination Survey. Webpage: https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf
  14. Luong CT, Rew L, and Banner M. (2018). Suicidality in Young Men Who Have Sex with Men: A Systematic Review of the Literature. Issues in Mental Health Nursing 39(1): 37-45. Webpage: https://www.tandfonline.com/doi/citedby/10.1080/01612840.2017.1390020?scroll=top&needAccess=true
  15. Finkelstein Y, Macdonald EM, Hollands S, et al. (2015). Risk of Suicide Following Deliberate Self-Poisoning. JAMA Psychiatry 72(6): 570–575. Webpage: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2211890
  16. City University of New York, Graduate Center, Social Justice Sexuality Project. (March, 2018). Intersecting Injustice: Addressing LGBTQ Poverty and Economic Justice for All: A National Call to Action. Webpage: https://trumphealthcaresystemreform.files.wordpress.com/2019/08/cadd0-finalpovertyreport_highres.pdf
  17. Reynolds GM, and Shendruk A. (April 24, 2018). Demographics of the U.S. Military. Council on Foreign Relations Webpage: https://www.cfr.org/article/demographics-us-military
  18. National Institute on Drug Abuse (NIDA). Trends and Statistics. Webpage: https://www.drugabuse.gov/related-topics/trends-statistics
  19. Schuler MS, Rice CE, Evans-Polce RJ, et al. (2018). Disparities in substance use behaviors and disorders among adult sexual minorities by age, gender, and sexual identity. Drug and Alcohol Dependence 189: 139-146. Webpage: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6083846/#!po=2.77778
  20. Sinha Rajita. (2008). Chronic Stress, Drug Use, and Vulnerability to Addiction. Annals of the New York Academy of Sciences 1141: 105-130. Webpage: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732004/
  21. Russell ST, and Fish JN. (2016). Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth. Annual Review of Clinical Psychology 12: 465-487. Webpage: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4887282/
  22. Bosma-Bleeker MH, and Blaauw E. (2018). Substance use disorders and sexual behavior; the effects of alcohol and drugs on patients’ sexual thoughts, feelings and behavior. Addictive Behaviors 87: 231-237. Webpage: https://www.ncbi.nlm.nih.gov/pubmed/30077915
  23. Byrnes H. (June 19, 2019). 13 countries where being gay is legally punishable by death. USA Today Webpage: https://www.usatoday.com/story/money/2019/06/14/countries-where-being-gay-is-legally-punishable-by-death/39574685/
  24. Paraguassu L, and Rampton R. (March 19, 2019). Trump forges bond with Brazil’s Bolsonaro in White House visit. Reuters Webpage: https://www.reuters.com/article/us-usa-brazil/trump-forges-bond-with-brazils-bolsonaro-in-white-house-visit-idUSKCN1R01VV
  25. Gstalter M. (January 2, 2019). Brazil’s new president removes LGBT concerns from human rights ministry. The Hill Webpage: https://thehill.com/policy/international/human-rights/423594-brazils-new-president-removes-lgbt-concerns-from-human
  26. Shear MD, and Haberman M. (March 19, 2019). For Trump, Brazil’s President Is Like Looking in the Mirror. New York Times Webpage: https://www.nytimes.com/2019/03/19/us/politics/bolsonaro-trump.html
  27. Human Rights Watch (HRW). (December 11, 2018). No Support. Russia’s “Gay Propaganda” Law Imperils LGBT Youth. Webpage: https://www.hrw.org/report/2018/12/11/no-support/russias-gay-propaganda-law-imperils-lgbt-youth
  28. RadioFreeEurope/RadioLiberty (RFE/RL). (December 12, 2018). ‘A Living Hell’: Russia’s ‘Propaganda’ Law Damaging LGBT Youth, HRW Finds. Webpage: https://www.rferl.org/a/russia-gay-propaganda-law-rights/29651416.html