Over the past few years, we have seen a record-breaking onslaught of anti-LGBTQ+ legislation across the country. So far in 2024, 515 anti-LGBTQ+ bills have already been introduced in states all across the United States. Of these bills, 336  specifically targeted trans and non-binary people. This is nearly three times the number of such bills introduced in 2022. These bills target all aspects of LGBTQ+ people’s lives, including healthcare, education, and even using the restroom. This legislation is a direct response in recent years to the increasing protection of LGBTQ+ people against discrimination in healthcare, the workplace, housing, marriage, education, and public accommodations. Increasingly, conservative extremists are using anti-LGBTQ+ legislation as a prominent part of their political platforms to rally support from their voter base. In honor of Pride month, this blog will take a brief look at the history of anti-LGBTQ+ bills and examine the current-day anti-LGBTQ+ bills we are fighting against. With the upcoming election in November, we all have the opportunity to act and push back against this harmful legislation!

History of Anti-LGBTQ+ Legislation

While we have seen a historic amount of anti-LGBTQ+ legislation over the past few years, this new wave of anti-LGBTQ+ legislation is part of a historically sustained campaign to erode or eliminate LGBTQ+ rights. Since its founding in 1974, Howard Brown Health has been serving LGBTQ+ communities and helping queer communities fight against legislative attacks on their rights. In the 1970s, there was a notable increase in anti-LGBTQ+ legislation stemming from supposed “moral” panic in response to the increased support for LGBTQ+ rights. For example, Anita Bryant and the Save Our Children campaign was one of the first very high-profile examples of targeted anti-LGBTQ+ legislation. This campaign produced the original “Don’t Say Gay” bill, which resulted in the repeal of an ordinance in Dade County, Florida that protected gay and lesbian teachers from being fired because of their sexuality. This spawned lookalike bills against gay and lesbian teachers in Oklahoma and Nebraska. At this time, states also started to pass statutes restricting marriage to heterosexual couples, as well as sodomy laws targeting queer people. This pattern of successful anti-LGBTQ+ legislation spawning a surge of lookalike and new legislation across the country would continue to repeat itself, especially as opposition to LGBTQ+ rights has become a more prominent political issue. From same-sex marriage bans, to anti-trans bathroom bills, to religious exemption bills, to this current surge of anti-LGBTQ+ legislation, Howard Brown and the LGBTQ+ community continue to push back against these attacks.

The New Wave of Anti-LGBTQ+ Legislation

In 2023 we saw an expansion and proliferation of anti-LGBTQ+ bills that has continued into 2024.

Gender-affirming care bans – These bills deny access to medically necessary gender-affirming care that many trans and nonbinary people rely on. They are still the most popular version of anti-LGBTQ+ bills. Many of these bills were aimed at trans and non-binary youths attempting to access GAC.

185 anti-trans GAC bills were introduced in 2023.
137 GAC bans have been introduced in 2024 so far.

“Don’t Say Gay” curriculum restriction bills – “Don’t Say Gay” bills prohibit teaching about sexual orientation or gender identity in the classroom. These bills can also often include bans on use of pronouns and censoring of books and other educational resources with LGBTQ+ characters or themes.

Last year, 314 education-related bills were introduced in 2023.
Around 203 bills have been introduced in 2024 related to education and curriculum restrictions.

Trans bathroom and sports bans – Sports bans prevent trans youth from participating in school sports aligned with their gender identity. Bathroom bans ban trans individuals from using public facilities, particularly bathrooms, that correspond to their gender identity.

73 sports and 29 bathroom bans were introduced in 2023.
48 sports and 36 bathroom bans have been introduced in 2024 so far.

Drag ban bills – Drag bans generally prohibit drag performances and gender non-conforming expression in public places and/or in the presence of minors.

15 drag bills were considered in 2023 with two states, Montana and Tennessee passing these bans. However, these bans have been deemed law restricting drag performances is currently unenforceable due to a federal court order.
21 drag-related bills have been considered in 12 states in 2024, but a number of them are carried over from 2023 legislative sessions.

Unfortunately, 2024 is poised to be another challenging year in fighting against anti-LGBTQ+ legislation, and there are some new and growing trends in the types of legislation or aspects of legislation that advocates should be aware of. One emerging trend is the increasing number of forced outing policies often included in “Don’t Say Gay” bills. These policies typically require school staff to notify parents about changes in the name or pronoun used for a student at school. Eight states have forced outing polices in place with Idaho, South Carolina, and Tennessee passing bills with forced outing provisions in 2024. This puts students in incredibly vulnerable positions as their homes may not be a safe space. A 2022 survey by the Trevor Project shows that 51% of trans youth considered school a safe space, in stark contrast to the 32% who felt the same about their homes. School may present as one if not the only safe space for queer students. According to the Journal of Adolescent Health, students who couldn’t use their preferred name and pronouns were 29% more likely to consider suicide and 56% more likely to exhibit suicidal behavior.

There is also a growing introduction of bills that redefine the legal meaning of “sex.” These bills attempt to exclude trans and non-binary people from protection under the law by codifying definitions of sex and gender that are completely binary and solely about reproductive capacity or physical genital categorization. This will prevent trans and non-binary individuals from being able to legally change their gender marker on their IDs, access GAC, or be protected under certain discrimination protections, especially in healthcare. 41 of these bills have been introduced in 2024.

There is also an uptick in anti-LGBTQ+ bills being introduced at the national level in the United States Congress. In 2023, an unprecedented 37 anti-LGBTQ+ bills were introduced at the federal level impacting LGBTQ+ rights in healthcare, student athletics, the military, incarceration, and education. As of May 2024, we have already outpaced 2023 with 45 anti-LGBTQ+ bills being introduced into the U.S. Congress. This includes the newly introduced Protection of Women in Olympic and Amateur Sports Act that would require all national governing bodies for amateur sports to bar trans girls and women from participating in athletic events for females. This would affect Olympic teams, national championships, and more.

How to push back against Anti-LGBTQ+ legislation

With the historical number of anti-LGBTQ+ bills we have seen this year, we have seen some recent wins against this hateful legislation. Recently the Biden Administration released an updated rule implementing Section 1557 of the Affordable Care Act (ACA). The new Section 1557 rule reinstates explicit prohibitions on discrimination based on gender identity, and it introduces new provisions that prohibit discrimination based sexual orientation or sex characteristics, including intersex traits. The new Section 1557 rule applies to all federal health programs and activities, including health insurance issuers. The Biden Administration also released an undated Title IX rule that adds explicit protections for LGBTQ+ students and expands the definition of sexual harassment to include sexual orientation and gender Identity.

Even with these wins, we need an unprecedented amount of support to push back against these bills and uphold LGBTQ+ rights! It is vital to vote and support candidates who support LGBTQ+ rights and push back against these harmful bills. The Human Rights Campaign has a Congressional Scorecard so you can track how your legislators in Congress are voting regarding important LGBTQ+ issues. You can also look at past year’s scorecards to better understand your legislators’ voting record. You can visit the GLESN Action Center to learn more about how to support important legislation that will improve LGBTQ+ students’ lives and make schools safer and more affirming. You can support Gender Cool’s Play It Out Campaign which supports trans kids’ participation in sports without discrimination. You can also tell your Members of Congress to protect LGBTQ+ people from discrimination in healthcare! You can read more about some of the legislation discussed by reading our Don’t Say Gay, Drag Bans, and support trans athletes blogs. You can also visit our Advocacy page to learn more about our work.

This past March in Chicago, voters were asked to vote on the Bring Chicago Home initiative. This initiative would have restructured the Real Estate Transfer Tax (RETT), a one-time tax on properties when they are sold to create a substantial and legally dedicated revenue stream to provide permanent affordable housing for people experiencing homelessness. Homelessness and unstable housing in Chicago is one of the largest issues among LGBTQ+ and people living with HIV (PLWH). Social and economic barriers, including anti-LGBTQ+ housing discrimination, have long been a barrier to the safety and welfare of queer and trans people. Voters ultimately voted down this initiative, but not before putting a local and national spotlight on the reality of homelessness in Chicago. There is a need for increased funding for affordable housing and cultural competency training for shelters, landlords, and housing providers to help eliminate the housing crisis among LGBTQ+ people.

LGBTQ+ Discrimination in Housing

LGBTQ+ people continue to face significant bias based on sexual orientation and gender identity (SOGI) in housing. Affordable housing needs are especially important to LGBTQ+ people as they are more likely to be low-income and unhoused. LGBTQ+ adults have higher rates of being poor compared to their cisgender counterparts and LGBTQ+ people, especially trans people, people of color, and youth, experience higher rates of poverty compared to their cisgender, heterosexual counterparts. Discrimination consistently exasperates queer people from accessing shelter and housing. LGBTQ people face widespread harassment and discrimination by housing providers. For example, studies have shown housing providers are less likely to respond to rental inquiries from same-sex couples and are more likely to quote male same-sex couples higher rents than comparable different-sex couples. LGBTQ+ people face similar discrimination when attempting to own a home. Same-sex couples face system-wide discrimination by mortgage lenders. One study found that same-sex borrowers experienced a 3% to 8% lower approval rate and higher interest rates on loans than their non-LGBTQ+ counterparts. LGBTQ+ youth and adults also face challenges in accessing homeless shelters and services. 28% of LGBTQ+ youth reported experiencing homelessness or housing instability at some point in their lives. LGBTQ+ youth report experiencing harassment and violence, staff who are not equipped to appropriately serve LGBTQ+ people, and sex-segregated facilities in which trans people are housed according to their sex assigned at birth. This leads many trans youths to go unsheltered instead. For LGBTQ+ older adults, many are at risk of being turned away from or charged higher rents at independent or assisted living centers as well as harassed, treated poorly, or forced to go back in the closet once moved to protect the housing they have secured.

For PLWH, access to housing can save their lives. Homelessness and housing instability are associated with increased vulnerability to new HIV infection and poorer health outcomes for those living with HIV. In 2020 alone, 17% of PLWH were unhoused or experiencing unstable housing. People with unstable or temporary housing have lower levels of viral suppression than those with stable housing (77.3% versus 90.8%). Stable housing is such a vital piece in reducing new HIV infection rates, that organizations like the AIDS Foundation of Chicago have made it an integral part of the Getting to Zero Illinois statewide initiative to end the HIV epidemic in the state by 2030. Housing discrimination against PLWH is illegal, but many still face housing providers and shelter systems that lack adequate cultural competency around HIV.

How To Support Affordable, Affirming, and Safe Housing

Initiatives like Bring Home Chicago highlight some of the much-needed funding for affordable housing programs and housing service providers. There are also steps that must be taken to ensure LGBTQ+ and PLWH and not discriminated and intimidated away from meeting their housing needs.

• Expansion of housing and shelter options for LGBTQ+ youth and adults so that they are sheltered safely and appropriately.
• Mandated training for all staff at agencies providing housing, child welfare, homelessness, and other relevant services to the LGBTQ+ and PLWH population, to ensure that staff become and remain equipped to serve this population in an affirming manner.
• Evaluation of the extent to which LGBTQ+ people face barriers to accessing programs and services to increase housing affordability and reduce housing instability—such as Section 8 and homebuying programs of the Federal Housing Administration—and execution of corrective actions as necessary.
• Ensuring comprehensive federal and state protections against sexual orientation and gender identity discrimination in housing, lending, and government-funded programs and activities, among other settings are being adopted and enforced. This includes advocating for $85 million in new funding in the Illinois Fiscal Year 2025 budget—spearheaded by the AIDS Foundation of Chicago (AFC) — for homeless prevention, emergency shelter, homeless youth programs, supportive housing, and other priorities—to keep making progress on the HOME Illinois plan to prevent and end homelessness

Housing is an essential right. Housing is also an essential part of healthcare, The discrimination, and social and economic barriers LGBTQ+ and PLWH face when trying to secure shelter will lead to poorer health outcomes. Housing needs to be a top priority for everyone. You can visit the Bring Home Chicago website to learn more about their initiative and visit Getting to Zero Illinois to learn more about how housing can support ending the HIV epidemic in Illinois.

To learn more about how Howard Brown Health contributes to vital advocacy work and has an impact on local, state, and federal policymaking, please visit our Advocacy webpage. 

The U.S. Department of Health and Human Services (HHS) recently issued a final rule under Section 1557 of the Affordable Care Act (ACA) that outlines strengthened protections for LGBTQ+ people in health care. Section 1557 specifically prohibits discrimination based on race, color, national origin, sex, age, or disability in health programs or activities that receive federal funding. Over the last decade, this provision has undergone several alterations by prior Administrations, which has led to confusion and fear from LGBTQ+ patients trying to seek health care. With the historical surge of anti-LGBTQ+ healthcare legislation being introduced over the past couple of years, this new rule is a much-needed step in protecting LGBTQ+ people as they seek care.

History Of The Rule Under The Obama And Trump Administrations

LGBTQ+ people have long experienced discrimination and barriers when seeking healthcare. Based on a 2022 survey by the Center for American Progress (CAP),  15% of LGBQ respondents—and 23% of LGBQ people of color—experienced care refusal by a provider in the past year. For trans and non-binary (TNB) individuals, 32% reported that they experienced care refusal by a healthcare provider in the past year. Rates of discrimination were even higher for TNB people of color, with 46% reporting care refusal. The CAP survey also showed that 55% of intersex respondents reported a healthcare provider refused to see them because of their sex characteristics or intersex variation. For TNB patients, having their insurance cover necessary and affirming medical care has become an ever-increasing obstacle. In the past year, 30% of TNB patients, including 47% of TNB patients of color, reported at least one form of denial by a health insurance company, including denials for necessary gender-affirming hormone therapy or gender-affirming surgery. Delaying or avoiding healthcare due to discrimination contributes to poorer health outcomes for LGBTQ+ individuals, including higher rates of chronic diseases like heart disease, certain cancers, asthma, and strokes. Discrimination also takes a toll on mental health, with LGBTQ+ patients having higher rates of mental health distress and suicidality. With the numerous healthcare barriers that LGBTQ+ patients face, Section 1557 became one avenue to provide better protection in healthcare for LGBTQ+ patients.

Section 1557 is the non-discrimination provision of the Affordable Care Act (ACA), introduced in 2010, that made it unlawful for health care providers to refuse to treat—or to otherwise discriminate against—an individual based on their race, color, national origin, sex, age, or disability. While Section 1557 and the ACA provided certain protections for LGBTQ+ patients, there was still the need to clearly and explicitly implement protections for LGBTQ+ people, especially TNB individuals. So, under the Obama Administration, HHS released a new Section 1557 rule in 2016 that expanded the definition of sex discrimination to include discrimination related to gender identity, thereby prohibiting anti-trans discrimination in insurance coverage and in health care settings.The sex discrimination definition was also updated to prohibit discrimination based on sex stereotypes. These stereotypes are usually based on heteronormative and binary views and result in prevalent forms of anti-LGBTQ+ discrimination in our health care system. This new rule provided historic protections for LGBTQ+ patients.

Unfortunately, in 2020, the Trump Administration released its new Section 1557 rule as part of a systematic erosion of LGBTQ+ protections. This new rule eliminated the general prohibition on discrimination based on gender identity and sex stereotyping. The 2020 rule only worsened anti-LGBTQ+ and particularly anti-trans discrimination in healthcare. For example, the rule would have allowed denying a trans man a medically necessary hysterectomy for gender-affirming care, even though this procedure would have been provided for a cisgender woman without issue. The 2020 rule also adopted blanket religious freedom exemptions for health care providers making it easier for LGBTQ+ patients to be denied care based on a provider’s religious beliefs. The Trump Section 1557 rule also removed sexual orientation and gender identity nondiscrimination protections in several Centers for Medicare & Medicaid Services (CMS) programs. This was especially heinous as many of the impacted CMS programs disproportionately benefit LGBTQ+ individuals.

Just a few days after the release of the 2020 rule, The Supreme Court issued a ruling in Bostock v Clayton County, Georgia. The Court found that discrimination based on sex encompasses sexual orientation and gender identity in the context of employment. This would provide legal challenges to the Trump Administration’s new 1557 rule and an injunction would prevent healthcare providers and insurers from having to abide by it. Even with the hope of the Bostock v Clayton ruling, there was already confusion and fear on the part of LGBTQ+ patients as they were unsure if they would be discriminated against or denied care.

The 2024 Section 1557 Rule

After the Biden Administration sought public comments from stakeholders on how to best strengthen Section 1557, the Administration released the new Section 1557 rule in 2024. This updated Section 1557 reinstates explicit prohibitions on discrimination based on gender identity and it introduces new applications that prohibit discrimination based sexual orientation or sex characteristics, including intersex traits. Section 1557 will apply to all federal health programs and activities, including health insurance issuers, and for the first time in six years, Medicare Part B providers. The new rule makes sure to clarify the broad intended scope of the rule to cover all health programs and activities and health insurers receiving federal funds. This new rule comes at a crucial time as LGBTQ+ patients have been fending off attacks against the care they need. Over 300 anti-trans laws have already been introduced in 2024, and most have been directed at banning access to gender-affirming care. The new Section 1557 rule not only reinstated necessary protections for LGBTQ+ patients, but it will also provide more protections for LGBTQ+ patients to seek care safely. With this new rule in place, if you believe that you or someone else has been subject to discrimination in health care or health coverage, you may file a complaint with the HHS Office for Civil Rights (OCR) under Section 1557. 

The history of Section 1557 is not just about protecting LGBTQ+ patients, it’s reflective of elected official’s support for those protections. It’s important to have elected officials who will fight for the right to healthcare for everyone. You can visit HHS to read more about the new Section 1557 rule and you can visit our Advocacy page to read our public comment to the Biden Administration on Section 1557.  

You can also visit our Advocacy page to learn more about our work.

_{Paraphrased from an episode of Charting Queer Health entitled “Revolutionizing Research with Pride“}

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Before you pop your next PrEP pill or even your next Tylenol, pause a moment and think of all the resources, time, and research that it took to get that pill into your hand safely. If you think about any medication you can get at a pharmacy, it had to go through a strict process to ensure the safety and efficacy of the drug before it could be legally dispensed to you.

At Howard Brown Health, we pride ourselves on being on the cutting edge of vital HIV medical research. Our Research Department and our patients play a significant part in researching, trialing, and ultimately advancing the technology behind the life-saving medications that people use every day. We do this by partnering with universities and major pharmaceutical companies like ViiV, Gilead, and Merck. And that long list of symptoms that are listed off at the end of drug commercials? We help provide the data that adds to that list.

Within Howard Brown Health, the Research Department is part of the Center for Education, Research, and Advocacy (ERA). Our team is made up of four investigators, who work full-time with our clinical trials, plus several sub-investigators who lend us their time and talent when available, purely because they care about the work we are doing. They’re nurses and providers who moonlight with us here in Research because of what we can offer their patients. They’re people like Dr. William Kvasnicka, Dr. Zach Long, Dr. Kathya Chartre, and more. And overseeing it all from a medical standpoint, we have Dr. Cathy Creticos, who is my Principal Investigator and Medical Director of Clinical Research. 

Pharmaceutical companies will approach us to trial their HIV medications because they know and trust Howard Brown Health and Dr. Creticos, and our reputation for decades of excellent work with HIV care and medical research. They trust us to invite patients to trial their new medicines because we have our community’s best interests at heart.  

Logistically, they’ll approach us with a new medication, a list of patient requirements, and a timeframe. Dr. Creticos and I sit down together and determine whether or not the study is well-suited for us. We don’t just take any offer, it must be a good fit for our patients. We evaluate the cost, the number of patients we could see participating, and together we work out all the details. If it all looks good, we begin offering the treatment to patients. From start to finish, these medical trials can last several years. 

Through it all, our priority is patient safety. Most commonly, the treatments we are proposing to our patients are innovations in medicine that will make their lives better. It may mean they only have to take one pill a day instead of eight to manage their HIV. It might mean drastically reducing the amount of time they spend in a doctor’s office. Because of that, our patients tend to be eager to participate. Not to mention they are compensated for their time and efforts.  

When a patient is participating in a clinical trial, every single aspect of their health is closely examined. Even if it may seem unrelated, every new symptom or problem is examined and treated. As a result, our clinical trial patients receive incredible custom healthcare that allows us to provide quality data and advance the limits of medicine. We provide case management resources too! Can’t get to your appointment? We’ll schedule an Uber. How’s your nutrition? If a medication says, “take with food” but a patient has inconsistent access to food – well, that is going to be a problem. So my team helps with all those other social determinants of health issues as well.  

The key to making all this work is trust. Our patients must trust us when we say that we believe this new medicine or treatment would be good for them. Especially when you consider that many patients have been historically marginalized and discriminated against in other healthcare settings. Our providers have to take all that history and say, “Just trust me with this.” It’s only because of the incredible care that they provide that patients are willing to take that chance.  

All of these parts make for a win-win situation all around: drug companies gain valuable research and approval for their medications, our patients receive excellent care and have their lives improved, and we gain crucial funding that allows us to continue the good work we do every day.  

One development in HIV medical research that we’re participating in now that I’m especially excited about is a trial for an infusion to manage HIV in a brand-new way. Like the way someone might receive chemotherapy, in this trial people living with HIV receive an infusion of their medications once a year. They receive this infusion, and then they don’t have to worry about managing their HIV for the rest of their year.

I have a friend right now that is a patient of Howard Brown Health who received their HIV diagnosis in the 90’s. Back then, they had to take close to 20 pills a day. To go from 20 pills a day to just one infusion a year? That is groundbreaking innovation that will change the way our society looks at HIV. And our patients at Howard Brown Health are a vital part of that change.

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If you’re a patient here at Howard Brown Health or elsewhere that would like to get involved with medical trials, you can always visit https://clinicaltrials.gov/ to see if your condition or treatment might qualify. That way, you can understand your options and bring them up with your provider.  

Advocate for historic investments in community health centers

Community Health Centers (CHCs) are vital providers of healthcare in the United States, providing care to around 31 million people annually. CHCs provide affordable, high-quality, comprehensive primary care to medically underserved populations regardless of insurance status or ability to pay. Most CHC patients are people of color, and the vast majority are low-income: 80% of CHC patients nationally are uninsured and around 48% utilize Medicaid. CHC patients are also more diverse as 63% of CHC patients identify as a racial and/or ethnic minority. During the height of the COVID-19 pandemic, CHCs delivered more than 22 million vaccine doses, with 69% of those shots going to people of color.  CHCs play a critical role in the U.S. health care system but funding for these CHCs has not kept up with demand for services. Since 2012, CHCs have seen a 45% increase in the number of people seeking care, but inflation-adjusted federal funding for CHCs has decreased over time, stretching limited funds even further. Learn more about CHC funding issues and how you can help support the critical work of CHCs, especially in an election year!

Challenges in CHC funding

In recent years, CHCs have faced challenges in funding that make it difficult to sustain and expand our services and maintain our workforce. The federal government funds CHCs nationwide through two main funding streams: the Community Health Center Fund (CHCF) and federal health care discretionary appropriation funding. The CHCF was established in the mid-1960s to fill the gap between what it costs to operate a health center and the amount of revenue a health center receives. CHCs rely on this money to cover the cost of uncompensated care, which was around $42 billion per year between 2015-2017, and to increase the services they provide. The CHCF provides about 70% of federal funding for health centers and is the primary funding source for services provided to uninsured and underinsured patients. The CHCF is allocated in multi-year chunks meaning that if funding allocated in the CHCF is too low, CHCs will be underfunded for multiple years. In conjunction with the CHCF, additional funding for CHCs is also included in Congress’s annual discretionary appropriations. This is funding that needs to be re-authorized every year. In the past few years, this funding has stagnated or been reduced. The past three authorizations have not significantly increased the level of funding. With inflation, this has amounted to a nearly 10 percent decrease in funding. The CHCF and federal discretionary appropriations are usually met with bipartisan support, but funding is still falling short of being authorized at the level CHCs need. Advocates for Community Health, a coalition of CHCs across the country, asked for a $13 billion increase in annual CHC funding in 2023. That would have allowed for expanded access to CHC programs necessary growth of the CHC workforce to help manage the increasing number of patients, much-needed CHC infrastructure updates, and investments in innovations such as telehealth to address patients’ unique needs and underlying health-related social needs. Unfortunately, Congress approved just $4.4 billion for 2023.

Funding for CHCs also comes from the federal 340B Drug Pricing Program, which requires pharmaceutical manufacturers who participate in Medicaid to provide discounted drug pricing to FQHCs and other 340B-covered entities. It allows CHCs to provide discounted medications to our uninsured patients while generating 340B savings from filling prescriptions for insured patients. We reinvest 100% of our 340B savings into maintaining and expanding critical programs that our patients rely on. In recent years this program has been hindered by inconsistent oversight, contrasting court rulings, and attacks on the program from pharmaceutical companies. This has resulted in a decrease in 340B revenue and uncertainty about the availability of future 340B revenue to continue supporting vital services at CHCs. Since 2020, 30 pharmaceutical companies have imposed restrictions on the contract pharmacies of 340B covered entities, essentially clawing back 340B savings that should be going to serve our patients for themselves. There have also been legal challenges from drug companies attempting to limit the amount of contract pharmacies CHCs can use to provide medications to their patients, and burdensome and inconsistent data collection requirements imposed on 340B covered entities using contract pharmacies. Altogether, these attacks and restrictions reduce important 340B revenue used to enhance and create more necessary services for patients. For example, Howard Brown utilizes our 340B savings to fund services like HIV case management, our Broadway Youth Center, the Trans and Non-Binary health team, and dental clinics.

One large issue CHCs face as they try to stretch their funding to serve as many patients as possible is Medicaid reimbursement rates. CHCs face stagnant and low Medicaid reimbursement rates that fail to cover the costs of providing care to Medicaid patients. Medicaid reimbursements are the a major source of federal financing for CHCs. Unfortunately, Illinois Medicaid reimbursement rates are among the lowest in the nation and fall in the lowest quartile of all state Medicaid Fee-For-Service (FFS) rates. One CHC in Illinois stated Medicaid reimbursement rates only cover about one-third of their actual costs to deliver services. For example, one dose of a COVID-19 vaccine costs about $115 for the Pfizer vaccine and about $128 for the Moderna vaccine. The Medicaid reimbursement rate for COVID-19 vaccines in Illinois is on average just $42. The rates to see a mental health professional run an average of $100-$200 an hour. In Illinois, the Medicaid reimbursement rate to see a mental health professional such as a psychologist, alcohol and drug abuse counselor, or clinical social worker for that hour is on average $75. At Howard Brown, around 30% of our patients participate in Medicaid. These low reimbursement rates mean we provide many services at a financial loss and must find ways to stretch already strained funding so we can continue to provide necessary services to the community.

Ways we can support CHC funding

These unstable funding streams and increasing attacks against essential programs have put CHCs at a crossroads. There are several things we can do to ensure the future of CHCs and continue to provide healthcare for everyone.

• Increase Medicaid Reimbursement Rates and Continue to Expand Medicaid
  • Medicaid expansion can ensure more patients have access to health care while generating revenue for health centers and bolstering their workforce. Increasing reimbursement would offer centers greater opportunities to invest in their workforce and care delivery.
• Commitment to increasing funding for the CHCF and discretionary appropriations and to meet the needs of CHCs
  • Find out your elected officials voting records/support for CHC funding.
  • Ensure legislators account for inflation when determining funding. One estimate states funding needs to increase by $2 billion to account for inflation.
• Reach out to your Congressional representatives and tell them there needs to be continued bipartisan support for reauthorizing the CHCF and the yearly Federal discretional appropriations for CHCs
  • Congress recently passed The Lower Costs, More Transparency Act increasing funding for the CHCF 10% for the next two and a half.
• Enact state and federal legislation to protect the 340B program to ensure centers continue to maintain revenue streams and can pass on these savings to patients.
  • Show support for this important program by reaching out to your State Senators and asking them to support The Illinois Patient Access to 340B Pharmacy Protection Act (SB3727).
  • Contact Congress and tell them to pass legislation similar to the PROTECT 340B introduced in the House of Representatives in 2023 or the SUSTAIN 340B Act introduced in the Senate in 2024.

This November, Chicago will hold elections for the Chicago Board of Education (CBE) for the first time. Based on a law passed in 2021, the Chicago Board of Education will transition from a seven-member board appointed by the mayor to a 21-member elected board. This will eventually make the CBE the largest school board in any major city. The CBE oversees Chicago Public Schools (CPS), a large public school system that educates an average of 325,000 students annually. Deciding who sits on school boards is one of the most important decisions we make as voters!

History of Chicago School Board Elections

The upcoming transition to a fully elected CBE is part of years-long attempts to see reforms to the board. Since the 1870s, the selection of CBE positions rested in the hands of the mayor. In 1988, CPS experienced what is still the longest strike in its history, lasting nearly three weeks. During this strike, there were calls to reform the CBE, including the potential to directly elect CBE members to increase community input. In response, the Illinois General Assembly passed the Chicago School Reform Act. This Act created local school councils (LSCs) for each CPS school composed of teachers, parents, community members, and a student representative at the high school level. These councils were responsible for issues like hiring and evaluating principals and approving the school site budget. The Act also created a School Board Nominating Commission consisting of 23 parents, community members, and five members appointed by the Mayor of Chicago who would recommend nominees for all the CBE seats to the mayor. The results of these new reforms were mixed. Some schools thrived under this new local council system, while others struggled due to dysfunction or a lack of expertise on how to manage schools. While the LSCs would stay in place, due to the inconsistent results of the Chicago School Reform Act, in 1995 the power to appoint members to the Chicago school board was put solely back in the hands of the mayor. Giving the ability to appoint members of the CBE back to the mayor would only increase calls for a fully elected school board.

The decades-long call by advocates for an elected CBE is rooted in the belief that there must be more accountability of the CBE to the public through regular elections. Pro-CBE election advocates point to the closure of multiple schools on the city’s South and West sides, which disproportionately affect Black and Latinx low-income families. There is also a large concern over the lack of transparency.  Advocates state that mayor-appointed CBEs give special-interest groups with large funding the upper hand in influencing local politics. There has been an expansion of privately-run, non-union charter schools that advocates point to as a major priority of Chicago’s board over the years. Both former Mayors Richard M. Daley and Rahm Emanuel were avid proponents of privatizing education and replacing regular public schools with non-unionized charter schools and people believe their CBEs reflected the push in that direction. Advocates state that not allowing parents of CPS students and community members the ability to elect CBE members greatly limits the ability of CBEs to meet the needs of minority CPS students. While advocates do point to the more diverse CBE appointments by former mayor Lori Lightfoot and current mayor Brandon Johnson, they feel elections will allow the majority of CPS students, who are 47% Latinx and 35% Black compared to 11% white, to have a greater voice and access to resources.

How will the new school board elections work?

The move towards a fully elected school board will happen in a couple of phases. This November, voters will elect 10 of the new 21-member board while the other 11 seats will be appointed by the mayor. The CBE school board will spend the next two years as a half-elected, half-appointed school board. In 2026 voters will elect the full number of school board seats. For this November’s election, Illinois lawmakers divided Chicago into 10 districts. On Nov. 5, residents of each district will elect a school board member to represent them for two years. On or before Dec. 16, 2024, Mayor Brandon Johnson will appoint 10 school board members — one from each district — and a board president to serve two-year terms. For example, District 1 is made up of two parts: 1A and a 1B. If the winning candidate in District 1 lives in 1A, the mayor must appoint someone who lives in 1B. If the winner in District 2 lives in 2B, the mayor must appoint someone who lives in 2A, and so on. The districts have been drawn with the intention that anyone running in that district is reflective and knowledgeable of the demographics and needs of students in those districts.

The Chicago school board votes on the district’s annual multi-billion dollar budget determines the metrics for how well schools are performing, authorizes contracts with vendors to bus students to and from school, clean classrooms and hallways, and even operates entire schools under charter agreements. This is an opportunity for Chicagoans to be involved in supporting the needs of CPS students. You can visit the Chicago Board of Elections to learn more about the school board elections and to see a list of candidates. You can read furtherabout school boards to better understand how school boards are at the forefront of providing or eliminating inclusive and equitable environments and the effect on LGBTQ+ students.

To learn more about how Howard Brown Health contributes to vital advocacy work and has an impact on local, state, and federal policymaking, please visit our Advocacy webpage. 

Forget what you thought about OB/GYN healthcare, someone’s life may depend on it.  

We’re diving into a vital topic that affects many trans men and transmasculine folks out there: reproductive health and gynecological care. A visit to your local OB/GYN isn’t just for cisgender women. So, let’s talk about why it’s crucial for trans men and non-binary individuals, what situations call for birth control, and why keeping tabs on your reproductive health is a big deal.

Why Reproductive Care for Trans Men Matters

First things first, let’s clear something up: not all trans men have a vagina or cervix, and not all trans men need gynecological care or birth control. In fact, not all cis women have a vagina or cervix. Whatever the case is, genitals don’t impact your gender identity. Your reproductive organs, however, can and do impact your health. That’s where Howard Brown Health is stepping in to make sure everyone gets the care they need, regardless of their identity or experience.

 Here are some things to keep in mind: 

• Hormone Therapy: Many trans men opt for hormone therapy (HRT) as part of their transition journey. While this can lead to changes like facial hair growth and voice deepening, it certainly doesn’t eliminate the need for regular OB/GYN visits. And when you’re in those visits, you should advocate for yourself: a recent study from our research team showed that when compared to cis women, trans men on HRT were significantly less likely to receive screenings for bacterial vaginosis at their visits than cis women were. Other related studies have shown that this decreased rate of testing also occurs with HPV, cervical cancer, STIs, and more. You owe it to yourself and your wellbeing to keep your reproductive health front-of-mind.
• Preventing Unplanned Pregnancy: No matter what you hear, HRT is NOT effective as birth control. If you’re sexually active with a partner who produces sperm and not looking to start a family, birth control is essential. Regular birth control methods like oral contraceptives, IUDs, or injections can help you take control of your reproductive choices and ensure you can focus on your relationships and, if you want, build a family on your own terms.  
• Menstrual Health: Even if you’re on HRT, you might still get periods if you haven’t had gender-affirming surgery. Since this can be a recurring traumatic experience for trans men, regular competent gynecological care is especially important to help manage unpleasant symptoms and minimize the discomfort you may feel during that time.

• Menstrual Health: If you still experience menstruation, your OB/GYN can help manage it, whether through hormone therapy or other methods.
• Birth Control Options: We said it before, we’ll say it again: don’t rely on HRT to prevent pregnancies, it is not a reliable and effective form of birth control. Discuss birth control methods with your healthcare provider to find the one that suits your needs and lifestyle best. There are a lot of options!
• Family Planning: Some trans men may want to be the gestational carrier of their child. If that sounds like you or your partner, our Alternative Insemination program might be a good fit for you.

Consequences of Neglecting Reproductive Health 

Now, let’s talk about what can happen if you neglect your reproductive health as a trans man. Ignoring this aspect of your health can lead to several issues: 

Whether or not you’re on HRT, whether or not you’ve had gender-affirming surgery, taking care of your reproductive health is essential. It’s all about making informed choices, ensuring your health fits with your gender identity and life goals, and avoiding any unwanted surprises. Remember, your health is your power, so take charge and prioritize it.  

OB/GYN Services at Howard Brown Schedule an Appointment

They may be farther down the ballot, but school board elections are some of the most important decisions we make as voters.

School boards are responsible for a wide range of academic, legal, and financial issues impacting our students’ quality of education. For example, boards often approve curricula, evaluate student achievement, and oversee the hiring of superintendents; all of the day-to-day things that impact our children’s lives. As such, their decisions have far-reaching consequences for students, families, and communities. In Illinois, school board members represent the interests of two million public school children.

In recent years, school boards across the country have been leading the attempts to eliminate inclusive learning and erode safe and affirming classrooms for LGBTQ+ students and students of color. 16 states currently have some form of restriction or ban on LGBTQ-related curricula including “Don’t Say Gay” bills and at least 18 states have imposed bans or restrictions on teaching topics of race and gender. It’s these types of attacks that make it important to understand how school boards function and be as informed as possible on who should be on your community’s school boards when it comes time to vote.

What Are the Functions of a School Board?

Illinois has over 850 school districts. There is one school board for every school district. We did the math. There are nearly 6,000 members that serve on school boards in Illinois. Most school boards in Illinois are comprised of 5 – 15 members with four-year terms. These boards hire and evaluate superintendents, who oversee the day-to-day management and policies of school districts set in place by school boards. School boards approve budgets and set spending priorities around classroom resources and educational materials like laptops, textbooks, and art supplies. School boards also determine critical policies impacting students, including disciplinary action, COVID-19 safety requirements, anti-bullying initiatives, police presence on campuses, and criteria for suspensions and expulsion. School boards can only enact a decision or policy by majority vote. Members of the public are welcome to attend school board meetings to listen and observe, but only board members vote to enact policies. This makes it imperative to understand who you are electing on school boards as they are the active voice for the needs of students.

Due to a law passed in 2021, the school board for Chicago will, during the next few years, triple from a seven-member board appointed by the mayor to a 21-member elected board. This will eventually make the Chicago School Board the largest school board in any major city. This first of these voter-elected board members will be on this year’s general ballot in November.

How School Board Elections Impact LGBTQ+ Students?

School board members must engage in tough community conversations on how to handle critical and pressing issues such as school security, racial and gender equity, and public health concerns. There are several school boards across the country that are reducing, or eliminating completely, safe and affirming spaces for students in an already hostile climate for LGBTQ+ students and students of color.  For example:

• In 2022, the Miami-Dade School Board, one of the largest school districts in the U.S., rejected a resolution to observe October 2022 as LGBTQ History Month. 
• In August 2023, the Chino Valley Unified School District in San Bernardino County instituted a new policy requiring parental notification when students change their gender identity at school.
• Some school boards in California are voting to ban Pride flags, or making it difficult to form LGBTQ+ clubs like Gay/Straight Alliances.
• In 2023, the Francis Howell School Board in Missouri voted to stop offering Black History and Black Literature in the predominantly white suburban area of St. Louis and revoked an anti-racism resolution and ordered copies removed from school buildings.

The increasing number of school boards enacting aggressive anti-LGBTQ+ and students of color is happening in an already hostile climate for these students. In 2024, the American Civils Liberty Union (ACLU) is already tracking 156 anti-LGBTQ+ bills including sports and bathroom bans for trans students, eliminating the teaching of LGBTQ+ history in classrooms and banning books containing queer characters. For students of color there is an increasing number of book bans aimed at the histories of people of color and a coordinate attack to ban Critical Race Theory (CRT) curriculum in K-12 even though most primary and secondary schools do not teach CRT and is almost exclusively taught in higher education settings.

These policies are having negative effects on students. According to The Trevor Project, nearly 1 in 3 LGBTQ young people said their mental health was poor most of the time or always due to anti-LGBTQ policies and legislation and a majority of LGBTQ+ students reported verbal abuse because fellow students thought they were LGBTQ+. This is increasing rates of mental health difficulties, isolation, suicidal thoughts, and more.

Final Thoughts

We all know how difficult school can be, regardless of your sexual orientation, gender expression, or race. It is our duty to ensure that our communities’ children can live and learn in a safe and inclusive environment. School boards can take an active role in promoting equity and making sure all students get a high-quality education. They partner with superintendents, teachers, families, students, nonprofits, employers, and local colleges to break down barriers to learning, open real-world learning opportunities, and create pipelines to college and career. You can learn more about school boards by visiting the Illinois Association of School Boards.

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To learn more about how Howard Brown Health contributes to vital advocacy work and has an impact on local, state, and federal policymaking, please visit our Advocacy webpage. 

Historically, the fields of medicine and dentistry evolved very separately. So it wasn’t like dentistry developed as a subspecialty of medicine. As a result, I think that dentists and physicians just concentrated on just our own individual professions. I think this mindset crept into the general population, where people began to see their dental health as very separate from their general health. You see your dentist to take care of your teeth, and you see your doctor to take care of the rest of your body. Never mind the fact that your teeth and your mouth are part of your body, those things had to be handled separately and don’t affect each other. Right?  

So should it be that way? Myself and a lot of other medical and dental professionals will say: absolutely not, it’s all interconnected. If you have inflammation in your mouth (like gum disease), that’s a chronic infection in your mouth. Infections spread, so it doesn’t just stay localized in your mouth. If it’s not treated, something we see as strictly ‘dental’ like gum disease can impact other parts of your body, especially if you’re living with diabetes, cardiovascular disease, HIV, or other chronic conditions.  

It’s wonderful to be able to immediately look at a patient’s medical history and background and know that, okay, these are things I need to keep in mind when I see this person. Because oftentimes the dental care that we provide needs to be adjusted based on medications that people may take, medical conditions they may be living with, and many other factors. So being connected with medical providers helps us provide better care, it makes a huge difference. It really does.

Unfortunately, dental health always seems to be at the bottom of the list for people. Because dental care is often so expensive and requires a completely different type of insurance, seeing a dentist is usually not a high priority for anyone who’s low-income or struggling with finances. Our country’s health system has decided that dental care is a luxury rather than a necessity, which does many people a huge disservice.

Framing dental care as something extra or uncommon means that most people don’t decide to go to the dentist until something really bad is happening in their mouth. So when people come see us for the first time, they often have severe issues that need extensive and urgent treatment. But if people were able to come see a dentist on a regular basis, they could’ve taken smaller preventative measures that would have kept severe issues from happening in the first place.

That’s why I think organizations like Howard Brown are so important. We provide service that many people otherwise would not be able to get, because we will work with you regardless of whether you have insurance and regardless of your ability to pay. For me, that is one of the best things about working in dental care at Howard Brown.

I once had the opportunity to take care of a patient who was missing one of her front teeth. As a result, she was extremely self-conscious and would never smile. When we finally saw one another again after I was able to fix her smile, she was like, “Oh my gosh. I cannot believe how much more my coworkers talk to me! My cheeks hurt from smiling so much!” Her coworkers told her they had thought she was rude because she never smiled and rarely spoke. But that was so far from the truth, she was just self-conscious. We were able to do a lot more than just improve her dental health: we were able to help restore her confidence and connect with other people. 

And it’s not just people who are low-income or uninsured: even people with dental insurance don’t seek dental care as often as they should because there is this perception that going to the dentist is always going to be painful. But what we find is that avoiding that discomfort often leads to more pain in the long run. Most people who come to us are already in pain because of chronic issues that have gone unaddressed. Sometimes people may have trauma from past experiences with a dentist that went poorly or were extremely painful. We understand and try to hold space for that in our clinics.

If you’re fearful of going to the dentist, we encourage you to come to us just for a consultation. Just come and meet us. We don’t have to do any dental work during the first appointment, we can just talk through your worries and figure out how to help make you feel more comfortable seeking care. Working inside someone’s mouth requires a lot of trust, and we’ll do anything to earn it.  

Working inside someone’s mouth requires a lot of trust, and we’ll do anything to earn it.  

Dr. Teofilo limosnero

As of fall 2023, we now operate two dental clinics: one in Englewood and one in Northalsted. Our first clinic dental clinic opened in Englewood in 2018 after tremendous effort from our Chief Dental Officer, Dr. Robin Gay. It would not have been possible without her. I worked with her to provide comprehensive, affordable dental care to patients on the South Side for five years until last fall, when we opened the new Dr. Harrison Mackler Dental Center on the North Side.

To close with some ever-necessary reminders: there is no substitute for seeing your dentist regularly. Despite whatever a new miracle toothbrush or gadget says, you should always see a dentist regularly. If for some reason you can’t see a dentist, at the bare minimum you should be brushing, flossing, and eating healthy. Those are all the things that are going to help you long term.

If you’re looking for excellent and comprehensive dental care, you can make your first appointment with us online at the link below. We hope to see your smile soon!

Become A Dental Patient

You read that right, “From Couple to Throuple.” Peacock’s new show presents us with four couples that have decided they want to add a third and make their couple a “throuple” and follows them over the course of several weeks full of Bachelor-style dates, experiments, and drama. Ashmal and Rehman, Chicago locals and the couple at the center of much of the drama this season, sat down with us for a quick chat about their time on the show, polyamory, authenticity, and mental health.

There are very few illustrations of polyamory in the media at the moment. Maybe an off-hand line from Parks and Recreation or “Sister Wives” on TLC. What knowledge did you have surrounding polyamory going into this experience?

Ashmal: “Honestly, for me, I knew about it, but I didn’t even have the terminology. You only hear the word polygamy, but then hearing the word polyamory and defining that was new. I think the biggest thing was that I knew so little about how many ways there are to do polyamory. I think the experience has a big educational aspect to it; there’s no right way to do this. I learned terms like triad and comet partner; we could go all through the terms. So going into it, I didn’t know that much, which kind of I think was perfect because we were just there to learn. Since we didn’t have that many preconceived notions, it didn’t feel like we were comparing ourselves to what it should be; that was a nice thing. Not having those preconceived notions allowed us to freely explore it.”

Did it occur to you that you are sort of breaking ground when it comes to representing polyamory on TV?

Rehman: “I think going into it as far as representation, Ashmal and I both, we have very diverse backgrounds ourselves. He’s bisexual; I was gay, but I’m a little bit more questioning my sexuality now. Also, our ethnic backgrounds, religious backgrounds… there are so many different parts of us. I think we’re so confident in ourselves and who we are that we went into it just saying we’re just going to be ourselves. We just have to fully be comfortable with ourselves and not necessarily worry about how we’re representing our different identities or even the poly community. Especially when it comes to polyamory, like Ashmal said, we were brand new to it. We knew we could possibly make a lot of mistakes and we were okay with that. We wanted to take the risk to really learn a little bit more about this lifestyle and see where it can go.”

Ashmal: “In terms of representing people who want to maybe explore polyamory, I think the cool part about it is that we kind of were doing that before going on the show, we just didn’t know the terminology. I think the cool thing is that it’s also representation for people who maybe are in a similar boat, but they just didn’t know there’s a term for it. There’s a whole community for it. I hope that people watch it and they learn and they’re like, ‘Oh, there’s others like us!’ I feel like a lot of people don’t realize that that’s what they’re kind of doing until they’re seeing the show, and then they feel it’s something they can pursue.”

The show is pretty upfront about showing the throuples having sex. What kind of sexual health resources existed for you on-set, given that people were swapping sexual partners every week?

Ashmal: “I’m glad you bring that up, because that was actually something very important to us. A few months before filming we did a full health STI panel and then days before we did another one. So we kind of were going in there knowing there’s already that base level of knowledge of everyone’s been through the same process. And yeah, they did have the condoms, but you might’ve noticed I also said they have no lube, which I was like, “Come on!” Then they did get it immediately, so that was nice. They listened.”

Rehman: “We also did a sexual health training to go over the basics and make sure we understood what the risks were and what the different STIs look like and all that. So that was definitely helpful. They took it very seriously. I felt comfortable to just kind of engage and be the way that we are normally outside of the show.”

Ashmal: “Consent was also really huge and you could always feel comfortable to say no to anything. They [production] even had told us, in the middle of something, if you just don’t feel comfortable, all you have to do is just stand on the side of your bed and someone will step in. I think just that level of comfort I’ve not had in regular sexual situations. So that was nice.”

As these relationship-focused reality shows have increasingly high-stakes, what mental health resources existed for you? How did you prioritize that during your time on the show?

Ashmal: “We had the on-camera therapist, but then they also have another therapist check-in with us during our non-filming days. Because it’s a psychologist who specializes in television, I would joke, ‘I have Kyle Richard’s therapist!’ But I think it was nice that we had check-ins whenever we needed. The big thing that they kind of told us about, but we didn’t experience until after coming back, was that you go from being there, where everything is secret secret, you’re doing your experience and you come back and it’s just a lull period. I’m just back at home sending emails at work and it’s just like this emptiness. I’m glad we had each other, and the welfare team would check in on us weekly and then monthly to see how we were.”

As the show has been airing, how have you dealt with the world being able to see into your relationship?

Ashmal: “For me personally, going on the show at all was a big deal. Before this, I was out on my Instagram, to my friends and most of my family. But you know there’s people that would still think we were just roommates or we were friends – and you let them because it’s easier. I got on there and I had to remind myself that there’s no way I can minimize my sexuality. There’s no way you can straight-wash yourself. Just fully go into it. I think I had a moment where I was like, ‘I don’t think I’ve ever come out this big.’ I think the gayest way to come out is on television. So then we just started having fun and then we had each other and the rest of the cast also. I was like, ‘Everything’s going to be okay.’ It’s been really positive.”

Rehman: “I just had to remember the confidence that I have in myself and who I am as a person and just own it and not let anybody take that away from me. Then also realizing who are the important people in my life, and knowing that their opinions and their feelings about us doing this experience matter more than anyone else. Everybody else is going to have an opinion either way. At the end of the day, Ashmal and I showed up to this experiment and it was very real. Watching the episodes, especially seeing myself, it was a very real process for me. It was a rollercoaster, but that’s what life is, and I want to experience life to the fullest. I just kept telling myself: ‘We went through this. It was tough. It’s not for the faint of heart, but I did it and I’m proud that I did it.’ It was a year ago. So I think we could both confidently say that we’re very different people from when we filmed this. It is definitely fun to watch ourselves back to kind of see how much we’ve grown even in just that year.”

Ashmal: “There was some family who were going to see me be queer on main, I was like, ‘I think the important thing is they’re going to see that I’m still me, I’m still being me, and I’m still the same guy.’ I think we’re really proud of just being ourselves throughout it.”

The “Where Are They Now” segment revealed that the three of you are now single. Looking back on it, would you do it again? Would you recommend that someone else do it?

Rehman: “I think for me, I am definitely happy that we did this experience. I think we both just learned so much about ourselves. For me in particular, watching myself back, there are so many things that I learned about myself that maybe I can improve on or maybe I can work on to become a stronger and better version of myself. So I would never want to take that back. And at the end of the day, we showed up, we were real, we were our authentic selves, and that is part of life. What happens in the end is part of life. It was just another thing that happened in our lives and we dealt with it and we’re dealing with it. My main thing is just really looking at the positives that came out of this and starting these conversations around polyamory. I think it was scary. It was a risk for us, but hopefully something good will come from this.”

Ashmal: “I’m so glad we did it too, because one thing that we really focused on is we did this experience that is always going to connect us; we can’t share that with anyone else. That’s so cool. We were even joking, if we start dating someone, that person is going to be so jealous and insecure of the fact that they can’t do this, they can’t have this experience to look back on. I think we’ve really focused on the humor of the situation and the cool experiences and the people we’ve met. Just being here in LA and staying with our friends from the show, it’s so fun. We have a whole new community now, and I think that’s the good thing to focus on.”

What advice would you give to someone who has a friend or family member in a polyamorous relationship?

Ashmal: “I think just most importantly, don’t feel weird about asking questions and being honest. I think even when we were exploring it, we knew it was a new experience and we were still figuring it out. So it’s normal for other people to have questions. Like if you want to invite that friend to hangout, but maybe not all of their partners, think about it like a monogamous relationship. How they would feel? They would feel like, ‘Oh, you don’t like my partners.’ So it’s just nice to extend the courtesy. But as always, if you have questions, ask! Having these conversations is what is most important.”

What advice would you give to someone who is interested in being in a polyamorous relationship?

Rehman: “I think just try it out and do your research first, but just understand that no relationship is the same. So you can read everything, you can talk to people and get their experiences, but at the end of the day, you’re an individual relationship, so you just have to figure out what works best for you, what works best for you and your partner or partners, and then go from there. I feel like sometimes people try and fit into this mold of what they think it’s supposed to be, even with polyamorous relationships, and you just have to realize that they’re all different. Even from the show, all of our relationships as far as the different couples and throuples go, they’re all so different. The coolest thing about it was to see that, oh, they’re doing polyamory in a slightly different way that we are, but that’s okay because they figured out what works for them and we figured out what works for us. But just take risks like any normal, any monogamous relationship, this would just be another risk that you’re taking and trying to figure out if it works.”

Ashmal: “The research part is so important. Just really do your research because just the terminology can really affect the dynamics. We learned the term ‘primary partner’ and then ‘additional partners’, and it just sets the expectations of what polyamory is going to be for you and your partners. If you go into it without even the knowledge of how to express what you want, I think it makes it harder because you feel lost, your partner feels lost, your other partner feels lost. So that baseline education I think is very important.”

Ashmal: “I will give a warning that what they don’t tell you about polyamorous communication is that the texting is crazy, texting one person and then you’re texting the other person and you have your group message. So if you’re responding to the group message but not a partner, you have to send your other two messages. Oh, it is a minefield.”

Any final thoughts to share?

Rehman: “I think, again, just continuing to normalize polyamory and have conversations around this. I feel like especially sometimes in the LGBTQ+ community, even talking about open relationships, you have some people that have very strong opinions either way. At the end of the day, this is just another way to go about having relationships. And it’s okay because like we said, we’re both normal people. He’s an attorney. I work for a bank. We live pretty just normal, boring lives, but we went on a TV show and experienced this and took a huge risk and are entering into a lifestyle that maybe isn’t the majority. Like I said, it’s just another way to do things, and it shouldn’t be something that’s taboo. It shouldn’t be something that is looked down upon. And I hope the more this becomes normalized and more integrated into society, people will feel more comfortable being themselves. People are interested in it, but I feel like there’s still some stigma around it. So hopefully this will help break some of that up.”

Ashmal: “And I’ve been getting a lot of people who have been reaching out, and there’s just one term when people are saying, ‘We’re so proud of you for being so unapologetically yourself.’ I think my thing with that term is where the true liberation and the true ease really comes from. I don’t take pride in being told like, ‘Oh, you’re so unapologetically yourself.’ I have nothing to apologize for, I’m just being myself. No one has anything to apologize just for being themselves. I think just celebrate people instead of being like, ‘Oh, well, normally that’s so weird what you’re doing, but congratulations for doing it.’ “

What is next for the two of you separately or together?

Ashmal: “We actually do have something in the works coming soon, just how we navigate this next chapter, being besties and going about life. So stay tuned for that. That’s all I can say right now.”

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Couple to Throuple season one is streaming now on Peacock.

Click the buttons below to learn more about Howard Brown Health’s sexual and mental health resources.

Walk-In Sexual Health Mental and Behavioral Health

A conversation with Howard Brown Health Board Member B. Pagels-Minor: entrepreneur, public speaker, and advocate for change.

As the Howard Brown Health Board of Directors begins the search for a new class of board members, we spoke with B. Pagels-Minor about their experience on the board, their commitment to healthcare, and what advice they would give to future board members.

My name is B. Pagels Minor. My pronouns are they, them, and theirs, and I am the founder of Divergent Ventures, which is a venture firm that invests in Middle America. And I also am the co-founder of The Wealth Salons, which is a financial wellness platform that works to help support people building their wealth and keeping their wealth. I’m also a longtime board member of the Howard Brown Health Board. I actually am entering my final six months here on the board. I can’t believe it’s been nine years, but in some ways it feels like I’ve actually grown up with Howard Brown.

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I’m from a very small town in Mississippi. The most popular thing it’s known for is being very close to where Elvis was born. The very first time I got on a flight was to go to Chicago for a cousin’s wedding. I remember at 12 being amazed by that. Because, you know, my family was very country, and I mean that in the most affectionate possible way. When I go home, we have fish fries, and I honestly miss them desperately because while I love California and its smoothies, nothing beats a fish fry. 

I ended up going to college in Evanston at Northwestern. I was so fortunate that one of my professors, Myron Kwan, a gay Asian American professor, recommend I take an internship with a local non-profit, the Lesbian Community Cancer Project. I applied, got the internship, and I spent the summer working alongside Howard Brown Health employees, asking women about gynecological visits. If you want to get to know people in the city, that’s the best way: asking about results and being okay doing it, helping them however you can.  

I was grateful to be a part of the process when the Lesbian Community Cancer Project became Lesbian Community Care Project, and then eventually Women’s Healthcare at Howard Brown Health. We made the decision to merge because we knew we could do more to support women in Chicago by being part of Howard Brown Health. At the time, Howard Brown Health didn’t have a reputation for helping women. We wanted to change that and knowing the scale at which Howard Brown Health operated, we knew we could do it.  

Later in 2015, I applied to be on the board of Howard Brown. The cool thing about my work there is that as an intern, I understood what Howard Brown could do. When I was diagnosed with thyroid cancer in my junior year of college, I had insurance, but it wasn’t enough for my treatment. When I needed tests, I went to Howard Brown. It wasn’t just because I worked there.  

When I got treatments, I couldn’t be around people due to radioactive iodine being used on me. I was quarantined in my room without access to the outside world. A volunteer from Howard Brown Health dropped off the full collection of Gilmore Girls to distract me from my isolation. So yes, I’m a fan, proud of it. I love it. My mom and dad couldn’t be there, but that volunteer was. She sat outside my door and talked to me. Howard Brown Health made sure I felt okay and seen.  

That’s one reason I was committed to Howard Brown. It’s one reason I’m still committed, even though my disease was curable. The worst thing for someone who’s sick is to feel alone and sad. Keeping my spirits uplifted and making sure I knew I mattered was a tremendous factor in my recovery. It supercharged my ability to do other things. 

By the time I got to Howard Brown, I kind of had a laissez-faire relationship with healthcare. I ended up on a softball team with the person who would end up being my provider at Howard Brown Health. They said, “Hey B, let’s run all of your blood tests!” From my test results, we formulated a plan. Between vaccines, supplements, and lifestyle changes, my health was transformed. It was like this game-changing understanding that there’s ways that you can fine-tune your body to be more effective. I was delighted in it.

I love the fact that there were doctors who were just like, “Hey, I see some weird stuff going on here. Let’s ask some basic questions. And since you don’t know, we’re going to teach you so you can have better outcomes.” 

Howard Brown’s expansion forced us to become better and smarter, humbling ourselves when we didn’t know things. It’s been an honor to get this separate experience in healthcare management by being part of the board. 

What people need to understand about the board is that because Howard Brown Health is a federally qualified health center (FQHC), at least 51% of our board members must be patients. Our goal is not just to meet the minimum requirement: we aim for 100% patient representation on the board because patient experience is paramount. 

I have a personal connection to Howard Brown as a patient managing a disease. When I moved to California, I remained a patient at Howard Brown. I provided feedback about the blood draw experience, and it improved. Having patients on the board is crucial because they bring firsthand experiences and drive positive changes. 

To be on the board, you can be a current patient or former employee. We want individuals who understand the community’s needs, and our board reflects the diversity of our patient population; people who are Black, Asian, Latine, lesbian, trans, gay, gender-expansive, polyamorous, and more sit on our board. 

While we value diversity, we also seek specific expertise, such as financial, legal, medical, and people management. The application process is rigorous, involving a thorough review, interviews, and careful selection based on the needs of the board. We take this seriously. 

Our board meetings involve committees, each handling different aspects. Committees like governance, executive, and quality assurance contribute significantly to the board’s day-to-day activities. The executive committee, on which I serve, addresses various opportunities and challenges that may arise. The experience is challenging but rewarding, as we collectively strive to fulfill our responsibility to the community, ensuring the best possible care for the 38,000 individuals served by Howard Brown Health each year. 

I was like, “Who’s going to say anything? I’m here every day and I pull my weight, right?” That’s all we care about because it’s all about the work. 

It goes down to the DNA of every Howard Brown employee. I’ve been around Howard Brown since 2006; almost 18 years. The DNA of Howard Brown employees has not changed much. It’s full of very mission-oriented people. It’s people who could potentially get paid a lot more doing other things but choose to work at Howard Brown because they understand what they’re doing is literally going to change lives. 

Someone who is community-based, who can talk to folks, tell us what we’re doing wrong and be willing to help us be better? That’s super valuable. Historically people used to always talk about value related to money, but we’ve tried to think about value in new ways. What social capital do you possess? What insight can you offer? Whenever a board has representation across all categories of humans, I’ve found it to be much more effective. 

And remember, we have more than one opportunity to get involved. So obviously, there’s the board of directors. We also have the community advisory board. And then we also have the Vernita Gray board as well.  

Most importantly, statistics tell us that people from historically under-invested-in communities tend not to apply to things unless they’re a perfect match. I say, “Just apply. Go for it.” Worst case scenario, we respond back to you and say, “Hey, you seem amazing. Would you consider joining this other board?” That’s not a bad proposition. We are a group of volunteers, but we’re also almost all people,who have had challenges in our lives. So, we all know what it feels like to be rejected. We try not to do anything like that in our process. Our goal is to get everyone involved because this is big work, and it’s a lot easier when we can break off pieces and then split it up and all take a little piece.  

I had never had any queer friends before because I didn’t even realize I was part of that community since I grew up in a place that didn’t see people like me. I didn’t even know my friends at BYC were unhoused. We would just be in the clubs, we would be out eating tacos, whatever. When we finally got close enough, they were like, “Oh, I’ve been unhoused.” Then they’d come crash on my couch. My first time going to BYC was as a senior in college. After seeing what they did and seeing my friends feel whole for the first time, I decided that was a place I wanted to support.  Now to see it with its own building, with its own facility, with a space that makes people feel so safe and so cared for, you know, it feels like a real dream come true. That’s exactly the type of exciting stuff that we get to do.  

It’s only because we scrimped and saved. We try our best to create these programs and possibilities, despite their not necessarily being very profitable. It’s the challenge of running a nonprofit: you must be nimble and figure out how to do these things, even when they can’t pay for themselves. So, finally giving BYC a permanent home just feels beautiful. 

You can have the chance to create change like that too. To make progress for the people you know, for the community around you, and for those that need it most. How will you get involved? 

Every queer person can imagine the day: a pink pastel Valentine’s Day filled with traditional displays of love for a romantic partner. A rose, maybe some chocolates, or dinner out to a new place. These celebrations look a lot like the heteronormative love we’ve been conditioned to desire and subconsciously replicate. Queer intimacy on Valentine’s Day can be hard to find.

What if this Valentine’s Day, we dedicated time to appreciating all of the wonderful intimacy that our lives contain? What if we used Valentine’s Day to celebrate friends, lovers, or even strangers? Think about it: almost everything we’re taught about intimacy relates to gender norms and the context of a heterosexual relationship. How different would Valentine’s Day look if we added other types of flowers to our bouquet of roses?

According to The Trevor Project, LGBTQ+ youth who found their family, school, or community to be affirming had much lower rates of attempting suicide. As it stands, queer people are twice as likely to have a mental health condition and trans individuals are four times as likely to have one. Isolation and lack of intimacy can play a large part in generating the feelings of depression or hopelessness that many queer people in our country display.

Clear some room in your metaphorical Valentine’s Day vase: we know there is room in our lives for a bouquet of beautiful relationships and intimacies. Scroll down to learn about all the ways we can relate to one another!

Intimacies of The Body

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Intimacies of The Mind

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Intimacies of the Heart and Soul

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A Bouquet of Intimacy

When it comes down to it, we have an abundance of ways we connect with people. Big or small, intentional or not, every day represents countless opportunities to enrich our own life and the lives of others. Our vase is full, not only of roses, but of freesias, daisies, lilies, and more.

Intimacy is the opposite of loneliness. By stitching ourselves to other people wherever we can, we fight the depression, isolation, and sorrow that can often affect queer people.

Regardless of your identity, promoting kindness, vulnerability, and intimacy in our daily lives can help grow the kind of world that we are proud to call home. If you are in need of mental health resources or want to become a patient here at Howard Brown Health, visit the links below:

Behavioral Health Group Therapy