Each summer, Howard Brown Health welcomes a group of undergraduate students to our organization for The Gregory Shapen Public Health Fellowship. The Shapen Fellowship focuses on developing project management skills in the field of public health and community medicine. This summer, we were delighted to have six fellows join us, working with our Education, Advocacy, Diabetes Care, and Behavioral Health teams. Each student devised and developed their own project over the course of our ten week fellowship, working in partnership with a Howard Brown Health Mentor. We are proud to share summaries of their work with us this summer.
Ifeyinwa Allanah, she/her/hers (Education and Behavioral Health)
Research Proposal: Effects of Menstrual Cycles and Hormonal Contraceptives on the Mental Health Quality of Life (MHQoL) of Cisgender Women (18-40 yr/o)
The menstrual cycle is an important aspect of reproductive health, influencing various physiological and psychological processes. Attention has increasingly turned towards understanding how these cycles, along with the use of hormonal contraceptives, impact the mental health quality of life (MHQoL) of individuals, particularly cisgender women aged 18-40. This observational study aims to explore the relationship between menstrual cycles, the use of different types of hormonal contraceptives, and MHQoL. By focusing on women who are either using combination hormonal contraceptives, progesterone-only contraceptives, or no hormonal contraceptives at all, this study seeks to uncover potential differences in the MHQoL across these groups, which could lead to more personalized and effective healthcare strategies for cis women experiencing menstrual-related mental health challenges.
Grace Courter, she/her/hers (Education)
Toolkit: Sapphics on Sex
Despite advances in LGBTQ+ health, significant gaps remain in research and services for sapphic individuals. This student-led project aims to create a comprehensive sapphic sexual health toolkit to address common misconceptions and provide accurate information about sexual health for sapphic people. The toolkit will empower individuals to make informed decisions and offer advocacy strategies for spreading awareness. Our goal is to reduce health disparities in the LGBTQ+ community, enhance sapphic sexual health knowledge, and promote inclusive sex education. We seek to ensure all sapphic individuals have access to accurate and comprehensive sexual health resources.
Sophia Hwang, she/her/hers (Diabetes Care)
NDPP Implementation Plan: Diabetes Prevention Program Implementation and Best Practices: Howard Brown Health
National Diabetes Prevention Program (NDPP), which we hope to offer at Howard Brown. In addition to researching how to successfully implement the NDPP, I investigated stress as a risk factor for chronic disease among LGBTQ+ populations, as well as potential strategies to address patients’ social needs that may be barriers to participation. This process involved reviewing literature, consulting other NDPP providers, and surveying patients, which provided valuable insight on how to tailor the NDPP to the specific needs of Howard Brown’s patient population.
Pietro Juvara, he/him/his (Policy and Advocacy)
Legal Guide: The Legal History of 340B
As part of the Advocacy team at Howard Brown this summer, I developed a guide to the legal history of the federal 340B Drug Pricing Program. 340B requires drug manufacturers to sell their products at a discounted rate to organizations like Howard Brown, which then get reimbursed by private insurance companies at market price, creating “340B savings” to help provide accessible healthcare. Since 2020, manufacturers have been slowly dismantling 340B in major lawsuits. Through studying landmark cases, I developed a guide to the legal defense of 340B for any health center to use, with findings on its current legal vulnerabilities, and recommendations for health organizations to apply in their own advocacy work and protect their 340B savings.
Naima McRoberts, she/her (Education and Behavioral Health)
Research Paper: Integrating Behavioral Healthcare into Primary Care for LGBTQ+ Adolescents with Chronic Pain
This summer, I conducted an independent research project reviewing the literature on primary care behavioral health integration and LGBTQ+ adolescent chronic pain disparities to argue for the benefits of integrating behavioral health care into primary care. My mentor, Dr. Kelly Ducheny was a leader in establishing integrated care at Howard Brown, so I was grateful to have her as a resource as I worked on this project. I also spent time shadowing therapist Dondee Gujilde and got to see integrated care in action. With my project, I hope to highlight the intersections of health disparities in minority communities and the urgent need for holistic and accessible health care.
Ari Zweibaum, she/they (Education)
Gender Affirming Care Guide: Guide to Transition Options in the Midwestern United States
Transgender and Gender Diverse (TGD) people often seek ways to change their existence in society to feel more comfortable in their own skin through a process called transition. However, this process can be very abstract and confusing to TGD people who are early on in their journey. The Guide to Transition Options in the Midwestern United States seeks to help remove information barriers by making it easier for TGD people to visualize their transition and work towards a life they want to lead. It explains in detail what goes into various forms of social, medical, and legal transitions to create a more welcoming environment for TGD people.
To learn more about the vital work done by the Education Department at Howard Brown Health, please visit our Education webpage.
Honoring the Legacy of the Lesbian Community Cancer Project at Howard Brown Health
At Howard Brown Health, we are proud to announce an upcoming tribute that will honor the legacy of the Lesbian Community Cancer Project (LCCP). In late Spring 2025, we will unveil a tribute wall on the third floor of our Halsted Clinic (3501 N Halsted), celebrating the incredible impact of LCCP and its contributions to our community.
Founded in 1990 by a group of passionate individuals, LCCP emerged as a vital resource for women with cancer and their families of choice. At a time when healthcare settings often lacked inclusive care, LCCP created a space for lesbians to find support, solidarity, and care. From direct services to peer groups, LCCP’s work not only provided care, but also created a community that lifted one another through grief, loss, and the triumphs of beating cancer. In 2007, LCCP merged with Howard Brown to expand the agency’s ability to serve LGBTQ+ women and their families.
The tribute wall will be a lasting memorial located in the waiting area of our Halsted Clinic. This will be a space for reflection and recognition of the individuals and families who shaped LCCP and contributed to its lasting impact on healthcare equity and community-building.
Tracy Baim, a Chicago-based LGBTQ+ journalist, editor, author, and filmmaker is leading the project. “LCCP was so important to us finding community together,” shares Baim. “When it started at the Cheetah Gym, LCCP was a space to support one another through grief and loss and celebrate when we beat cancer. It’s important that we remember and name the people who helped build that supportive community.”
In addition to memorializing those connected to LCCP, the tribute wall will be a reminder of the broader contributions lesbians have made to the health and well-being of the LGBTQ+ community. All donations up to $50,000 will be matched by an anonymous donor and all gifts will support access to care at Howard Brown.
“Honoring LCCP at Howard Brown Health Halsted gives us an opportunity to look back on some of the lesbians who helped our community age alongside one another,” said Katie Metos, Vice President of External Relations, “Lesbians have always been a backbone to the Queer community.”
We invite our community to participate in this tribute. For gifts of $500 or more, your name and the name of your honoree will be included on the donor wall. If your loved one wasn’t directly connected to LCCP, we offer other ways to honor them. All gifts, regardless of size, will ensure that you and your honoree are recognized in our annual report and on a dedicated webpage celebrating LCCP.
This tribute wall is a meaningful opportunity to reflect on the work that has been done, honor those who were part of it, and ensure that the spirit of LCCP continues to inspire future generations. We encourage everyone to be part of this lasting memorial.
Decoding Project 2025: A Danger to Healthcare Access
by Center for Education, Research, and Advocacy
Project 2025 is a comprehensive plan to enact extreme conservative policies that would reduce access to healthcare, economic security, and social services support. Project 2025’s goal is for conservative ideals to be enacted across every level of federal and state government. One of the primary goals of Project 2025 is to reduce access to necessary healthcare services specifically for LGBTQ+ people and other marginalized communities. We must take action now to stop the elimination of vital healthcare services and non-discrimination protections in healthcare!
Medicaid and Medicare Access
Project 2025 recommends that the Department of Health and Human Services (HHS) evaluate some of its programs for cuts or alterations to services. For example, Project 2025 calls to restructure the 340B Drug Pricing program. The Federal 340B drug discount program has required pharmaceutical manufacturers to sell drugs at a discount to covered entities, including safety net hospitals and FQHCs that care for uninsured and low-income patients. This allows FQHCs to pass along the discounts directly to uninsured patients to help them afford their medications. When we dispense medications to insured patients, we can generate 340B in savings or revenue—at no cost to the patient—that FQHCs use to provide and expand essential services and programs. For example, Howard Brown uses our 340B savings to help fund our HIV and PrEP navigation programs, our trans and non-binary health teams, our Broadway Youth Center, and other crucial services for our patients that are often poorly reimbursed and underfunded. Project 2025 would restructure this program restricting the amount of revenue FQHCs could generate. This would result in fewer affordable medications for underinsured or uninsured patients and a critical funding loss for community health centers.
Project 2025 also calls for stark reductions in funding to state Medicaid programs. Currently, the federal government guarantees to match payments made by the states for services provided to Medicaid patients with no pre-set limits. In states with lower per capita incomes, the federal government pays a larger share of Medicaid funding. Project 2025 proposes a “balanced or blended match rate,” which would provide a flat funding rate to all states. This would eliminate a substantial amount of federal funding for state Medicaid programs, ultimately resulting in reductions in the medical workforce and services for low-income Americans. Project 2025 also calls for more stringent and burdensome eligibility requirements for Medicaid coverage, including work requirements. Work requirements for Medicaid coverage have been shown to be ineffective in helping Medicaid recipients attain employment, and instead just result in many low-income patients losing their Medicaid coverage. For example, when Arkansas briefly implemented work requirements in Medicaid, 1 in 4 participants lost their health coverage. Project 2025 also recommends applying lifetime coverage caps for Medicaid. This would mean that once a person has been on Medicaid for a set amount of time, they can no longer access Medicaid benefits. People who have been on Medicaid for a certain number of months or years could immediately lose eligibility for Medicaid coverage. Project 2025’s eligibility requirements would result in around 18.5 million people at risk of losing their coverage.
Medication Affordability
Project 2025 also proposes the repeal of the Inflation Reduction Act (IRA). The IRA greatly helped reduce the out-of-pocket drug costs for more than 1.5 million Medicare Part D enrollees. Importantly, it capped out-of-pocket costs at $2,000. Medicaid Part D recipients are some of the most vulnerable patients with significant health needs, and repealing the IRA would see Part D enrollees lose upwards of $7.4 billion in out-of-pocket savings next year. This would be especially harmful to people living with HIV (PLWH). When it comes to the costs of HIV treatment including doctor visits, labs, mental health access, and ART medication, about 60% of these costs come from the high cost of medications alone. The costs of HIV medications are estimated to run between $500-$4500 each month during a person’s lifetime. Increasing the costs of HIV treatment or having HIV treatments be mostly, if not fully out-of-pocket, will lead to less PLWH being able to afford their life-saving medications.
Abortion and Reproductive Healthcare
Since the Dobbs v. Jackson Women’s Health Organization decision eliminated the constitutional right to an abortion, Project 2025 now aims to enact policies that would amount to a nationwide abortion ban. These attempts to erode or eliminate access to abortion access will lead to providers denying care due to fear of being prosecuted and ultimately result in increased health disparities and poorer health outcomes. States that currently have abortion restrictions report fewer reproductive health providers. There is a 32% lower ratio of obstetricians to births and a 59% lower ratio of certified nurse midwives to births. States with abortion restrictions experience 62% higher maternal death rates than states with full abortion access. States with abortion bans also see higher rates of mental health conditions, including suicide and substance use disorder overdoses, as the most frequently reported causes of preventable pregnancy-related deaths. According to the Center for American Progress, if a nationwide abortion ban is enacted, the overall number of maternal deaths would rise by 24%. Maternal deaths for Black women would rise by 39%. Abortion access is also an important healthcare issue for LGBTQ+ people. A survey by the Guttmacher indicates that LGBTQ+ people make up as many as 16% of U.S. abortion patients.
Project 2025 also focuses on eliminating access to abortion pills via the mail. Project 2025 would try to weaponize the long-dormant Comstock Act to try and make the delivery of medication abortion by mail illegal. Without a mailing option for medication abortion, the steep logistical and financial burdens of travel will put abortion care out of reach for many patients. Project 2025 also calls to eliminate access to free no-cost emergency contraception that millions of people rely on. This could result in over 47 million reproductive-age women losing access to no-cost contraception.
LGBTQ+ Non-discrimination Protections
Project 2025 aims to eliminate non-discrimination protections for LGBTQ+ patients by reverting Section 1557 of the ACA to the 2020 version enacted under the Trump Administration. This would mean eliminating the general prohibition on discrimination based on gender identity and sex stereotyping and adopting 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.
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 increasing number of anti-LGBTQ+ legislation, including gender-affirming care bans, the elimination of anti-discrimination polices for LGBTQ+ patients will result in increased poor health disparities.
Conclusion
Project 2025 will infiltrate many levels of healthcare access and patients’ ability to afford their treatments. Creating barriers to accessing Medicaid, enacting harsh abortion restrictions, and eliminating non-discrimination protections would be detrimental to the health of all Americans.
With the Presidential election coming up in November, it is important to vote for candidates that support the civil rights and equity of everyone. Be sure you are registered to vote. To register to vote, receive information on voting by mail, find a polling location, or get updates on the upcoming election you can visit your local election boards for more information.
For all residents, regardless of where in Illinois you reside, you can go the Illinois State Board of Elections at www.elections.il.gov.
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.
Decoding Project 2025: Fight Back Against this Anti-LGBTQ+ Agenda
by Center for Education, Research, and Advocacy
This election year there has been much discussion around Project 2025, a political transition plan being pushed by a coalition of conservative extremists. Project 2025 is comprised of numerous harmful policy proposals that would harm access to healthcare, economic security, and social services support, especially for already vulnerable and marginalized communities. Project 2025’s goal is for extreme conservative ideals to be enacted across multiple Federal agencies, to inform state legislation, and to train appointees in its conservative tenets through an online “education academy.” Project 2025 specifically targets LGBTQ+ people and lays out a clear plan to erode or eliminate non-discrimination protections for LGBTQ+ people. It is imperative to understand what Project 2025 is so that we can take action to prevent this threat from taking hold!
What is Project 2025?
Project 2025 is a 900-page document published by the Heritage Foundation that is meant to serve as a road map for a conservative extremist federal government. Project 2025 contains a 180-day playbook of regulations and executive orders that could be signed and implemented by the next conservative president upon taking office. It also includes a database of potential presidential appointees and information on the kinds of bills conservatives in Congress and state legislatures should attempt to enact. Project 2025 contains plans for enacting long-standing extreme conservative idealsthat impact all aspects of everyday life, including reducing federal spending on social services for low-income people, eliminating efforts to fight climate change, increasing military spending, and impeding reproductive and sexual healthcare access, to name a few.
Project 2025 was created by the Heritage Foundation. Founded in 1973, the Heritage Foundation is a conservative think tank whose mission is “to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values, and a strong national defense.” As part of furthering their mission, the Heritage Foundation has a long history of anti-LGBTQ+ advocacy. For example, the Heritage Foundation has fought against out LGBTQ+ military service, LGBTQ+ Boy Scouts and leaders, marriage equality, protections against discrimination for LGBTQ+ workers, rights of LGBTQ+ parents, bans on conversion therapy, evidence-based healthcare for trans youth, and LGBTQ+ inclusive curricula. The Heritage Foundation took a leading role in the conservative movement in the 1980s during the presidency of Ronald Reagan, whose policies were informed by the Heritage Foundation’s Mandate for Leadership. The Mandate for Leadership would continue to be released every Presidential election year as a way for the Heritage Foundation to instill conservative and traditional ideals into the federal government. Project 2025 is the name for this year’s iteration of the Mandate for Leadership.
The main difference between Project 2025 and past Mandate for Leadership editions is the massive coalition of conservative and far-right groups that have contributed to Project 2025, uniting under this singular vision. Some high-profile organizations that have contributed to Project 2025 alongside the Heritage Foundation include the Family Research Council (FRC), Alliance Defending Freedom (ADF), and the American Legislative Exchange Council (ALEC). All these organizations have a long history of being powerful lobbyists on behalf of conservative causes. Many of these organizations are designated hate groups by the Southern Poverty Law Center due to their goals and activities being based on a shared antipathy towards people based on race, religion, ethnicity/nationalities/national origin, gender and/or sexual identity. The goal of many of these groups is to reduce or eliminate LGBTQ+ rights using legislative advocacy. Project 2025 is a consolidation of these groups’ decades-long campaigns to erode or eliminate many non-discrimination protections for the LGBTQ+ community.
How does Project 2025 affect the LGBTQ+ community?
Given the anti-LGBTQ+ work of many of the groups behind Project 2025, it is not surprising that one of Project 2025’s main goals is to drastically roll back rights for the LGBTQ+ community to promote “life and strengthening the family.” Many of these policy changes would be enacted by the President through executive orders and presidential appointments. Just a few of these actions would include:
Department of Justice (DOJ): Project 2025 would encourage the DOJ to pursue litigation that is consistent with the agenda of the President. This means litigators with the DOJ would be encouraged to prosecute someone performing abortion care or providing gender-affirming care (GAC) to someone traveling from another state where that care is banned, or where the language on how and when these procedures can be given is vague. This would cause providers of services like abortion and GAC to refuse to provide these services out of fear of prosecution. This would put the physical and mental health of LGBTQ+ patients at risk.
Department of Health and Human Services (HHS): Project 2025 recommends that the future HHS secretary reverse focus on LGBTQ+ equity, and instead enact policies that encourage “marriage, work, motherhood, fatherhood, and nuclear families.” Project 2025 urges for policies that protect adoption and foster agencies that refuse to work with LGBTQ+ couples, as well as bans on in-vitro fertilization (IVF)—preventing many LGBTQ+ people from becoming parents. Project 2025 also would eliminate free birth control access and enact a national abortion ban.
Medicaid: Project 2025 calls for imposing targeted time limits or lifetime caps on Medicaid benefits. Similar policies have previously been introduced, including a proposal to impose a 36-month lifetime maximum for Medicaid coverage. It also proposes introducing a work requirement to be eligible for Medicaid coverage, even though work requirements for Medicaid have been shown to reduce insurance coverage for patients while not increasing employment. These proposals would greatly limit and restrict access to Medicaid, and this would disproportionately impact LGBTQ+ communities. LGBTQ+ people utilize Medicaid at higher rates than non-LGBTQ+ with around 21% of LGBTQ+ adults in the U.S. accessing Medicaid every year. This would put millions of LGBTQ+ patients at risk of losing their healthcare coverage immediately as Project 2025 may retroactively impose these limits.
Supreme Court: Project 2025 calls for not only limiting the application of the Supreme Court’s ruling in Bostock v. Clayton County,which held that Title VII’s sex discrimination protections applied to LGBTQ+ Americans, but also threatens to prevent the ruling from extending to other sexual and gender minority communities, such as two-spirit, intersex, an asexual Americans.
Department of Defense: Project 2025 threatens to reverse policies allowing trans individuals to serve in the military.
Department of Education (DOE): Project 2025 calls for eliminating the DOE. This would eliminate most of the mechanisms to enforce non-discrimination protections for LGBTQ+ students and put their lives and well-being at risk.
How can we fight back against Project 2025?
Project 2025 is just the beginning of a long-term plan to eliminate protections for LGBTQ+ and other marginalized people. First, it’s important that you learn more about what Project 2025 is. You can read more info about what Project 2025 is and how extensive Project 2025 goals are. You can also read our blog on the state of anti-LGBTQ+ legislation.
With the Presidential election coming up in November, it is important to vote for candidates that support the civil rights and equity of everyone. Be sure you are registered to vote. To register to vote, receive information on voting by mail, find a polling location, or get updates on the upcoming election you can visit your local election boards for more information.
For all residents, regardless of where in Illinois you reside, you can go the Illinois State Board of Elections at www.elections.il.gov.
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.
Roundup of the 2024 Illinois Legislative Session
Every year, Howard Brown Health (HBH) supports several state legislative priorities to advance healthcare for LGBTQ+ patients. There were some important LGBTQ+ health equity and healthcare funding bills that Howard Brown and our community advocated for and passed during the 2024 Illinois General Assembly Legislative Session!
State Budget
The FY 2025 State budget and recently passed Medicaid omnibus bill includes a few vital funding provisions that will help health centers in Illinois. Legislators included an increase of funding for the HBIA/HBIS or Healthy Illinois for All programs for ages 42 and older in the state’s FY25 budget. This will provide $440 million from the General Revenue Funds and $189 million from other sources for a total of $629 million. This will help further close coverage gasps as it provides Medicaid-like coverage for low-income residents regardless of immigration status. This funding is necessary with the influx of immigration into Chicago from Central and Latin America. This additional funding will positively impact Howard Brown’s patients to gain better access to healthcare coverage. On average 30% of Howard Brown patients utilize Medicaid, and 21% are uninsured or qualify for a sliding scale.
An additional $40 million above the initial proposed appropriation was given to implement the HOME Illinois plan to prevent and end homelessness. This funding will primarily be focused on rental assistance, homeless prevention, and funding to address youth homelessness. 28% of LGBTQ youth report experiencing homelessness or housing instability at some point in their lives. Howard Brown’s Broadway Youth Center provides support for LGBTQ+ youth experiencing homelessness or unstable housing and this funding will go a long way in helping LGBTQ+ youth find the safe and stable housing they deserve.
There are some important additions to the 2025 Medicaid omnibus bill around psychiatric care and medication access. SB3668 will lift unnecessary prior authorization (PA) requirements for certain psychiatric medications so patients can get vital medications as soon as they need them. This budget will also increase Medicaid psychiatry reimbursement rates (SB3668) and increase rates for psychiatric evaluations and substance use disorder treatment, as well as medication monitoring performed by community mental health centers (HB4664). The cost of psychiatric care can be high for patients and Medicaid reimbursement rates in Illinois are historically low compared to neighboring states. Increasing these reimbursement rates will make psychiatric care more affordable for low-income residents. This will allow places like Howard Brown where a large population of our patients use Medicaid for their healthcare coverage to affordably treat more patients.
Diversity, Equity, and Inclusion
In this session, we were able to see the passage of the Nonprofit Board Diversity Reporting Bill (SB2930). Illinois will now require non-profits that provide $1,000,000 or more in grants each year to release aggregated demographic information of its board of directors and officers. This includes race, ethnicity, gender, disability status, veteran status, sexual orientation, and gender identity. This is to ensure non-profit boards and leadership are reflective of the populations they serve. We want to applaud our partners at Equality Illinois for their leadership in the passage of this bill!
The other bill, the Support Trans Candidates Running for Chicago’s Elected School Board Act (HB4924) would update the Illinois School Code to ensure trans individuals who are candidates for Chicago’s elected school board don’t have to publish their deadnames on their nominating petitions. This requirement is harmful to trans and gender-diverse individuals who would be forced to release a deadname or inadvertently out themselves as these names would become public record. While these bills did not pass this session, we will continue to advocate for these important bills.
340B
Even with the wins this legislative session, there is still further advocacy work to be done. One major bill that unfortunately didn’t pass this session was the Illinois Patient Access to 340B Pharmacy Protection Act (SB3727). This bill would prohibit pharmaceutical manufacturers from prohibiting, restricting, or interfering with a local pharmacy that contracts with a 340B covered entity, including community health centers like Howard Brown, to dispense medications acquired through the 340B program. This legislation will help to ensure that the medications needed by patients are available at their local pharmacies and safeguard critical 340B savings that we invest in expanding services and programs our patients rely on. We can still do lots of advocacy to ensure the 340B program is protected. Congress recently introduced the 340B ACCESS Act (HR 8574) aimed to ensure 340B’s long-term viability as a critical resource for Community Health Centers and their patients. You can show your support for the 340B Access Act by contacting your Representatives and telling them we need Congress to take action and reform the 340B Program to ensure we can continue to serve our nation’s most vulnerable patients.
Insurance Coverage and Prior Authorization
We strongly advocated for The Prior Authorization Reform Act (HB5051) which would prohibit health insurance providers from requiring prior authorization for a prescription drug prescribed to a patient by a healthcare professional for 6 or more consecutive months. Many of our patients have experienced denials of coverage for necessary and life-saving medications due to burdensome and unnecessary prior authorization requirements from insurers. This bill would also prohibit prior authorization requirements for certain specific FDA-approved prescription drugs, including insulin, human immunodeficiency virus prevention medication such as PrEP and PEP; human immunodeficiency virus treatment medication; viral hepatitis medication; and hormonal therapy drugs used for gender-affirming care. We are continuing to push for this legislation as it will provide immediate and life-saving medications for our patients.
The Illinois legislature passed a SB3203 that would cap patient costs for prescription inhalers at $25 a month. The bill’s passage follows years of outcry from patients with asthma and other lung conditions over the cost of inhalers. The annual per person medical cost for asthma prescriptions was $1,830. The passage of this bill will relieve the high financial burden of rising inhaler costs.
The passage of the Healthcare Protection Act (HB5395) will ban PAs for admission for inpatient psychiatric services for the first 72 hours on an inpatient stay. These will help make access to psychiatric medications and inpatient care more available. When needed it also bans step therapy, an insurance practice that requires a patient to try a lower-cost drug or therapy first. This will ensure that patients have access to the medications that best suits their needs.
Education and Training
There were a couple of bills focused on education introduced in this session that HBH strongly supported. The Supporting Implementation of the Keeping Youth Safe and Healthy Act (SB3384) requested an appropriation of $20 million in the FY25 State Budget as a grantmaking program to support those public school districts that want to teach comprehensive sex education that is vital to the health and safety of Illinois students. This would have helped eliminate barriers to teaching comprehensive sex education by funding much needed training and curriculum development.
We also sought to pass the LGBTQ+ and HIV Cultural Competency for Legal Professionals (HR582) that urged the Illinois Supreme Court to adopt a continuing education mandate for LGBTQ+ and HIV cultural competency education for attorneys, judges, and courtroom staff. LGBTQ+ and people living with HIV (PLWH are disproportionately incarcerated and have negative experiences when trying to access legal services due to their identities and HIV status. While the cultural competency for legal professionals resolution was adopted by the house, it failed to advance. We are committed to fully pushing this bill through in the upcoming legislative sessions.
HIV Treatment and Prevention
There are a couple of HIV-related budget appropriations HBH advocated for that would ease the burden of individuals getting tested for HIV and connected to healthcare quickly. However, for the first time in the last four fiscal years, state legislators did not include any new HIV-related funding in the state’s Fiscal Year 2025 budget. There are several HIV-related budget items that will operate with level funding for the FY 2025 budget.
Getting to Zero (GTZ) Illinois Omnibus budget which is a state-wide initiative to end the HIV epidemic in the state by 2030 ($5.5 million).
HIV treatment and prevention services, also known as the HIV Lump Sum ($25.5 million).
The African American HIV/AIDS Response Act (AAHARA) funds grants to Black-led community-based organizations and HIV services meant to address the disproportionate impact of HIV/AIDS on African Americans and other communities of color ($15 million).
Grants and administrative expenses for the distribution of PrEP medication access ($2 million).
The Quality-of-Life Endowment Fund for grants related to HIV/AIDS prevention and education ($1 million).
Administrative expenses associated with STI testing, treatment, and prevention. ($500,000).
We would like to thank our partners at AIDS Foundation of Chicago for all their hard work and leadership on securing this important funding.
The Strengthening & Protecting Illinois HIV Funding Infrastructure (SPIHFI): (HB5667) bill would have provided an $2 million increase in state funding for HIV education, prevention, testing, and treatment. This would include $2.5 million in new funding to launch eight Rapid Start for HIV Treatment pilot sites that establish HIV treatment standards that would connect people with treatment within 7 days of initial diagnosis or 7 days of referral to HIV medical care. While this bill didn’t pass, we will fight to increase access to HIV testing and treatment in Illinois. We would like to thank our partners at AIDS Foundation of Chicago for all their hard work and leadership on this bill.
the Connection to HIV Testing and Linkage to Care (LTC) Act (HB5417) would enact reforms to ease HIV-testing and connection to treatment by mandating at-home HIV and/or sexually transmitted infections (STIs) testing kits be covered by insurers and Medicaid without cost-sharing; create 8 rapid start pilot sites that would connect people with treatment within 7 days of initial diagnosis or within 7 days of referral to HIV medical care; and ensures that all county jails provide HIV/AIDS education to people who are incarcerated and visitors, as well as link them to HIV testing as mandated by Illinois’ County Jail Act. It is vital that people newly diagnosed with HIV gain access to treatment and other wrap-around services as soon as possible. HB5417 passed the Illinois House with a bipartisan, unanimous vote, but the bill was unable to advance through both chambers. We will continue to fight for people to gain immediate access to the healthcare they need. We would like to thank our partners at AIDS Foundation of Chicago for all their hard work and leadership on this bill.
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 Fight Against Anti-LGBTQ+ Legislation
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.
Safe Spaces: Combating Housing Disparities for LGBTQ+ Individuals
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 higherrates of being poor compared to their cisgender counterparts and LGBTQ+ people, especially trans people, people of color, and youth, experience higherrates 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.
Beyond The Ballot – Know Your Right To Treatment!
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.
Revolutionizing Research – Pushing Medicine Forward With Pride
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.
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.
Funding The Future Of Healthcare
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.
Beyond The Ballot: Vote For Chicago’s First Elected School Board!
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.
OB/GYN for the Modern Man: Why Gynecology for Trans Men is So Important
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.
What OB/GYN Care for Trans Men Involves
So, what does OB/GYN care for trans men actually entail? How is it different? What are the conditions and treatments we are thinking about? It’s all about keeping tabs on your reproductive health and addressing any concerns that may arise. Here’s what it involves:
Pap Smears: Just like cisgender women, trans men with cervixes should have regular pap smears to screen for cervical cancer. Early detection is key to effective treatment.
STI Testing: Like we said above, research has shown that trans men are far less likely to get regularly tested for STIs. This means that it is especially crucial to pursue routine testing, because your providers are less likely to give it to you unprompted. Many STIs can be asymptomatic, so regular check-ups are a must.
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:
Cervical Cancer Risk: Skipping pap smears can result in undetected cervical abnormalities or cancer, which can have severe consequences if not treated early.
STI Complications: If you’re sexually active and skip regular STI testing, infections can go unnoticed and potentially lead to complications.
Menstrual Health: Ignoring menstrual health issues can result in severe symptoms that can cause significant discomfort or pain.
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.
