U.S. Rep. Robert Garcia (D-Calif.) on June 12 sent a letter to Secretary of State Antony Blinken, Homeland Security Secretary Alejandro Mayorkas, and Federal Bureau of Investigation Director Christopher Wray to work to ensure LGBTQ people during Pride events.

“Over the last several weeks, your respective agencies and departments have issued stark warnings, and travel advisories to the public over potential threats from foreign terrorist organizations (FTO), and their supporters during this year’s Pride Month,” said Garcia in his letter. “I understand that these steps have come after deeply concerning increases in anti-LGBTQ+ rhetoric, calls for targeted violence, and foiled violent plots.”

The FBI on May 10 issued an advisory that warned of potential violence at Pride events and other LGBTQ-specific events. The State Department on May 17 — the International Day Against Homophobia, Biphobia, and Transphobia — announced a similar warning.

“Ensuring that people can peacefully and safely celebrate Pride and the diversity of the LGBTQ+ community is of utmost importance,” wrote Garcia, a gay man who represents California’s 42nd Congressional District that includes Long Beach.

June 12 also marked eight years since a gunman killed 49 people inside the Pulse nightclub in Orlando, Fla.

The massacre at the time was the deadliest mass shooting in modern U.S. history. The gunman pledged his allegiance to the Islamic State, even though there is no evidence that suggests the extremist group ordered him to carry out the massacre. 

“This week marks the eight (sp) anniversary of the horrific Pulse nightclub Orlando shooting — during which the attacker deliberately and viciously targeted the LGBTQ+ community,” wrote Garcia in his letter. “It is important to put the recent escalation of extremist anti-LGBTQ+ propaganda and messaging in the context the Pulse nightclub shooter who was influenced by these same forces of extremism.”

The Washington Blade joined Assistant Secretary for Health Adm. Rachel Levine of the U.S. Department of Health and Human Services and Administrator Isabel Guzman of the U.S. Small Business Administration as they toured two LGBTQ-owned small businesses on Tuesday in Washington, D.C. — Big Gay Smiles and Price Medical.

The event provided an “amazing opportunity” to “talk about the different synergies in terms of small businesses and the SBA, and health equity for many communities,” including the LGBTQ community, Levine told the Blade.

Representation matters, she said, adding, “that’s true in dental care and medical care,” where there is a tremendous need to push for improvements in health equity — which represents a major focus for HHS under her and Secretary Xavier Becerra’s leadership, and in the Biden-Harris administration across the board.

“Small businesses identify needs in communities,” Guzman said. With Big Gay Smiles, Dr. Robert McKernan and his husband Tyler Dougherty “have clearly identified a need” for “dentistry that is inclusive and that is respectful of the LGBTQIA community in particular.”

She added, “now that they’re a newly established business, part of the small business boom in the Biden-Harris administration, to see their growth and trajectory, it’s wonderful to know that there are going to be providers out there providing that missing support.”

The practice, founded in 2021, “is so affirming for the LGBTQIA community and we certainly wish them luck with their venture and they seem to have a great start,” Levine said. “They’re really dedicated to ending the HIV epidemic, providing excellent dental care, as well as oral cancer screenings, which are so important, and they’re really providing a real service to the community.”

Big Gay Smiles donates 10 percent of its revenue to national and local HIV/AIDS nonprofits. McKernan and Dougherty stressed that their business is committed to combatting homophobia and anti-LGBTQ attitudes and practices within the dental field more broadly.

“We try to align our practices here within this dental office to align with the strategic initiatives being able to help reduce HIV transmission, reduce stigma, and help to ensure people have the knowledge and [are] empowered to ensure that they’re safe,” Dougherty said.

McKernan added, “With the Academy of General Dentistry, we’ve done a lot of discussions around intersex, around trans affirming care, in order to help educate our fellow dental providers. It’s very important that every dentist here in the [D.C. area] provide trans affirming care and gender affirming care because it’s very important that someone who comes to a medical provider not be deadnamed, not get misnamed, and have an affirming environment.”

Trans and gender expansive communities face barriers to accessing care and are at higher risk for oral cancer, depression, and dental neglect. Levine, who is the country’s highest-ranking transgender government official, shared that she has encountered discrimination in dental offices.

After touring the office, Levine and McKernan discussed the persistence of discrimination against patients living with HIV/AIDS by dental practices, despite the fact that this conduct is illegal.

“I’ve traveled around the country,” the assistant health secretary told the Blade. “We have seen that many FQHCs [federally qualified health centers] or community health centers as well as LGBTQIA community health centers have had dentists, like Whitman-Walker, to provide that care because many people with HIV and in our broader community have faced stigma and have not been able to access very, very important dental care.”

Prior to opening his practice, McKernan practiced dentistry at Whitman-Walker, the D.C. nonprofit community health center that has expertise in treating LGBTQ patients and those living with HIV/AIDS. Big Gay Smiles is a red ribbon sponsor for the organization’s Walk & 5K to End HIV.

After their visit with Big Gay Smiles, Levine and Guzman headed to Price Medical, a practice whose focus areas include internal medicine/primary care, HIV specialty care, immunizations, infectious disease treatment, and aesthetics like Botox.

There, the officials talked with Dr. Timothy Price about his office’s work advancing health equity and serving LGBTQ patients including those living with HIV/AIDS, as well as the ways in which small businesses like his have benefitted from access to electronic health records and telemedicine.

“People being able to access medical care from the comfort of their home or workplace can be very important,” Price said, with technology providing the means by which they can “ask questions and get an answer and have access to a health care provider.”

Often, LGBTQ patients will have concerns, including sexual health concerns, that need urgent attention, he said. For instance, “we’ve had patients need to access us for post-exposure prophylaxis for HIV,” in some cases when “people are vacationing and they have something that might be related to their health and they can reach us [via telemedicine] so that’s the way it’s really helped us and helped the patients.”

Access to technology for small businesses is an area in which the SBA can play a valuable role, Guzman noted.

“The Biden-Harris administration has focused on a whole-of-government approach to making sure we can support the community, and that includes in entrepreneurship,” she told the Blade.

“There’s a surge in [small] businesses starting and that includes” those founded by members of the LGBTQ community “and so you see that there’s products and services that need to be offered,” and the administration is “committed to making sure that we can fund those great ideas.”

Guzman said she sees opportunities for future collaboration between her agency and HHS to help encourage and facilitate innovation in the healthcare space. “Small businesses are innovators creating the future of health tech,” she said.

Levine agreed, noting “we have been talking about that, about different ways that we can work together, because as we think about the social determinants of health and those other social factors that impact health, well, economic opportunity is absolutely a social determinant of health,” and small businesses are certainly a critical way to broaden economic opportunity.

Speaking with the Washington Blade on Monday, U.S. Department of Health and Human Services Secretary Xavier Becerra and Assistant Health Secretary Adm. Rachel Levine detailed plans to expand health equity initiatives under a second Biden-Harris administration.

The conversation came shortly after the agency held a Progress Pride flag-raising ceremony, where U.S. Rep. Mark Takano (D-Calif.), delivered opening remarks alongside the top HHS officials who also spoke at the department’s second annual Pride Summit later on Monday.

Levine highlighted a slate of recent actions and goals on which to build in a second term: The issuance in April of a final rule clarifying that discrimination on the basis of sexual orientation and gender identity is prohibited under the Affordable Care Act; a demographic data collection plan on sexual orientation and gender identity metrics; the pursuit of regulations and litigation (coordinated with the Justice Department) to combat healthcare restrictions, including those which target LGBTQ communities; and the agency’s commitments to diversity, equity, inclusion, and accessibility.

“To put an exclamation point behind some of that,” Becerra said, “on SOGI, we think it’s important to gather the data that lets us figure out where to go next, or where you have issues” in “getting access to the care that you need.”

“And we know we’re going to end up in court with a lot of the rules that we’ve enacted,” added the secretary, who previously served as attorney general of California, “but we’re ready for that — they’ll get tested, and we’re ready to defend [them].”

Becerra added that along with the initiatives outlined by Levine, HHS is looking to expand efforts in the behavioral health space to maximize opportunities to match patients with providers who have shared backgrounds, identities, and lived experiences.

That way, he said, “chances are that individual in need of care is going to open up faster. So we’re going to try to move quicker towards providing, in the behavioral health setting, people with lived experiences who can speak to what this individual is hurting from, is suffering from, so we can try to help them with their behavioral health challenges.”

The secretary praised the Biden-Harris administration’s pro-equality record, noting, “the fact that we’re the first department to fly the Pride flag, I think it shows that we’re out front, and we are very intent on making sure everyone has access to the care that they need.”

“And to do that, you’re going to find yourself in court,” Becerra said. “To do that, you need to do an aggressive job of collecting data. To do that, you have to show people that you can approach them with someone who’s experienced in what they’re going through. And so all of those things have to be amped up if we’re going to make further progress in the next administration’s four years.”

Levine repeatedly credited the secretary’s leadership as well as President Joe Biden’s work advancing equity throughout his administration, including through executive orders, when discussing HHS’s efforts to expand healthcare access and improve health outcomes for diverse populations including the LGBTQ community.

“One of the highlights, I think, of the Biden-Harris administration and Secretary Becerra’s leadership is the the emphasis on building representation in Washington that looks like the people of our country,” said Levine, who became the highest-ranking transgender government official with her appointment as assistant health secretary in 2021.

“Whether it is communities of color, whether it is the LGBTQI+ community, young people, seniors, I mean, we really want the the people who work for the people of our country to look like them and to represent them,” she said.

She also highlighted the extent to which her and Becerra’s work on this front has involved putting boots on the ground. “I’ve been to Austin. I’ve been to Dallas. I’ve been to Nashville. I’m going to Jacksonville. We tried to get to Idaho to Boise, but we got snowed out.”

“We are everywhere,” Levine said, adding that she likes to say the secretary has been doing “everything, everywhere, all at once,” (the title of a critically acclaimed film that won the Academy Award for Best Picture in 2023.)

In a Pride month press release shared by the agency on Monday evening, Becerra said in a statement, “HHS works every day to build an America where LGBTQI+ Americans have access to quality, affordable health care and can go to the doctor without fear of stigma or discrimination. Where the state you live in doesn’t determine whether you can access lifesaving, gender-affirming care. And where more communities embrace the diversity that has always strengthened our national character.”

“Pride reminds us that we are a strong, resilient, and powerful community that fights hate with love,” Levine said. “As we celebrate Pride Month, we should recognize how far we have come, even as we take stock of the challenges that we face. Everything we do at HHS emphasizes health equity and this pride month, we are making a focused effort to address and eliminate the health disparities within the LGBTQI+ community.”

She added, “We are focused on our efforts to end the HIV epidemic in the U.S., prevent syphilis and congenital syphilis, and promote access to care for LGBTQI+ people across America. Together, we can work to support healthy people, healthy communities, and a healthy nation for all. I am a positive and optimistic person, and I believe that working together, we can create a healthier, better future for all people living in the United States.”