Being Vigilant and Responsive to Structural Stigma

The Trump administration has been in office for only one and a half years, but its agenda with respect to LGBT issues is clear:

• Strip the LGBT rights page from the White House website (January 2017).
• Disband the White House's HIV/AIDS Advisory Council (December 2017).
• Ban transgender individuals from serving in the military (August 2017).
• Delete the item assessing sexual identity from the National Survey of Older Americans Act Participants, the premier survey that assesses the needs of elderly Americans and whether federally funded aging programs meet those needs in, for example, nutrition, transportation and caregiving services; Meals on Wheels is one of the programs (March 2017).

Efforts to prevent deletion of the sexual identity item from the elderly survey have been successful. Nevertheless, one must be vigilant and ready to respond to these and related challenges.

As compared with other actions by the Trump Administration, it might seem trivial whether items assessing sexual identity or gender identity — or SOGI items as they are known — are included in national surveys.

However, I cannot underscore the importance of including SOGI items in national surveys. Without such items, LGBT individuals do not exist. Their strengths, vulnerabilities, experiences and health are erased. Consequently, no need exists to respond to LGBT individuals. The bottom line is this: if we are not counted, we do not count.

Let me provide an example of the benefits of SOGI items. Various federal surveys conducted by various departments use representative samples of the US population to assess and monitor all sorts of things. The Department of Health and Human Services conducts several such surveys. One survey in particular is unique because it is longitudinal and assesses lifetime psychiatric diagnoses. It is the National Epidemiological Survey on Alcohol and Related Conditions (NESARC).

In the early years of this century, NESARC accidently monitored a natural experiment between its longitudinal Waves 1 and 2. Between those waves, several US states passed constitutional bans against gay marriage while others did not. Change in the prevalence of psychiatric morbidity between Waves 1 and 2 was examined between LGB individuals living in states that passed such bans and LGB individuals living in states that did no such thing. The evidence was clear. There was a marked increase in psychiatric morbidity among LGB individuals living in states banning gay marriage from Wave 1 to Wave 2 but no change in psychiatric morbidity among those living in states with no such bans. Without this superb data set, one would not have the evidence documenting the negative health effects of discriminatory public policy on LGB individuals (for article, see, Hatzenbuehler ML, et al., American Journal of Public Health, AJPH, 2010, 100, 452-459).  

These findings make clear what was brilliantly summarized by Kathy Greenlee, a lawyer with the Center for Practical Bioethics, "Only if we know more about the health, lives and station of LGBT people can we implement federal programs, policy and funding that will accurately and meaningfully improve lives and better health" (p. 1212, AJPH, 2017, 107, 1211-1212).

It is imperative that LGBT individuals continue to be counted in federal surveys and that SOGI items are added to those federal surveys and other data banks that do not collect such data.

To assist in this and related efforts, we will work this year:

• To be alert and responsive to Administration attempts to erase or discriminate against LGBT individuals.
• To partner with other divisions and non-APA entities to reach our goals.
• To enhance the division's strength so that we can be successful in our efforts.

By so doing, we build on the successes of our predecessors and leave for our successors a stronger division. I ask all of you to assist in these efforts by joining or engaging more actively in committees or task forces, alerting me and others to new or unfolding Administration insults and suggesting ways that our voices and energies can be maximally effective against the turbulent winds that we face.

This statement has been slightly modified from its original oral version. The oral version was presented at the annual convention of the American Psychological Association in Aug. 7, 2018, in San Francisco.