Statistician, epidemiologist, physician-in-training and Boston Children’s Hospital post-doctoral fellow Elle Lett kicked off the eighth annual Midwest LGBTQ+ Health Symposium with a keynote, “Transgender Health Equity in Troubled Times,” on Sept. 14.

Howard Brown Health’s Center for Education, Research and Advocacy presented the virtual symposium on Sept. 14-15. Since the symposium began in 2015, there have been more than 600 participants. Over the years, the event has brought together healthcare professionals, educators, researchers and community organizations and advocates from across the country to discuss innovative LGBTQ+ healthcare emerging topics.

The symposium’s goal is, according to the event website, “to empower and equip healthcare professionals to offer high-quality care that supports and affirms the LGBTQ+ community.”

Howard Brown Health’s Director of Education Cec Hardacker and Director of Community and Strategic Partnerships Channyn Lynne Parker welcomed participants to the symposium.

Parker said events like this are vital, especially in this current political climate, to amplify LGBTQ+ health equity issues.

“It is so important that we remain grounded, anchored and steadfast in ensuring that our community has the tools they need and also those who charged with our care actually are educated and are on the forefront of supporting us and our needs,” said Parker.

Hardacker highlighted the work she and her staff does in the education realm of Howard Brown including community engagement. She also spoke about how harmful and unjust laws like “Don’t Say Gay” in Florida are because they erase entire communities from public life. This also negatively impacts LGBTQ+ people’s healthcare access. Hardacker added that medical colleges and universities and nursing schools still do not have LGBTQ+ curriculum requirements which means healthcare professionals rely on this and other conferences to get this information.

Howard Brown Health TNB Community Health Manager Trisha Holloway-Riddle spoke about Lett’s work ahead of her keynote speech. Holloway-Riddle highlighted the work Lett does focusing on intersectional approaches to transgender health and health impacts of systemic racism in health equity research.

Lett opened her talk with a reminder of how many Black transgender women and transgender women of color have been killed over the past two years. She called this “one of the greatest human-rights violations in America.”

In terms of transgender health in troubled times, Lett said that it is always hard to work in this research field because of the lack of comprehensive public health data for this community. This is due to the change in Presidential administrations who either help or hinder this effort. Lett added that due to the Trump administration curtailing access to this information on a national level the Biden administration is having a hard time reversing this because there is four years of lost data and GOP-controlled states enacting many anti-transgender laws over the past two years.

“This is a very scary time to be an advocate, a transgender person or a person working in transgender health,” said Lett. “There is an active and purposeful campaign of disinformation that is being used by conservative right-wing extreme groups [across the country] that has led to their [followers] threatening the lives of people who provide gender-affirming care.”

Lett specifically mentioned the targeted harassment and bomb threats against Boston Children’s Hospital and said this is happening in other parts of the country at children’s hospitals who provide gender-affirming care to transgender youth. She added that his is causing fear amongst healthcare professionals at these hospitals.

In terms of having a more principled approach to transgender health equity, Lett said that intersectionality is the guiding force for her work. She included a quote from Kimberlé Crenshaw, who coined the term for academia, that said “intersectionality is the lens through which you can see where power comes and collides, where it interlocks and intersects. It’s not simply that there’s a race problem here, a gender problem here and a class or LGBTQ problem there. Many times, that framework erases what happens to people who are subject to all of these things.”

Lett said that for her the core principals of intersectionality are “contextual and interacting social identities, multilevel power structures, mutual constitution/simultaneity and centering historically oppressed groups” and that her focus is on who is erased from the data and approaches to transgender health.

“If you navigate a world that hates you it will make you sick,” said Lett.

Lett said that transgender people living in GOP-controlled states and who also have additional stress factors experience adverse health outcomes due to discrimination and laws designed to criminalize their existence.

“Black and Latine people have the highest rates of interpersonal racism and transphobia,” said Lett.

In terms of the takeaways of what people need to do, Lett said “for transgender care alone it is structural interventions … that act on multiple levels of society.” She added that this involves HIV testing and direct aid but what needs to be done is multiple interventions happening at the same time.

Lett also spoke about the government’s response to monkeypox (MPV) which she calls a “categorical failure” after what happened with the COVID-19 pandemic regarding who had the worse outcomes. She added that many marginalized groups of people are being turned away when they want to get the MPV vaccine. Lett said that there needs to be a shift towards being proactive, not reactive and “prepare for war in times of peace.”

A Q&A session followed.