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Pride 2020: What is the meaning of Pride and how should it impact our practice?

June 24, 2020

By Klint Peebles, MD, and Erica D. Dommasch, MD, co-chairs of the AAD’s Expert Resource Group (ERG) on LGBTQ/Sexual and Gender Minority (SGM) Health

As we commemorate another LGBTQ (lesbian, gay, bisexual, transgender, queer) Pride Month, we recognize that each year’s celebration carries a distinct tone — an aura that is emblematic of both the accomplishments and setbacks of the prior year as well as the current cultural context in which we find ourselves.

This year has been, and will continue to be, a year like no other. The challenges of COVID-19 have created a new shared reality, and although we may not know how long this ‘new normal’ will last, it is certain that our society will fundamentally change. One idea remains certain: It is up to us to ensure we emerge stronger than ever in our immutable dedication to our patients and to the art and science of dermatology.

Our commitment in the AAD Expert Resource Group on LGBTQ/SGM (sexual and gender minority) Health remains steadfast in unwavering support of LGBTQ/SGM people of color. We affirm the inherent value of every human being and recognize that the ongoing oppression of health disparities and barriers to care are unacceptable.

Additionally, the AAD position statement on sexual and gender minority health, which was approved just over a year ago, emphasizes the importance of intersectionality as we approach inequity in marginalized populations. These principles will serve as our guidepost in our work to create more inclusive medical curricula, address work force diversity, and to help guide the AAD in its mission to become a visionary leader in LGBTQ/SGM health in dermatology.

Pride 2020 is a somber reflection and a particularly remarkable and opportune time to consider the common thread shared by oppressed and marginalized people, including the tumultuous and often painful legacies of combating structural and institutional discrimination. In the last weeks, we have witnessed a crisis in our nation with the tragic and reprehensible murder of George Floyd, who unfortunately joins a list of others taken far too soon: Breonna Taylor, Ahmaud Arbery, Philando Castile, Sandra Bland, Alton Sterling, Eric Garner, Michael Brown, Tamir Rice, Trayvon Martin, and many others.

Discrimination of any form impacts the social mobility of marginalized people, the framework of which is captured in the idea of intersectionality, originally coined by Professor Kimberlé Crenshaw in 1989 when describing the unique experiences of Black women in the context of both racism and gender bias. It explains how combinations of factors across a variety of domains (e.g., race, ethnicity, gender identity, sexual orientation, education, socioeconomic status, etc.) are associated with unique forms of discrimination. As was so rightly enshrined in our collective consciousness by Dr. Martin Luther King Jr. in his Letter from a Birmingham Jail: “Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly.”

As physicians, it is necessary to address the profound role of implicit bias in shaping our history, acknowledging that in some instances that bias can in fact attempt to rewrite history and affect care going forward. Reflecting on the layers of discrimination that impact health outcomes and well-being, we are confronted with the stark reality in our nation that LGBTQ people of color are twice as likely to report discrimination because of their identity when applying for jobs and when interacting with police compared to Caucasian LGBTQ people. Black gay, bisexual, and queer (GBQ) men are more likely to be living with HIV in the United States compared to their White counterparts despite evidence that Black GBQ men have not been shown to have higher sexual behavioral risk and are actually more likely to report preventive behaviors.

Amplifying and contributing to these disparities, Black GBQ men have twice the odds of being unemployed, low income, and previously incarcerated compared to other GBQ men. According to a national survey, 38% of Black transgender people who interacted with police reported harassment and 14% reported physical assault from police. In another large survey, almost 40% of Black transgender individuals reported living in poverty compared to 24% of Black people in the general U.S. population. Black transgender people also reported living with HIV at rates more than 20 times that of the US population. 37% of Black transgender individuals reported being fired, denied a promotion, or not being hired for a job they applied for because of their transgender identity compared to 27% of all surveyed transgender respondents. Sadly, in the year 2019 alone, at least 26 transgender or gender non-conforming people were victims of fatal anti-transgender violence in the United States, 91% of them Black women and 81% under the age of 30.

As we commemorate another Pride Month, let us work toward that more perfect Union while working tirelessly to bend the arc of the moral universe ever closer to justice. Only by carrying the banner for all those whose lived experiences are different from our own and who are disenfranchised by a society that doesn’t always sufficiently meet their needs can we hope for equality and fairness. Unless we intentionally act to mitigate these disparities in all the ways that we can while echoing with resounding clarity that Black Lives Matter, we are complicit and unable to meaningfully contribute to the solution. As Marsha P. Johnson, an early LGBTQ rights activist and prominent figure in the now-infamous Stonewall uprising of 1969, once said, “History isn’t something you look back at and say it was inevitable, it happens because people make decisions that are sometimes very impulsive and of the moment, but those moments are cumulative realities.”

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