Fauci and the Failing of Trans Healthcare: The Legacy of HIV/AIDS and COVID-19 in the Trans Community

Dr. Anthony Fauci’s inattention to the needs of trans individuals in the HIV/AIDS epidemic was detrimental to the LGBTQ+ community. Photo by NIAID.

This is not Dr. Anthony Fauci’s first time in the national spotlight. In 1981, as HIV/AIDS started to run its disastrous course, Fauci and his team began researching a cure. In an attempt to understand the virus and develop a vaccine, Fauci examined patients at the NIH Clinical Center in Bethesda, Maryland. Sadly, despite observation and attempted care, many of these patients died very early on due to the severity of their illness. 

Cementing his presence as a prevalent public health figure, Fauci secured the position of Director of the National Institute of Allergy and Infectious Diseases (NIAID) in 1984, a position he has held ever since. 

Fauci’s rise began with a public health emergency of devastating consequences for queer communities, and, today, we are observing a similar reality. Amid the COVID-19 pandemic, LGBTQ+ households and communities have faced disproportionately high rates of financial insecurities, problems with access to education and internet, and employment disruption. But perhaps the most troubling indication of inequity is the fact that, for queer households, rates of inaccessibility to proper medical services are approximately double that of Non-LGBTQ+ households. These disparities have led to a heightened vulnerability of LGBTQ+ communities to COVID-19—much like HIV/AIDS. For these same communities, COVID-19 bears a tragic hint of familiarity. 

While the HIV/AIDS epidemic was particularly harmful to the LGBTQ+ community at large, one of the groups most affected was the transgender community. 

This vulnerability of the trans community is consistent across many societal contexts. And, for HIV/AIDs in particular, many of these marginalizations exacerbated not only each other, but the transmission of HIV/AIDs as well. As outlined in a 2014 National Center for Biotechnology Information article, conditions such as homelessness, economic hardship, and lack of access to education and healthcare collectively contributed to an increase in transmission of HIV/AIDs among trans women. 

Despite this adverse impact, many of the socioeconomic disparities responsible were not initially addressed or researched in the appropriate public health settings. Some of this failure can be attributed to Fauci. According to the NIAID website, Fauci’s responsibilities as Director of the NIAID include providing guidance in developing health policy and coordinating the overall public health response(s) of the federal government. Although Fauci’s work was integral to the development of treatments and therapies for HIV/AIDS, his oversights triggered severe repercussions for the trans community and other particularly marginalized groups. 

One of the major shortcomings in the public health response to HIV/AIDS was the fact that trans people were not given necessary inclusion in proper medical and public health research. As outlined in Understanding the HIV/AIDS Epidemic in the United States, a 2016 book on the crisis, the trans community was not included in early studies and reports of HIV/AIDS and its transmission. Despite the fact that trans individuals were experiencing some of the most severe impacts of HIV/AIDS, they were explicitly omitted from study by public health experts.  

Although decades have passed since the height of HIV/AIDS in the US, this same oversight continues. According to an article from the National Institute of Health (NIH), of which the NIAID is a branch, COVID-19 data collection has failed to consider gender identity. Even though there is a history of severe health vulnerabilities among the trans community—especially during public health emergencies—the required data collection is still not occurring.  

Fauci and the NIAID must implement radical change in approaching COVID-19. The current reality is unacceptable. 

An obvious solution would be to further incorporate the trans community into public health research. According to the aforementioned NIH article, gender identity data collection in COVID-19 data is vital to inform an appropriate public health response.  

However, we need to do more than the bare minimum. Not only must the trans community be granted inclusion in formulating the necessary public health responses to COVID-19, but the lived experiences and hardships of trans individuals must be given particular focus. It is not enough for COVID-19 data collection to involve gender identity data. Research initiatives that are specifically targeted to issues of trans public health in the context of COVID-19 ought to be prioritized and expanded.

The road to achieving equity for the trans community is clear. America currently finds itself situated in a social context that is uniquely promising for necessary change. The convergence of post-COVID-19 reconstruction with the inauguration of Joe Biden and Kamala Harris is a crucial factor in achieving justice for marginalized groups. 

One of the Biden-Harris campaign’s LGBTQ+ policy initiatives is to address gaps in data collection and research with respect to LGBTQ+ health. The campaign cited a 2011 report in its discussion of this policy priority, but it neglects to mention the magnified severity that COVID-19 brings to this issue. Given that these inequities are especially relevant in the context of COVID-19, the necessary approach must be undertaken as quickly as possible. While this named initiative is a promising signal to the future of trans equality in the United States, it must be one of the administration’s highest priorities. 

Despite apparent room for improvement, a further indication of promise presented itself in then President-elect Biden’s victory speech. After being declared the winner of the 2020 Presidential Election, Biden specifically thanked the trans community. This historic recognition of the trans community in a presidential acceptance speech reflects the potential held by our current juncture.

Another sign of the Biden-Harris administration’s dedication to equity came just a day before the inauguration ceremony. On January 19th, then President-elect Biden announced that he would be nominating Dr. Rachel Levine, an openly transgender public health offical, as assistant secretary of health. Dr. Levine’s confirmation proves to be extremely momentous. She would be the highest-ranking transgender U.S. government official and first trans person to be confirmed by the Senate. 

Dr. Rachel Levine at a March 2020 press briefing. Photo by Governor Tom Wolf.

This course of action taken by the Biden-Harris administration is certainly reflective of a social and political climate that can facilitate the necessary change, but only if it persists. Dr. Levine must be allowed to operate in her position and promote greater equity for marginalized communities without obstruction. 

On February 25th, during the first of her confirmation hearings, Dr. Levine faced harmful lines of questioning from GOP Senator Rand Paul. As Democratic Senator and Chairwoman of the Senate Health Committee, Patty Murray, later communicated, the questions contained “harmful misrepresentations” of transgender medicine as a field. Senator Paul’s questioning is a clear example of the obstructive behavior that Dr. Levine should not be subject to. But the reality that precludes these perverse occurrences can only come to fruition when government officials, no matter their party or affiliation, are fully held responsible for their words and actions. 

Similarly, in order to capitalize on this moment for the trans community, ensuring proper accountability is required. President Biden recently asked Dr. Fauci to continue serving as Director of the NIAID, and, while many Americans are confident in Fauci, we cannot allow for complacency to hinder vital change. If we are to achieve a more equitable future, Fauci must be held to a higher standard.

Holding Fauci responsible necessitates putting pressure on the Biden-Harris administration—especially in its early, formative days. But the necessary pledge for greater accountability extends beyond our government officials. Building a more egalitarian future necessitates the general public making a more tangible commitment to equality. To truly improve trans healthcare, we must also engage with and garner support from everyday Americans. Contrary to conventional wisdom, the status quo of pre-pandemic life is not something to strive for.  

As particuarly evidenced by the trans community, significant marginalization and discrimination plagued the most vulnerable populations far before the pandemic. We cannot let our failures to address systemic disparities hinder a more equitable future. 

Colby Malcolm is a Staff Writer for CPR and a first-year student in Columbia College. Outside of CPR, you can find him consuming copious amounts of caffeine, scrolling endlessly through TikTok, or curating another playlist on Spotify.