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2014 Resolution: Attaining Equality for LGBT People Left Behind

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In place of the usual resolutions -- like losing weight and paying down debt -- I'd like to suggest something else altogether for readers to focus on over the next year: Resolve to work for LGBT equality.

LGBT people are at a cultural nexus between great advances and real equality. This past year brought a string of improbable victories on the marriage equality front. It started in January with President Obama's call in his inaugural address for the right to marry for same-sex couples in every state in the country: "Our journey is not complete until our gay brothers and sisters are treated like anyone else under the law -- for if we are truly created equal, then surely the love we commit to one another must be equal as well."

And in this context, the President called for a state of equality that would extend to all regardless of sexual orientation, gender identity -- or the desire to marry.

In June, the U.S. Supreme Court struck down the section three of the Defense of Marriage Act. Through a string of electoral, judicial and legislative victories, same-sex couples can legally wed in nine additional states: California, Hawaii, Illinois, New Jersey, Delaware, Rhode Island, Minnesota, New Mexico and Utah, bringing the number of marriage equality states to 18, along with the District of Columbia. Additionally, Ohio now recognizes the marriages of same-sex couples performed out of state, even though such couples cannot legally wed there. Today, nearly 40 percent of the U.S. population lives in a marriage equality state, or one that recognizes the out-of-state marriages of same-sex couples.

Marriage equality raises the specter of true equality, and it may be tempting to feel, as Andrew Sullivan did in his memorable 2004 essay for The New Republic, that we are experiencing the "end of gay culture."

As he wrote, "You see it beyond the poignant transformation of P-town: on the streets of the big cities, on university campuses, in the suburbs where gay couples have settled, an in the entrails of the Internet. In fact, it is beginning to dawn on many that the very concept of gay culture may one day disappear altogether." At the same time, he allowed that "gay culture in its old form may have its most fertile ground in those states where homosexuality is still unmentionable and where openly gay men and women are more beleaguered: the red states."

But it is important that we recall another memorable essay, written seven years after Sullivan's, that illuminates the limits of making grand post-gay announcements, and comports with my experience as a physician and teacher. Shortly after being named Salon.com's news editor, Steve Kornacki (who has since moved on to MSNBC), wrote a deeply personal piece about his struggle to come out.

"You may be wondering why I was so afraid. It's 2011, after all, and I live in Manhattan, surrounded in social and professional settings by gay people," wrote Konacki, who attended Boston University during the run-up to Massachusetts' judicial and legislative victories on marriage equality. "It's not like I come from a morally judgmental family; I never feared my parents or other relatives turning their backs on me. But 17 years of fear and hang-ups can be hard for a person to shake."

Kornacki's experience is not unusual -- or uncommon. A colleague I have worked with just told me of his struggles coming out at the age of 35. I work with students who regularly talk about how often they feel stigmatized by negative comments about LGBT people made by faculty and staff in hospitals. And based on what I regularly see in my work at The National LGBT Health Education Center, where I travel the country -- red and blue states alike -- providing trainings to health care providers about how to make their LGBT patients feel truly welcome (and thus provide them with better care), I can assure you that we are nowhere near living in a post-gay world.

Coming out and developing a positive LGBT identity is still an enormous and defining struggle for many. LGBT people still experience horrific health care disparities. As the U.S. Centers for Disease Control (CDC) noted, "Social inequality is often associated with poorer health status, and sexual orientation has been associated with multiple health threats."

Approximately 40 percent of homeless youth are LGBT, nearly 70 percent of whom report that they became homeless after their family rejected them for being queer.

Others struggle to get an education and a job, and we must remember that many LGBT people work in places that are not covered by non-discrimination policies. And 30 years into the AIDS epidemic, gay and bisexual men and transgender women -- particularly those of color -- remain disproportionately vulnerable to HIV infection. The incidence of HIV remains stubbornly unchanged despite great advances in prevention in recent years. Twenty percent of those infected are unaware of their status, but the promise of the CDC's 2006 policy to implement universal screening for HIV has yet to become reality.

For many LGBT people, Sullivan's bold 2004 pronouncement was true then, and remains true today. They feel equal. But for so many millions of others, it is simply not the case. These are the LGBT people who have not been able to catch up. Or they have been left behind. For them, real equality is a challenge. It is a huge challenge.

In December, President Obama delivered one of the best speeches of his tenure. While it focused on the problems of economic inequality, his points hold true for LGBT equality.

"Now, the premise that we're all created equal is the opening line in the American story. And while we don't promise equal outcomes, we have strived to deliver equal opportunity -- the idea that success doesn't depend on being born into wealth or privilege, it depends on effort and merit," Obama said.

There is no way to live with dignity -- and all that comes with it as an LGBT person -- without equal opportunity.

In the year ahead, I propose that we really think about the people who have been left behind in our otherwise astonishing ascent thus far -- homeless youth, transgender men and women, closeted men and women in their 50s, 60s and 70s, and LGBT people of color, who bear the additional burden of racism -- and think of more innovative ways to provide equal opportunities.

It's what I plan to do, and I hope to share my thoughts with you in this space over the next 12 months. Please let me know what you think in the comments below.