This week, the Senate made history by passing the Employment Non-Discrimination Act (ENDA), which would prevent employers from discriminating based on sexual orientation or gender identity. While the vast majority of Americans assume that federal employment protections for LGBT individuals already exist, the reality is that in many states, LGBT workers can be fired simply because of who they are or whom they love. Congress must remedy this immediately, both as a matter of fairness and equality and as a crucial tool in combating HIV.
While the link between income and HIV vulnerability is less pronounced among gay and bisexual men, a strong link remains between an individual's employment status and his or her risk of acquiring the disease or encountering difficulty managing it. Evidence clearly demonstrates a negative relationship between unemployment and treatment adherence, resulting in poorer health outcomes for unemployed LGBT individuals living with HIV, while also increasing their chances of transmitting the virus to their partners.
Much of this can be attributed to the traditional model of employer-based health insurance coverage utilized in the United States. LGBT individuals who lack gainful employment or lose their jobs are also more likely to lack access to affordable health insurance, which is critical for both preventing and treating HIV. But this relationship is also attributable to the mental health implications of employment insecurity.
The stress of losing one's job, or even the fear of losing it, can have a significant impact on an individual's mental health, especially for minority and LGBT communities, who already face higher rates of depression and mental illness, often related (not surprisingly) to discrimination. This impact is especially severe for transgender individuals, who face particularly high rates of unemployment and workplace discrimination based on their gender identity. As a result, many are forced into transactional sex or sex work, further increasing their vulnerability to HIV infection.
Failure to protect LGBT employees can also compound other social inequities and health disparities. For LGBT individuals of color, employers who may have been predisposed to discriminate based on race are prevented from doing so by federal law. But should that employer find out the the individual is gay, that employer can legally use this as a proxy for their discrimination. At the same time, LGBT people of color in the U.S. are by and far the most vulnerable to HIV infection and poor HIV-related health outcomes.
HIV is much more than a public health crisis. It is, at its core, a matter of social justice. Poverty, racism and homophobia all contribute to the epidemic's continued and disproportionate toll on minority and marginalized communities, including LGBT individuals, especially those of color. Employment is about much more than a paycheck or an avenue for insurance coverage. A job provides individuals with a sense of dignity and purpose. LGBT Americans work and serve in all sectors of our economy, and they deserve fair and equal treatment. As such, the members of the House of Representatives should follow the lead of their Senate colleagues by immediately passing ENDA, both because it is the right thing to do and because it is a critical component of our work to end the domestic HIV epidemic.