Adrian Shanker, who advises Biden administration officials on a broad range of issues pertaining to LGBTQ+ health, has ensuring access to competent medical care for all LGBTQ Americans as a key part of his job description.
Shanker has been senior advisor on LGBTQI+ health equity in the Office of the Assistant Secretary for Health (OASH) at U.S. Department of Health and Human Services (HHS) since 2022. He works under Assistant Secretary for Health ADM Rachel Levine and advises both her and other OASH staff on health policy.
"When we're talking about LGBTQI+ health equity, we're talking about access to affirming quality healthcare throughout our lives," Shanker told Windy City Times during a visit to Chicago.
He noted that, while HIV/AIDS and other STI prevention and care are an important part of his office's mission, his office has a variety of goals.
"It includes a lot of other components in our lives," he said. "It includes the experience of when we go to the doctor. Do the forms that we fill out let us reflect who we are? We're working on data equity, for example, to ensure that federal forms and surveys are inclusive of LGBTQI+ people. We are [also] working on issues to safeguard youth from the harms of conversion therapy and to ensure ensure suicide-prevention resources for LGBTQI+ youth are provided in culturally-affirming and -accurate methods."
Shanker, a New York native, was raised by lesbian mothers, and, as such, was cognizant of societal inequities from an early age.
"Even as a kid, I saw differences in how people were treated in society," he recalled. "My dad was able to get remarried when my parents got divorced. My mom couldn't."
When he realized that he was gay in high school, he noticed that the sexual education at his high school was inadequate for people like himself. Shanker said, "I had a supportive family and was able to get resources from an LGBTQ youth center in that community, but many people did not have access to that basic level of literacy that we all deserve."
He eventually led LGBTQ+ community centers in both Pennsylvania and California. Among his accomplishments are a book he edited detailing the LGBTQ+ community's response to the COVID-19 pandemic.
Shanker called his appointment in the administration "the honor of a lifetime, because this is an administration that really prioritizes equity from the start." He emphasized that HHS deploys its policies and programs "to make sure that everything that we do is about the attainment of the highest quality of health for all people, which is our definition of health equity."
The Biden administration aims to end new HIV/AIDS transmissions in the U.S. by the year 2030; funding for treatment and prevention of HIV/AIDS stayed relatively the same from last year's to this year's budgets.
While Washington has worked toward improving access to PrEP (pre-exposure prophylaxis) as one goal, Shanker described most HHS priorities as "granular" and "programmatic"—pinpointing areas nationwide where disparities in PrEP and Treatment as Prevention (a regimen that reducing the viral load of a person living with HIV, making transmitting HIV virtually impossible) access exist. Those disparities can occur anywhere from underserved urban neighborhoods to rural communities lacking HIV/AIDS service providers
"The health disparities are both an opportunity and a challenge," Shanker said. "The disparities are an opportunity to work to achieve health equity, but are a challenge because disparately-impacted communities are…without resources and sometimes are harder to reach with certain types of program and services."
To respond to these complexities, the Centers for Disease Control & Prevention last year sent out a million at-home HIV tests.
"That's a really big deal," Shanker explained. "…Some populations can't easily access providers because of geographic barriers to care. Some people have medical mistrust because of negative experiences with care. Some people feel significant HIV stigma, shame and judgment that prevents them from openly speaking to a provider. … It has some limitations because you're not sitting there with a provider, but it hopefully reduces some of the gaps in testing."
He further emphasized that HHS officials are committed to gender-affirming care as a standard.
Shanker said gender-affirming care is "based on decades of study. It's evidence-based and it is the best-practice medicine for transgender youth when it is recommended by a provider."
He praised Levine, a transgender woman who is a pediatrician specializing in adolescent medicine, for bringing "her lived experience as a trans woman to work every day. That's part of who she is. We have visible leadership throughout the administration."
Shanker said that all Americans "deserve to attain the highest qualities of our health. LGBTQI+ people deserve that, and yet it's an unmet dream. On our lived experience we have not yet achieved health equity. We have work to do, so on the policy side of HHS we're working to bring us closer to achieving [that]."
