Dr. Rachel Levine, Pennsylvania’s Physician General, is breaking down barriers and focusing attention on HIV treatment and prevention
by Chip Alfred
Photographed Exclusively for A&U by Freedom G Photography
[dropcap]T[/dropcap]he commonwealth of Pennsylvania is steeped in American history and tradition. In Philadelphia, known as the birthplace of our nation, the Declaration of Independence was signed. Our country’s most iconic symbol of freedom, the Liberty Bell, first rang. And a woman named Betsy Ross sewed the first American Flag. In 2015, nearly two and a half centuries later, another woman made history in the Keystone State. Dr. Rachel Levine was sworn in as Pennsylvania’s fourth physician general. At that moment, she became the highest-ranking openly transgender person in state government history, joining a very small group of out transgender government officials across the country.
Although she is extremely grateful for her appointment and its significance for the LGBT community, Dr. Levine wants to point out one important caveat. “Governor Wolf did not nominate me to this position because I am an openly transgender woman; he nominated me for my professional qualifications. To his credit, he didn’t shy away from nominating me because I am an openly transgender woman.” In the Patriot News, Equality PA Executive Director Ted Martin commented about the appointment of his organization’s former board member. “She is an excellent physician. This is a highly qualified and smart person. That has to be said first and foremost. We can’t miss the fact that it’s incredibly historic…and a remarkable step forward.”
Pennsylvania’s new top doc describes the series of events that led to her appointment as “quite a whirlwind.” The former Vice-Chair for Clinical Affairs for the Department of Pediatrics at Penn State Milton S. Hershey Medical Center was introduced to state government when she was asked to co-chair Governor Wolf’s transition team for health. After spending most of her career in academic medicine, the Harvard alumnus and graduate of the Tulane University School of Medicine quickly became intrigued by the opportunity to impact public health on a statewide level. On Friday, January 16, 2015, she received a call from the governor about the Physician General position. On Saturday, her nomination was announced. On Tuesday she was sworn in, and the next day she started her new job.
In June, Dr. Levine, fifty-eight, will serve as Honorary Chair for the 22nd annual AIDS Education Month (AEM), a series of events throughout Philadelphia to increase HIV/AIDS awareness and to bring people together to find strategies to combat the virus. She describes the project, which is facilitated by Philadelphia FIGHT, as “a very important initiative that highlights and elevates the state’s conversation about all aspects of HIV disease. I am thrilled and honored to be the Honorary Chair for AEM in 2016.” As a resident at New York’s Mt. Sinai Hospital in the 1980s, the young physician had a connection to the HIV/AIDS crisis from the early days of the epidemic. “In the beginning there was a very limited understanding of the disease and there was a lot of stigma.” Encouraged by the progress made since then in treatment, prevention, and in handling the social implications of the disease, she notes that “HIV and AIDS continue to be a serious public health problem in Pennsylvania and in this country.” Referencing the recent CDC study which forecasts one in two black gay men will be diagnosed with HIV during their lifetime, she says, “This is absolutely startling, and it demonstrates what needs to be done.”
In Pennsylvania, with an estimated 1,000 new HIV diagnoses per year, Dr. Levine tells A&U there needs to be a focus on decreasing the risk factors for specific populations, including young people, African-American MSM, IV drug users, and transgender women of color. The state’s objective is to “make Pennsylvania a better place in this regard where new infections for HIV are very rare, and where patients with HIV have access to appropriate medication and healthcare.” Supporting these efforts are the expansion of Medicaid, which makes coverage more accessible for Pennsylvanians living with HIV who do not have an AIDS diagnosis, and additional funding for the Special Pharmaceutical Benefits Program (SPBP). Bolstered by resources from a federal drug assistance program, SPBP is able to offer free hepatitis C medications to qualified individuals with a dual diagnosis of HIV and hepatitis C. Dr. Levine and the Wolf administration are also strong proponents of expanded access to PrEP. “We need to educate patients; we need to educate providers about PrEP,” she declares. “We need to prevent this infection.”
On a broader scale, Dr. Levine is a staunch advocate for taking a holistic approach to healthcare in Pennsylvania. “My whole career has been focused on the intersection between medical issues and mental and behavioral issues. That has always been my passion.” As it relates to HIV/AIDS, she explains that there are medical issues which are often compounded by substance abuse, depression, anxiety, and other coexisting conditions. “We have to work toward comprehensive care. That’s why we have organizations like Philadelphia FIGHT and other Ryan White health centers, and comprehensive service organizations where patients can receive medication for HIV, primary care and also mental health care and counseling. That type of integration is critical.”
For individuals in the transgender community, she asserts, the integration of medical and behavorial health care is even more critical—especially for trans women of color. According to HealthyPeople2020, transgender people have a high prevalence of HIV/STDs, victimization, mental health issues, and suicide. Dr. Levine adds, “Transgender individuals are less likely to have health insurance and they face significant barriers as far as access and in terms of reporting discrimination, reporting harassment.” And in some states including North Carolina, the fight for transgender equality is heating up. In March, the state passed a sweeping anti-LGBT protection measure which restricts trans people’s access to use the bathrooms that correspond with their gender identity.
“What is happening in North Carolina and in other states is extremely troubling and should serve as a rallying call for Pennsylvania to pass non-discrimination legislation,” she states. “In Pennsylvania LGBT individuals can still be fired or denied housing for who they are or who they love.” She maintains that the next step in Pennsylvania and nationwide should be pushing through legislation that ensures full equality for all LGBT citizens. She is pleased that Governor Tom Wolf recently signed two executive orders that expand protections from discrimination based on sexual orientation, gender expression or identity for state employees and, for the first time, employees of contractors doing business with the commonwealth. Dr. Levine realizes she was fortunate that her own transition (while employed at Penn State) went so smoothly. “They didn’t fire me and they didn’t marginalize me. I was not just accepted, but welcomed and celebrated from a diversity point of view, and promoted to Vice-Chair after my transition.” Her family, which includes her two adult children and her ninety-one-year-old mother, has also been very supportive.
For now, Rachel Levine looks forward to her next three years in office, rolling up her sleeves, and building coalitions to improve the overall health and wellness of all Pennsylvanians. “Anybody who knows me knows I don’t lack for enthusiasm or hard work. I’m ready for the challenge.”
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Chip Alfred, A&U’s Editor at Large, is the Director of Development & Communications at Philadelphia FIGHT.