Y’all Means All: Past and Present LGBTQ+ Rights in the South

While major metropolitan areas, such as New York City, San Francisco, and Los Angeles, are commonly thought of as hubs for the LGBTQ+ community, queer individuals are everywhere. In fact, the South is home to the largest percentage of LGBTQ+ individuals living in the United States.^[1] Unfortunately, the South is also a common target for anti-LGBTQ+ discrimination. With the introduction of a record number of anti-LGBTQ+ bills over the past two years, the South is represented in a significant proportion of this legislation.^[2] Southern states such as Virginia, South Carolina, Tennessee, Mississippi, Georgia, and Florida are each facing over 10 anti-LGBTQ+ bills.^[3] However, this targeting of LGBTQ+ rights in the South is not new, and LGBTQ+ Southerners remain resilient.

Anti-LGBTQ+ policies, and the debates surrounding them, are harmful to LGBTQ+ health. A poll created by the Trevor Project revealed that this political climate is negatively impacting the mental health of LGBTQ+ youth, especially those who identify as trans or nonbinary.^[4] Additionally, many of these policies ban gender-affirming care, which directly affects LGBTQ+ health. These bans are not only unjust but unethical, putting trans and nonbinary individuals at risk for worsening mental health and even suicide.^[5] As these bills are enacted, LGBTQ+ Southerners are disproportionately impacted. But LGBTQ+ Southerners also know what it’s like to fight.

The fight for LGBTQ+ rights has a long, rich history in the Southern U.S. Although much of this history has been forgotten, historians are working to resurface it through efforts like the Invisible Histories Project.^[6] This history includes “the Stonewall of the South,” which formed the Georgia Gay Liberation Front in 1969, and the 50 years of famous Alabama drag queen Bronzie De’Marco.^[7] Another key piece of history is the nationally televised pieing of Florida’s Anita Bryant, whose “Save Our Children” anti-LGBTQ+ rhetoric can still be heard in modern “Don’t Say Gay” arguments.^[8]

Despite the current political climate against trans individuals in the South, trans people have exerted a profound influence on Southern history. Even gender-affirming care, which is so heavily debated today, has been provided for over 50 years.^[9] A notable Southern trans woman in history is Rhoda Winters from Roanoke, Virginia, who received gender-affirming hormone treatment in 1976 from a gender-affirming care clinic at the University of Virginia Medical Center.^[10] However, Rhoda was not alone in receiving this treatment, and many Southern trans individuals have received gender-affirming care since.

Rhoda and other trans people have been receiving hormone replacement therapy and other gender-affirming treatments for nearly 60 years. Therefore, politicians’ claims that gender-affirming care is new reveal a remarkable ignorance of the U.S.’s long history of transgender medicine. Moreover, healthcare providers required trans people of the 1960s and 70s to follow strict requirements to receive gender-affirming care (e.g., commitment to appear as their gender identity “full time,” emphasis on their gender dysphoria, and affirmation of a heterosexual and monogamous lifestyle).^[11] This medical gatekeeping continues today, with some clinicians closely following guidelines that recommend trans people have “well documented gender dysphoria” and mental and physical health concerns that are “well controlled” when pursuing medical transition.^[12] Undoubtedly, this gatekeeping is a form of discrimination within the healthcare system and is thereby unethical. However, medical gatekeeping is likely to worsen in Southern states where clinicians are beginning to face legal repercussions for providing gender-affirming care.^[13]

The anti-LGBTQ+ legislation of 2023 and 2024 is only the most recent discrimination affecting LGBTQ+ Southerners. The Movement Advancement Project mapped LGBTQ+ equality throughout the South and found that, even before this current wave of anti-LGBTQ+ bills, 93% of LGBTQ+ Southerners lived in states with negative or low equality rankings.^[14] This hostile political climate in the South is reflected by the absence of nondiscrimination laws protecting LGBTQ+ individuals, religious exemptions allowing healthcare providers to refuse service to LGBTQ+ people, and a lack of affirmation from any Southern state to cover gender-affirming care for trans Medicaid recipients. These policies, or lack thereof, result in significant health disparities among those at the intersection of Southern and LGBTQ+ identities.^[15] Moreover, decreased access to quality medical care exacerbates these disparities for BIPOC LGBTQ+ Southerners and those living in the rural South. Even the HIV epidemic, which is often thought of as history, has seen a shift in its epicenter from Los Angeles and New York City in the 1980s to the Southern U.S. today.^[16]

Despite this alarming data, progress is being made. However, it is important to understand the distinctive nature of Southern political successes from those of other parts of the country. While other states such as California, New Mexico, and Oregon have succeeded in enacting LGBTQ+-protective legislation, Southern activists must take a more defensive approach.^[17] More often than not, Southern advocates are fighting harmful legislation as opposed to championing progressive policy. These wins are still significant for advancing equality for LGBTQ+ Southerners by minimizing the potential for future harm. The state of Virginia is an incredible example of this success, and some activists even consider Virginia a “roadmap for the South” due to its progressive LGBTQ+ legislation and repeal of antiquated unconstitutional bans on same-sex partnerships in 2020. In this case, Virginia became the first Southern state to pass a law banning discrimination based on gender identity and sexual orientation.

There has long been a unified LGBTQ+ activism in the South. The current successes in LGBTQ+ rights are the result of LGBTQ+ Southerners of color who have organized and built coalitions for years.^[18] Despite an unwelcoming political climate and a dearth of LGBTQ+ protections, LGBTQ+ Southerners have persisted. In the 1970s, advocates began to form coalitions such as the Carolina Gay Association on the University of North Carolina at Chapel Hill campus. These coalitions not only created a safe space for queer students but also provided information on support during the AIDS epidemic despite the opposition’s efforts to defund the organization.^[19] In 1985, two years before New York City’s formation of the AIDS Coalition to Unleash Power (ACT UP), grassroots organizers mobilized across the state of Tennessee to serve LGBTQ+ people affected by AIDS.^[20] Many of these grassroots efforts became nonprofit organizations that continue to serve Tennessee today. In 1989, activists first protested anti-LGBTQ+ discrimination with Birmingham’s Gay Pride March, and the city now boasts an affirming space for gay youth developed by the Magic City Acceptance Center.^[21][ Across the region, activist organizations such as the Campaign for Southern Equality, Gender Benders, and Funders for LGBTQ Issues work to advocate for, support, and invest in the Southern LGBTQ+ community. Their efforts have only strengthened during the ongoing attacks on LGBTQ+ rights, leading to the creation of rapid response support for trans youth.^[22]

The fight for LGBTQ+ rights in the South including equitable health, is far from over. Healthcare providers occupy a critical position in this fight. They must align themselves with activist organizations and use their positions of power to advocate for LGBTQ+ health. Additionally, healthcare providers need to remember their duty to “do no harm,” which includes educating themselves on LGBTQ+ health issues and ensuring that their practice is a safe space for LGBTQ+ individuals. Although some states have proposed bills banning clinician involvement in gender-affirming care, healthcare providers can make a significant impact by vocally opposing such legislation. This is the ideal time for clinicians to make it clear that they value LGBTQ+ Southerners’ health.

Like over 3 million other queer people, I call the South home. North Carolina raised me, and the LGBTQ+ community there remains near and dear to my heart. For this reason, I will continue to advocate for my home and push for it to be a welcoming space for everyone. Thankfully, I’m not alone in this effort. Because of the people who continue to show up for the LGBTQ+ community in the South, I am certain that the community will prevail against anti-LGBTQ+ hate. After all, it has a strong foundation of years of fighting, and queer Southern resilience is only growing.

Featured image courtesy Sean Davis on Flickr.

Brittany Daniel

Brittany Daniel (she/her) is a Doctor of Nursing Practice student specializing in Psychiatric-Mental Health. Although she currently lives in New York City while attending Columbia University, her home is North Carolina and her passion lies in LGBTQ+ health, especially in the Southern United States. She credits her chosen family, Anna, Seth, Grayson, Amber, Hannah, and Chris, for sparking this passion and fueling her growth as a provider.

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