{"id":2064323,"date":"2025-07-30T05:00:00","date_gmt":"2025-07-30T09:00:00","guid":{"rendered":"https:\/\/kffhealthnews.org\/?post_type=article&#038;p=2064323"},"modified":"2025-07-30T10:17:31","modified_gmt":"2025-07-30T14:17:31","slug":"tribal-groups-gender-affirming-care-lgbtq-trump-cuts-policies-indian-health-sovereignty","status":"publish","type":"article","link":"https:\/\/kffhealthnews.org\/news\/article\/tribal-groups-gender-affirming-care-lgbtq-trump-cuts-policies-indian-health-sovereignty\/","title":{"rendered":"Tribal Groups Assert Sovereignty as Feds Crack Down on Gender-Affirming Care"},"content":{"rendered":"\n<p>ELKO, Nev. \u2014 At the Two Spirit Conference in northern Nevada in June, Native Americans gathered in support of the LGBTQ+ community amid federal and state rollbacks of transgender protections and gender-affirming health care.<\/p>\n\n\n\n<aside class=\"block--sidebar alignright \">\n\t\n\n<div class=\"wp-block-kaiser-health-news-partner block--partner\">\n\t\t\t\t\t\t<a class=\"partner__image--link\" href=\"https:\/\/19thnews.org\/2025\/07\/native-american-tribal-leaders-lgbtq-protections\/\">\n\t\t\t\t<img decoding=\"async\" class=\"partner__image\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2022\/11\/the-19th-logo.png?w=120\" alt=\"Partner logo\" \/>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t<p class=\"partner__content\">\n\t\tThis story also ran on <a href=\"https:\/\/19thnews.org\/2025\/07\/native-american-tribal-leaders-lgbtq-protections\/\">The 19th<\/a>. It can be <a href=\"https:\/\/kffhealthnews.org\/news\/article\/tribal-groups-gender-affirming-care-lgbtq-trump-cuts-policies-indian-health-sovereignty\/view\/republish\/\">republished for free<\/a>.\t<\/p>\n<\/div>\n\n<\/aside>\n\n\n\n<p>\u201cI want people to not kill themselves for who they are,\u201d said organizer Myk Mendez, a trans and two-spirit citizen of the Fort Hall Shoshone-Bannock Tribes in Idaho. \u201cI want people to love their lives and grow old to tell their stories.\u201d<\/p>\n\n\n\n<p>\u201cTwo-spirit\u201d is used by Native Americans to describe a distinct gender outside of male or female.<\/p>\n\n\n\n<p>The conference in Elko reflects how some tribal citizens are supporting their LGTBQ+ community members as President Donald Trump rolls back protections and policies. In March, the National Indian Health Board, which represents and advocates for federally recognized Native American and Alaska Native tribes, <a href=\"https:\/\/www.nihb.org\/wp-content\/uploads\/2025\/03\/25-03-NIHB-Resolution-Support-for-Two-Spirit-Relatives.pdf\">passed a resolution<\/a> declaring tribal sovereignty over issues affecting the Native American community\u2019s health, including access to gender-affirming care.<\/p>\n\n\n\n<figure class=\"wp-block-image alignwide size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"2272\" height=\"1515\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg\" alt=\"A photo of a man seated at a table during a conference. A two-spirit pride flag is draped over the table.\" class=\"wp-image-2064983\" srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg 2272w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=150,100 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=500,333 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=768,512 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=1270,847 1270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=1536,1024 1536w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=2048,1366 2048w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=770,513 770w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=840,560 840w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=720,480 720w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=570,380 570w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=370,247 370w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=270,180 270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=170,113 170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=100,67 100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=120,80 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=1170,780 1170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=300,200 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=200,134 200w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=315,210 315w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=630,420 630w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_05.jpg?resize=1200,800 1200w\" sizes=\"auto, (max-width: 2272px) 100vw, 2272px\" \/><figcaption class=\"wp-element-caption\">Myk Mendez, who organized the conference, says he did it because he wanted to give community members a chance to learn about the history of two-spirit people and to preserve their traditions.<span class=\"photo-credit\">(Jazmin Orozco Rodriguez\/KFF Health News)<\/span><\/figcaption><\/figure>\n\n\n\n<p>The resolution calls on the federal government to preserve and expand programs that support the health and well-being of two-spirit and LGBTQ+ Native Americans. Tribes and tribal organizations are navigating how to uphold their sovereignty without jeopardizing the relationships and resources that support their communities, said Jessica Leston, the owner of the Raven Collective, a Native public health consulting group, and a member of the Ketchikan Indian Community.<\/p>\n\n\n\n<p>In January, Trump signed an executive order recognizing <a href=\"https:\/\/www.whitehouse.gov\/presidential-actions\/2025\/01\/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government\/\">only two sexes<\/a> \u2014 male and female \u2014 and another to terminate <a href=\"https:\/\/www.whitehouse.gov\/presidential-actions\/2025\/01\/ending-radical-and-wasteful-government-dei-programs-and-preferencing\/\">diversity, equity, and inclusion<\/a> programs within the federal government.<a href=\"https:\/\/lgbtqbar.org\/programs\/trump-executive-order-tracker\/\"><\/a><\/p>\n\n\n<div\n\tclass=\"wp-block block--newsletter  \"\n\tdata-type=\"kaiser-health-news\/newsletter\"\n\tdata-align=\"center\"\n\tstyle=\"\"\n>\n\t<h4 class=\"newsletter__title\">\n\t\t<a href=\"\/email\/\">\n\t\t\tEmail Sign-Up\t\t<\/a>\n\t<\/h4>\n\t<p class=\"newsletter__description\">\n\t\tSubscribe to KFF Health News&#039; free Morning Briefing.\t<\/p>\n\t\n<form\n\taction=\"\/email-signup\/\"\n\tclass=\"kaiser-hubspot-mini-signup-form\"\n\tmethod=\"post\"\n>\n\t<input type=\"hidden\" id=\"kaiser_hubspot_nonce\" name=\"kaiser_hubspot_nonce\" value=\"00b79a3908\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/article\/2064323\" \/>\t\t\t\t<label\n\t\tclass=\"kaiser-hubspot-mini-signup-form__label--email\"\n\t\tfor=\"kaiser-hubspot-mini-signup-form-email\"\n\t>\n\t\t<span class=\"screen-reader-text\">\n\t\t\tYour Email Address\t\t<\/span>\n\t\t<input\n\t\t\tautocomplete=\"email\"\n\t\t\tclass=\"kaiser-hubspot-mini-signup-form__input--email\"\n\t\t\tid=\"kaiser-hubspot-mini-signup-form-email\"\n\t\t\tname=\"kaiser_hubspot_email\"\n\t\t\ttype=\"email\"\n\t\t\t\t\t\t\tplaceholder=\"Your email address\"\n\t\t\t\t\t\/>\n\t<\/label>\n\t<button class=\"kaiser-hubspot-mini-signup-form__submit\">\n\t\tSign Up\t<\/button>\n<\/form>\n<\/div>\n\n\n\n<p><a href=\"https:\/\/www.ihs.gov\/lgbt\/twospirit\/\">An Indian Health Service website<\/a> describing two-spirit people was removed this year but restored following a court order. The page now has a disclaimer at the top that declares any information on it \u201cpromoting gender ideology\u201d is \u201cdisconnected from the immutable biological reality that there are two sexes, male and female.&#8221;<\/p>\n\n\n\n<p>Two-spirit is not a sexual orientation but refers to people of a \u201cculturally and spiritually distinct gender exclusively recognized by Native American Nations,\u201d according to a definition created by two-spirit elders in 2021. According to two-spirit leaders, people who did not fit into the Western binary of male and female have lived in their communities since before colonization.<\/p>\n\n\n\n<div class=\"block--side-by-side-photo alignfull \">\n\t<div class=\"wp-block-columns side-by-side__columns\">\n\t\t<div class=\"wp-block-column side-by-side__column\" style=\"\">\n\t\t\t\t\t\t\t<figure class=\"wp-block-image side-by-side__block-image side-by-side__block-image--left\">\n\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg\" class=\"wp-image-2064985 size-full attachment-full\" alt=\"\" sizes=\"auto, (max-width: 781px) 100vw, 768px\" srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg 2328w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=150,100 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=500,333 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=768,512 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=1270,847 1270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=1536,1024 1536w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=2048,1365 2048w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=770,513 770w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=840,560 840w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=720,480 720w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=570,380 570w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=370,247 370w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=270,180 270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=170,113 170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=100,67 100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=120,80 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=1170,780 1170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=300,200 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=200,134 200w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=315,210 315w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=630,420 630w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_04.jpg?resize=1200,800 1200w\" \/><!-- image-left -->\n\t\t\t\t\t\t\t\t\t\t\t<figcaption>\n\t\t\t\t\t\t\tColleen Couchum, a member of the Te-Moak Tribe of Western Shoshone, created this skirt that was gifted to a speaker at the conference. The buffalo on the skirt represents Buffalo Barbie, a two-spirit member of the Navajo Nation.\t\t\t\t\t\t<span class=\"photo-credit\">(Jazmin Orozco Rodriguez\/KFF Health News)<\/span><\/figcaption>\n\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t<\/div>\n\t\t<div class=\"wp-block-column side-by-side__column\" style=\"\">\n\t\t\t\t\t\t\t<figure class=\"wp-block-image side-by-side__block-image side-by-side__block-image--right\">\n\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg\" class=\"wp-image-2064987 size-full attachment-full\" alt=\"\" sizes=\"auto, (max-width: 781px) 100vw, 768px\" srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg 2592w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=150,100 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=500,333 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=768,512 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=1270,847 1270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=1536,1024 1536w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=2048,1365 2048w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=770,513 770w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=840,560 840w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=720,480 720w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=570,380 570w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=370,247 370w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=270,180 270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=170,113 170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=100,67 100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=120,80 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=1170,780 1170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=300,200 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=200,134 200w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=315,210 315w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=630,420 630w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_03.jpg?resize=1200,800 1200w\" \/><!-- image-right -->\n\t\t\t\t\t\t\t\t\t\t\t<figcaption>\n\t\t\t\t\t\t\tThe conference included speakers who talked about the trauma that two-spirit individuals may endure and how to create healing as well as a fashion show that highlighted local Native American designers.\t\t\t\t\t\t<span class=\"photo-credit\">(Jazmin Orozco Rodriguez\/KFF Health News)<\/span><\/figcaption>\n\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n\n<p>Already, tribal citizens and leaders say some people have had trouble accessing gender-affirming care in recent months, with some community members being denied hormone treatments or having their medications delayed, even in places where gender-affirming care remains legal. Panic has spread, and tribal citizens have considered leaving the country.<\/p>\n\n\n\n<p>\u201cThere is a chilling effect,\u201d said Itai Jeffries, who is trans, nonbinary, and two-spirit, of the Occaneechi people from North Carolina, and a consultant for the Raven Collective.<\/p>\n\n\n\n<p>Mendez said he requested hormone treatment at his local Indian Health Service clinic at the end of June and was told by his provider that the facility has had trouble receiving the treatment for patients.<\/p>\n\n\n\n<p>Lenny Hayes, a two-spirit citizen of the Sisseton-Wahpeton Oyate in South Dakota, said the Indian Health Service clinic on the reservation also isn\u2019t dispensing hormone treatment, though it is legal for people 18 and older. Hayes is the owner and operator of Tate Topa Consulting and provides educational training on two-spirit and LGTBQ+ Native Americans and Alaska Natives.<\/p>\n\n\n\n<p>The National Congress of American Indians <a href=\"https:\/\/ncai.assetbank-server.com\/assetbank-ncai\/action\/viewAsset?id=888&amp;searchId=-1&amp;index=1&amp;total=3&amp;view=viewSearchItem\">passed a resolution in 2015<\/a> to encourage the creation of policies to protect two-spirit and LGBTQ+ communities. And the organization <a href=\"https:\/\/ncai.assetbank-server.com\/assetbank-ncai\/action\/viewAsset?id=210&amp;index=0&amp;total=3&amp;view=viewSearchItem\">adopted a resolution<\/a> in 2021 to support providing gender-affirming care in Indian Health Service, tribal, and urban facilities.<\/p>\n\n\n\n<figure class=\"wp-block-image alignwide size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"2592\" height=\"1728\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg\" alt=\"A photo of a man posing for a picture surrounded by ferns. He holds a Western Shoshone flag. The back of his shirt has a custom design of three horses.\" class=\"wp-image-2064988\" srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg 2592w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=150,100 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=500,333 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=768,512 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=1270,847 1270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=1536,1024 1536w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=2048,1365 2048w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=770,513 770w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=840,560 840w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=720,480 720w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=570,380 570w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=370,247 370w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=270,180 270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=170,113 170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=100,67 100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=120,80 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=1170,780 1170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=300,200 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=200,134 200w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=315,210 315w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=630,420 630w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/07\/IndigLGBTQ_06.jpg?resize=1200,800 1200w\" sizes=\"auto, (max-width: 2592px) 100vw, 2592px\" \/><figcaption class=\"wp-element-caption\">Justin Couchum, a member of the Te-Moak Tribe of Western Shoshone, wears a shirt he created for the Two Spirit Conference\u2019s fashion show.<span class=\"photo-credit\">(Jazmin Orozco Rodriguez\/KFF Health News)<\/span><\/figcaption><\/figure>\n\n\n\n<p>The National Indian Health Board\u2019s resolution cites homophobia and transphobia as contributing to higher rates of truancy, incarceration, self-harm, attempted suicide, and suicide among two-spirit young people. The board also lists health disparities among the broader Native LGBTQ+ population, including increased risks of anxiety, depression, and suicide.<\/p>\n\n\n\n<p>Two-spirit and LGBTQ+ Native American and Alaska Native young people are <a href=\"https:\/\/www.thetrevorproject.org\/research-briefs\/the-mental-health-and-well-being-of-indigenous-lgbtq-young-people\/\">particularly vulnerable to depression, suicidality<\/a>, and sexual exploitation. In Minnesota, <a href=\"https:\/\/www.cnay.org\/wp-content\/uploads\/2020\/01\/trading_sex_and_sexual_exploitation_among_high_school_students.pdf\">a 2019 state survey<\/a> found that two-spirit and LGBTQ+ Native American and Alaska Native students had the highest rates of those ages 15-19 who responded \u201cyes\u201d to having traded sex or sexual activity for money, food, drugs, alcohol, or shelter.<\/p>\n\n\n\n<p>Tribal leaders are also concerned that Medicaid cuts recently approved in Trump\u2019s budget law will undercut efforts to expand testing and treatment for HIV infection in Native American communities.<\/p>\n\n\n\n<p>The rates of HIV diagnosis among Native American and Alaska Native gay and bisexual men <a href=\"https:\/\/www.cdc.gov\/hiv\/data-research\/facts-stats\/gay-bisexual-men.html\">increased 11%<\/a> from 2018 to 2022, according to the Centers for Disease Control and Prevention.<\/p>\n\n\n\n<p>Despite this increase, Native American and Alaska Native gay and bisexual men are among the groups with the least access to HIV tests outside of health care settings, such as community-based organizations, mobile testing units, and shelters.<\/p>\n\n\n\n<p>As tribes respond to state and federal regulations of two-spirit and LGBTQ+ people, organizations and communities are focused on providing information and resources to protect those in Indian Country, even from the president.<\/p>\n\n\n\n<p>\u201cHe will never, ever wipe out our identity, no matter what he does,\u201d Hayes said.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Native American groups declare that tribal sovereignty trumps state and federal efforts to restrict or ban gender-affirming care for two-spirit and LGBTQ+ tribal citizens. Tribes are analyzing the risk of opposing Trump\u2019s policies, advocates say.<\/p>\n","protected":false},"featured_media":2064978,"template":"","meta":{"_cr_original_post":"","_cr_replace_post_id":"","_cr_replacing_post_id":"","jetpack_post_was_ever_published":false,"kff_featured_video":0,"kff_show_featured_video":false,"kff_show_mute_audio_button":false,"custom_shortlink":"\/MjA2NDMyMw","kaiser_health_news_byline_override":"","kaiser_health_news_can_republish":true,"kaiser_health_news_featured_image_caption":"","kaiser_health_news_header_overlay_color":"","kaiser_health_news_header_theme_slug":"","kaiser_health_news_hero_image":0,"kaiser_health_news_backdrop_padding":115,"kaiser_health_news_hide_partner":false,"kaiser_health_news_kicker":"","kaiser_health_news_kicker_background_color":"","kaiser_health_news_kicker_text_color":"","kaiser_health_news_kicker_url":"","kaiser_health_news_nav_theme_slug":"compact","kaiser_health_news_nav_transparency":false,"kaiser_health_news_sharing_title":"","kaiser_health_news_show_featured_image":true,"kaiser_health_news_subheadline":"","kaiser_health_news_suppress_kicker":false,"kaiser_health_news_suppress_subheadline":false,"kaiser_health_news_update_time":"","kaiser_health_news_vertical_image":0,"kaiser_health_news_title_align_left":false,"kaiser_health_news_custom_header_image":0,"photo_byline":[],"story_update":"","update_position":"bottom","kaiser_syndication_sites":[],"apple_news_api_created_at":"2025-07-30T09:04:45Z","apple_news_api_id":"be8e4d44-d15e-4c3f-bf98-0f2ec8557a13","apple_news_api_modified_at":"2025-07-30T14:17:35Z","apple_news_api_revision":"AAAAAAAAAAAAAAAAAAAAAg==","apple_news_api_share_url":"https:\/\/apple.news\/Avo5NRNFeTD-_mA8uyFV6Ew","apple_news_cover_media_provider":"image","apple_news_coverimage":0,"apple_news_coverimage_caption":"","apple_news_cover_video_id":0,"apple_news_cover_video_url":"","apple_news_cover_embedwebvideo_url":"","apple_news_is_hidden":"","apple_news_is_paid":"","apple_news_is_preview":"","apple_news_is_sponsored":"","apple_news_maturity_rating":"","apple_news_metadata":"\"\"","apple_news_pullquote":"","apple_news_pullquote_position":"","apple_news_slug":"","apple_news_sections":["https:\/\/news-api.apple.com\/sections\/20265c01-23d7-4d15-96e0-0691b89c3772"],"apple_news_suppress_video_url":false,"apple_news_use_image_component":false,"footnotes":""},"categories":[5004,439525647,439525648,10314551,439528530,31304,36835],"tags":[303230885,59347,439529140,439529141,59354,20037,439529137,303298089,439530184,80822,439524171],"primary-topic":[],"partners":[439529178],"funder":[439528999,439525512,439528750],"coauthors":[439529013],"class_list":["post-2064323","article","type-article","status-publish","has-post-thumbnail","hentry","category-mental-health","category-midwest-bureau","category-mountain-states-bureau","category-rural-health","category-southern-bureau","category-states","category-syndicate","tag-hivaids","tag-idaho","tag-indigenous-health","tag-lgbtq-health","tag-nevada","tag-north-carolina","tag-sexual-health","tag-south-dakota","tag-state-watch","tag-transgender","tag-trump-administration","partners-the-19th","funder-helmsley-charitable-trust","funder-missouri-foundation-for-health","funder-robert-wood-johnson-foundation"],"apple_news_notices":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Tribal Groups Assert Sovereignty as Feds Crack Down on Gender-Affirming Care - KFF Health News<\/title>\n<meta name=\"description\" content=\"Native American groups declare that tribal sovereignty trumps state and federal efforts to restrict or ban gender-affirming care for two-spirit and LGBTQ+ tribal citizens. 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