The fight for LGBT rights doesn’t end with the legalization of same-sex marriage.

by Daniela Sirtori-Cortina

The words “suicide note” stand out against the soft-pink background of Leelah Alcorn’s Tumblr page. The 17-year-old girl took her own life on December 28, 2014, and she’d set the note to post automatically after she died.  

“The life I would’ve lived isn’t worth living in … because I was transgender,” the post read. Her parents never understood that she felt like a girl trapped in a boy’s body. They shunned her and forced her to attend “conversion therapy,” hoping she’d get out of the “phase” she was going through. They even pulled her out of public school and isolated her from her friends.

Leelah soon had enough. She took her life by walking out in front of oncoming traffic on Interstate 71 in southwest Ohio. In a Facebook post, Leelah’s mother, Carla Wood Alcorn, said her daughter’s death had been an accident and continued to refer to her daughter with male pronouns. Carla’s reaction sparked fierce backlash from allies and compelled President Obama to call for an end to conversion therapy for transgender people.

It’s been more than six months since Leelah’s death. Her face no longer dominates the airwaves, and her note isn’t the current subject of discussion on Internet forums. Instead, many people interested in LGBT rights have had their eyes set on today’s Supreme Court decision about whether states can ban same-sex marriage.

Before today, thirteen states had laws that prohibited marriage between two people of the same sex.  And some states, such as Missouri, had constitutions that define marriage as only between a man and a woman. Today, the Supreme Court declared such laws unconstitutional, so now states have to perform and recognize same sex marriages — an enormous win for the LGBT community.

But while two happy partners say their vows in New York, a transgender person in Wyoming could be experiencing harassment. As newlyweds celebrate their unions, a young lesbian girl who was kicked out of her home could be looking for a place to sleep. And as a groom kisses his new husband, he could be wondering if he’s going to be fired because of his sexual orientation.

The ruling in favor of same-sex marriage don’t solve the wide array of issues the LGBT community faces. As we celebrate the court’s decision, let’s remember some of the difficulties lesbian, gay and transgender people still have to overcome.

1. LGBT people’s status as a target for hate crimes.

More than 50 percent of people who identify as lesbian, gay, bisexual or transgender are concerned about becoming victims of a hate crime, according to a report by the Human Rights Campaign, a prominent LGBT organization. The same report shows that, by contrast, more than 50 percent of Americans who don’t identify as LGBT never worry about being on the receiving end of bias-based violence.

Fort its report, the Human Rights Campaign compiled FBI reports hate-crime reports. The organization found that in the United States, sexual orientation ranks third as a justification for bias-motivated attacks, only surpassed by violence motivated by someone’s race or religion. Sexual orientation was cited as the trigger for five of the nine hate-crime murders in 2007.

The FBI doesn’t track crimes related to gender identity. To fill the gap, the National Coalition of Anti-Violence Programs — an organization that tracks and fights discrimination against LGBT and HIV-affected people — gathered its own data. The numbers are astonishing: In 2014, at least 11 transgender women were murdered.  That year, a total of 20 LGBT-identified people were killed — an 11 percent increase from 2013. No fewer than 16 of the victims were people of color.

Daily harassment and discrimination lead many LGBT people to contemplate or attempt to take their own lives. Youth who identify as lesbian, gay or bisexual are four times more likely to attempt suicide as their straight peers. If, like Leelah, LGBT youth face rejection from their families, they’re roughly eight times more likely to try to take their own lives as peers who reported no or low levels of rejection.

It’s even worse for transgender youth. Nearly half of young trans people have seriously contemplated suicide. And at least 25 percent have attempted taking their own lives.

LGBT-identified people often face physical attacks, sexual and psychological abuse, harassment and other forms of violence. There numerous studies and fact sheets showing the frequency and severity of crimes against people who identify as something other than heterosexual and/or cisgender.

Yet, many members of the LGBT community don’t trust police to protect them. For decades, law enforcement personnel have participated in the victimization of people who identify as LGBT.

Roughly 21 percent of LGBT adults who’ve had encounters with police said officers were hostile, and 14 percent said law enforcement personnel were verbally abusive. Other LGBT adults cited being sexually and physically abused by police.

Without police protection, LGBT people might turn to self-defense. But that might earn them some trouble. CeCe McDonald, a transgender woman, was charged with intentional manslaughter for stabbing a person, out of self defense, who verbally and physically assaulted her. McDonald was sentenced to 41 months and sent to a men’s prison. She was kept in solitary confinement for four months, supposedly for her own protection.

“Well, where were y’all… some years ago when this happened if y’all want to worry about my protection?” McDonald told The Huffington Post after she was released, following months of petitions from friends and concerned activists.

2. It can be extremely difficult for LGBT people to find jobs, houses or visit public places.

Here’s a phrase that’s become popular among LGBT-rights activists: “Married on Sunday. Fired on Monday.”

Yes, 37 states currently allow same-sex marriages. But only 20 states have legal protections against discrimination in employment for people who identify as something other than heterosexual and/or cisgender.

In short, you can marry your same-sex partners in states like Virginia, Florida and Wyoming. But beware of posting wedding pictures: if one of your employers finds out and doesn’t like it, you or your partner could be legally fired for being gay.

Discrimination doesn’t end with failing to hire qualified LGBT employees, or with harassing workers because of their identity. In 30 states, it is legal to refuse housing to LGBT people. Even if you have the means to pay the rent, a landlord can dismiss your application because of your real — or “apparent” — gender identity and sexual orientation.

What’s more, some states allow businesses to deny service to people because of their sexual orientation or gender identity on  “religious freedom” grounds — cue a law passed by the Indiana legislature earlier this year that could have allowed businesses to discriminate against LGBT people. After public outcry over the legislation, lawmakers “clarified” that it couldn’t be used to single out people for their sexual orientation or gender identity.

Some cities in states that don’t offer legal protections for LGBT people have taken on the challenge and passed their own ordinances. By a Williams Institute count, 18 localities in Missouri — a state whose only protection for LGBT people is against hate crimes — have their own laws banning discrimination against lesbian, gay, bisexual and transgender people.

Still, this patchwork of protections means LGBT people and families have limited employment options if they want to be protected from bias.

“These discriminatory practices have real effects on real people, and they go far beyond bakeries refusing to provide wedding cakes for weddings of gay people, based on their ‘religious’ beliefs,” Gene Robinson, a retired Episcopalian bishop, wrote in an article for The Daily Beast. He’s the first openly gay priest to be named bishop of a major Christian denomination.

One of the real life effects of the lack of legal protections for LGBT people is the prevalence of higher poverty rates among that group in comparison with cisgender and/or heterosexual adults.

There’s a “myth of affluence,” created by the media and corporate interests,” surrounding the LGBT community. As the term suggests, it is pure fiction.

Of the 9 million LGBT people in the United States, about half are lesbian and bisexual women. These women not only face sexual orientation discrimination but also bias based on their sex and/or gender. Roughly 24 percent of lesbians and bisexual women are poor, compared to 19 percent of heterosexual women, according to a report by the Williams Institute, a nonpartisan think tank based in the UCLA School of Law that researches LGBT issues.

The statistics are even more staggering for transgender people, who are “four times as likely to have a household income under $10,000 and twice as likely to be unemployed as the typical person in the U.S.,” according to the Williams Institute report. A person with earnings of $11,770 a year is considered to be poor by the federal government.

Roughly 90 percent of trans people reported being harassed, mistreated or discriminated on the job. And at least 20 percent have been homeless at some point in their lives.

Discrimination affects LGBT people in all age groups. Of the 1.6 million youth in the U.S. who experience homelessness each year, between 20 and 40 percent identify as LGBT. And children of same-sex couples have twice the poverty rates of children in heterosexual married couples.

LGBT people are also disproportionately food insecure. In the last year, 29 percent of LGBT adults — or 2.4 million people — experienced a time when they didn’t have enough money to feed themselves of their family. The risk of being insecure prevailed among different genders, age groups, racial and ethnic groups, and levels of education.

Race, religion, ability, and other personal identities also influence the likelihood of an LGBT person to be discriminated. That means a one-size-fits-all solution will do little for LGBT people.

“Understanding the diversity within the LGBT community is both the key to breaking down the myth of affluence and beginning to understand where and how to combat LGBT poverty,” according to a William Institute Report.

3. “Hi, I am a lesbian,” and other things LGBT people might be afraid to tell their doctors.

Until 1973, homosexuality — a term that has fallen into disfavor among many LGBT people, who now prefer terms such as gay or lesbian — was considered a disorder in the Diagnostic and Statistical Manual of Mental Disorders, a book published by the American Psychiatric Association. Transgender identity still is.

Being lesbian, gay, bisexual or transgender was considered to be a medical condition.

“Treatment” methods included electroshock therapy and castration.

Times have fortunately changed. Still, long-standing biases against LGBT individuals continue to influence their likelihood to seek medical help. Anti-LGBT attitudes are still shaping the quality of help available to people outside of the cisgender and/or heterosexual binary.

Some biases have been eradicated, but some remain. As recently as 2002, six percent of doctors still said they were uncomfortable treating LGBT patients. And one in five transgender people have been declined care by a provider.

It perhaps comes as no surprise that many LGBT people are hesitant to tell their doctors about their sexual orientation or gender identity. Many might have already experienced discrimination or are expecting poor treatment — not a far-fetched thought, given than most medical students only get five hours of training about LGBT issues in all their years in medical school.

When you mix bias, ignorance and a history of mistreatment, you get a hostile and LGBT-repellent health system. Nearly 29 percent of LGBT adults delay or don’t seek medical care. And 22 percent of people who don’t identify as cisgender and/or heterosexual put off or don’t get needed prescription medication.

The rates for postponed medical care and medication for heterosexual adults are 17 and 13 percent, respectively.

There are no gay, lesbian or trans specific diseases. But some conditions, such as HIV, affect the LGBT community at higher rates. And, again, these rates manifest differently for each subgroup. Because of limited access to therapy in non-white communities, black and white non- Hispanic men who have sex with men experience higher rates of HIV infection than white men who have sex with men.

It’s not just STIs that disproportionately affect LGBT people. Women who identify as lesbians are more likely to be overweight or obese in comparison with their heterosexual counterparts. According to the same report, it’s likely that eating disorders and body image issues are more prevalent among gay and bisexual men than among heterosexual men.

In addition, LGBT-identified people are twice as likely to smoke as the rest of Americans. There’s also evidence that LGBT people have higher rates of depression and anxiety. These mental health concerns were once seen as inherent to LGBT people, but now they’re attributed to stress stemming from real or expected discrimination.

And let’s not forget that most sex education in the United States isn’t only inadequate, but also heteronormative, or geared to cisgender women who have sex with cisgender men, and vice versa. Needless to say, information about sex between a person with a penis and person with a vagina isn’t all that useful to some LGBT people.

To top things off, LGBT people are among the groups with the lowest insurance rates. Getting care, even with insurance, can be tricky. A transgender woman, for example, can’t be covered for cervical cancer screenings if her insurance card doesn’t say she’s a “female.”

Roughly 90 percent of LGBT adults in the U.S. say society has become more accepting of them in the past decade. But there’s plenty of room for change in a country where 45 percent of people still believe that “engaging in homosexual behavior is a sin.”  So, now that the Supreme Court ruled in favor of same-sex marriage, let’s wave our rainbow flags, make our toasts and rejoice over the pictures of happy couples. But let’s then get back to work.