Gay Marriage Kansas Licenses

In this photo provided by Liz Dickinson, Kelli, left, and Angela pose for a picture after their wedding ceremony at the Johnson County Court House in Olathe, Kan., Friday, Oct. 10, 2014. The Johnson County newlyweds asked to be identified only by their first names to help protect their privacy, but did agree to allow a photograph of them after the ceremony to be used. In a statement released through the gay-rights group Equality Kansas, they said they wanted to celebrate privately.

(AP Photo/piperlucyphotography.org, Liz Dickinson)

NEW YORK -- Even as they celebrate epic victories in the push for marriage equality, gay-rights activists acknowledge that other difficult issues remain on their agenda. There's the persistent high rate of HIV infections, the struggles to expand transgender rights, and the striking fact that even in some states allowing same-sex marriage, people can lose their job for being gay.

For many activists, the top priority after marriage is federal legislation that would outlaw a broad range of discrimination against lesbians, gays, bisexuals and transgender people. There's no such federal law now, and more than half the states do not ban discrimination by employers or public accommodations based on sexual orientation.

"There's absolutely no good reason -- if you can get married -- why you should be denied a hotel room or a job," said Fred Sainz, a vice president of the Human Rights Campaign. "There will be a fair number of states where you can get married and be fired the same day for having gotten married."

Anti-LGBT discrimination is among several issues likely to gain more attention following the Supreme Court's Oct. 6 decision to turn away appeals by five states seeking to preserve their bans on same-sex marriage. The number of gay-marriage states -- previously 19 -- is expected to nearly double soon, and continue growing toward what many Americans now assume is inevitable expansion to all 50 states.

As a whole, the LGBT population is elated by the expansion of gay marriage. Yet according to a 2013 Pew Research Center survey, about 40 percent of LGBT adults aren't interested in getting married, compared to 24 percent of the general public. And nearly 40 percent of the LGBT respondents said the marriage issue had drawn too much attention away from other concerns.

A look at some of the challenges that remain:

HIV/AIDS

While marriage developments have kindled joy in the gay community, news regarding HIV and AIDS is sobering.

According to the latest data from the Centers for Disease Control and Prevention, gay and bisexual men, who represent about 2 percent of the U.S. population, accounted for 62 percent of new HIV infections. Each year, about 50,000 new infections are tallied.

A CDC report last month said only about half of gay and bisexual men diagnosed with HIV, the virus that causes AIDS, received continuing treatment for the virus.

Many AIDS activists and health professionals hope the infection rate can be slashed through wider use of Truvada, a drug that has proven effective in protecting uninfected men who engage in gay sex. The CDC has endorsed the preventive use of Truvada; so have many big-city health departments.

Progress has been slow, says Scott Schoettes, HIV Project director for the LGBT-rights group Lambda Legal. He said some health-care providers refuse to prescribe Truvada even when a patient requests it.

"It's a misplaced perception that anyone who wants it must be promiscuous and taking risks that they shouldn't be taking," Schoettes said.

New York City's health department is working to overcome such attitudes by sending staff into clinics and doctors' offices to promote the preventive option among providers who up until now have been uninterested.

Another problem is lack of awareness. A recent survey by the Kaiser Family Foundation found that only about one-fourth of gay men knew of Truvada's preventive potential.

New York's health department is trying to combat that with an outreach program using social media, including gay dating apps. "That's where the risk is happening," said Dr. Demetre Daskalakis, the department's assistant commissioner for HIV/AIDS control and prevention.

A few vocal critics -- notably the Los Angeles-based AIDS Healthcare Foundation -- argue that preventive use of Truvada is misguided. In an ad campaign launched in August, the foundation says many gay men fail to adhere to Truvada's once-a-day regimen and described government promotion of the drug as "a public health disaster in the making."

NON-DISCRIMINATION

For all their advances, activists remain deeply frustrated by the lack of federal legislation barring discrimination based on sexual orientation or gender identity.

A long-sought bill called the Employment Non-Discrimination Act finally passed the Senate last November, with 10 Republicans joining majority Democrats in a 64-32 vote. But GOP leaders in the House have not taken up the measure.

Rep. Jared Polis, D-Colo., has been trying to orchestrate a "discharge petition" that would force the bill to the floor for a vote. It would need nearly 20 GOP votes as well as solid Democratic backing.

"We should have a federal statute," said Polis, who is gay. "You shouldn't be able to be fired based on who you love."

Gay-rights groups are looking ahead to the next session of Congress. Sainz of the Human Rights Campaign said there will be an aggressive push for a comprehensive LGBT civil rights bill that would seek anti-bias protections even beyond the workplace -- in realms such as housing and access to credit.

In past years, broad GOP support for such a bill would have seemed impossible, but Sainz foresees a new era.

"The constant expansion of the marriage map changes the reality for Republicans," he said. "With every passing day, those who oppose LGBT equality increasingly look like dinosaurs."

Outside of Congress, activists will keep pressing for state and local anti-bias laws. Only 21 states have employment non-discrimination laws that cover sexual orientation; 18 also cover gender identity.

TRANSGENDER RIGHTS

Transgender-rights activists view their own array of causes in a good-news, bad-news context.

There's relief over some recent legal victories for people who lost jobs because they were transgender. And there's encouragement over the positive portrayals of transgender characters on TV shows such as "Orange is the New Black" and "Transparent."

"There's definitely more visibility than ever, and that's wonderful," said Masen Davis, executive director of the California-based Transgender Law Center. "But a minority of Americans know a transgender person, and that makes us somewhat vulnerable."

Davis said negative stereotypes are still widespread, and violence persists -- notably attacks on black and Hispanic transgender women. Another problem, he said, is that many transgender people have difficulty getting needed health care.

Among the groups expanding work on transgender issues is the National Center for Lesbian Rights. It has represented many transgender students who felt their rights were infringed at school, and is promoting transgender-inclusive policies for student athletes.

Shannon Minter, the center's legal director, said the "breathtaking progress" on marriage equality shouldn't weaken the broader drive for LGBT rights.

"Every day, LGBT people are fired from their jobs, kicked out of families, and stigmatized in their communities," Minter said. "Our future work must assure that every LGBT person, no matter who they are or where they live, enjoys equality, dignity, and justice."