Editor's note: A reference to a flyer purportedly posted on a store's community posting board has been removed because that information could not be confirmed.

Transphobic flyers circulated in Des Moines last month, transgender Iowans and advocates said.

Flyers using offensive slurs were spotted on telephone poles on the east side, said Aidan Zingler of the Transgender Action Group for Iowa.

"I saw it on some of the telephone poles on the east side when I was out to run an errand," Zingler said. "It was really horrifying."

At the bottom of the flyers, the Stormer Book Club, an identified neo-Nazi group, encouraged residents to join the local chapter. The flyers depicted a little girl running away from a transgender woman in the women's bathroom, and urged taxpayers to tell representatives they are against "gay socialism." They also included a historically offensive slur against transgender people.

The Stormer Book Clubs are local white nationalist groups affiliated with the website the Daily Stormer. The Iowa Department of Human Rights, the Iowa Civil Rights Commission, both state agencies, and the independent advocacy group Iowa Citizens for Community Improvement said they were not sure about the extent of the groups' presence in Des Moines.

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The flyers prompted fear for some; others said they were not surprised.

"My first reaction wasn't shock at there being a neo-Nazi group's flyer in south Des Moines, it was at the antiquated level of content included within the image," said Alex Jimenez, an officer for the Transgender Alliance of Iowa and the advisory committee for the Queer Communities of Color Coalition at the state Office of Latino Affairs.

"I did not feel any more fear than I already do walking out the door everyday as a transgender person of color. I think I was surprised to learn many people in the transgender community did feel an increase in fear upon learning of the flyer."

A history of hate and violence

Nationwide, at least 19 transgender people have been killed so far in 2019, the Human Rights Campaign reported, and last year fatal anti-transgender violence was deemed a national epidemic by the campaign.

"Des Moines has not been as bad as other cities that I've lived in; I haven't gotten death threats in Des Moines like I did when I was living in Cedar Falls. But I have friends, especially trans people of color, who have received death threats here," Zingler said.

"The flyers are shattering the illusion that Des Moines was safe, to some degree."

Ysandril Morrigan, executive director of the Transgender Alliance of Iowa, expressed similar anxiety over the flyers.

"We are really concerned that the presence of the flyers are in close proximity to our community. It's just... harrowing," Morrigan said. "Because we are in the Midwest, we've been kind of sheltered. We emphasize and support the trans community from all over the country, but it's utterly horrifying that this blatant hatred is now creeping into our lives in the Midwest and becoming a reality here."

Tah'Di Fierro is a Mexican transgender woman who is a Des Moines native and a drag performer. She considers herself luckier than most, but feels more fearful today than when she began transitioning years ago.

"Honestly, Des Moines has never been safe. I started transitioning years ago to live my truth, and even then it wasn't safe. I've always been fearful," she said. "But now people are now thinking it's OK to show their hate and act on it."

"I've been in situations where I feel like if something goes wrong, this is it."

Fierro said she believes these acts such as posting the flyers are becoming the norm.

New law adds to feeling of hostility

Many transgender Iowans interviewed by the Register pointed to an ongoing battle over health care coverage for transgender Iowans as a contributor to their sense of alienation.

In April, the Iowa Legislature passed a law that denies public health insurance coverage for transgender Iowas seeking transition-related medical services by allowing government entities to opt out of using public insurance dollars, including Medicaid, for this type of care. The bill was signed into law by Gov. Kim Reynolds in May.

The American Civil Liberties Union of Iowa challenged the law, but the legal challenge was tossed out by a Polk County judge in July. An appeal is in progress. The bill was proposed in response to an earlier legal battle over transition-related care.

While some trans persons might not find surgery necessary, others do and consider surgery a vital aspect of their identity and survival.

Morrigan said she's one of the transgender Iowans on Medicaid affected by the law.

She was taking hormones for 16 months, which is around the suggested length of time before undergoing transitional surgery. But right as Morrigan planned to have her surgery in August, she was told by her medical provider they were no longer accepting patients or consults for surgery because they were afraid they would not get paid.

"This is something that is life-saving; it changes the way people view their own worth." Morrigan said. "For me, it's the last piece of my puzzle. It's not something that is elective or cosmetic, I've always known who I am and what I am."

Without Medicaid coverage, Morrigan can no longer afford the hefty bill her surgery would amount to.

Medicaid is provided to over 600,000 Iowans who meet the economic or disability requirements. Supporters of the bill have not provided an estimate on how much of a dent transition-related surgeries, which can range between $5,000 and $100,000, would cause in Medicaid funds.

"I think what is happening is there's a direct correlation with the way our state has handled our health care (and the violence transgender Iowans are experiencing); the state has been allowed to be discriminatory, and use language that is harmful to our community." Morrigan said.

Increased fear within the transgender community

While there have been recent reports of other white nationalists flyers in Des Moines and throughout the country, the ones found last month single out the transgender community.

"It feels like they were specifically targeting us to scare us," Zingler said. "It just feels like there's a group of people that don't want us to exist at all."

The flyers are not the only signs of hate transgender Iowans have received, Jimenez told the Register that recently a white power symbol, the "OK" sign, was used in front of him. He said this is a frequent occurrence in Des Moines.

Jimenez has seen an increase in people acting out their hatred towards the transgender community.

"People feel emboldened to act rather than just use words, and you're seeing it in public. They aren't shy," he said.

Transgender Iowans also fear that these flyers won't be the last, and attacks against LGBTQ and non-binary communities will continue to rise.

Daye Pope, organizing director of Trans United, believes in tackling white nationalism in order to fight transphobia.

"How racism and white supremacy intersects with transphobia is really at the forefront of our minds," Pope said. "White nationalist ideology is about cis white men in power, and that their power is not questioned. That power requires a gender binary to rely on."

Pope has also seen an increase of threats to the trans community through her work with community partners and transgender women of color leaders, citing the current political climate under President Donald Trump as a potential explanation.

Transgender people, Pope argues, pose a threat to white nationalism because their very existence goes against their beliefs, especially regarding gender.

"The fact that there are trans and non-binary people shows there are more ways to live, to be, to move through the world than these very narrow definitions of what a man is, what a woman is, and what constitutes masculinity and femininity," Pope said. "It doesn’t have to be this rigid hierarchy."

Pope also discussed how black and brown transgender women of color are too often the target of violence, because it is not just their gender that poses a threat to white nationalist ideology, but also their race.

Alexandra Gray, a performer and activist, said her experience as a black transgender woman in Des Moines has been drastically different than other transgender women of color she knows, who are often attacked for who they are.

"Here's the difference: trans women of color are generally the more vulnerable in the community, but in Des Moines we are such a small minority, it's actually more likely to be a white trans woman receiving attacks, but that’s only because we are a minority within the minority." Gray said. "I understand that not everybody who is a black, trans woman has this particular privilege."

Gray did not dispute, however, the attacks against transgender women of color in Des Moines specifically or increased fears. But she believes it is important to realize that while transgender women of color, especially transgender black women of color, are often the target of hate crimes, there are some like herself who do hold privilege.

The Des Moines flyers, while they were meant to ignite fear, instigated more conversations and positive actions from the transgender community and its allies, including gatherings for transgender and queer Iowans to support one another.

Jimenez said that if there is anything he wants people to know about the transgender community, it's that strength allows them to move forward.

And transgender women of color like Fierro and Gray continue to break down barriers for other transgender women, showing that they can be unashamed of who they are and stronger because of it.

"I refuse to let someone make me fearful to the point where I am unable to leave my house. If you went through hell and back from the beginning, it's like, well, I'm here and I'm still living," Fierro said.

"They push me down and I continue to stand up. I'm not giving in now."

Andrea Sahouri covers breaking news for the Des Moines Register. She can be contacted at asahouri@registermedia.com, 515-284-8247 or on Twitter at @andreamsahouri.

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