A 30-second ad for former President Donald Trump features footage of Vice President Kamala Harris saying she supports taxpayer-paid gender transition surgery for inmates. A narrator intones that Harris is "for they/them. President Trump is for you."

Shown alongside Harris is an image of former Pennsylvania Physician General and Secretary of Health Rachel Levine, the first openly transgender person confirmed by the Senate to a federal position. Levine is currently assistant U.S. secretary of health.

By juxtaposing images of Harris and Levine, who is not identified in the spot, the ad makers appear to be implying that Levine is an imprisoned criminal.

"One of the biggest challenges of online misinformation like this is recontextualized media," said Matthew Stamm, director of the Multimedia Information and Security Lab at Drexel University's College of Engineering. "You take real images but present them in a different context to make it seem like Secretary Levine is a prisoner when she's not.

"It's very easy to do. You don't need technical skills."

Here is a look inside the Trump ad and its implications.

What's the ad based on?

During the presidential debate on Sept. 10, Trump criticized Harris on her support for taxpayer-funded medical care for transgender individuals, including what's known as gender-affirming surgery.

"Now she wants to do transgender operations on illegal aliens that are in prison," Trump said. "This is a radical left liberal that would do this."

His statement was based on Harris' response to a 2019 American Civil Liberties Union questionnaire, in which Harris endorsed policies ensuring that incarcerated transgender individuals have access to medically necessary treatments, including gender-affirming surgeries.

The questionnaire asked: "As President, will you use your executive authority to ensure that transgender and nonbinary people who rely on the state for medical care — including those in prison and immigration detention — will have access to comprehensive treatment associated with gender transition, including all necessary surgical care?"

She responded yes, adding, "it is important that transgender individuals who rely on the state for care receive the treatment they need, which includes access to treatment associated with gender transition."

Harris is seen in the ad giving similar answers in an interview in 2019 with Mara Keisling, founding executive director of the National Center for Transgender Equality.

The Harris campaign said last month that the 2019 questionnaire is not what the vice president is proposing in this election and that it's not part of her platform. Campaign officials didn't say where Harris currently stands on the issue.

What else does the ad show?

Besides the picture of Levine, the Trump ad includes an image of Harris near a photo of a man in lipstick and a dress, who has been identified as former Department of Energy official Sam Brinton. Self-identifying as "openly gender fluid," Brinton will receive mental health treatment to avoid jail time on charges of stealing a woman's luggage in 2018.

There's another photo in the ad that appears to show Harris standing near drag performer Pattie Gonia.

The ad also includes an image, purportedly depicting inmates, that is actually a publicity still hawking the TV show Orange is the New Black.

"I'm not sure many would recognize Levine in the ad," said Temple University political science professor Michael Hagen, an expert on campaigns and elections. "She's the least provocative of the images of the people in it."

The spot is "complicated — not just a culture-war ad about associating Democrats with transgender surgery. It also talks about taxpayer funding of the surgery, illegal immigration, crime, the prison population," Hagen said.

Hagen concluded that the ad isn't meant simply for Trump's base, but also for uncommitted voters "who might be revolted by the images."

Do most Americans really worry about transgender people?

Joey Teitlebaum, senior vice president for research at Washington-based Global Strategy Group, which does public opinion research and strategy for Democratic campaigns, said the ad angered her.

"Disparaging an upstanding public servant like Rachel Levine takes the Trump campaign to an all-time low," she said. "Levine as a felon? Garbage is a good word for this."

Teitlebaum said she believes the spot is irrelevant because most people don't spend much time thinking about transgender individuals, who are a fractional part of the population. The number of Americans over age 13 who identify as transgender is around 1.6 million, or 0.47% of the population, according to the UCLA School of Law.

When Americans do consider transgender people, 83% say they should have the same rights as all others, according to the University of Minnesota. That flies in the face of commentators such as conservative Tucker Carlson, who called transgender people "the natural enemies of Christianity."

Overall, the ad "reeks of desperation and campaign malpractice," said Sarah Kate Ellis, president and CEO of GLAAD (formerly the Gay and Lesbian Alliance Against Defamation) in a statement to the Advocate, an influential LGBTQ publication.

Neither Levine nor spokespeople for the Trump campaign responded to requests for comment. The Harris campaign declined to comment.

In the end, it may turn out that "the ad is defamatory toward Levine by association," said Matt Jordan, a misinformation expert at Pennsylvania State University. "It comes right out of the extreme-right playbook: Blow up a microscopic thing into a huge culture war."

©2024 The Philadelphia Inquirer, LLC. Visit at inquirer.com. Distributed by Tribune Content Agency, LLC.