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Christy Smith faces Trump super fan in May 12 special election

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The contrast couldn’t be more stark. Assemblymember Christy Smith is bright, effusive and clearly enjoys engaging with her community in campaign ads shot before the stay at home order. Mike Garcia loves fighter jets and his family. Voters with mail-in ballots must decide by May 12 which candidate will better represent the 25th congressional district in filling out former Rep. Katie Hill’s term.

The Los Angeles Times April 17 endorsement is straightforward.

“There’s no question which candidate is better prepared to step into the debate and help shape smart policy. That’s state Assemblywoman Christy Smith, a quietly accomplished and centrist Democrat whose background includes stints as a U.S. Department of Education policy analyst and as a longtime member of the Newhall School District board. Her experience guiding a school district through the last economic downturn and now the state through its pandemic response makes her uniquely qualified for precisely this job at precisely this moment,” said The Times.

“Smith’s opponent, by comparison, is simply not a good fit for Congress at any moment,” with the editorial noting that Republican Mike Garcia‘s “nice backstory…doesn’t translate into legislative competence.”

Perhaps unsurprisingly, after several Garcia supporters chimed in on Twitter about proving the LA Times wrong, on April 20, President Trump pecked out two tweets endorsing Garcia, the second of which hyped the Second Amendment: “[Garcia] is Strong on Crime, the Border, and the Second Amendment. Mike has my Complete and Total Endorsement!”

“Thank you @realDonaldTrump for your support. I am running to keep this nation safe, lower taxes, grow jobs and to ensure we protect the Constitution through all times!” Garcia tweeted. He later added: “It is crucial to know the difference between the candidates, especially during times of crisis. I’m a former fighter pilot who believes CA taxes are out of control.”

“Like most voters in our community, I trust and prefer the endorsement of our doctors, nurses and firefighters,” Smith said in response. “Donald Trump is failing to provide testing to millions of Californians and encouraging citizens to go against the advice of public health professionals, putting their lives at risk, and delaying the re-opening of our economy.”

She, meanwhile, is completely focused” on getting “protective equipment to medical personnel, financial assistance for workers who have lost their jobs, and funding our health care system to lower costs.”

Smith’s campaign posted an online video with Trump on the coronavirus side by side with Garcia. “I think Trump is a good President,” says Garcia. “No, I don’t take responsibility at all,” says Trump. “Everyone should have to figure out how to fend for themselves,” says Garcia.

Smith criticized Trump for encouraging supporters to protest, to “LIBERATE” three states. “While millions of Californians are staying home to protect their families, emergency responders & frontline workers, @realDonaldTrump‘s remarks spurred reckless protests that could jeopardize public health for all,” she tweeted. “I saw this firsthand in Sacramento today.”

Smith was at the Capitol for the Legislative Budget SubCommittee Hearing on COVID-19.  As the daughter of a nurse, she applauded the nurse “patriots” who tried to block the unmasked, ungloved protesters.

That day, April 20, Los Angeles County reported preliminary results from a new scientific study suggesting that coronavirus infections “are far more widespread – and the fatality rate much lower – in L.A. County than previously thought,” according to a county press release. “The research team estimates that approximately 4.1% of the county’s adult population has antibody to the virus,” says the release, “which translates to approximately 221,000 to 442,000 adults in the county who have had the infection.”

On April 21, Yahoo News reported that the protests were organized around the country by Trump Republican groups, including a longtime political advisor to the wealthy family of Secretary of Education Betsy DeVos, the leader of an organization called Minnesota Gun Rights, and InfoWars screamer Alex Jones.

But April 20 was important to Smith for another reason: it was the 21st anniversary of the Columbine school shooting, “which took the lives of 13 innocent souls and injured 24 others, we remember and honor the fallen by renewing our resolve to end senseless gun violence. #NotOneMore.”

Garcia offered no similar sympathy post.

In an April 22 phone interview, the Los Angeles Blade asked Smith if she was concerned that Trump’s promotion of the Second Amendment might be dangerous. She noted that her 25th CD has “a decidedly strong common-sense advocacy around gun control” with local high schools creating chapters of the March For Our Lives movement, as well as a strong and sizable Moms Demand Action group.

“While a number of us respect responsible gun owners’ rights, there is also a much, much greater proportion of the community who believes the time is now to take greater action, especially because one of the most recent school shootings that occurred prior to the COVID crisis and more people staying at home was at Saugus High School,” in Santa Clarita.

So, says Smith, Garcia’s “not going to get a lot of traction fighting about that issue in this district.” Additionally, “Donald Trump lost this district in 2016 by six points, and he was rebuked here again in 2018 when Democrats won this congressional seat. So, there is no love lost here for the president and his positions on a number of issues.”

In fact, says Smith, “the bulk of his platform is that he is a Trump loyalist. He’s not really putting forward any policy solutions on anything related to housing, or health care, environmental concerns, LGBTQ rights, women’s equity rights. So, I think for lack of an ability to formulate what it is he believes in and what he’s going to be fighting for, he just says he’ll stand with the president. In particularly in this moment, that’s not enough.”

Photo of Christy Smith by gay political activist Michael Colorge (via Facebook)

Meanwhile, work continues in the State Legislature, including work-arounds the unintended consequences of AB5 that was supposed to help gig workers, freelancers and independent contractors but has instead hurt by disallowing access to unemployment and other safety net funding.

“So, the good news on AB5 is a couple of things. At this time where a lot of those businesses, restaurants, performing arts spaces are closed anyway as a function of the Cares Act, independent contractors, 1099 employees are afforded through something called the PUA (Pandemic Unemployment Assistance),inability to qualify for unemployment insurance. That includes in California, the $600 a week add on. It was also part of the Cares Act,” says Smith.

“On April 28, that link will be available to people across California to go on to EDD and apply for that financial support now, regardless of their current employment status, if at any point recently they have been an independent contractor or 1099 employee, they’ll be able to qualify. We’re being told that those qualifications, once everyone has their data in the system, will be given within 24 to 48 hours. So, help is on the way there.”

Smith says “progress has been made on negotiating on changes to AB5, particularly with freelance and for people in the different areas of the entertainment industry. Those fixes, according to the bill’s author, Lorena Gonzalez, will be added to a bill with urgency for when the legislature returns on May 4th, and so those will be added and moved on pretty quickly. We will continue to monitor that.”

Gov. Gavin Newsom must make the decision about whether to suspend or set AB5 aside during the crisis. “But I think there’s never been a more critical moment and more critical time that proves that — regardless of what happens with that bill going forward — we know that workers need these job protections. Because in crisis moments like this, people need to be able to access unemployment benefits, they need to have healthcare protections, they need to have return to work rights.”

“When workers are misclassified or they are out of the employment systems because employers aren’t adhering to those regulations, a lot of people end up getting hurt,” says Smith. “I heard somebody brilliantly say it a few weeks ago that crises like this, a pandemic fractures society along known fault lines. We definitely now know that one of those big fault lines in our employment system was those with rights and benefits and those without. Both sets of workers working equally hard, but some left out of the greater benefit of having some of those protections. So, I think it’s a conversation that will continue, but I am excited that we’ve made some progress, especially on the industries that are most impacted in Southern California, and we will continue to work on that.”

Smith says that she “completely agrees” and is “very, very happy” about the letter sent by California LGBT Legislative Caucus leaders Sen. Scott Wiener, and Assemblymember Todd Gloria asking Newsom to start LGBT healthcare data collection during the novel coronavirus crisis and will ask to have her name added to the roster. “That was one that didn’t end up in front of me, but I was glad that it happened,” she says.

Smith is also concerned about how the COVID-19 crisis is impacting non-profits.

“The work for the nonprofit community is important for two vital reasons, one of which is that they are a significant part of our social safety net in everything from provision of healthcare services to food support and housing support services. These are essential aspects of support in the time of crisis that are really urgently need it,” says Smith.

“But secondarily, they are one of California’s, in particular, largest employers,” she says. “About 15% of California is employed in the nonprofit sector. So, to not support nonprofits in this moment would be shortsighted from the perspective, not only losing the services, but also losing the really important employment that comes along with it.”

Smith “completely supports” Rep. Adam Schiff’s effort to get large non-profits such as the Los Angeles LGBT Center included in the Federal Reserve loan program.

“I completely support that. Large nonprofits and small. The LGBTQ Center, in particular, you know the number of folks that that helps day in, day out — to lose those vital and critical services would be a huge loss. To lose those 800 employees and the economic benefit that comes from that would be a huge loss,” Smith says.

“But here in the 25th CD, we have a cancer support organization and it does just enough every year to support those people on the healthcare margins. They are almost entirely out of money, yet they’re helping patients who now find themselves jobless and without their healthcare coverage,” she says. “Just last week they sent down almost the rest of their remaining funds paying for a year’s worth of chemotherapy treatment to a patient who had just become unemployed, but couldn’t get that treatment from the hospital unless she paid up front. So, there are very real life impacts that are happening from our nonprofits struggling right now.”

Smith, who has a strong background in education, is also concerned about how to help marginalized students in minority neighborhoods during coronavirus pandemic.

“I’ve been part of conversations with legislative colleagues around how we continue to make sure that families in need — and that children in need, in particular — still have avenues to check in with the caring adults in their lives who usually are there through that physical school setting, but that they’re still having that opportunity. It’s been a very high priority for our state’s teachers to check with their kids, even the ones that don’t have that wifi connectivity or the technology. There are teachers all over the state making calls to homes to check in with kids, but in particular, with respect to those kids who struggle because they do find that homebase at school, I’d say it’s incumbent on all of us who care to continue to push out that resource publicly in places where we can so that they know where those support centers are. They know those phone numbers they can call just to check in with someone if they are struggling.”

Not just students, but teachers, too, need help.

“We recognize the significance of our schools as part of that vital social safety network. Kids on the margins are checking in with adults. They’re being seen by people who will know something is a little bit off and can help direct that child to get the help and support that they need. Having that opportunity be lost in this moment is really hard. I know I’ve talked to a number of teachers and it’s incredibly hard on our teachers right now,” she says. “They are really feeling it in profound ways; they’re struggling with it because they do the job because they care. It’s been hard.”

Smith says the legislature is moving in the direction of supporting more tele-health services – something Smith has incorporated in her own congressional campaigning.

“This is just a part of our team ethos now that we’re campaigning in an environment where we are calling people who have been at home and suffering through the challenges of this unusual isolation,” Smith says. “I’ve equipped anybody who’s volunteer phone banking for me with resource hotlines and information. We start every call to voters with, ‘Hi! First of all, we want to know how you’re doing.’ If the conversation moves in a direction where that person needs additional help, needs those resources, we point them in that direction. I am grateful that I have such an amazing and wonderful field team — there have been a couple of these calls now where we needed to call someone back a little bit later and say, ‘Just checking in on you. Wanted to make sure everything’s moving along okay.’ So, we take that role very, very seriously.

“This is about more than winning an election. This is about a very unique opportunity for us to be there as a support for our community,” Smith says. “But having grown up in a family where there was both mental health issues and domestic violence, it is an issue that is very near and dear to my heart and ever front of mind for me and something I’m going to continue to look at from both the policy perspective and then the work and advocacy that I do directly in the community.”

Despite her clear connection to the community, Smith says the race is still close because Democrats traditionally skip voting in special elections. She wants to reverse that trend.

“I just appreciate people to stay tuned to this May 12 election,” she says. “Please engage, if you can. If you have friends, family members who live in the district, urge them to vote because the thing that will make the difference in this election is if our voters get those ballots in. That’s it. That’s the single most important thing.”

If you want help with remote phone banking, go to: https://www.mobilize.us/mobilize/event/263189/

 

 

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AIDS and HIV

Maxine Waters criticizes House GOP over proposed cuts to HIV/AIDS programs

Calif. Democrat spoke at U.S. Conference on HIV/AIDS in D.C.

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U.S. Rep. Maxine Waters (D-Calif.) speaks at the U.S. Conference on HIV/AIDS on Sept. 6, 2023, in Washington. (Washington Blade photo by Michael Key)

WASHINGTON — U.S. Rep. Maxine Waters (D-Calif.) on Wednesday sharply criticized House Republicans over their proposed cuts to HIV/AIDS prevention programs.

The California Democrat who represents the state’s 43rd Congressional District in a speech she delivered at the U.S. Conference on HIV/AIDS noted the House Appropriations Committee’s Fiscal Year 2024 Labor, Health, Human Services, Education and Related Agencies Appropriations Bill would cut $767 million from domestic HIV/AIDS programs.

Waters said the bill would cut funds to fight HIV/AIDS among underrepresented groups by 53 percent and “completely eliminates” funding for “Minority AIDS Initiative activities within the Substance Abuse and Mental Health Services Administration.” Waters also noted the appropriations measure “eliminates funding” for the Centers for Disease Control and Prevention’s Ending the HIV Epidemic Initiative, the Ryan White HIV/AIDS Program and community health centers.

“The cuts to the Minority AIDS Initiative will exacerbate racial disparities and the elimination of the (Ending the) HIV Epidemic Initiative,” said Waters.

Waters also criticized House Republicans for “refusing to authorize” the President’s Emergency Plan for AIDS Relief.” The California Democrat said ending PEPFAR “would endanger the lives of millions of people around the world who are living with HIV and endanger the lives of millions more who are at risk.” 

“Moreover, it would compromise United States leadership on global health issues,” added Waters. “These programs used to have widespread support. It’s shameful that House Republicans are now trying to eliminate them. We cannot allow these cuts to pass. We cannot compromise. We will not give up.”

U.S. Reps. Jim Jordan (R-Ohio) and Marjorie Taylor Greene (R-Ga.) are among those who Waters criticized by name in her speech.

“I will speak truth to power. I want to use words that they will understand. Hell no! We won’t go! We are not going to give up,” said Waters. “That’s the people’s money. You can’t decide who you’re going to spend it on and not who you’re going to spend it on.”

More than 3,000 people are expected to attend the National Minority AIDS Council-organized conference that will end on Saturday. This year’s theme is “A Love Letter to Black Women.”

“We need a love letter to Black women,” said Waters. “We need it not only from this conference. We need it from our families often times. We need it from our communities. We need it from the churches that we give so much attention to and give our resources to and don’t really get it back. We need a love letter coming from all over this country for what we have suffered, for what we have endured, for the way that we have been denied and for the way that we have been ostracized.” 

Waters in her speech specifically praised former Massachusetts Congressman Barney Frank and the late U.S. Sen. Ted Kennedy (D-Mass.) for their work in support of LGBTQ+ rights and efforts to combat HIV/AIDS. Waters also thanked Jewel Thais-Williams, who opened Catch One, a bar and restaurant on Pico Boulevard in Los Angeles that became a refuge for people with HIV/AIDS.

“They had nowhere to gather, nowhere to go, nowhere to be recognized as people who needed support,” said Waters.

B. Kaye Hayes, deputy assistant secretary for infectious disease in the Office of the Assistant Secretary for Health who is also the executive director of the Presidential Advisory Council on HIV/AIDS, is among those who are expected to speak at the conference. Mark S. King, an HIV/AIDS activist and blogger who published “My Fabulous Disease: Chronicles of a Gay Survivor” on Sept. 1, is scheduled to talk on Thursday.

Cal Benn contributed to this story.

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Health

Cases of multi-drug resistant “super strain” of gonorrhea multiply

Last February, cases of XDR, or “extensively drug resistant,” gonorrhea, are on the rise in the U.S., the CDC said

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Gonorrhea bacterium (CDC/Los Angeles Blade graphic)

ATLANTA, GA. – The U.S. Centers for Disease Control and Prevention (CDC) along with the World Health Organization (WHO) are raising red flags for the second time this year as cases multiply of a “super strain” of drug-resistant gonorrhea globally, but particularly among men who have sex with men.

This strain of gonorrhea has been previously seen in Asia-Pacific countries and in the United Kingdom, but not in the US. A genetic marker common to two Massachusetts residents and previously seen in a case in Nevada, retained sensitivity to at least one class of antibiotics. Overall, these cases are an important reminder that strains of gonorrhea in the U.S. are becoming less responsive to a limited arsenal of antibiotics.

Gonorrhea is a sexually transmitted infection (STI) with most people affected at aged 15–49 years, that remains a major public health concern. Antimicrobial resistance in gonorrhea has increased rapidly in recent years and has reduced the options for treatment.

Last February, cases of XDR, or “extensively drug resistant,” gonorrhea, are on the rise in the U.S., the CDC said.

Gonococcal infections have critical implications to reproductive, maternal and newborn health including:

  • a five-fold increase of HIV transmission
  • infertility, with its cultural and social implications
  • inflammation, leading to acute and chronic lower abdominal pain in women
  • ectopic pregnancy and maternal death
  • first trimester abortion
  • severe neonatal eye infections that may lead to blindness.

This past January, Fortune reported the U.S. is experiencing “a rising epidemic of sexually transmitted disease,” Dr. Georges Benjamin, executive director of the American Public Health Association, said with some experts referring to the issue as a “hidden epidemic.” 

Cases of gonorrhea—an STD that often shows no signs, but can lead to genital discharge, burning during urination, sores, and rashes, among other symptoms—rose by 131% nationally between 2009 and 2021, according to public health officials. While rates of STD transmission in the U.S. fell during the early months of the pandemic, they surged later in the year, with cases of gonorrhea and syphilis eventually surpassing 2019 levels, according to the CDC.

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Health

Meet the director of Johns Hopkins Center for Transgender Health

Dr. Fan Liang, is the medical director of the Johns Hopkins Center for Transgender and Gender Expansive Health in Baltimore, Maryland

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Dr. Fan Liang (Photo courtesy of Fan Liang)

BALTIMORE – The topic of gender affirming healthcare has never attracted more attention or scrutiny, presenting challenges for both patients and providers, including Dr. Fan Liang, medical director of the Johns Hopkins Center for Transgender and Gender Expansive Health and assistant professor of plastic and reconstructive surgery.

Speaking with the Washington Blade by phone last week, Liang shared her perspective on a variety of topics, including her concerns about the ways in which media organizations and others have shaped the discourse about gender affirming care.

Too often, she said, the public is provided incomplete or inaccurate information, framed with politically charged and polarizing language rather than balanced and nuanced reporting for the benefit of audiences who might have little to no familiarity with the topics at hand.

“This is an evolving field that requires input from many different types of specialists,” Liang noted, so one issue comes when providers “start to comment outside of their scope of practice, or extrapolate into everybody’s experience.”

A more intractable and difficult problem, Liang said, is presented by the fact that, “issues with transgender health have really taken center stage with regard to national politics, and as a result of that, the narrative has really been reduced to an unsophisticated representation of what’s going on.”

“I think that is dangerous for patients and for the community that these patients live in and have to work in and survive in because it paints a picture that is really inaccurate,” she said.

Conservative state legislatures across the country have introduced a record number of anti-LGBTQ bills this year, passing dozens, including a slew of anti-trans healthcare restrictions. The Human Rights Campaign reports 35.1 percent of transgender youth now live in states that have passed bans on gender affirming care, many of which carry criminal penalties for providers.

A big part of the Center’s work, Liang told the Blade, involves working closely with trans patients and organizations like Trans Maryland and the Trans Rights Advocacy Coalition “to make sure that the community’s voices are being heard, so that we’re able to represent those interests here.”

She described “a generalized sense of anxiety and fear,” concerns that she said are “pervasive throughout the community,” over “access to surgery and to overall gender healthcare.”

“I get a lot of questions about that,” she said.

While Liang has not yet worked with any patients who traveled to the Center because gender affirming care was banned in the states where they reside, she said, “I do anticipate that will happen in the relatively near future.”

Challenges for clinicians

The political climate “really interferes in physician autonomy and basically using our training and discretion to provide the best therapies that we can,” based on research and evidence-based guidelines from medical organizations on best practices standards of care, Liang said.

“I earnestly believe that people who go into medicine try to do right by their patients and try to provide exceptional care whenever they can,” she said. “When I speak to other providers who are engaged in trans care, the reason they entered the field was because they saw patients that were suffering and had no other providers to go to and they were filling a need that desperately needed to be filled.”

“It is unfortunate that their motives are being misinterpreted, because it is causing significant emotional harm to these providers who are being targeted,” Liang said, noting “there is so much vitriol from the anti-trans side of things,” including “this narrative out there that physicians are providing trans care because of financial reasons or because of some sort of politically motivated, I don’t know, conspiracy.”

The political climate, along with the realities of practicing in this speciality, may threaten to stem the pipeline of new providers whose practice would otherwise include gender affirming care, said Liang, who serves on the interview board for incoming residents who are looking to specialize in plastic surgery.

Many, perhaps even most, she said, are eager to explore transgender care, often because, particularly among young trainees, they are friends with trans and non-binary people. “I don’t know how much of that interest persists as they move through the training pipeline, because — especially if they are at an institution that does provide trans care — they do see a lot of the struggles that physicians encounter in being able to offer these services.”

Liang noted the “significant hurdles from an insurance standpoint” and the “significant prerequisites in order to access surgery,” which require “a tremendous amount of back-end coordination and optimization of the logistics for surgical readiness.”

“And then,” she said, “they see a lot of the backlash in the media against trans providers, and I think that that does discourage residents who otherwise would be interested in the field because physicians, by and large, are a pretty conservative bunch. And having them start their practice where they’re sort of stepping into a political minefield is not ideal.”

Speaking up can be beneficial but risky

“Some physicians feel like they can make the most amount of impact by being advocates for the patient population on a national stage or being more vocal about how anti-trans legislation has been impacting their patients,” Liang said.

“My goal, as the director for the Center for Transgender Health here at Hopkins is really to normalize this care to allow for the open conversation and discussion amongst providers to create a safe space for people to feel comfortable providing this care,” she said.

Destigmatizing gender affirming care and connecting clinicians who practice in this space will help these providers understand they are not “functioning in isolation” and instead are part of “a national effort and a nationally concerted effort toward delivering state-of-the-art health care,” Liang said.

“It’s important,” she said, to “bring the generalized healthcare community to the table in offering these services and have a frank discussion when it comes to education, research and teaching.”

Other providers, however, “do not feel comfortable putting themselves into that place of vulnerability,” Liang said, “and I don’t fault them for it because I personally know people who’ve received death threats and who have been targeted because of what they say to the media,” in many cases because their comments were reported incorrectly or out of context.

In July, Liang participated in an emergency trans rights roundtable on Capitol Hill with representatives from advocacy groups like the Southern Poverty Law Center and the Transgender Law Center, as well as members of Congress including U.S. Reps. Mark Takano (D-Calif.), Barbara Lee (D-Calif.), and Sara Jacobs (D-Calif.).

She told the Blade it was “a really wonderful experience” to “hear the heartfelt stories” of the panelists advocating on behalf of themselves, their friends, and their families, earning the attention of members of Congress.

“I do think advocacy is important,” Liang told the Blade. “I try to make time for it when I can,” she said, “but I have to balance that with all of my other clinical obligations.”

Finding compassion and lowering the temperature

On Aug. 1, The Baltimore Banner reported that the director of the Mayor’s Office of LGBTQ Affairs in Baltimore filed a discrimination complaint with the city’s Office of Equity and Civil Rights against the Hopkins Center for Transgender and Gender Expansive Health.

Asked for comment, Liang said “it was an upsetting article to read,” adding, “I was upset that there wasn’t more due diligence done to investigate a little bit further” because instead the article presents “just this one person’s account of things.”

She noted there is “not much I can say from a physician standpoint because everything is contained within HIPAA,” the federal Health Insurance Portability and Accountability Act, which prohibits providers from even acknowledging which patients they may or may not have worked with.

The Banner article underscores the importance of journalists’ obligations to “make sure there is due diligence to confirm sources and make sure things are accurate,” Liang said, including, of course, when covering complicated and politically fraught subjects like gender affirming care.

“On the one hand, it’s really wonderful that there’s a fair amount of press being dedicated to trans issues around the country,” Liang said, but what is “frustrating for me is these conversations always seem to be so loaded and politically charged, and there doesn’t seem to be much space for people to ask earnest and honest questions” without taking heat from either side.

There is “compassion to be offered for patients who are struggling to receive basic health care” as well as for “people who are struggling to understand how this issue is evolving,” those for whom the matter is “uncharted territory” and therefore likely to “cause consternation and fear,” she said.

“Most of the time, the way to overcome” this is to cultivate “relationships with people who do identify as transgender or non-binary” on the grassroots level, she said, while leaving room “for people to ask earnest and honest questions.”

Removing the artificial “us-versus-them” paradigm provides “opportunity for more compassionate interactions,” Liang said.

At the same time, she conceded, amid the heightened polarization and escalation of an anti-trans backlash over the last few years, efforts to fight sensationalization with compassion and understanding have often fallen short, presenting hurdles that have long plagued other areas of science and medicine like abortions and vaccines.

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Health

CDC official talks about new STI prevention drug guidelines

Mena called DoxyPEP an “amazing tool,” noting the need for new ways to combat the increase in rates of STIs

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Dr. Leandro Mena, director of the Centers for Disease Control and Prevention's Division of STD Prevention (Screenshot/YouTube)

ATLANTA – The Centers for Disease Control and Prevention is expected to soon issue draft guidelines for the use of doxycycline to help prevent the spread of gonorrhea, chlamydia and syphilis in transgender women and gay and bisexual men who have sex with men.

Doctor Leandro Mena, director of the public health agency’s Division of STD Prevention, talked to the Washington Blade by phone on Thursday about the post-exposure prophylactic intervention — DoxyPEP for short — which he characterized as “the first important innovation that we have had in the field of STIs in almost three decades.”

Studies show a 200 mg dose of the widely available antimicrobial antibiotic, if taken within 72 hours after sex, has shown tremendous efficacy in reducing the risk of transmitting these three diseases, he said.

For now, research is limited to certain LGBTQ populations for whom “we know that network prevalence, the prevalence of STIs in the sexual network of this group, is sufficiently high that the benefits outweigh the potential risks,” Mena said, while “other strategies like the use of condoms, you know, are not really that feasible.”

Research on DoxyPEP conducted and published over the past couple of years has been game-changing, he said, “because it’s an antimicrobial that’s already approved, we know it’s very low-cost, and I think we have the evidence of its effectiveness.”

“Since the development of nucleic acid amplification test — which allows [providers to] diagnose gonorrhea and chlamydia by amplifying nucleic acids, by doing PCR, that really revolutionized access to STI testing — we really haven’t had much,” Mena said.

The CDC expects to work quickly on DoxyPEP, but a few hurdles must be cleared first.

“We have engaged with the communities, right, that are poised to benefit the most from this intervention,” Mena said. “And where we are is that we are finishing our guidance, we anticipate that it will be out for public comment close to the end of this fall, and shortly after we will be able to have the final guidance.”

“Guidelines like these that have important public health consequences goes all the way up to the highest levels of clearance in the CDC,” he added.

“While we know that that benefits are significant, there are some unknowns about the potential risks of taking antimicrobials to prevent infections, as they may perhaps have other effects [like] inducing resistance” in STIs and other types of bacteria, Mena said.

“Those are some of the unknowns that we’re trying to currently understand better, as we try to balance risk and benefits of the use of doxycycline as post exposure prophylaxis,” he said.

Another challenge for the CDC as it develops the guidelines, Mena said: They must be as relevant for folks in San Francisco as for people in Montgomery, Ala., and (the) Navajo Nation, based on each place’s “local epidemiology, local context and population.”

Additionally, the agency warns, doxycycline can carry side effects — namely, “phototoxicity, gastrointestinal symptoms, and more rarely esophageal ulceration.”

So, the CDC is working diligently, Mena said, to “better understand the potential risk that its use – its regular use, in this way, may present to the individual and potentially at the population level.”

Mena called DoxyPEP an “amazing tool,” noting the need for new ways to combat the increase in rates of STIs that has persisted for nearly a decade.

“In 2021, we had more than 2.5 million cases of syphilis, gonorrhea and chlamydia reported, and the reasons we’re seeing these increases, it’s really, you know, multifactorial,” he said. “There are subpopulations that are disproportionately affected — among these, racial-ethnic minorities, young people, men who have sex with men.”

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AIDS and HIV

American Red Cross ends ban on blood donations by gay men

Many healthy individuals who previously could not give will now be able to support their community through the gift of blood donation

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Photo Credit: American Red Cross

WASHINGTON – The American Red Cross announced a historic change in the organization’s policies regarding blood donations by gay and bisexual men. Under this new donor screening process, all donors answer the same eligibility questions regardless of gender or sexual orientation and will be assessed for blood donation based on individual risk factors, not on sexual orientation.

This change by the Red Cross falls within the U.S. Food and Drug Administration finalized guidelines for blood donation issued this past May that will use a uniform individualized risk assessment questionnaire for respondents regardless of their sexual orientation, sex, or gender.

In a statement the Red Cross noted:

“This change means many healthy individuals who previously could not give will now be able to support their community through the gift of blood donation.

Andrew Goldstein, a cancer researcher from Los Angeles, was a regular blood donor in his younger years before the FDA’s previous policies made him ineligible to donate as a gay man. His desire to influence change compelled him to register as a participant in the FDA funded ADVANCE Study in 2021, which sought to gather data to evaluate the possibility of moving to an individual donor assessment. He is proud he was able to be part of the study that led to this change and is excited to finally be able to give blood again.

“There’s so much in the world that you can’t help with, and you sometimes have to see people going through difficult times, but something like giving blood feels like something so small that you can do, and it means a lot to me that I’ll be able to do that again,” said Andrew. Now, Andrew and many others are able to share their good health with patients in need of lifesaving transfusions.”

The FDA’s new protocols issued in May note that prospective donors who have had a new sexual partner, or more than one sexual partner in the past three months, and anal sex in the past three months, would be ineligible.

So would those who are “taking medications to treat or prevent HIV infection (e.g., antiretroviral therapy (ART), pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP),” because these drugs can delay the detection of HIV.

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Health

AMA strengthens gender affirming care policies

The AMA pledged to work with federal regulators to oppose policies criminalizing guideline-directed healthcare interventions

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American Medical Association President Dr. Jesse Ehrenfeld (center left) (Photo courtesy AMA)

CHICAG0 – The American Medical Association on Monday voted to strengthen its policies governing access to gender affirming care for trans and gender diverse individuals.

The group committed to opposing the criminalization of patients for seeking gender affirming care, and of families and healthcare providers for facilitating access to or administering that care.

Additionally, the AMA pledged to work with federal and state legislators and regulators to oppose policies criminalizing these guideline-directed healthcare interventions and to educate the Federation of State Medical Boards on their importance.

The resolution was introduced by the Endocrine Society, which issued a press release Monday celebrating the move: “As political attacks on gender-affirming care escalate, it is the responsibility of the medical community to speak out in support of evidence-based care.”

“Medical decisions should be made by patients, their relatives and health care providers, not politicians,” the Endocrine Society wrote.

The resolution was cosponsored by the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Urological Association, the American Society for Reproductive Medicine, the American College of Physicians, the American Association of Clinical Endocrinology, GLMA: Health Professionals Advancing LGBTQ+ Equality and AMA’s Medical Student Section.

The Endocrine Society explained the legislative bans on gender affirming care – passed in states in which 30 percent of the nation’s transgender and gender-diverse youth now live – are misguided.

“Pediatric gender-affirming care is designed to take a conservative approach,” the group wrote.

“When young children experience feelings that their gender identity does not match the sex recorded at birth, the first course of action is to support the child in exploring their gender identity and to provide mental health support, as needed.”

“Medical intervention is reserved for older adolescents and adults, with treatment plans tailored to the individual and designed to maximize the time teenagers and their families have to make decisions about their transitions.

“Major medical organizations also agree on waiting until an individual has turned 18 or reached the age of majority in their country to undergo gender-affirming genital surgery.”

Additionally, the Endocrine Society noted research that shows gender affirming care can be lifesaving.

“A 2020 study analyzed survey data from 89 transgender adults who had access to puberty-delaying medication while adolescents and data from more than 3,400 transgender adults who did not. The study found that those who received puberty-delaying hormone treatment had lower likelihood of lifetime suicidal ideation than those who wanted puberty-delaying treatment but did not receive it, even after adjusting for demographic variables and level of family support.”

“Approximately nine in ten transgender adults who wanted puberty-delaying treatment, but did not receive it, reported lifetime suicidal ideation.”

AMA inaugurates first gay president

The AMA’s first openly gay President Jesse Ehrenfeld was inaugurated during the 2023 Annual Meeting of House of Delegates on Tuesday.

An anesthesiologist who formerly served as the Joseph A. Johnson Jr. Distinguished Leadership Professor of anesthesiology, surgery, biomedical informatics & health policy at Vanderbilt University’s School of Medicine, Ehrenfeld spoke to the Washington Blade for an exclusive interview last month.

Dr. Jesse Ehrenfeld with his sons and husband.
(Photo courtesy of Dr. Ehrenfeld)

During his inaugural speech on Tuesday, Ehrenfeld relayed a personal story about how his now four-year-old son, born early and severely underweight, needed a blood transfusion. “At this moment,” he said, “watching my son cling to life, I was struck by the painful reality that, even though I was a physician and now, a father … neither I, nor my husband, could donate blood – simply because we are gay.”

“Just recently, the FDA, thanks in large part to a decade of advocacy by our AMA and others, rescinded some of these discriminatory practices, making it possible for my husband and I to give someone else’s child a much-needed blood transfusion,” Ehrenfeld said. “This kind of advocacy is why I am so proud to lead our AMA at this moment.”

“Today there is an unconscionable effort to interfere in medicine,” Ehrenfeld said. “An assault on patient and physician autonomy. Legislative over-reach. Attacks on maternal health … on LGBTQ patients.”

“We have a duty to push back against legislative interference in the practice of medicine that is leading to the criminalization of care.”

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AIDS and HIV

Elton John AIDS Foundation launches ambitious new initiative

Throughout Pride Month, Sir Elton John and the co-chairs of The Rocket Fund are challenging supporters to let their #InnerElton out

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Elton John & David Furnish at Oscars Viewing Party 2021 (Screenshot/YouTube Hollywood TV)

NEW YORK – The Rocket Fund is the Elton John AIDS Foundation’s latest transformative $125 million campaign to redouble the fight against AIDS everywhere. Growing levels of stigmatization, marginalization, and poverty have led to high rates of HIV and low access to healthcare globally. 

“For years, HIV/AIDS has caused enormous pain across the world, but I pray that soon this epidemic will be a thing of the past” said Sir Elton John. “More than 30 years after I launched the Elton John AIDS Foundation, my passion for reaching everyone, everywhere with education and compassionate care is still as strong as ever. The Rocket Fund will turbo-charge our mission and reach those most at risk from this terrible disease. Now is the time. This epidemic has gone on too long. We must all act together to see AIDS defeated in our lifetimes.”

Money from the fund will go towards supporting access to HIV prevention and treatment services, including providing access to HIV tests, antiretroviral therapies, and Pre-Exposure Prophylaxis (PrEP), according to the press release. Donatella Versace, one of the Rocket Fund’s co-chairs — alongside Furnish, Tani Austin, and David Geffen — has also pledged to match donations to the fund up to $300,000 during the month of June.

Throughout Pride Month, Sir Elton John and the co-chairs of The Rocket Fund are challenging supporters to let their #InnerElton out. Letting your #InnerElton out is about proudly expressing your authentic self, showing love for others and taking compassionate action. Supporters are encouraged to join the movement by posting photos of themselves on social media wearing their own take on Elton’s signature looks – or whatever makes them feel their true self – with the hashtag #InnerElton. Many notables are joining to let their #InnerElton out, including Dolly Parton, Michaela Jaé Rodriguez, JoJo Siwa, Heidi Klum, Smokey Robinson and more. Learn more here. The Let Your Inner Elton Out campaign was created by advertising agency Invisible Man and produced in partnership with global communications agency BCW.

The Foundation launched this critical initiative on June 5, the day in 1981 when the Centers for Disease Control released its first report on what would become the AIDS epidemic. This inaugural Rocket Day commemorates the early days of the fight against HIV/AIDS, while committing to accelerate progress towards ending AIDS for all.

“The end of the HIV/AIDS epidemic is within sight, and The Rocket Fund is the push we need to finally cross the horizon,” said David Furnish, Chairman of the Elton John AIDS Foundation. “To end AIDS, we must make targeted investments that can level the playing field, by tackling the inequalities and stigma that prevent people from accessing the care they desperately need. By joining The Rocket Fund and our mission, you can help transform the future for millions of people globally.”

“As we’ve learned through the global fight to stop COVID-19, epidemics do not recognize state borders, economic or cultural differences. If left unchecked, they only worsen with devastating impacts on the most vulnerable,” said Anne Aslett, Chief Executive Officer of the Elton John AIDS Foundation. “It is critical that we meet this moment to connect vulnerable people with the care and resources they need to live vibrant, healthy lives and we welcome all who want to see an end to this disease to join us.”

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Health

Gilead awards $5 mil grant to HRC’s HIV & health equity programs

Funds are for the HRC Foundation’s HIV and Health Equity Program, its Historically Black Colleges & Universities Program

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Entrance sign to Gilead Corporate Headquarters, Foster City, Calif. (Photo Credit: Gilead Media Affairs)

WASHINGTON – The Human Rights Campaign was awarded a $5 million grant from drugmaker Gilead Sciences to expand the organization’s HIV and health equity programs, supporting efforts to end the HIV epidemic by 2030 while combatting stigma in Black and Latino communities.

Funds will be used over the next three years for the HRC Foundation’s HIV and Health Equity Program, its Historically Black Colleges & Universities Program, and its Transgender Justice Initiative, HRC said in a statement Wednesday announcing receipt of the award, which extends Gilead’s $3.2 million grant to the HRC Foundation in 2021.

The organization said its HIV and Health Equity Program plans to develop a “benchmarking tool for institutions that provide HIV services, helping better evaluate the quality of care and measure racially and socially inclusive approaches” while defining “best practices, policies, and procedures to optimize HIV service provision for BIPOC LGBTQ+ communities.”

HRC President Kelley Robinson said, “Since the beginning of the HIV epidemic, racism and anti-LGBTQ+ discrimination have created dangerous hurdles for those seeking prevention or treatment.

“With the generous support of Gilead Sciences, we’ll be able to continue providing critical
resources to help overcome these hurdles, especially focusing on Black and Latiné communities in the U.S. South.

“We’ll also be able to expand our efforts, as we seek to remove institutional barriers often unknowingly created by HIV service providers. We must decrease the disparities that place an unnecessary burden on Black and Latiné LGBTQ+ people and people living with HIV.”

Gilead Executive Vice President of Corporate Affairs and General Counsel Deborah Telman said the company “is committed to advancing health equity, particularly in Black communities and other communities of color that are disproportionately affected by HIV.”

“This grant will build on the impactful work HRC has done with community partners and HBCUs to increase awareness of HIV treatment and prevention options and reduce health disparities, combat discrimination and fight stigma,” Telman said.

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AIDS and HIV

New data shows HIV infections dropped- mostly among whites

Significant decline in new HIV infections, but impact of prevention efforts far less substantial for Black and Hispanic-Latino populations

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Centers for Disease Control and Prevention headquarters in Atlanta. (Photo Credit: CDC/GSA)

ATLANTA – Data published Tuesday. by the Centers for Disease Control and Prevention shows a significant decline in new HIV infections, but suggests the impact of prevention efforts was far less substantial for Black and Latino populations.

From 2017 to 2021, as rates of HIV testing, treatment, and the use of pre-exposure prophylaxis (PrEP) medication rose, new cases dropped by 12 percent overall and by as much as 34 percent among gay and bisexual males aged 13 to 24.

The numbers show a “move in the right direction,” CDC Director Rochelle Walensky said in a press release.

However, when broken down by race, the CDC found new infections were down by 27 percent and 36 percent, respectively, among Black and Hispanic-Latino populations, compared with 45 percent of whites.

Similarly, by 2021 about one third of those who are considered eligible were taking PrEP for HIV prevention, but the CDC noted this number includes “relatively few Black people or Hispanic/Latino people” despite the significant increase in prescriptions up from just 13 percent in 2017.

“Longstanding factors, such as systemic inequities, social and economic marginalization and residential segregation,” Walensky noted, continue to act as barriers “between highly effective HIV treatment and prevention and people who could benefit from them.”

She added, “Efforts must be accelerated and strengthened for progress to reach all groups faster and equitably.”

Robyn Neblett Fanfair, acting director of the CDC’s Division of HIV Prevention, said that “At least three people in the U.S. get HIV every hour—at a time when we have more effective prevention and treatment options than ever before.”

“These tools must reach deep into communities and be delivered faster to expand progress from some groups to all groups,” she said.

The HIV+Hepatitis Policy Institute issued a press release following the CDC’s announcement of the new data, noting both the encouraging progress and need for improvement.

“It appears that our investments in HIV prevention are providing some positive results, but the persistent high number of new diagnoses and the low usage of PrEP among the communities most impacted by HIV point to the need for increased resources, particularly for a national PrEP program,” said the group’s executive director, Carl Schmid.

President Joe Biden’s FY24 budget requested $237 million for a national PrEP program along with $850 million to support the U.S. Department of Health and Human Services’ “Ending the HIV Epidemic in the U.S.” initiative.

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Monkeypox

Mpox prevention, vaccinations for this year’s LGBTQ events urged

The CDC on Monday issued a Health Alert Network Health Update on the potential risk for new mpox cases urging vaccinations

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Drs. Robert Fenton and Demetre Daskalakis, coordinator and deputy coordinator for the White House national mpox response, during a briefing in August 2022 (Official White House Photo by Cameron Smith)

ATLANTA – Federal health agencies, in coordination with their state and local counterparts and community partners, are exploring opportunities to offer mpox prevention initiatives and vaccinations at LGBTQ events this summer, Dr. Demetre Daskalakis said on Thursday.

Daskalakis, deputy coordinator for the White House national mpox response, described these deliberations in response to a question from the Washington Blade during a media telebriefing update on mpox that was hosted by the Centers for Disease Control and Prevention.

The CDC on Monday issued a Health Alert Network Health Update on the potential risk for new mpox cases.

Since the peak of about 460 cases per day in August 2022, new cases have steadily declined, but following the cluster recently reported in the Chicago area, the update warns, “spring and summer season in 2023 could lead to a resurgence of mpox as people gather for festivals and other events.”

“We have the vaccine, and we have organizations that are willing to do it,” Daskalakis said during Thursday’s call, adding that resources are available and can be deployed flexibly because they are built into existing “HIV and STI funding to allow for this work.”

And the Mpox Crisis Response Cooperative Agreement, Daskalakis said, “provides even more resources locally for such efforts.”

Daskalakis and CDC Mpox Response Incident Manager Dr. Christopher R. Braden also briefed reporters on findings from new studies on the efficacy of the JYNNEOS vaccine for the prevention of mpox.

That data, per the CDC’s Morbidity and Mortality Weekly Report, reveals that “Among gay, bisexual, and other MSM and transgender adults aged 18–49 years, 2 doses of the JYNNEOS vaccine were 86% effective against mpox, indicating substantial protection against mpox.”

Additionally, “All routes of vaccine administration provided similar protection.”

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