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Trans people more likely to avoid health care due to cost

Improved training and policies will ensure access for transgender people to knowledgeable health care providers

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LOS ANGELES – Two studies released this week from the Williams Institute at the University of California Los Angeles School of Law provide new insight into transgender health. Despite high rates of insurance, transgender people are more likely than cisgender people to avoid health care due to costs.

The first study shows that despite the high level of insurance coverage, transgender people are more likely than cisgender people to have avoided care due to cost. An estimated 90% of transgender people report having health insurance coverage, but one-third (33%) said they avoided health care due to cost in the past year, compared to 15% of cisgender people. In addition, only 64% of transgender people accessed specialized transgender-related health care, but many more (82%) said that they would like to access such care.

The second study underscores the need for quality health care for transgender people. Results show that transgender people had greater odds of discrimination, psychological distress, and adverse childhood experiences—stressors that were associated with increased odds of a cardiovascular condition. A greater proportion of transgender than cisgender people were current smokers, which increases the risk of cardiovascular disease. Transgender women also have more than three times greater risk of venous thromboembolism, compared to cisgender women.

“Our findings add to a growing body of research examining the cumulative burden of minority stress and discrimination on a person’s mental and physical state. Stress is a driver of chronic inflammation, which elevates the risk for cardiovascular disease,” said study author Tonia Poteat, Associate Professor of Social Medicine at the University of North Carolina. “Additional research on the pathways by which psychosocial factors affect cardiovascular health in transgender people is needed.”

Both studies used data from TransPop, the first nationally representative survey of transgender people in the United States.

“Even with proper health insurance, transgender people face barriers to good quality and specialized care,” said study co-author Ilan H. Meyer, Principal Investigator of the TransPop study and Distinguished Scholar of Public Policy at the Williams Institute. “These studies showed the role of minority stress in cardiovascular disease disparities between transgender and cisgender people. Access to high-quality culturally responsive transgender care is essential for reducing such health disparities.”

KEY FINDINGS
Healthcare access

  • Transgender nonbinary people were more likely to have avoided care due to cost compared to transgender women and men.
  • Only 56% of transgender people overall had a transgender-related health care provider. Fewer nonbinary people accessed transgender-related health care.
  • Of transgender participants, 82% said they would like to access an LGBT or transgender-specific clinic or provider. But 64% of transgender people had not been to an LGBT or transgender-specific clinic or provider over the five-year period prior to the interview.
  • Nonbinary transgender people were less likely to have been to an LGBT or transgender-specific clinic or provider over the five-year period than transgender men or transgender women.

Health outcomes

  • Transgender people had more poor physical health days per month (8 days) than cisgender people (4 days).
  • Transgender people experienced greater numbers of poor mental health days per month (15 days) compared to cisgender people (6 days).
  • Transgender people were more likely to report having HIV, other sexually transmitted infections, emphysema, ulcers, liver disease, and sleep disorders than cisgender people.

Cardiovascular conditions

  • The study found no differences between cisgender and transgender participants in cardiovascular disease overall. But transgender women were at more than three times greater risk of venous thromboembolism (VTE) compared to cisgender women.
  • There was little difference between cisgender and transgender people in having ever smoked tobacco cigarettes, but a greater proportion of transgender people were current smokers.
  • Transgender people had greater odds of everyday discrimination, psychological distress, and adverse childhood experiences.
  • Among transgender individuals, exposure to adverse childhood experiences and psychological distress were associated with increased odds of smoking, a risk for many adverse health conditions.

“Our study found that both transgender and cisgender people were equally likely to have a personal health care provider and a place to go for health care, and, in contrast to previous studies, feel satisfied by the health care they received,” said study author Jamie L. Feldman, Associate Professor at the University of Minnesota Medical School. “However, improved training and policies will ensure access for transgender people to knowledgeable health care providers.”

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Coronavirus

White House orders distribution of 400 million free N95 masks

Dr. Tom Inglesby, the administration’s Covid testing coordinator; “We know that these masks provide better protection than cloth masks”

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President Joe Biden (Blade file photo/screenshot)

WASHINGTON – As the latest surge of the highly contagious and easily transmissible Omicron variant of the coronavirus continues to cause a rise in hospitalizations, especially among unvaccinated adults and children, the White House announced Wednesday it is making 400 million N95 masks available for free at thousands of locations across the nation.

The plan an admkistartion official said, is to start shipping the nonsurgical masks to pharmacies and community health centers to distribute this week, which will come from the Strategic National Stockpile.

In an interview with NBC News, Dr. Tom Inglesby, the administration’s Covid testing coordinator, said, “We know that these masks provide better protection than cloth masks.”

The N95 masks will be made available to everybody, and recipients will not be prioritized based on vulnerability to Covid, income or other criteria. Inglesby said the administration was “confident that people who want to access them will be able to access them,” but it was not immediately clear how many masks a person could receive at one time.

On January 13, President Joe Biden had announced a plan to have the government distribute 1 billion rapid, at-home COVID-19 tests free to Americans, along with the N95 masks, as the administration works to fight the spiraling upward spike in coronavirus cases.

The White House website to order free at-home Covid tests went live Tuesday. The website says: “Every home in the U.S. is eligible to order 4 free at-home COVID-19 tests. The tests are completely free. Orders will usually ship in 7-12 days.”

A White House official said Wednesday that the distribution of 400 million masks would be the largest deployment of personal protective equipment in U.S. history.

Inglesby told NBC News that the administration was “absolutely preparing for the possibility of additional variants in the future” and that people could expect the government to make N95 masks “more and more available.”

Biden announces free masks, tests to fight omicron:

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AIDS and HIV

Federal blood donation study recruiting gay, bi men

The study is aimed at assessing the individual risk of a gay or bisexual man transmitting HIV if they donate blood

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FDA headquarters in Silver Spring, Maryland (Photo Credit: FDA/GSA)

SILVER SPRING, Md. – Washington D.C.’s Whitman-Walker Institute and the Los Angeles LGBT Center are among LGBTQ supportive organizations in eight U.S. cities working with the nation’s three largest blood donation centers on a study to find a way to significantly ease blood donation eligibility for men who have sex with men or MSM.

The study, which is funded by the U.S. Food and Drug Administration, calls for recruiting a total of 2,000 gay and bisexual men in eight U.S. cities selected for the study to test the reliability of a detailed donor history questionnaire aimed at assessing the individual risk of a gay or bisexual man transmitting HIV if they donate blood.

A statement released by the study organizers says the questionnaire, which could be given to a gay or bisexual person showing up at a blood donation site, could be a replacement for the FDA’s current policy of banning men who have had sex with another man within the previous three months from donating blood.

In the early years of the AIDS epidemic in the 1980s, the FDA put in place a permanent ban on blood donations by men who have sex with men. In 2015, with advanced HIV testing and screening techniques readily available, the FDA lifted its permanent ban on MSM blood donations and replaced it with a 12-month restriction for sexual activity between MSM.

The FDA further reduced the time of sexual abstinence for MSM to three months in 2020.

LGBTQ rights organizations and others advocating for a change in the current FDA restriction point out that at a time when the nation is facing a severe shortage of blood donations due to the COVID pandemic, the three-month donation deferral requirement for MSM is preventing a large number of blood donations from men whose risk of HIV infection is low to nonexistent.

Under the FDA-funded and initiated study, the American Red Cross, Vitalant, and OneBlood — the nation’s three largest blood donation centers — have been conducting the questionnaire testing since the study was launched in March 2021.

“To gather the necessary data, the blood centers will partner with LGBTQ+ Centers in Washington, D.C., San Francisco, Orlando, New Orleans/Baton Rouge, Miami, Memphis, Los Angeles, and Atlanta,” the study organizers say in a statement on a website launched to help recruit volunteers for the study.

“The study will enroll a total of 2,000 gay and bisexual men (250 – 300 from each area) who meet the study eligibility criteria,” the statement says.

Among the criteria for being eligible, the statement says, is the person must be between 18 and 39 years old, have expressed an interest in donating blood, must have had sex with at least one other man in the three months before joining the study, and must agree to an HIV test. A negative test result is also required for acceptance into the study.

The study is officially named ADVANCE, which stands for Assessing Donor Variability And New Concepts in Eligibility.

“The ADVANCE study is a first step in providing data that will help the FDA determine if a donor history questionnaire based on individual risk would be as effective as time-based deferral, in reducing the risk of HIV in the blood supply,” the study organizers statement says.

“If the scientific evidence supports the use of the different questions, it could mean men who have sex with men who present to donate would be assessed based upon their own individual risk for HIV infection and not according to when their last sexual contact with another man occurred,” the statement continues. “The ADVANCE study is groundbreaking because it’s the first time a study is being conducted that could result in individual risk assessment for men who have sex with men to donate blood,” the statement says.

The Whitman-Walker Institute, which is among the community-based organizations involved in helping organize and conduct the study, is an arm of Whitman-Walker Health, the LGBTQ supportive D.C. health center.

Christopher Cannon, director of Research Operations for Whitman-Walker Institute, said that since the D.C.-based part of the study was launched early last year prior to the official announcement of the study on March 20, D.C. has surpassed the original city goal of recruiting 250 participants for the study.

“We are currently at 276 as of last Friday’s report,” Cannon told the Blade in a Jan. 13 interview. “And the current goal is now 300,” he said. “So, we’re hoping to push this over that goal line in the coming days and weeks.

Cannon said that like the community organizations involved in the study in other cities, Whitman-Walker Institute’s role has been focused on recruiting gay and bisexual men to participate in the study and to send them to the American Red Cross headquarters building at 430 17th St., N.W. near the White House. That site, which serves as a blood donation center, is also serving as the site where study participants are screened, interviewed, and presented with a detailed questionnaire.

“We promote the study within ,” Cannon said. “We promote it to our networks. We did social media promotions across the city.’

Although Whitman-Walker doesn’t have the final draft of the questionnaire being presented to study participants, Cannon said he has seen “bits and pieces” of it.  

“They ask very direct questions about the person’s sex life, sexual partners, sex acts, numbers of partners,” Cannon said. “There are questions about condom use, PrEP use, drug use. How recently have you had sex? Lots of related questions,” he said.

“It’s really about trying to figure out effectively which are the best questions,” according to Cannon. “The hope is by analyzing the questions and identifying maybe the best 10 to 12 questions that can be universally used…to get the best answers that identify the individuals that may have the highest risk,” he said. Doing that, he points, out can help determine which men who have sex with men should be eligible to safely donate blood.

A statement released by Whitman-Walker last March calls the study a “monumental research effort” that has the potential to lift the stigma imposed on gay and bisexual men whose ability to donate blood is currently based on their sexual orientation.

“The ADVANCE study is designed to understand if, by asking carefully crafted and research-informed research questions, blood collectors can screen potential blood donors for their individual HIV risk factors rather than applying a ban against sexually active gay and bisexual men,” the statement says.

“The goal is to move away from overly broad questions that exclude potential donors and spread stigmatizing messages about MSM and their HIV risks,” it says.

Cannon said that as of last week, study organizers had recruited a total of 879 study participants nationwide out of the goal of 2,000 participants needed to complete the study. He said issues related to the COVID pandemic created delays in the recruitment efforts, but study organizers were hopeful the study could be completed by this summer.

Information about participating in the study or learning more about it can be obtained at advancestudy.org.

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Coronavirus

COVID-19 Cases increase by nearly 10 times in one month

While hospitalizations continue to climb, Public Health data shows that many positive cases are admitted for reasons other than COVID

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Graphic courtesy of UCLA/Centers for Disease Control & Prevention

LOS ANGELES – A total of 31,576 new COVID-19 cases were documented on Monday — up ten times the number of cases reported on Dec. 17, 2021, when there were 3,360 new cases recorded the Los Angeles County Department of Public Health reported Monday.

There are  4,564 people with COVID-19 currently hospitalized, nearly 6 times the number from one month ago when 772 people were hospitalized. The daily positivity rate is 16.5%, more than 8 times the 2% daily positivity rate on December 17th.

Just one week ago, the county surpassed 2 million total COVID-19 cases, with the figure reaching 2,289,045 cases as of Monday.

“On this national holiday where we celebrate the life and legacy of Dr. Martin Luther King, we remember his deep commitment to health equity.  As Reverend King memorably said, ‘Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death,’ ” said Dr. Barbara Ferrer, Director of Public Health.

“Tragically, we have seen this play out in real life and very clearly over the past two years with the disparate impacts of the COVID-19 pandemic on people of color. From the onset of the pandemic, communities of color have experienced the greatest devastation from COVID-19 in Los Angeles County and throughout the nation,” she added.

“The good news is that while hospitalizations continue to climb, Public Health data shows that many positive cases are admitted for reasons other than COVID but, are identified with COVID when tested for COVID upon hospital admission,” the health department said in a statement released last week.

As of Friday, more than 80% of all adult ICU beds in the county were occupied.

There are also 27 new deaths due to COVID-19 in Los Angeles County and 31,576 new positive cases.

The public health department also noted that while the number of children hospitalized with the virus remains low, the number of them admitted to L.A. County hospitals “significantly increased” over the past month, with the largest increase among children younger than 5 years old.

The increase mirrors trends seen nationwide for the age group — the only one not yet eligible for the vaccine.

The county also saw its highest coronavirus death rate in nearly 10 months over this past week, with an average of 40 COVID-19 deaths a day.

“From the onset of the pandemic, communities of color have experienced the greatest devastation from COVID-19 in Los Angeles County and throughout the nation. As we continue to implement strategies – enforcing worker protections through our Health Officer Orders, providing resources needed by many to survive the impact of the pandemic, funding community-based organizations in hard hit areas to serve as trusted public health messengers, and increasing vaccination access in under-sourced neighborhoods – we also need to come together to address the impact that racism, historical disinvestment, and social marginalization have on COVID-19 outcomes,” Ferrer said.

“While these conditions predate the pandemic, without deliberate collective actions to address the root causes of health inequities, we are unlikely to close the gaps we have documented for 2 long years,” she added.

California has recorded more than 7 million coronavirus cases after its fastest accumulation of reported infections in the history of the pandemic, the Los Angeles Times reported.

The unprecedented count, recorded in California’s databases late Monday, comes one week after the state tallied its 6 millionth coronavirus case.

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