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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

LA County requiring vax proof for indoor bars & nightclubs by Oct. 7

Participants and workers at outdoor “mega events” with more than 10,000 attendees must provide proof of vax or show a recent negative test

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Photo Credit: County of Los Angeles

LOS ANGELES – The Los Angeles County Department of Public Health announced Wednesday that it will begin requiring verification of vaccination in select high-risk settings by October 7.

During a Los Angeles County Board of Supervisors meeting Wednesday, L.A. County Health Director Barbara Ferrer told the supervisors that vaccine verification will be required for customers and employees at indoor portions of bars, wineries, breweries, night clubs, and lounges.

The modified Health Officer Order would require customers and employees at bars, breweries, wineries, night clubs and lounges to have at least one dose of the vaccine by October 7 and both doses by November 4.

Public Health will require vaccination verification or a negative test within 72 hours prior to attending outdoor mega events. Participants and workers at outdoor “mega events” with more than 10,000 attendees must provide proof of vax or show a recent negative test.

Attendees at indoor mega events are already required to show proof of vaccination or a negative test result prior to entry. 

Los Angeles County Department of Public Health officials are prepared to move forward with the updated order later this week, Ferrer said.

“This modified health officer order aligns with the continued need to reduce risk for transmission and increase vaccination coverage,” Ferrer said. “This is a reasonable path forward that can position us to be better able to break the cycle of surges.”

She noted that while the health order won’t require it, Public Health will recommend that restaurants also begin verifying vaccination status for indoor dining.

“As evidence mounts affirming the safety and effectiveness of COVID-19 vaccines, vaccination mandates are an increasingly important tool to prevent future COVID surges that cause widespread suffering. The modified Health Officer Order aligns with the continued need to reduce risk for transmission and increase vaccination coverage; this is a reasonable path forward that can position us to be better able to break the cycle of surges,” Ferrer added.

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Coronavirus

LAUSD to require vaccines- Biden lays out new plan to require vaccines

“The COVID-19 vaccines are safe, effective & requiring students to be vaccinated is the strongest way to protect our school community.”

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Photo Credit: Los Angeles Unified School District

LOS ANGELES – The Los Angeles Unified School District announced Thursday that it will require for students 12 and older who are attending class in person to be vaccinated against the coronavirus.

The LAUSD Board of Education voted, 6-0, to pass the measure making it the first major school system, the second largest in the United States to require its more than 460,000 students, including some enrolled at independent charter schools located in LAUSD owned buildings, to be vaccinated.

Interim superintendent, Megan Reilly, said at Thursday’s board meeting that student vaccination was one way to ensure that the district’s classrooms would be able to remain open. Los Angeles had some of the country’s most extended school closures last year. All students ages 12 and up will be required to be fully vaccinated by Jan. 10, 2022, unless they have a “medical or other exemption,” Reilly noted.

The science is clear — vaccinations are an essential part of protection against COVID-19,” Reilly said in a statement following the vote. “The COVID-19 vaccines are safe, effective and requiring eligible students to be vaccinated is the strongest way to protect our school community.”

New York Times educational journalist Dana Goldstein tweeted:

As the Delta variant brought another wave of COVID-19 infections this summer, in California the number of unvaccinated young people being hospitalized has increased in certain areas of the state.

The Los Angeles County Department of Public Health noted that while case rates increased among children in all age groups between mid-July and mid-August, cases have declined by about 30% in all age groups among children (0-4, 5-11, and 12-17 years old) over the past two weeks.

The decrease is similar to the decreases we are seeing in cases among adult residents and occurred as many schools reopened with testing, masking, infection control and outbreak management protocols in place.  Over the past week, children under 18 comprised, on average, 27% of all cases seen in L.A. County.

Among L.A. County teens 12 to 17 years old, more than half of whom are vaccinated, we see just how powerfully protective the vaccines really are. As of August 28, the case rate among unvaccinated 12 to 17-year-olds was 424 cases among every 100,000 unvaccinated children in this age group compared with 51 cases among 100,000 of those vaccinated.

Among groups ineligible for vaccination, the case rate was 130 per 100,000 children aged 0 to 4, and 230 per 100,000 children aged 5 to 11.

As of September 5, 62% of L.A. County residents 12 to 15 years old received at least one dose of vaccine, while 51% were fully vaccinated. Sixty-nine percent of residents 16 to 17 years old received at least one dose, and 59% were fully vaccinated.

In K-12 school settings countywide, between August 15 and September 7, 7,784 student cases and 1,250 staff cases were reported, with the vast majority occurring at LAUSD, which tests everyone weekly.

The second highest number of cases came from other K-12 schools in L.A. County. With more than 1.5 million students and 175,000 staff countywide (by last year’s counts), 0.5% of the student body and 0.7% of staff have become infected since school districts reopened.  This is slightly higher than the 0.4% rate of infection experienced overall in the County.

“We support the actions taken by the Los Angeles Unified School District and other schools and school districts to add an additional layer of protection at schools through a sensible school vaccine requirement for eligible students,” said Barbara Ferrer, Director of Public Health.

“Vaccination remains one of the quickest and most powerful ways to decrease community transmission and prevent serious illness, which helps keep students, teachers, and staff in school, and the COVID-19 vaccines have proven to be safe and effective. Public Health will continue to work closely with school districts as they take critical actions to protect students and staff from a dangerous and highly infectious virus,” said Ferrer.

Battle over vaccinations and mask wearing has become so acrimonious in some parts of the country it is not unusual to see fistfights breaking out at school board meetings and law enforcement agencies effecting arrests as those who are adamantly opposed to coronavirus safety protocols protest, sometime violently, measures designed to protect the risk of infection by the COVID-19 virus.

As school boards weigh their options in implementation, in one highly publicized and now viral moment, anti-maskers in Rutherford County Schools in Tennessee at a school board meeting attacked a teen student who had lost a grandparent to the pandemic.

At the White House Thursday, President Joe Biden addressed the nation on his plans to implement plans to address the shortfall in the number of Americans who are vaccinated.

Many of us are frustrated with the nearly 80 million Americans who are still not vaccinated, even though the vaccine is safe, effective, and free,” the President acknowledged. 

This is a pandemic of the unvaccinated.  And it’s caused by the fact that despite America having an unprecedented and successful vaccination program, despite the fact that for almost five months free vaccines have been available in 80,000 different locations, we still have nearly 80 million Americans who have failed to get the shot

And to make matters worse, there are elected officials actively working to undermine the fight against COVID-19.  Instead of encouraging people to get vaccinated and mask up, they’re ordering mobile morgues for the unvaccinated dying from COVID in their communities.  This is totally unacceptable,” Biden argued. 

The President then took direct aim at officials and others who in his eyes who have blocked progress saying; “These pandemic politics, as I refer to, are making people sick, causing unvaccinated people to die.” 

President Joe Biden (Official White House photo by Adam Schultz)

Biden laid out the steps he was going to order to combat the lack of vaccinations in the nation.

I’m announcing that the Department of Labor is developing an emergency rule to require all employers with 100 or more employees, that together employ over 80 million workers, to ensure their workforces are fully vaccinated or show a negative test at least once a week. Some of the biggest companies are already requiring this: United Airlines, Disney, Tysons Food, and even Fox News,” he said.

He announced vaccination requirements for all nursing home workers who treat patients on Medicare and Medicaid and then expanded those requirements to include those who work in hospitals, home healthcare facilities, or other medical facilities –- a total of 17 million healthcare workers.

The President then said he would sign an executive order requiring all executive branch federal employees to be vaccinated as well as another executive order that will require federal contractors to do the same.

As part of his plan Biden said that the Department of Labor will require employers with 100 or more workers to give those workers paid time off to get vaccinated.  “No one should lose pay in order to get vaccinated or take a loved one to get vaccinated,” he said.

The President then noted; “And my message to unvaccinated Americans is this: What more is there to wait for?  What more do you need to see?  We’ve made vaccinations free, safe, and convenient. The vaccine has FDA approval.  Over 200 million Americans have gotten at least one shot.”

We’ve been patient, but our patience is wearing thin.  And your refusal has cost all of us.  So, please, do the right thing.  But just don’t take it from me; listen to the voices of unvaccinated Americans who are lying in hospital beds, taking their final breaths, saying, “If only I had gotten vaccinated.”  “If only,” he said. 

Biden also addressed the future availability of vaccines for children under 12 and schools.

Now, if you’re a parent of a young child, you’re wondering when will it be — when will it be — the vaccine available for them.  I strongly support an independent scientific review for vaccine uses for children under 12.  We can’t take shortcuts with that scientific work

Now to the schools.  We know that if schools follow the science and implement the safety measures — like testing, masking, adequate ventilation systems that we provided the money for, social distancing, and vaccinations — then children can be safe from COVID-19 in schools.

Today, about 90 percent of school staff and teachers are vaccinated.  We should get that to 100 percent.  […] And tonight, I’m calling on all governors to require vaccination for all teachers and staff.  Some already have done so, but we need more to step up,” Biden said.

The President castigated local and state officials he viewed as an impedimentg to winning the fight against the virus;

Let me be blunt.  My plan also takes on elected officials and states that are undermining you and these lifesaving actions.  Right now, local school officials are trying to keep children safe in a pandemic while their governor picks a fight with them and even threatens their salaries or their jobs.  Talk about bullying in schools.  If they’ll not help — if these governors won’t help us beat the pandemic, I’ll use my power as President to get them out of the way. 

The Department of Education has already begun to take legal action against states undermining protection that local school officials have ordered.  Any teacher or school official whose pay is withheld for doing the right thing, we will have that pay restored by the federal government 100 percent.  I promise you I will have your back,” he stated.

Addressing the increasing violence against mask wearing and other simple measures Biden noted;

In addition to testing, we know masking helps stop the spread of COVID-19.  That’s why when I came into office, I required masks for all federal buildings and on federal lands, on airlines, and other modes of transportation,” he said.

Today — tonight, I’m announcing that the Transportation Safety Administration — the TSA — will double the fines on travelers that refuse to mask.  If you break the rules, be prepared to pay.  And, by the way, show some respect.  The anger you see on television toward flight attendants and others doing their job is wrong; it’s ugly,” he added.

 







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AIDS and HIV

Surviving Voices, “Substance Users, the Recovery Community & AIDS

The Surviving Voices storytelling initiative is being recognized for its powerful work in helping tell the story of AIDS

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Surviving Voices is a program of the National AIDS Memorial (Photo Credit: NAM)

SAN FRANCISCO – The National AIDS Memorial Surviving Voices storytelling initiative is being recognized for its powerful work in helping tell the story of AIDS through the voices of survivors of the pandemic, now in its 40th year.

More than 700,000 U.S. lives have been lost since the first cases of AIDS were first reported in 1981. Today, more than 1.2 million people are living with HIV, with a disproportionate impact in communities of color and in southern U.S. states.

The Memorial has officially released its most recent mini-documentary, “Substance Users, the Recovery Community & AIDS” following exclusive screenings at two LGBTQ+ film festivals – Frameline45 and SF Queer Film Fest 2021.  The mini-documentary, along with deep dive personal interview segments with survivors and advocates, can be viewed on the Memorial’s website at www.aidsmemorial.org.

“The National AIDS Memorial is honored to have our Surviving Voices mini-documentary featured at these influential film festivals,” said Chief Executive John Cunningham. “It speaks to the important work our organization is doing to share these powerful personal stories of hope, resilience and the journey of survivors around the issue of HIV/AIDS and addiction in an authentic and powerful way.”

“Substance Users, the Recovery Community & AIDS” focuses the camera on the unique challenges of HIV/AIDS faced by this community. Through personal stories of survival, the film powerfully captures the journey of AIDS advocates and those of individual survivors living with HIV/AIDS who have struggled simultaneously with the disease of addiction, in raw, honest and forthright conversations.  It depicts their individual strength, power, hope and resilience, the importance of community, spirit, self-respect, and the will to live with dignity and pride.  It also shows their vulnerabilities, the shame, denial, stigma, and hopelessness they have experienced. 

As Queer Chaplain Bonnie Violet Quintana shares, “I can be as I am. Me getting HIV. Me being in recovery – all of that is a big part of Me.” 

The National AIDS Memorial’s Surviving Voices mini-documentaries are produced and directed by Jörg Fockele and funded through a grant by Chevron, a long-standing partner of the National AIDS Memorial. Community partners include the San Francisco AIDS Foundation, The Elizabeth Taylor 50-Plus Network, Stonewall Project and the Castro Country Club.

“We believe in the power of storytelling and the lessons it can teach current and future generations,” said Huma Abbasi, General Manager, Health & Medical at Chevron. “Our long-time support for Surviving Voices is part of our commitment to sharing the very human experiences that have shaped 40 years of the AIDS epidemic. At Chevron, our success is tied to the progress and prosperity of the communities where we operate. In line with the U.N. Sustainable Development Goals, we believe that healthy, educated communities are critical to that success.”

Surviving Voices is a program of the National AIDS Memorial created to ensure the myriad stories and lessons of the epidemic are captured, curated, and retained for current and future generations.  “Substance Users, the Recovery Community & AIDS” is the sixth film produced in this multi-year oral history initiative, which also includes “The Transgender Community & AIDS,” “The A&PI Community & AIDS,” “Women & AIDS,” “The National Hemophilia Community & AIDS,” and “The San Francisco Leather Community & AIDS.”

“I hope that these mini-documentaries will be as inspiring for current and future generations confronting their own challenges as they were for us when we filmed them,” said Fockele.

Learn more about the Surviving Voices, the National AIDS Memorial, its mission, programs and how to provide support at www.aidsmemorial.org.

Surviving Voices Mini-Documentary: Substance Users, Recovery Community and AIDS:

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