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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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Monkeypox

WeHo victim of monkeypox: “This … sucks and you don’t want it”

“I also currently have monkeypox. Here’s what my experience has been like so far and why you should take it seriously”

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Matt Ford (Screenshot via TikTok)

WEST HOLLYWOOD – A 30-year-old actor who divides his time between Los Angeles and New York was infected in the virulent monkeypox outbreak and took to social media and wrote a post on Buzzfeed about his experience with the illness.

Matt Ford, who is openly gay, wrote in a Buzzfeed commentary titled; “I Have Monkeypox — Here’s What It’s Like And What You Should Know,” detailing that he learned that he had been exposed to the illness on June 17. He went to a doctor three days later to be tested, and a few days afterwards, his positive test was confirmed by the Los Angeles County Department of Public Health.

“I also currently have monkeypox. Here’s what my experience has been like so far and why you should take it seriously. Trust me, you don’t want to have it,” Ford wrote.

Ford explained that after the confirmation by the LA County Public Health officials, his lesions grew in number and intensity, so much so that he “couldn’t sleep some nights,” and he also experienced “intense flu-like symptoms: a fever, full-body chills, night sweats, a cough, a sore throat, and swollen lymph nodes” for about a week.

Public Health also issued Ford a stay-at-home order by email.

“It basically said that I’m legally mandated to stay at home and isolate, except for medical visits or emergencies, until fully recovered (more on what that means in a moment),” he noted.

“The pain was a dull, sore constant, with fun little spikes of sharp pain if I moved the wrong way … All that seemed to help were frequent baths and ointments — until I went back to the doctor and was prescribed narcotic painkillers. Even those were only so-so at managing the pain,” he added.

Courtesy of Matt Ford

Currently in Los Angeles County, Public Health has recorded the number of probable and confirmed cases as of July 1, 2022 at 9:00 a.m. to be 35.

In an interview Ford told KTLA: “From the data, this does seem to primarily affect queer men at present. It is by no means a gay disease, it can spread to anyone,” he said. “But at the moment, we’re being primarily affected, so I do worry that will lend itself to some stigma, as we’ve seen in other epidemics. HIV comes to mind, having affected queer men. That’s why I’m being vocal, to try to fight that stigma and reinforce to everyone that there’s no shame in getting this.”

He also thinks public health officials should do more to expedite testing and encourage vaccines.

“If you can get vaccinated, do go get vaccinated, especially if you think you’re in a demographic where you can be more easily exposed to it,” Ford said. “There’s no reason to go through this. It’s unnecessary and miserable.”

Ford advised in his piece; “So, what to do if you think you have monkeypox? First, don’t panic. Do, however, limit your exposure to others, see a health provider as soon as possible, and inform your local department of public health.”

From the Los Angeles County Department of Health:

What is monkeypox and how does it spread?

Monkeypox, a disease caused by infection with monkeypox virus, is a rare disease and does not naturally occur naturally in the US. Monkeypox infections in the US are usually associated with travel to West or Central Africa or contact with imported infected animals. However, as mentioned above, cases of monkeypox have recently been identified in some countries where the virus is not typically found, including in the US, and appear to have spread through human-to-human contact.

Monkeypox can spread when a person has close contact with a person infected with monkeypox virus or when a person comes in contact with materials (e.g., bedding, towels) that are contaminated with the virus. The monkeypox virus can also spread from animals to people.

The monkeypox virus can spread by:

  • Touching monkeypox lesions on a person’s skin
  • Touching contaminated objects, fabrics (clothing, bedding, towels), and surfaces that have been in contact with someone with monkeypox
  • Coming into contact with respiratory droplets or secretions from the eyes, nose and mouth from a person with monkeypox

To prevent the spread of the monkeypox virus, persons should avoid:

  • Oral, anal, and vaginal sex, or touching the genitals or anus of someone with monkeypox
  • Hugging, massaging, kissing, or talking closely with someone with monkeypox
  • Touching shared fabrics, shared surfaces, and objects (e.g. sex toys) used by someone with monkeypox

Symptom onset ranges from 5-21 days.

What does monkeypox look like and what are the symptoms?

All of the above images are from GOV.UK, https://www.gov.uk/guidance/monkeypox

Early signs may include fever, muscle aches, headache, swollen lymph nodes, exhaustion, and sometimes cough or sore throat. A rash may develop often beginning on the face and spreads to other parts of the body, including the hands, feet, eyes, mouth and/or genitals. Rashes may vary in severity between people and change in appearance through infection. Infections can last two to four weeks.

Skin lesions typically begin to develop simultaneously, may appear anywhere on the body, and change from being flat to bumps to blisters before scabbing over and resolving.

Many individuals infected with monkeypox virus have a mild, self-limiting disease with the symptoms lasting from 2 to 4 weeks in the absence of therapy. Monkeypox is usually a self-limited disease. Severe cases can occur.

RASH, BUMPS, OR BLISTERS

FEVER & HEADACHES

MUSCLE ACHES

SWOLLEN LYMPH NODES

How is monkeypox treated?

At this time, there are no specific treatments approved for monkeypox virus infections. Most treatment is supportive, easing the symptoms of illness. However, antivirals developed for use in patient with other viral diseases may prove beneficial in certain cases. Additionally, some measures including vaccination may be given to prevent the monkeypox infection after a high-risk exposure to the virus.

How can I prevent monkeypox? 

The risk to the US population remains low. Those who experience symptoms consistent with monkeypox, such as characteristic rashes or lesions, should contact their health care provider for a risk assessment or call DPH at 2-1-1 for assistance if you do not have a regular provider. This includes anyone who traveled to countries where monkeypox cases have been reported or has had close contact, including sexual contact, with someone who has a similar rash or received a diagnosis of suspected or confirmed monkeypox.

Steps to help prevent monkeypox include:

  • Avoid contact with materials, like bedding, that has been in contact with a sick animal or person infected with this virus
  • Keep infected patients away from others
  • Wash hands with soap and water or use an alcohol-based hand sanitizer after contact with infected animals or humans.
  • Avoid contact with animals that could have the virus (such as animals that are sick or that have been found dead)

There is a vaccine that can prevent monkeypox and can be used, under certain circumstances, for the protection of people who are at high risk of exposure to this disease.

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Monkeypox

2.5 Million more doses of JYNNEOS Monkeypox vaccine ordered by U.S.

The order announced today is in addition to 500,000 doses of vaccine being produced for use in the current response to monkeypox in the U.S

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Photo Credit: County of Los Angeles

WASHINGTON – The U.S. Department of Health and Human Services (HHS) announced Friday that it has ordered an additional 2.5 million doses of Bavarian Nordic’s JYNNEOS, an FDA-licensed vaccine indicated for prevention of smallpox and monkeypox, for use in responding to current or future monkeypox outbreaks and as part of U.S. smallpox preparedness.

The FDA first approved Bavarian Nordic‘s Jynneos vaccine in 2019 as the first vaccine meant to prevent a rare viral infection that affected dozens of people in the Midwest nearly twenty years ago.

The vaccine is meant for adults who are considered to be at high risk of either infection. In addition to being the first FDA-approved monkeypox vaccine, it is also the first non-replicating smallpox vaccine to win the agency’s approval, MedCity News had reported at the time.

A 2003 outbreak in the Midwest marked the first time monkeypox was found outside of its native Africa. Smallpox has been eradicated, but bioterrorism concerns remain.

Deliveries from this latest order of the Bavarian Nordic‘s Jynneos vaccine will begin arriving at the Strategic National Stockpile (SNS) later this year and will continue through early 2023 HHS said in a statement.

“We are working around-the-clock with public health officials in states and large metro areas to provide them with vaccines and treatments to respond to the current monkeypox outbreak,” said HHS Secretary Xavier Becerra. “This order of additional JYNNEOS vaccine will help us push out more vaccine quickly, knowing that we have more doses on the way in the coming months – and is only possible because of our longstanding investment in smallpox and monkeypox preparedness.”

The order announced today is in addition to the 500,000 doses of government-owned vaccine the company is producing in 2022 for use in the current response to monkeypox in the U.S and brings the total vaccine doses to be delivered in 2022 and 2023 to more than 4 million.

The company will produce these doses in liquid frozen form using vaccine already manufactured in bulk under an existing 10-year contract with the Biomedical Advanced Research and Development Authority (BARDA), within the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR); that contract was part of ongoing national preparedness efforts against smallpox.

“The medical countermeasures available to help respond to the current outbreak are the result of years of investment and planning made possible through the ongoing work between HHS and private industry,” said Gary Disbrow, director of the Biomedical Advanced Research and Development Authority. “We are pleased that we have been able to work with our partners at Bavarian Nordic to accelerate delivery of vaccines that can help keep people safe and stem the spread of the virus.”

BARDA supported the development of JYNNEOS, which is approved by the FDA to prevent smallpox and monkeypox. The U.S. government owns enough smallpox vaccine – JYNNEOS and ACAM2000 – to vaccinate millions of Americans, if needed.

As of June 24, ASPR’s SNS held approximately 65,000 doses of JYNNEOS in immediate inventory with delivery of an additional 300,000 doses in the coming days. On June 28, HHS announced that it would immediately make available 56,000 doses and soon after would make available 240,000 additional doses. The SNS also has more than 100 million doses of ACAM2000 which was developed with SNS support and is approved by FDA for use in preventing smallpox. The Centers for Disease Control and Prevention (CDC) currently has an expanded access Investigational New Drug protocol which allows use of ACAM2000 for monkeypox.

In addition, the SNS has over 1.7 million treatment courses of the smallpox antiviral drug TPOXX, which was developed with BARDA support and can be used to treat individuals with monkeypox under an appropriate regulatory mechanism. CDC currently has an expanded access Investigational New Drug protocol which allows its use for monkeypox.

As of June 29, the CDC has received reports of approximately 350 cases of monkeypox in the U.S., primarily among men who have sex with men.

To learn more about monkeypox, visit cdc.gov/monkeypox.

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Monkeypox

Risk of monkeypox infection not high, but ‘numbers may increase’

Fauci said the current outbreak is predominantly among men who have sex with men among individuals who have had sexual contact

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Dr. Anthony Fauci, the director of the National Institute of Allergy & Infectious Diseases & Chief Medical Advisor to the President (Screenshot/YouTube)

WASHINGTON – Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases and the Chief Medical Advisor to the President, who has been at the forefront of the battles against the HIV/AIDS and COVID-19 epidemics, downplayed Wednesday the idea gay and bisexual men are at high risk of contracting monkeypox as the outbreak begins to spread, but cautioned “the numbers may increase.”

“Given the numbers I would not say right now at this particular point, that it is a quote, high risk, but the numbers may increase, which means we just have got to be careful and pay attention,” Fauci said.

Fauci made the remarks in a conference call with reporters from LGBTQ news outlets on the heels of the Biden administration’s announcement that it would ramp up efforts to confront the emerging spread of monkeypox.

On Monday, the Department of Health & Human Services, announced a nationwide vaccination strategy against monkeypox, which consists of providing nearly 300,000 vaccines with priorities for individuals at risk and areas with high rates of infection. An estimated 750,000 vaccines are expected for delivery by the end of summer, according to HHS.

In response to a Blade question about the risk of gay and bisexual men contracting monkeypox, Fauci said that was difficult to quantify and he “wouldn’t say low, because then…that can be taken out of context,” but went on to express there’s a minimal risk of infection if precautions are taken.

“What we’re seeing given the number of cases and the rate in which they’ve accelerated, it’s clearly out there,” Fauci said. “But when you talk about the large number of gay and bisexual men who have sex with men, that on any given individual contact I think if one is careful, and make sure that both parties in a sexual interaction are aware of lesions that might go unnoticed, then you can go a long way in pure prevention to prevent that from happening, but I think it would be risky to classify it as low, medium or high.”

The U.S. has confirmed 306 monkeypox cases across 27 states and Washington, D.C., the Centers for Disease Control announced Tuesday. That represents a surge of 63 cases from the previous week.

Fauci said the current outbreak is predominantly among men who have sex with men among individuals who have had sexual contact. Monkeypox is technically not a sexually transmitted disease, Fauci said, because it’s spread through skin-to-skin contact, but “because of the close skin to skin interaction that occurs in sexual contact, that appears to be the modality spread.” Monkeypox, Fauci said, is “not fundamentally a lethal infection.”

Raj Panjabi, senior director for global health security and biodefense on the White House National Security Council, was also on the call and said the Biden administration’s monkeypox plan consists of “three pillars” of testing, vaccines, and outreach.

“In terms of outreach, there is no effective response to an outbreak without a community based response,” Panjabi said. “And so we’ve worked to ensure an open dialogue with leaders and stakeholders in the LGBTQIA+ community. What we’ve been doing is to try to understand from those most affected by this outbreak, learn from them, help them stay vigilant within the community to protect themselves from the disease and try to adjust our response according to the gaps that they’ve raised.”

The rise in monkeypox infections comes during Pride month, a time when LGBTQ community is engaged in celebrations and oftentimes in close contract and intimate settings, including sexual activity.

Asked by a reporter with NBC News whether this weekend’s Pride celebrations may have fueled the spread, Fauci said in theory “the risk is probably increased” in Pride activities “because people tend to get involved in sexual networking there,” but precautions at the end of the day would mitigate new infections.

“You don’t want to panic people but you want to get people to appreciate, particularly with the Pride activities that are going on now, to be aware and to just be careful,” Fauci said. “And being careful can be very practical, but making sure that you’re aware of things like skin lesions or lesions around areas of the body, particularly when you’re having a sexual encounter. Those are the things we’re trying to do.”

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