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Health

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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Health

FDA oks adverts for first condom specifically designed for anal intercourse

FDA authorized One Male Condom also aa a contraceptive to reduce risk of pregnancy and the transmission of STIs during vaginal intercourse

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Courtesy of Global Protection Corp.

WASHINGTON – Boston, Massachusetts-based Global Protection Corporation, a world leader in manufacturing and distributing sexual health products, condom manufacturing, lubricant manufacturing and much more was granted permission by the U.S. Food and Drug Administration, (FDA), to market its condoms designed for anal intercourse.

On Wednesday, the FDA authorized the marketing of the One Male Condom, are also indicated as a contraceptive to help reduce the risk of pregnancy and the transmission of STIs during vaginal intercourse.

Before today’s authorization, the FDA had not cleared or approved condoms specifically indicated for anal intercourse. Unprotected anal intercourse carries the greatest sexual exposure risk of HIV transmission. Consistent and correct condom use has the potential to significantly help decrease the risk of STIs. While today’s authorization underscores the public health importance of condoms tested and labeled specifically for anal intercourse, all other FDA-cleared condoms can continue to be used for contraception and STI prevention. It’s important to continue to use condoms consistently and correctly to reduce the risk of STI transmission, including HIV, and to prevent pregnancy.

“The risk of STI transmission during anal intercourse is significantly higher than during vaginal intercourse. The FDA’s authorization of a condom that is specifically indicated, evaluated and labeled for anal intercourse may improve the likelihood of condom use during anal intercourse,” said Courtney Lias, Ph.D., director of the FDA’s Office of GastroRenal, ObGyn, General Hospital, and Urology Devices in the Center for Devices and Radiological Health.

“Furthermore, this authorization helps us accomplish our priority to advance health equity through the development of safe and effective products that meet the needs of diverse populations. This De Novo authorization will also allow subsequent devices of the same type and intended use to come to the market through the 510k pathway, which could enable the devices to get on the market faster,” she added.

The One Male Condom is a natural rubber latex sheath that covers the penis. It has three different versions: standard, thin and fitted. The fitted condoms, available in 54 different sizes, incorporate a paper template to aid in finding the best condom size for each user. When used during anal intercourse, the One Male Condom should be used with a condom-compatible lubricant.

The safety and efficacy of the One Male Condom was studied in a clinical trial comprised of 252 men who have sex with men and 252 men who have sex with women. All participants were between 18 through 54 years old.  

The study found that the total condom failure rate was 0.68% for anal intercourse and 1.89% for vaginal intercourse with the One Male Condom. Condom failure rate was defined as the number of slippage, breakage or both slippage and breakage events that occurred over the total number of sex acts performed.

For the One Male Condom, the overall percentage of adverse events was 1.92%. Adverse events reported during the clinical trial included symptomatic STI or recent STI diagnosis (0.64%), condom or lubricant-related discomfort (0.85%), partner discomfort with lubricant (0.21%) and partner urinary tract infection (0.21%).

The symptomatic STI or recent STI diagnoses observed in the study were self-reported and may be the result of subjects having intercourse without a condom or may have preceded use of the One Male Condom, as STIs were not measured at baseline.

The FDA reviewed the One Male Condom through the De Novo premarket review pathway, a regulatory pathway for low- to moderate-risk devices of a new type. Along with this De Novo authorization, the FDA is establishing criteria called special controls that define the requirements related to labeling and performance testing.

When met, the special controls, in combination with general controls, provide a reasonable assurance of safety and effectiveness for devices of this type. This action also creates a new regulatory classification, which means that subsequent devices of the same type with the same intended use may go through the FDA’s 510(k) pathway, whereby devices can obtain clearance by demonstrating substantial equivalence to a predicate device.

The FDA granted the marketing authorization to Global Protection Corp.

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AIDS and HIV

New highly-infectious variant of HIV discovered by Dutch scientists

This new variant of HIV-1 damaged the immune system twice as fast, “placing individuals at risk of developing AIDS much more rapidly”

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The human immunodeficiency virus in the bloodstream (Photo Credit: NIH/CDC)

CAMBRIDGE, UK – A study published this week by Science (journal) detailed an alarming discovery by researchers, clinicians and epidemiologists in the Netherlands of a new, highly-infectious mutated variant strain of the human immunodeficiency virus, (HIV), circulating in the country.

The BEEHIVE project – which stands for “bridging the epidemiology and evolution of HIV in Europe and Uganda,” detailed the findings which showed that a distinct subtype-B viral variant of HIV-1 damaged the immune system twice as fast, “placing individuals at risk of developing AIDS much more rapidly”, and those with this variant were at a higher risk of transmitting the virus to others.

The variant, known as the “VB variant”, causes CD4 cell decline to occur twice as fast in infected individuals compared with other viral variants. This is a clinical hallmark, or “signature” of the extent of damage caused by the HIV virus. In addition, those infected with the VB variant also demonstrated an increased risk of transmitting the virus to others, the data suggests.

Individuals infected with the new “VB variant” (for virulent subtype B) showed significant differences before antiretroviral treatment compared with individuals infected with other HIV variants:

  • Individuals with the VB variant had a viral load (the level of the virus in the blood) between 3.5 and 5.5 times higher.
  • In addition, the rate of CD4 cell decline (the hallmark of immune system damage by HIV) occurred twice as fast in individuals with the VB variant, placing them at risk of developing AIDS much more rapidly.
  • Individuals with the VB variant also showed an increased risk of transmitting the virus to others.

The project’s researchers, clinicians and epidemiologists did determine however, that those infected with the VB variant had “similar immune system recovery and survival to individuals with other HIV variants.”

However, the researchers stress that because the VB variant causes a more rapid decline in immune system strength, this makes it critical that individuals are diagnosed early and start treatment as soon as possible.

BEEHIVE project‘s lead author Dr Chris Wymant, from the University of Oxford’s Big Data Institute and Nuffield Department of Medicine, said: “Before this study, the genetics of the HIV virus were known to be relevant for virulence, implying that the evolution of a new variant could change its impact on health. Discovery of the VB variant demonstrated this, providing a rare example of the risk posed by viral virulence evolution.”

“Our findings emphasize the importance of World Health Organization guidance that individuals at risk of acquiring HIV have access to regular testing to allow early diagnosis, followed by immediate treatment. This limits the amount of time HIV can damage an individual’s immune system and jeopardise their health. It also ensures that HIV is suppressed as quickly as possible, which prevents transmission to other individuals,” Senior author Professor Christophe Fraser from the University of Oxford’s Big Data Institute and Nuffield Department of Medicine, added.

In its Global HIV & AIDS statistics — Fact sheet, the UNAIDS Secretariat detailed the statistical data: 

GLOBAL HIV STATISTICS

  • 28.2 million people were accessing antiretroviral therapy as of 30 June 2021.
  • 37.7 million [30.2 million–45.1 million] people globally were living with HIV in 2020.
  • 1.5 million [1.0 million–2.0 million] people became newly infected with HIV in 2020.
  • 680 000 [480 000–1.0 million] people died from AIDS-related illnesses in 2020. 
  • 79.3 million [55.9 million–110 million] people have become infected with HIV since the start of the epidemic.
  • 36.3 million [27.2 million–47.8 million] people have died from AIDS-related illnesses since the start of the epidemic.

People living with HIV                                                                          

  • In 2020, there were 37.7 million [30.2 million–45.1 million] people living with HIV.
    • 36.0 million [28.9 million–43.2 million] adults.
    • 1.7 million [1.2 million–2.2 million] children (0–14 years).
    • 53% of all people living with HIV were women and girls.
  • 84% [67– >98%] of all people living with HIV knew their HIV status in 2020.
  • About 6.1 million [4.9 million–7.3 million] people did not know that they were living with HIV in 2020.

People living with HIV accessing antiretroviral therapy

  • As of 30 June 2021, 28.2 million people were accessing antiretroviral therapy, up from 7.8 million [6.9 million–7.9 million] in 2010.
  • In 2020, 73% [56–88%] of all people living with HIV were accessing treatment.
    • 74% [57–90%] of adults aged 15 years and older living with HIV had access to treatment, as did 54% [37–69%] of children aged 0–14 years.
    • 79% [61–95%] of female adults aged 15 years and older had access to treatment; however, just 68% [52–83%] of male adults aged 15 years and older had access.
  • 85% [63– >98%] of pregnant women living with HIV had access to antiretroviral medicines to prevent transmission of HIV to their child in 2020.

New HIV infections

  • New HIV infections have been reduced by 52% since the peak in 1997.
    • In 2020, around 1.5 million [1.0 million–2.0 million] people were newly infected with HIV, compared to 3.0 million [2.1 million–4.2 million] people in 1997.
    • Women and girls accounted for 50% of all new infections in 2020.
  • Since 2010, new HIV infections have declined by 31%, from 2.1 million [1.5 million–2.9 million] to 1.5 million [1.0 million–2.0 million] in 2020.
    • Since 2010, new HIV infections among children have declined by 53%, from 320 000 [210 000–510 000] in 2010 to 150 000 [100 000–240 000] in 2020.

AIDS-related deaths

  • AIDS-related deaths have been reduced by 64% since the peak in 2004 and by 47% since 2010.
    • In 2020, around 680 000 [480 000–1 million] people died from AIDS-related illnesses worldwide, compared to 1.9 million [1.3 million–2.7 million] people in 2004 and 1.3 million [910 000–1.9 million] people in 2010.
  • AIDS-related mortality has declined by 53% among women and girls and by 41% among men and boys since 2010.
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Coronavirus

CDC: 85% of gay & lesbian adults in U.S. are vaccinated against COVID

Data on COVID-19 vaccination among LGBTQ persons limited because of the lack of routine SOGI data collection at the national & state levels

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Photo Credit: Centers for Disease Control and Prevention/GSA

ATLANTA – A new study report released Friday by the Centers for Disease Control and Prevention, (CDC), found that found 85.4% of gay and lesbian Americans above age 18 had received at least one vaccine dose as of October 2021.

The study, conducted from August 29 until October 30, 2021, also found that by comparison, only 76.3% of heterosexuals reported receiving at least an initial dose by the same date.

The report noted that Lesbian, gay, bisexual, and transgender (LGBT) populations have higher prevalence of health conditions associated with severe COVID-19 illness compared with non-LGBT populations.

The potential for low vaccine confidence and coverage among LGBT populations is of concern because these persons historically experience challenges accessing, trusting, and receiving health care services

Data on COVID-19 vaccination among LGBT persons are limited, in part because of the lack of routine data collection on sexual orientation and gender identity at the national and state levels.

In March of 2021, the Blade reported the coronavirus (COVID-19) pandemic has revealed deep-seated inequities in health care for communities of color and amplifies social and economic factors that have contributed to those communities being hit hardest, and Mega-vaccination centers set up by California health officials and the Federal Emergency Management Agency have been addressing and tracking the issue- the LGBTQ communities are still not being tracked.

This lack of data collection has frustrated and angered California State Senator Scott Wiener who authored a bill last year that passed through the legislature and signed by Governor Gavin Newsom last Fall that mandates gathering sexual orientation and gender identity data related to the COVID testing in California.

“We’re one year into the pandemic, and LGBTQ people continue to be erased in our public health response to COVID-19 — similar to our invisibility throughout history. No government is successfully tracking COVID-19 cases in the LGBTQ community, despite a law I wrote mandating that California do so,” Weiner told the Blade. “And, we now know that LGBTQ people are more vulnerable to COVID-19. We’ve also just learned that vaccination demographic data doesn’t include LGBTQ data. It simply shocking that in 2021, progressive health agencies continue to forget about our community,” he added.

The CDC also noted that gay and lesbian adults were more likely to be concerned about COVID-19 and to believe in the safety and efficacy of vaccines.

“We know that the prevalence of certain health conditions associated with severe COVID-19 illness, such as cancer, smoking, and obesity, are higher in LGBT populations, and access to health care continues to be an issue for some people in the LGBT community,” Dr. A.D. McNaghten, a member of the CDC’s COVID-19 Emergency Response Team and corresponding author of the study, told ABC News. “We wanted to see if vaccination coverage among LGBT persons was the same as non-LGBT persons.”

The CDC data recorded that bisexual and transgender adults had similar vaccination rates to heterosexual adults with 72.6% of bisexual adults fully vaccinated by the end of October, as were 71.4% of transgender adults. The numbers however for Black and Hispanic lesbian women had lower rates of vaccination at 57.9% and 72.6%, respectively, compared to Black and Hispanic heterosexual women at 75.6% and 80.5%, respectively.

Higher percentages of gay or lesbian adults and bisexual adults reported that they thought COVID-19 vaccine was very or somewhat important to protect oneself (90.8% and 86.8%, respectively) compared with heterosexual adults (80.4%), and higher percentages of adults who identified as transgender or nonbinary reported they thought COVID-19 vaccine was very or somewhat important to protect oneself (83.2%) compared with those who did not identify as transgender or nonbinary (80.7%).

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