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Dr. Nina Vasan: mental health challenges facing LGBTQ+ youth

Dr. Nina Vasan, clinical assistant professor at Stanford University School of Medicine offers advice on mental health resources

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Dr. Nina Vasan, clinical assistant professor at Stanford University School of Medicine/Facebook

NEW YORK – Over the past few years, right-wing state legislatures and elected public education officials have turned schools across the U.S. into political battlegrounds, ushering in a new wave of policies designed to restrict the rights of LGBTQ+ students.

Dr. Nina Vasan, clinical assistant professor at Stanford University School of Medicine and chief medical officer at Real, talked with The Los Angeles Blade about how LGBTQ+ students and their families can protect their mental health in hostile educational environments, including by seeking help from qualified therapists. 

“All kids deserve to not be the target of political issues,” she said, and the politicization of LGBTQ+ identities can create environments in which young people will often experience “more open hostility and discrimination.” 

LGBTQ+ students need adult allies in their schools to “proactively create safe spaces,” Dr. Vasan said. Examples may include offering school-based clubs and support groups or hanging “safe space” signs in classrooms and integrating LGBTQ+ people and themes into curricula, she said.

However, some school officials, such as members of the board of Minnesota’s Becker Public School district, have enacted or are considering measures to expressly forbid some or all of these activities. So have state legislatures, with Florida’s widely derided “Don’t Say Gay” bill a notable example. 

Students in many cases have responded in kind by voicing their opposition to and mobilizing resistance against such policies and practices. For instance, in Florida alone, among other youth-led initiatives The Blade has covered a campaign to unseat radical right-wing school board officials in Flagler County and demonstrations against the state’s “Don’t Say Gay” bill, after it was signed into law by Gov. DeSantis in March.

For some students, Dr. Vasan said political organizing “can be healthy and helpful and give a strong sense of purpose and meaning,” but she cautioned young people should protect themselves by, for example: (1) finding a trusted adult who can help, including by providing advice on how best to navigate the school or school board’s political environment; (2) prioritizing one’s physical and psychological health by keeping an eye out for safety concerns or threats of retribution – weighing the pros and cons of each action accordingly; and (3) connecting with LGBTQ+ nonprofit and advocacy organizations whose considerable experience and resources can make political organizing efforts more effective and potentially less risky. 

Dr. Vasan said that regardless of whether they choose to lead walkouts and launch petitions, it is critical for young people, particularly those who identify as LGBTQ+, to have ready access to mental health resources. “Proactive and preventive mental health care is so important,” and it is crucial for youth “to get professional help if they are struggling with their mental health.” 

Thankfully, Dr. Vasan has a variety of recommendations on that front. 

Advice for LGBTQ+ youth in search of mental health related resources and services 

A smart first step for students who may be interested in seeking help from a therapist is to solicit recommendations for providers from their existing clinicians, such as a primary care physician or pediatrician, Dr. Vasan said. 

Alternatively, “The Trevor Project is an incredible organization that has a collection of supportive resources, including therapists, counselors, peer community, and educational resources such as articles and FAQs,” Dr. Vasan said, adding that Yelp and Psychology Today are also excellent – the latter allowing users to search for mental health professionals who accept their insurance coverage and specialize in caring for LGBTQ+ patients. 

Of course, financial considerations are key. Ideally with help from parents or a trusted adult, Dr. Vasan said potential patients should evaluate each potential provider’s cost per session, insurance coverage, and whether and how their insurance plan could be used to pay for an out-of-network provider. 

“If one on one therapy is cost prohibitive, look at group therapy and other community resources that might be offered by places like your school, community centers, local nonprofit organizations, and LGBTQ+ support groups,” Dr. Vasan said. 

It pays to do some research online and consult with existing providers if possible to explore all available options. These days, telehealth visits are widely available in lieu of in-person visits, though Dr. Vasan cautioned that providers must nevertheless be licensed in the state where the patient resides. Some clinics offer low-cost therapy or charge patients on a sliding scale according to what they can afford, she added. 

One option that affords some flexibility is Real. Dr. Vasan described the service as “unique and effective, providing members with high quality care at a lower price point (for just $13 a month!)” She said the platform operates “outside the traditional 1:1 therapy model,” with a
“monthly membership that provides a suite of on-demand, digital tools for some of the most commonly felt inner-struggles.”

Dr. Vasan recommends setting up initial sessions with a few clinicians – giving each some background information beforehand, and then evaluating which is the best fit. 

“Think ahead of time what your goals are in therapy and after you meet with them, review this and reflect on who you felt comfortable with, who seemed to provide the space that makes you feel safe, who gave good insights into their assessment and plan for your diagnosis and/or treatment,” she said.

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Monkeypox

LA County Public Health expands Monkeypox vaccination eligibility

Eligible residents can go to a Public vaccinating site or visit Myturn.ca.gov to find other vaccinating sites near you

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Photo Credit: County of Los Angeles

LOS ANGELES – The Los Angeles County Department of Public Health has expanded eligibility to the monkeypox vaccine to closely align with the Centers for Disease Control and Prevention’s recent expansion, which includes persons in select occupational groups whose jobs may expose them to orthopoxviruses (such as monkeypox).

Monkeypox vaccine will be available to residents who self-attest to being in the following groups:

  • Gay, bisexual or other men who have sex with men or transgender people who have sex with men or other transgender people
  • Persons of any gender or sexual orientation who engage in commercial and/or transactional sex
  • Persons living with HIV, especially persons with uncontrolled or advanced HIV disease
  • Persons who had skin-to-skin or intimate contact with someone with suspected or confirmed monkeypox, including those who have not yet been confirmed by Public Health
  • (NEW) Sexual partners of people in any of the above groups
  • (NEW) People who anticipate being in any of the above groups

Monkeypox vaccine is also available for persons in select occupational groups whose may be exposed to orthopoxviruses including:

  • Research laboratory personnel working with orthopoxviruses
  • Clinical laboratory personnel performing diagnostic testing for orthopoxviruses
  • Designated public health response team members
  • Health care personnel who administer ACAM2000 (Smallpox [Vaccinia] Vaccine)
  • Designated health care workers who care for persons with suspected or confirmed orthopoxvirus infections, including clinicians and environmental services personnel

Note that the risk of monkeypox transmission remains very low for health care workers if appropriate personal protective equipment is worn and other infection control practices are followed.

Eligible residents can go to a Public vaccinating site or visit Myturn.ca.gov to find other vaccinating sites near you.

Residents do not need to show ID in order to get a vaccine at sites run by Public Health. However, because residents may need to show vaccination record and ID if you travel or visit certain venues, it is recommended that when getting a vaccine that residents provide the name that is on their ID.

Residents who met prior eligibility criteria can still get vaccinated (see below for prior criteria).

Gay or bisexual men or transgender people who:

  • Had multiple or anonymous sex partners in the past 14 days
  • Had skin-to-skin or intimate contact with persons at venues or events in the past 14 days
  • Had a history of early syphilis or gonorrhea in the past 12 months
  • Are on HIV pre-exposure prophylaxis (PrEP)
  • Had anonymous sex or sex with multiple partners in the past 21 days in a commercial sex venue or other venue.

Residents who have monkeypox symptoms or are currently under isolation for monkeypox, should not come to the vaccination clinics or walk-up sites. If residents think they have monkeypox, they should speak with a provider and get tested. If residents do not have a provider, residents can call the Public Health Call Center for more information on monkeypox, including general information, testing, treatment, and vaccines at (833) 540-0473 (open 7 days a week 8am – 8:30pm).

For more information, please visit: http://publichealth.lacounty.gov/monkeypox/.   

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Monkeypox

Los Angeles County Supervisors approve sick leave for monkeypox

Both coronavirus and the monkeypox outbreak has disproportionately affected essential workers, who are predominantly Black and Latino

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The Los Angeles County Board of Supervisors meeting room (Photo Credit: County of Los Angeles)

LOS ANGELES – The Los Angeles County Board of Supervisors unanimously passed a motion Tuesday, sponsored by Supervisors Hilda Solis and Sheila Kuehl, which directs County attorneys to report back to the board in three weeks on how the County could implement a paid sick leave policy for people who contract monkeypox, or other new and emerging infectious diseases.

The Board also is urging California Governor Gavin Newsom to extend the state’s coronavirus supplemental paid sick leave by signing the AB-152 COVID-19 relief leave bill.

Supervisor Solis prior to the vote pointed out that both coronavirus pandemic and the monkeypox outbreak has disproportionately affected essential workers, who are predominantly Black and Latino.

Solis further noted that without a form of paid sick leave, are in most cases, unable to take the recommended five to 10 days to isolate for COVID-19 — much less the two to four weeks needed to isolate for the duration of a monkeypox diagnosis as recommended by the Centers for Disease Control and Prevention as well as the County Dept. of Public Health .

During a monkeypox townhall hosted by the Blade in East Los Angeles last week, which was also attended by Supervisor Solis, Sherrill Brown, M.D, AltaMed’s Medical Director of Infection Prevention, in her presentation noted the need for economic relief.

In her practice treating primarily Latino monkeypox cases at AltaMed clinics in Los Angeles and Orange Counties, she told the townhall attendees she was hearing some of her patients were having difficulty with the required isolation protocols because of their economic needs.

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Monkeypox

Unvaccinated 14 times more likely to contract monkeypox

Racial disparities persist in new cases of monkeypox as Black & Latino people are overrepresented in the numbers

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White House Monkeypox Response Team and Public Health Officials (Screenshot/YouTube)

WASHINGTON – U.S. health officials are celebrating preliminary data on the vaccine used in the monkeypox outbreak, which has led them to conclude eligible persons who didn’t get a shot were 14 times more likely to become infected than those who are vaccinated.

The new data, as described by health officials on the White House monkeypox task force during a call with reporters on Wednesday, comes as the overall number of new cases of monkeypox is in sharp decline, although considerable racial disparities persist in the remaining cases as Black and Latino people are overrepresented in the numbers.

Rochelle Walensky, director of the Centers for Disease Control & Prevention, said during the conference call the preliminary data — collected from 32 states between July 2022 and September 2022 — provides an early shapshot of the effectiveness of the vaccine and cause for optimism on the path forward.

“These new data provide us with a level of cautious optimism that the vaccine is working as intended,” Walkensky said. “These early findings and similar results from studies and other countries suggest even one dose of the monkeypox vaccine offers at least some initial protection against infection.”

Walensky during the conference call admitted the data is incomplete in numerous ways. For example, the data is based on information on individuals who have obtained only the first shot as opposed to both shots in the two-shot vaccination process. (The data showing positive results from individuals who have only one shot contradicts previous warnings from the same U.S. health officials that one shot of the monkeypox vaccine was insufficient.)

The data also makes no distinction between individuals who have obtained a shot through subcutaneous injection, a more traditional approach to vaccine administration, as opposed to intradermal injection, which is a newer approach adopted in the U.S. guidance amid the early vaccine shortage. Skeptics of the new approach have said data is limited to support the idea the intradermal injection is effective, particularly among immunocompromised people with HIV who have been at higher risk of contracting monkeypox.

Not enumerated as part of the data were underlying numbers leading health officials to conclude the unvaccinated were 14 times more likely to contract monkeypox as opposed to those with a shot, as well as any limiting principle on the definition of eligible persons. Also unclear from the data is whether individual practices in sexual behavior had any role in the results.

Despite the positive data on the monkeypox vaccine based on one shot, U.S. health officials warned during the conference call the two-shot approach to vaccine administration is consistent with their guidance and more effective.

Demetre Daskalakis, the Biden administration’s face of LGBTQ outreach for monkeypox and deputy coordinator for the White House monkeypox task force, made the case that for individuals at risk obtaining a second dose is “really important.”

“So we see some response after the first [shot] in the laboratory, but the really high responses that we want to really get — that you know, level 10 forcefield as opposed to the level five forcefield — doesn’t happen until the second dose,” Daskalakis said. “So the important message is this just tells us to keep on trucking forward because we need that second dose at arms that people haven’t gotten the first should start their series of two vaccines.”

Also during the call, health officials said they would be expanding opportunities for vaccines as pre exposure prophylaxis, as opposed to practices in certain regions granting vaccines in their limited supply to individuals who meet certain criteria or have had risk of exposure.

The Centers of Disease Control & Prevention, officials said, is also updating its guidance to allow injection of the vaccines in places other than a patient’s arm.

Daskalakis said fear of stigma about getting a noticeable shot in the forearm after obtaining a monkeypox vaccine was a key part of the decision to issue the new guidance on implementation.

“Many jurisdictions and advocates have told us that some people declined vaccine to monkeypox because of the stigma associated with the visible but temporary mark often left on their forearm,” Daskalakis said. “New guidance from CDC allows people who don’t want to risk a visible mark on their forearm to offer a vaccine on their skin by their shoulder or their upper back. Those are areas more frequently covered by clothes.”

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