Category Archives: Commentary

Health Alert: An open letter from multiple LGBTQ+ leaders and medical experts regarding COVID-19

An open letter from the Gay and Lesbian Medical Association:

As the spread of the novel coronavirus a.k.a. COVID-19 increases, many LGBTQ+ people are understandably concerned about how this virus may affect us and our communities. The undersigned want to remind all parties handling COVID-19 surveillance, response, treatment, and media coverage that LGBTQ+ communities are among those who are particularly vulnerable to the negative health effects of this virus.

Our increased vulnerability is a direct result of three factors:

  • LGBTQ+ population uses tobacco at rates that are 50% higher than the general population.[1]. COVID-19 is a respiratory illness that has proven particularly harmful to smokers.
  • The LGBTQ+ population has higher rates of HIV and cancer, which means a greater number of us may have compromised immune systems, leaving us more vulnerable to COVID-19 infections.
  • LGBTQ+ people continue to experience discrimination, unwelcoming attitudes, and lack of understanding from providers and staff in many health care settings, and as a result, many are reluctant to seek medical care except in situations that feel urgent – and perhaps not even then. In addition, there are more than 3 million LGBTQ+ older people living in the United States.
  • LGBTQ+ elders are already less likely than their heterosexual and cisgender peers to reach out to health and aging providers, like senior centers, meal programs, and other programs designed to ensure their health and wellness, because they fear discrimination and harassment. The devastating impact of COVID-19 on older people – the current mortality rate is at 15% for this population – makes this a huge issue for the LGBTQ+ communities as well.[2]

LGBTQ+ communities are very familiar with the phenomena of stigma and epidemics. We want to urge people involved with the COVID-19 response to ensure that LGBTQ+ communities are adequately served during this outbreak. Depending on your role, appropriately serving our communities could involve any of the following actions:

  • Ensuring that media coverage notes the particular vulnerabilities of any person with pre-existing respiratory illnesses, compromised immune systems or who uses tobacco products.
  • While populations – like LGBTQ+ communities – can be at increased risk, it is important to note the overall state of health that contributes to any person’s increased vulnerability to contracting COVID-19.
  • Ensuring health messaging includes information tailored to communities at increased risk for COVID-19, including LGBTQ+ populations. An example of such tailored messaging is including imagery of LGBTQ+ persons in any graphic ads.
  • Providing LGBTQ+ individuals resources to find welcoming providers, such as the ones provided here, if they are experiencing symptoms like a cough or fever and need to seek medical attention.
  • Ensuring funding to community health centers is distributed in a fashion that accounts for the additional burden anticipated by LGBTQ-identified health centers.
    Whenever possible ensuring health agencies partner with community-based organizations to get messaging out through channels we trust.
  • Ensuring surveillance efforts capture sexual orientation and gender identity as part of routine demographics.
  • Ensuring health workers are directed to provide equal care to all regardless of their actual or perceived sexual orientation, gender identity/presentation, ability, age, national origin, immigration status, race, or ethnicity.
  • Ensuring that all COVID-19 responses take into account exceptionally vulnerable members of the LGBTQ+ communities, including our elders, bi people, and black and brown trans and gender nonconforming/nonbinary people.

Since xenophobic responses are heavily impacting the Asian American communities, ensuring all communications and responses related to COVID-19 attempt to counter any such xenophobic responses, avoid racial profiling, and discourage the public from doing so as well.
Ensuring LGBTQ+ health leadership, along with all providers and health care centers, are provided with timely and accurate information to disseminate.

As LGBTQ+ community and health leadership, the undersigned organizations offer to stand shoulder to shoulder with the mainstream health leadership to make sure we learn from history and do not allow any population to be disproportionately impacted or further stigmatized by a virus.

[Find out what  you can do to protect  yourself, if you are at a higher risk of infection, at https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html]

Initial Signers:
National LGBT Cancer Network
GLMA: Health Professionals Advancing LGBTQ Equality
Whitman-Walker Health
SAGE
New York Transgender Advocacy Group
National Queer Asian Pacific Islander Alliance

Additional Signers:
Advocates for Youth
Advocating Opportunity
Alder Health Services
Antioch University MFA Program
Athlete Ally
Atlanta Pride Committee
BiNet USA
Black Lives Matter Houston
Bradbury-Sullivan LGBT Community Center
California LGBTQ Health and Human Services Network
Callen-Lorde Community Health Center
CARES
Center on Halsted
CenterLink: The Community of LGBT Centers
Compass LGBTQ Community Center
Corktown Health Center
Counter Narrative Project
CreakyJoints & Global Healthy Living Foundation
CrescentCare
Darker Sister Center
Deaf Queer Resource Center
Desert AIDS Project
Desi Queer Diaspora
Equality California
Equality Federation
Equality North Carolina
Erie Gay News
Family Equality
Fenway Health
GALAEI
Gay City: Seattle’s LGBTQ Center
Gender Equality New York, Inc. (GENY)
Gender Justice League (Washington State)
Georgia Equality
GLAAD
GLBT Alliance of Santa Cruz
Greater Erie Alliance for Equality
Greater Palm Springs Pride
Harvey Milk Foundation
Hetrick-Martin Institute
HIV AIDS Alliance of Michigan
HIV Medicine Association
Horizons Foundation
Howard Brown Health
Human Rights Campaign
Independence Business Alliance
Indiana Youth Group
Infectious Diseases Society of America
Inside Out Youth Services
InterPride
Keystone Business Alliance
Lambda Legal
Lansing Area AIDS Network (LAAN)
Lansing Association for Human Rights
Legacy Community Health
LGBT Center of Greater Reading
LGBT Center of Raleigh
LGBT Elder Initiative
LGBTQ Center OC
MassEquality
Matthew Shepard Foundation
Milwaukee LGBT Community Center
Minority Veterans of America
National Center for Lesbian Rights
National Center for Transgender Equality
National Coalition for LGBT Health
National Equality Action Team
National LGBTQ Task Force
Newburgh LGBTQ+ Center
No Justice No Pride
Oasis Legal Services
Oklahomans for Equality
Our Family Coalition
Out Alliance
Out And Equal
Out Boulder County
OutCenter of Southwest Michigan
OutFront Kalamazoo
OutRight International
Pennsylvania Youth Congress
Persad Center, Inc.
PFund Foundation
Pizza Klatch
Positive Women’s Network
Pride Center of the Capital Region
Pride Center Of Vermont
Princess Janae Place Inc
Rainbow Community Center of Contra Costa County
Rockland County Pride Center
San Francisco AIDS Foundation
SAVE – Safeguarding American Values for Everyone
SERO Project
SF LGBT Community Center
SisTers PGH
St. James Infirmary
Still Bisexual
The LGBTQ Center Long Beach
The LOFT LGBT Community Services Center
The Montrose Center
The Social Impact Center
The Source LGBT+ Center
The Trevor Project
Thomas Judd Care Center
Thundermist Health Center
Transgender Education Network of Texas (TENT)
Transgender Legal Defense & Education Fund
Triangle Community Center
Trillium Health
TriVersity Center for Gender and Sexual Diversity
UNIFIED-HIV Health and Beyond
U.S. People Living with HIV Caucus
Wellness AIDS Services
William Way LGBT Community Cente
___
[1] Buchting et al. 2017; Creamer et al. 2019
[2] Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72?314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. Published online February 24, 2020. doi:10.1001/jama.2020.2648

NIH statement for World AIDS Day 2019

From the NIH

Ending the HIV Epidemic: A Plan for America aims to close this implementation gap. NIH-funded advances in effective HIV prevention, diagnosis, treatment and care are the foundation of this effort. In addition, expanded partnerships across HHS agencies, local community organizations, health departments, and other organizations will drive new research to determine optimal implementation of these advances. This type of research is called “implementation science,” and is essential to translate proven tools and techniques into strategies that can be adopted at the community level, particularly for communities most vulnerable to HIV.

Understanding what works to prevent and treat HIV at the community level is critical to the success of the Ending the HIV Epidemic plan. More than 50% of new HIV diagnoses in 2016 and 2017 occurred in just 50 geographic areas: 48 counties; Washington, D.C.; and San Juan, Puerto Rico. Seven states also have a disproportionate occurrence of HIV in rural areas. For its first five years, the new initiative will infuse new resources, expertise, and technology into communities in those key geographic areas.

However, communities are more than just geography. On World AIDS Day, we are reminded that Ending the HIV Epidemic must take place “Community by Community.” The people affected by HIV are a part of unique communities often shaped by differences in race, ethnicity, gender, culture, and socioeconomics. To reach people who have different needs, preferences, and choices, and ensure that HIV treatment and prevention tools can work in their lives, we must go beyond a “one-size-fits-all” approach.

Read the full statement on the NIH Website.

More evidence in support of needle exchange programs

In his State of the Union Address earlier this year, President Trump announced the laudable goal of eliminating HIV transmission by the year 2030. Needle exchange programs (also called Syringe Exchange Programs or SEPs) are a public health approach in use since the 1980s with a proven record of reducing the spread of HIV, hepatitis, and other blood-borne infectious diseases. I have presented much of the data supporting needle exchange programs here and, more recently, here. Now, new research reported in the Journal of Acquired Immune Deficiency Syndrome adds even more strength to the argument in favor of needle exchange programs.

Jeffrey A. Singer is a Senior Fellow at the Cato Institute and works in the the Department of Health Policy Studies

Because most of the averted cases would have received publicly funded health care, the study’s authors then translated averted cases into cost savings for the two cities.Using surveillance data of HIV diagnoses associated with intravenous drug use from Philadelphia and Baltimore, cities where needle exchange programs had been permitted since the early 1990s, their analysis concluded that more than 10,000 cases of HIV were averted in Philadelphia from the years 1993 to 2002, and nearly 1,900 cases were averted in Baltimore from 1995 to 2004.

The forecasts estimated an average of 1,059 HIV diagnoses in Philadelphia and 189 HIV diagnoses in Baltimore averted annually. Multiplying the lifetime costs of HIV treatment per person ($229,800) by the average number of diagnoses averted annually in both cities yields an estimated annual saving of $243.4 million for Philadelphia and $62.4 million for Baltimore. Considering diagnoses averted over the 10-year modeled period, the lifetime cost savings associated with averted HIV diagnoses stemming from policy change to support SEPs may be more than $2.4 billion and $624 million dollars for Philadelphia and Baltimore, respectively. Because SEPs are relatively inexpensive to operate, overall cost savings are substantial even when deducting program operational costs from the total amount.

Needle exchange programs have long been endorsed and encouraged by the Centers for Disease Control and Prevention, the Surgeon General of the United States, the World Health Organization, the American Public Health Association, and the American Medical Association. Nevertheless, needle exchange programs are legally permitted to operate in only 28 states and the District of Columbia. Drug paraphernalia laws make them illegal elsewhere.

Some critics argue that needle exchange programs “enable” or “endorse” intravenous drug use. Such moralizing is not appropriate in this context. Addiction is a behavioral disorder characterized by “compulsive use despite negative consequences.” Preventing organizations from providing an effective means of harm reduction to people with addiction who continue to use drugs is akin to denying insulin to diabetics who continue to make dangerous eating choices.

It is not unrealistic to set a 10-year goal for ending HIV transmission. Needle exchange programs are essential for that to happen.

Conversation about HIV is changing

By John-Manuel Andriote, author of Stonewall Strong

Let’s talk about drugs—specifically, drugs that keep HIV-positive gay men like me “undetectable,” and the drugs used in PrEP (pre-exposure prophylaxis) that, when taken daily, can prevent HIV-negative gay men (and others) from becoming infected.

John-Manuel Andriote

That’s essentially the theme for this year’s Gay Men’s HIV/AIDS Awareness Day—today, September 27—“The Conversation About HIV Is Changing: Talk Undetectable. Talk PrEP.”

But if we only talk about drugs to prevent and treat HIV, and don’t talk about the trauma behind gay men’s high-risk sexual and drug-use choices, we’ll see that same trauma continue to play out in our disproportionately high rates of crystal meth abuse, alcoholism, and other potentially harmful sexually transmitted infections besides HIV.

There is no question that today’s HIV drugs have dramatically changed the conversation about HIV. From the terrible illness and death that almost inevitably followed a positive HIV test 30 years ago, those of us living with the virus today can expect to live a virtually normal lifespan—so long as we adhere to treatment.

Read the full article.

Celebrating those who are aging with HIV

From the LA Blade
by Frank Gulli

I was living in the Castro in San Francisco in 1978 where optimism and liberation were in the air. Harvey Milk was an openly gay City Supervisor, gays and lesbians marched in the street for equal rights, and gay liberation was on display from Folsom Street to Golden Gate Park.

Frank Gulli

There was a real sense of belonging to a community. Our world shook when Harvey Milk and Mayor Moscone were assassinated by former Supervisor Dan White that year. Then it shook again when San Francisco became ground zero of the AIDS epidemic.

By 1985, the city was full of heartbreak and dying. My friends and I lived among it, terrified that we would be next. I was diagnosed with HIV that year, forever making 1985 a pivotal year.

Many of my friends who hadn’t been tested for HIV ended up in the ER at San Francisco General in respiratory failure. I was blindsided as an entire group of my friends and neighbors seemed to disappear overnight. There were no medical treatments, other than some antibiotics that seemed to prolong death for many.

For whatever reason, maybe by the grace of God, or good Italian food, I don’t know, I never got sick from HIV and I held on to hope for a better day. But my life and times would never be the same as it was back in 1978, before the shooting death of Harvey, when we felt liberated, before AIDS wiped out my entire phonebook.

Continue reading.

We won’t end the HIV epidemic until we help the most vulnerable

How do we reduce rates concentrated among black and Latino men who have sex with men? Or meet the needs of HIV-positive patients caught between insurance plans or places to live? To end the epidemic, we must start where we began — by focusing on those most affected, uniting advocacy efforts, pushing for a cross-sector response and focusing on the social determinants of health.

As someone who has spent the better part of my professional career as both an advocate and HIV public health expert, I’ve been reflecting on the decades-long fight for gay rights sparked by people who gathered together at Stonewall in 1969 to demand change for the LGBTQ+ community and put an end to years of discrimination. Not long after, the AIDS epidemic swept across the country, closely intertwining the movement for increased LGBTQ+ rights with the AIDS response. Gay rights groups were relentless in pushing for increased government attention and funding as thousands died from the disease. Activists organized “buyers clubs,” lobbied for faster FDA approval of promising drugs and countered the fear and discrimination people living with AIDS faced.

Read the full article.

Pride month includes HIV Long-Term Survivors Awareness Day

From the Human Rights Campaign

As we celebrate Pride Month, it is also important that we honor those in the LGBTQ community who are long-term survivors living with HIV. June 5 was chosen as HIV Long-Term Survivors Awareness Day to mark when the first case of AIDS was reported in the U.S. in 1981.

Long-time HIV survivor Elder Claude Bowen, M.Div

At the time, a person diagnosed with HIV or AIDS could expect to live only one to two years after that diagnosis. In the four decades since, more than 70 million people have been diagnosed with HIV worldwide and approximately 35 million people have died, according to the World Health Organization. People age 55 and older make up 26% of all Americans living with HIV, according to the Centers for Disease Control and Prevention.

In recent years, the LGBTQ community has benefited from biomedical interventions such as Pre-exposure prophylaxis (PrEP), a medication that prevents HIV when taken as prescribed. Yet, this medication is not always accessible to those most at risk for HIV, including Black and Latinx gay, bisexual and transgender people.

HRC spoke with three long-term survivors living with HIV to learn their stories.

See the interviews on the HRC Website.