My phone buzzed the other day with a long missive from a friend to a group Facebook chat we share with my husband and his fiancé. Earlier in the day, he had invited me and my husband over for dinner at their apartment. In the spirit of social distancing, I responded by suggesting maybe we do something outdoors—perhaps a picnic or a walk in the park?
He was furious. He felt like we were avoiding their “COVID germs.” After a series of angry messages, he left the group chat—the digital equivalent of a gauntlet-drop.
I looked at my husband, speechless. Had COVID-19 just caused a different kind of loss, our friendship?
We all manage and respond to risk differently—and with varied emotions. Most of us are becoming well acquainted with the small daily frustrations of encountering people engaging in behaviors once considered perfectly normal but now labeled as risky: shopping for groceries without a mask, walking too closely to others, or coughing without covering your face. But as my friend made clear, we can also find frustration in others we believe are being overprotective or too risk-averse.
As a sociologist who has studied how gay men practice and manage HIV risk, I think a lot about the way diseases shape our behaviors, emotions, and, ultimately, our social worlds. HIV is fundamentally different from COVID-19 in that it cannot be transmitted through casual contact like handshakes or shared Uber rides. Nonetheless, in order to navigate HIV risk, we engage in a similar kind of mental calculus.
Some gay men think the risk of contracting the disease is well worth the potential pleasures of eschewing condoms with a one-night stand. Other gay men recoil at the thought, so wary of HIV that they meticulously practice condom use or even avoid casual sex altogether (indeed, that recoil can at times translate into shame projected onto anyone who doesn’t take the same precautions). As anyone who has spent time cruising for sex online knows well, clashing views on risk and pleasure can lead to plenty of hurt feelings and libidinous disappointment.
HIV and COVID-19 risk can both put distance between us, but the pleasures interrupted are of a different stripe. For HIV, we take risk in search of human connection and sexual pleasure. For COVID-19, even the most ordinary of behaviors have become suddenly risky: sharing a meal, taking a walk, going to a movie. Avoiding COVID-19 is forcing us to deprive ourselves of all the many pleasures of life, both sexual and platonic.
Our new marching orders for our now-COVID-ridden lives seems straightforward enough: avoid gatherings, wear masks in public, wash your hands vigorously. But for most of us, the truth is more complicated. We are faced with a social isolation that hurts. And the promise of connection is not trivial or superfluous: we crave it. We need it.
Whether we are aware of it or not, we’ve all been doing a sort of risk-calculus in our heads these last few weeks. Is it OK to take a walk with my friend? Do we need to wear masks? Should I say yes to the invitation from my parents to come stay with them for a long weekend? For those of us that are single, is dating even possible anymore?
A tipping point in those risk-equations we all have been making these last few weeks is coming. As the loss of human connection and intimacy takes an ever-greater emotional and psychological toll, the potential risk of contracting COVID-19 won’t be enough to keep us away from those we love. For some, especially those suffering from depression, isolation will become unbearable to the point of even becoming deadly.
As restrictions lift and we come out of our isolation, many of our phones will buzz with eager invitations from friends asking to get together and connect—for dinner, a walk, or to get coffee. But we won’t all be ready to take those risks at the same time.
Try not to take it personally. The truth is we are all aching from the pain of isolation. We miss you. And in the words of Queen Elizabeth, I long for the day that “we will meet again.”
Lyon-Martin Health Services in San Francisco has served the health needs of lesbians, transgender women and other underserved women in the Bay Area since 1979. Named after pioneering lesbian activists Phyllis Lyon and Del Martin, the clinic had until recently been seeing 3,000 patients a year for such needs as physical exams, gynecologic services and consultations for gender-affirming surgeries.
Now, however, it is fighting to keep its doors open amid the coronavirus pandemic. Thanks to emergency funding from the city and private donors, it will be able to operate until July 1 without deep cuts to its services — which now include screening for COVID-19 — but its future is uncertain after that.
“The city needs to see how long COVID is going to play out,” J.M. Jaffe, the transgender health manager at Lyon-Martin, told NBC News. “They wanted to do a short-term contract so that we could re-evaluate what the situation will be in two months. I think they were just wary to make a commitment to continue to support us, but we did get kind of like a wink and a nod that they would like to support us to the end of the calendar year.”
Lyon-Martin Health Services is one of over 200 LGBTQ health clinics across the United States that provide affirming and competent care to lesbian, gay, bisexual, transgender and queer patients. And like Lyon-Martin, a number of these centers are struggling to adjust to — and in some cases survive — the new normal spawned by the global pandemic.
‘A gap of a support network’
Approximately 13 percent lesbian, gay and bisexual individuals in the U.S. reported getting their regular health care from an LGBTQ-centered clinic, according to a 2019 study from UCLA’s Williams Institute. A separate study found nearly 40 percent of transgender people reported having been to an LGBTQ clinic in the previous five years.
“We provide services to a population that may not seek care elsewhere or even if they do seek it elsewhere, they may not get what they need,” Jaffe said.
Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, said if some of these clinics do not survive the pandemic, the void will be felt deeply, especially in areas of the country where LGBTQ people face high levels of discrimination.
“It leaves a gap of a support network, but also may not provide another opportunity or option in some communities to get nondiscriminatory care, which is a concern,” she told NBC News.
LGBTQ discrimination in health care is not uncommon. A 2018 studyfrom the liberal Center for American Progress found 8 percent of lesbian, gay, bisexual and queer people and 29 percent of transgender people reported that a doctor or health care provider had refused to see them because of their sexual orientation or gender identity. The study also found that 9 percent of LGBQ people and 21 percent of trans people reported having a health provider use harsh or abusive language when treating them.
The Callen-Lorde Community Health Center in New York City, the epicenter of the U.S. pandemic, is doing all it can to stay open and provide patient care amid stay-at-home orders and declining revenues.
The COVID-19 crisis has forced the center, which sees over 17,000 patients annually, to pivot to virtual health care and cut a number of services, leading revenues to plummet nearly 60 percent, according to Executive Director Wendy Stark. But with many of their patients not feeling comfortable seeking care elsewhere, Stark said she and her team are “being innovative” to stay open.
“We have lived through traumas and pandemics. We know how to take care of ourselves and each other.”
CALLEN-LORDE EXECUTIVE DIRECTOR WENDY STARK
Callen-Lorde is currently helping clients by providing a number of online services, including video visits for primary medical care, behavioral health and counseling, along with legal aid and insurance consultation services by phone. The center’s in-person services include appointments for those who do not have access to smartphones or internet connections, and those who are pre-authorized for in-person visits.
The clinic is also working to protect its own front-line workers, approximately 20 percent of whom contracted the coronavirus, according to Stark. She said regular floor nurses are now “acting as intensive care unit nurses,” and everyone’s “being stretched to their maximum clinical capacity” and “having to learn on the spot.”
“I’m sure, deeply rewarding but also deeply frightening,” she added.
While providing health services, Stark and her team are also applying for “every possible” relief fund or grant available to help make it through the crisis.
“We are shapeshifters,” she said. “We have lived through traumas and pandemics. We know how to take care of ourselves and each other.”
In Philadelphia, the Mazzoni Center, which typically sees over 7,500 patients a year, is also trying to adapt. This has meant a combination of limiting in-person appointments on a case-by-case basis, implementing and expanding its remote health care offerings and finding ways to continue as many community programs as possible online.
Larry Benjamin, a spokesperson for the center, said the clinic has had to furlough some staffers and reduce the hours of others to keep it viable “in the short term”.
The center is still allowing abbreviated in-person appointments for things like HIV services and gender-affirming care, but Benjamin said staffers have been careful to ensure “the risks associated with exposure to the coronavirus” from patients to staff and vice versa don’t outweigh the benefit of in-person visits. Behavioral health services, such as medication management, support groups and counseling services, are being offered exclusively online, as are counseling for COVID-19 stressors. Most community programs have also been moved online, but those that cater to the “most vulnerable clients” and their basic needs, like food and shelter, are still operating in-person, according to Benjamin.
Fenway Health in Boston, which saw 33,500 patients in 2019, has also seen a loss in revenue amid the pandemic, leading it to furlough some staffers and operate at an “unsustainable deficit,” according to Chris Viveiros, a spokesperson for the center. To help weather the storm, he said the center has increased its virtual offerings.
“Some medical patients have chosen to reschedule nonurgent appointments, but we have ramped up our medical telehealth capacity so that we can provide care remotely to patients who don’t require an in-person visit,” he said. “We have also moved our behavioral health and addiction and wellness care to telehealth.”
Fenway Health has also changed its Access Drug User Health program from being held in drop-in centers to having staff visit at-risk people in the community to limit contact.
There have been some drawbacks to Fenway’s remote health services: Some patients are sheltering in place with unsupportive people and have nowhere to privately participate in a video visit, while others may be skeptical of a new platform for accessing health services altogether.
“Many of our community served have a history of medical mistrust and ongoing mistrust of the health care system due to structural discrimination and victimization,” explained Dr. Alex Keuroghlian, director of the Fenway Institute’s National LGBT Health Education Center and Massachusetts General Hospital’s Psychiatry Gender Identity Program.
However, Keuroghlian said there have been some silver linings to Fenway’s new remote offerings. Primarily, many patients are able to access health care from the safety and comfort of their own home without having to venture outside, potentially exposing themselves to anti-LGBTQ abuse — or the coronavirus.
“By and large, I have found it has worked really well,” he said. “I’ve had almost no no-shows in my schedule, and patients are answering the phone very appreciative that we can give them care despite what’s happening.”
Dr Richard Friedman, the psychoanalyst responsible for debunking the myth that homosexuality can be cured, has sadly passed away at the age of 79.
As a young man Friedman stood out in his field by becoming the first to combine findings in psychobiology, gender identity and family studies with psychoanalytic theory.
His revolutionary 1988 book, ‘Male Homosexuality: A Contemporary Psychoanalytic Perspective,’ showed that sexual orientation was largely biological, not mental.
It had a major impact at a time when most other psychoanalysts were continuing to describe homosexuality as a “perversion”, even though the American Psychiatric Association had stopped classifying it as an illness by 1973.
“I felt an ethical obligation to find the reasons for anti-homosexual prejudice,” he once told an interviewer, according to the New York Times.
His wife, Susan Matorin, explained his motivation more simply: “Straight people had the same personality issues, and they got away with murder, but gay people were stigmatised, and he didn’t think that was right.”
“He very much felt like you followed the science, and it didn’t matter what the political backdrop was,” his son,Jeremiah, added.
Using studies of identical twins and theories of developmental psychology, Friedman argued that it was biology, rather than upbringing, which played a significant role in sexual orientation.
The controversial position was a direct challenge to popular Freudian theories and thrust him into the centre of debates alongside more established heavyweights of his field.
“Given that he was a younger colleague, it was brave of him to take older experts on,” Jack Drescher, a professor of psychiatry at Columbia University, told the New York Times.
Friedman went on to publish an article on female homosexuality which received an award from The Journal of The American Psychoanalytic Association as the best publication of 1998.
His work on sexuality was well ahead of its time – just last year the American Psychoanalytic Association issued a belated apology for treating homosexuality as an illness, acknowledging that its past errors contributed to discrimination and trauma for LGBT+ people.
The implications of his work continue to have an impact today as LGBT+ advocates battle against the discredited practice of conversion therapy, which is still legal in most parts of the world.
Dr Richard Friedman sadly died on March 31 at his home in Manhattan. Although his cause of death has not yet been determined, he reportedly struggled for years with health problems, including cardiac and metabolic conditions.
He is survived by a wife, son, two daughters and two grandchildren.
The Trump administration is moving to scrap an Obama-era policy that protected LGBTQ patients from discrimination, alarming health experts who warn that the regulatory rollback could harm vulnerable people during a pandemic.
The health department is close to finalizing its long-developing rewrite of Obamacare’s Section 1557 provision, which barred health care discrimination based on sex and gender identity. The administration’s final rule on Thursday was circulated at the Justice Department, a step toward publicly releasing the regulation in the coming days, said two people with knowledge of the pending rule.
The White House on Friday morning also updated a regulatory dashboard to indicate that the rule was under review. Advocates fear that it would allow hospitals and health workers to more easily discriminate against patients based on their gender or sexual orientation.
Read the full article. As I’ve previously reported, this change has been long coming. Apparently the Trump administration figures they can finally push it through relatively unnoticed during the relentless pandemic news. They may be right.
The director of the U.S. Centers for Disease Control and Prevention warned that a potential second wave of the novel coronavirus could be far more fatal than the current phase of the pandemic because it may overlap with the beginning of flu season this winter.
Government leaders at all levels must use the months ahead to prepare for such a resurgence even as some states announce plans to resurrect their economies, CDC Director Robert Redfield told The Washington Post in a wide-ranging interview published Tuesday.
“There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through,” Redfield told the Post. “And when I’ve said this to others, they kind of put their head back, they don’t understand what I mean.”
The health official said the virus could be harsher in a second wave because having concurrent outbreaks of the flu and COVID-19, the disease caused by the novel coronavirus, would put immense pressure on the nation’s health care system. Both viruses cause respiratory symptoms and can require similar protective gear and medical equipment.
Redfield also said that government leaders must stress the need to continue social distancing as states lift stay-at-home orders, as well as exponentially scale up each state’s ability to identify infected residents through testing and then trace back others they’d come in contact with.
But Trump just this week dismissed bipartisan concerns about states not having adequate supplies, claiming that the U.S. was testing people “at a number nobody thought possible.”
“Not everybody believes we should do so much testing,” Trump said during Monday’s coronavirus briefing. “You don’t need so much. The reason that the Democrats and some others maybe … they want maximum because they want to be able to criticize, because it’s almost impossible to get to the maximum number, and yet we’ve been able to do it already.”
TRUMP: “Not everybody believes we should do so much testing. You don’t need so much. … Democrats and some others … want maximum because they want to be able to criticize because it’s almost impossible to get to the maximum number and yet we’ve been able to do it already.”94:44 PM – Apr 20, 2020Twitter Ads info and privacy25 people are talking about this
The White House released criteria last week for states to review how to best restore their economies in phases, including being required to first record 14 days of declining cases and to establish strong testing programs. The CDC has also created detailed guidelines for state and local governments on how to ease mitigation efforts to support a safe reopening, which Redfield told the Post will be “in the public domain shortly.”Subscribe to The Morning Email.Wake up to the day’s most important news.
Despite public demands to reopen the economy, a new set of HuffPost/YouGov polling found that the overwhelming majority of Americans support their state’s stay-at-home orders and are making a concerted effort to follow them. The most recent survey, conducted last Friday through Sunday, suggested that 86% of Americans were trying to stay home as much as possible, and about 65% said they would continue to stay home even if their area lifted all restrictions.
Part of the preparation for a potential second wave of COVID-19 includes convincing Americans to get their flu shots in the coming summer months so that public health officials can minimize the number of people hospitalized for one of the two respiratory illnesses. Redfield told the Post that getting vaccinated for the flu “may allow there to be a hospital bed available for your mother or grandmother that may get coronavirus.”
After the Food and Drug Administration changed the rules for blood donations from gay and bisexual men earlier this month, coronavirus survivor Lukus Estok saw an opportunity to help other patients recover from the disease.
For years, the FDA has restricted men who have had sex with men in the preceding year from donating blood, but loosened its rules on April 2 as a way to address a sharp drop in donors during the coronavirus outbreak.
Within days, Estok tried to donate blood plasma for a test program in New York City that treats severely ill COVID-19 patients with plasma from patients who have developed antibodies and recovered from the disease. He said he was turned away after revealing he was gay.
“I was shocked,” said Estok, 36. “I’ve been through a month of hell with this virus. I’m finally recovered. I’ve been through a screening process that tells me I’m a potential candidate to help somebody else and now I’m being told I can’t.”
NBC News found that despite the rule change hundreds of the nation’s blood centers are still unable to accept blood from gay men, even though there’s a desperate need for blood at U.S. hospitals and a desire to get plasma with antibodies from COVID-19 survivors. Both the Red Cross and America’s Blood Centers, which together represent 800 banks nationwide, told NBC News they haven’t been able to accept donations.
Estok and other gay men who have tried to give blood since April 2 have been unable to do so because many blood donation centers have not yet trained staffers or updated their computer systems to accommodate the new rule. It’s also because a trade group to which nearly all U.S. blood banks belong has not yet gotten approval for an important document from the FDA.
In 1985, as a way to block the transmission of HIV, the FDA blockedall men who had had sex with other men after 1977 from donating blood. The rule was changed to sex within the past 12 months in 2015, and then to sex within the past three months on April 2.
Gay and bisexual men began showing up at blood banks to donate immediately, only to be turned away.
Estok was trying to donate his blood plasma as a part of the Mount Sinai hospital system’s blood plasma therapy program. He found out about the program through friends and knew he wanted to donate his plasma to help others who were sick.
“Having gone through a bit of a horrific experience with the virus and feeling pretty grateful to have come out the other side, I reached out to Mount Sinai,” said Estok.
After multiple screenings, Estok said Mount Sinai called him and said his blood had sufficiently high levels of the needed antibodies and that New York Blood Center would be in touch to schedule an appointment. But once he arrived at New York Blood Center, Estok was told he would be unable to donate.
“I was not expecting the reaction I got,” said Estok on when he told the staff he was gay. “It was like I was radioactive.”
In an exchange that Estok recorded on his phone, the NYBC staff explained to him that they had not yet implemented the FDA’s new guidelines and that the process was “complicated.” Estok was forced to go home without donating plasma.
“I was so upset,” said Estok. “I genuinely want to be able to contribute to help somebody and right now they’re basically putting out messages that they need blood that there’s shortage of blood. But at the end of it, they sent me home.”
An NYBC staffer denied that a potential donor would be asked if he were gay, saying the donor would instead be asked about sexual activity with another man during the past 12 months.
Brandon Gunther, 24, of Sacramento, California, had a similar experience. He attempted to donate at a local blood bank, believing he was eligible under the new guidelines, but was turned away after revealing his sexual history.
“I hadn’t had sex in the past three months so figured I was good to go,” said Gunther. “But the computer rejected my eligibility to donate and I was told ‘you have to remain abstinent from male to male sex for at least one year to be eligible to donate.'”
Gunther says the experience felt discriminatory and jarring.
Blood bank representatives told NBC News the experience has also been frustrating for them, especially since they have been pushing for relaxation of the rules for years. The blood centers can’t just flick a switch and change their rules for donation, they say — making such changes can take months.
Linda Goelzer, a spokesperson for Carter BloodCare in Dallas, said “tons” of people showed up at their facilities the day after the FDA guidelines were announced, believing they were now eligible to donate. The staff were forced to turn them away.
“They were so angry with us,” said Goelzer. “People were calling and saying ‘You lied to us, you’re not following the FDA,’ and it’s so unfair. Every blood center in the country has been advocating for these changes, but we have to go through some very rigorous protocols to make these changes so that we can still keep safety in the blood supply and in the process.”
“When the FDA says the word ‘immediately’ that means something totally different in our world,” said Goelzer. “It takes about three months to implement this stuff but [the FDA] is relying on us to communicate that to the public.”
Kate Fry, CEO of America’s Blood Centers, said that the language in the FDA’s guidance was intended to mean that blood centers should immediately begin the process of implementation, recognizing that it would take some time.
“The struggle is in the public perception that it’s actually blood centers who are stalling the effort,” said Fry. “And that is just not the case at all. They are 100 percent working on it. It just takes time.”
According to Fry and confirmed by the FDA, the phrase “immediate implementation” as used in the FDA’s April 2 press release did not necessarily mean that blood centers could immediately begin collecting blood and plasma from newly eligible donors.
In a statement, an FDA spokesperson said that the agency understands that blood centers will have to undergo a lengthy implementation process and that they are willing to help blood centers if needed.
“We are hopeful that blood collectors will work expeditiously to make the changes needed to implement the modified recommendations so that they may begin collecting blood and blood products under these recommendations as quickly as possible,” said Michael Felberbaum, an FDA spokesperson. “The FDA is available and willing to work with them as appropriate to assist them.”
The question of a questionnaire
The spokesperson for the New York Blood Center, where Estok tried to donate plasma, told NBC News that the delay in implementation involved the time needed to train staff, but also involved receiving an updated Donor History Questionnaire from AABB, a industry group formerly known as the American Association of Blood Banks. AABB’s has more than 1,400 institutional members, accredits “virtually all” the blood centers in the U.S., according to a spokesperson, and collects the majority of the blood donated in the U.S.
In fact, representatives from all blood centers NBC News contacted said they’re currently waiting on AABB’s updated donor history questionnaire to first be approved by the FDA and then released by the industry group, before they can begin the implementation.
The AABB said it submitted its primary documents, including the donor history questionnaire, to the FDA on April 3 – just one day after the FDA announced new donor guidelines. AABB said it has since sent several documents to the FDA. An AABB spokesperson said that as of Monday it had submitted all of the needed documentation to the FDA, and is in touch with the agency, answering any questions it may have.
The FDA says it is reviewing all COVID-19 related items as quickly as possible, but also noted that the AABB’s member organizations don’t actually have to wait for approval of the AABB questionnaire to move forward. If they submit their own questionnaire to the FDA, they can begin accepting donors immediately.
“As noted in the guidance, while licensed blood establishments may wait to use the revised donor questionnaire and accompanying materials provided by industry associations and found acceptable to the FDA, they may also revise or create their own materials to implement these changes immediately upon receipt of this information by the FDA,” said Felberbaum.
Blood centers say that when they do receive an FDA-approved updated questionnaire from AABB, they will still need to update their computer systems and train their staff on new protocols. A spokesperson for Carter BloodCare said that the staff training would take at least 30 days. The NYBC spokesperson said it hopes to be able to receive newly eligible donors by mid-May.
The Red Cross said it anticipates being able to accept newly eligible donors in June. Kate Fry of America’s Blood Centers said she anticipates her network’s centers will be able to accept newly eligible donors in June or July.
‘The policy remains discriminatory in nature’
Gunther and Estok share in outrage from the LGBT community over what they call a discriminatory experience.
“Not only is it imperative that gay and bisexual men who are now able to donate blood be allowed to do so without delay, the FDA must also lift the 3 month deferral in its entirety,” said Sarah Kate Ellis, CEO of GLAAD, a LGBTQ advocacy organization. “The policy remains discriminatory in nature, unaligned with science, and continues to prevent LGBTQ Americans from saving lives.”
But those who are deferred under the old guidelines will still have to wait. Gunther said he wants to encourage others like him to keep trying to donate and not be discouraged if they are turned away.
“We have perfectly good blood to give, and we want to give it and help.”
Kate Fry advised that those who are newly eligible under the FDA guidelines should keep in touch with their local blood bank to check on when the facility expects to finalize implementation.
“We’re so excited to have these individuals become donors again,” said Fry. “We are absolutely working as fast as we can as an industry. Patience is what we ask for our guests during this time and we’ll get them into the fold as quickly as possible.”
A new clinical trial is underway in Spain that will assess whether Truvada, a drug commonly used as PrEP for HIV prevention, can stave off COVID-19 infection among medical practitioners seeking to treat patients amid the pandemic.
If successful, the trial may have broader implications for the general public and not just health workers. But the next step would be awaiting the result of the trials before the drug is determined to be effective.
The study, which began April 1 and is expected to run through the summer, is being conducted at Ramón y Cajal University Hospital in Madrid and sponsored by the Spanish National AIDS Plan, an arm of the Spanish government.
An estimated 4,000 participants will participate in the study, each of whom are medical workers age 18 to 65 working in areas of Spain heavily afflicted with the coronavirus.
Dr. Jose Arribas, research director of HIV and infectious diseases at La Paz Hospital in Madrid, said in Spanish via email to the Washington Blade one underlying basis for testing Truvada against COVID-19 is his findings that relatively few HIV-positive people have the disease.
“We are seeing few cases of HIV-positive people with severe COVID-19,” Arribas said. “This is surprising because the immune system of an HIV-positive person has similarities to that of older people who do have severe cases of COVID-19. Furthermore, there is evidence from in vitro studies support that Truvada can have an immunomodulatory effect.”
Asked whether Truvada could be used for everyone, not just health care workers, if shown to have a positive impact in the study, Arribas replied, “You have to wait for the results of the study before we can answer this question.”
The National Institutes of Health in the United States posted a notice Monday about the test on the agency’s website, which lists ongoing or upcoming clinical trials across the globe.
According to the abstract, the study will seek to assess whether the components of Truvada — as well as hydroxychloroquine, a drug with well publicized potential use against COVID-19 — are effective in preventing coronavirus infection among medical practitioners because “healthcare workers are particularly at risk of SARS-CoV-2.”
“In the absence of a vaccine, other strategies aiming to reduce the development of COVID-19 in the population, more specifically in healthcare workers is being sought,” the abstract says. “Administration of effective drugs to people at risk of developing an infectious disease is well accepted and is part of clinical practice.”
The choice of Truvada for the study, according to the abstract, is the result of anecdotal evidence the medicine may be effective against COVID-19.
“Existing recent and scarce literature shows that RNA synthesis nucleos(t)ide analogue inhibitors, acting as viral RNA chain terminators, like TDF, abacavir or lamivudine, amongst others, could have an effect against SARS-CoV-2 infection,” the abstract says.
Over the course of the 12-week study, administrators will provide daily doses of Tenofovir Disoproxil Fumarate and Emtricitabine, the components of Truvada, Hydroxychloroquine and placebos to study participants.
One group will receive a daily dose of Truvada and a hydroxychloroquine placebo; another will receive hydroxychloroquine and a Truvada placebo; another will receive both drugs; and another will receive a placebo of both drugs.
The trial will assess confirmed infections of COVID-19 as a primary outcome measure, then the severity of disease, including its duration, among confirmed infected participants as a secondary outcome measure.
The initial results of the study are expected to be compiled by June 30, but the study won’t be completed until July 31, the abstract says.
Overseeing the test will be Dr. Rosa Polo of the Spanish National AIDS Plan and Miguel Hernan, an epidemiologist at the Harvard School of Public Health, according to the abstract.
Ramón y Cajal University Hospital in Madrid and the Spanish National AIDS Plan didn’t respond to a request for comment.
Truvada has been brought up as a potential drug to test against COVID-19 among many other medications being assessed for use against the epidemic. Also in the mix is Remdesivir, an antiviral drug the medical experts have said may hold the best chance against COVID-19.
Dr. Sarah Henn, chief health officer of the D.C-based Whitman-Walker Health, welcomed news of the trial in an email responding to the Washington Blade’s request to comment on the study.
“We are happy to see trials focusing on both prevention and treatment of COVID-19 infections and look forward to learning from these results,” Henn said.
Dr. David Hardy, adjunct professor of medicine for the Division of Infectious Diseases at Johns Hopkins University School of Medicine, on expressed skepticism about study because it makes “a big jump” on the use of Truvada for HIV prevention to its use for COVID-19 prevention.
“Truvada for PrEP was created as a new option for trying to prevent those who aren’t infected with HIV,” Hardy said. “If we can use that analogy with COVID-19, we don’t have a treatment that we can easily extrapolate into prevention yet.”
Based on that, Hardy said he’d be more supportive of a study that strictly tested hydroxychloroquine as a means to prevent COVID-19, and not the combination of the drug with Truvada.
“That’s simply because of the fact that we list up some laboratory information that says that hydroxychloroquine does in fact have some anti SARS-CoV-2 antiviral activity,” Hardy said. “We know that it works against the virus, at least in a test tube.”
The Spain study appears strictly to be a project of the Spanish government; U.S. government health officials aren’t involved even though NIH posted an abstract of the study online.
Kathy Stover, a spokesperson for the National Institutes of Health, told the Washington Blade NIH doesn’t have any involvement in the study.
“The study you highlighted is actually not being funded or conducted by the NIH,” Stover said. “It’s being led by the Plan Nacional sobre el Sida (PNS) in Spain.”
Faced with tremendous pressure during the coronavirus crisis to lift its policy barring gay men from donating blood, the Food & Drug Administration announced on Thursday it has eased the restrictions.
While the previous policy, established in 2015, barred men who have had sex with men in the 12 months from making a donation, the new policy would shorten the deferral period, requiring abstinence for only three months.
The FDA indicated it would make a change in a notice to stakeholders on Thursday, indicating the decision was based on “evaluation of the totality of the scientific evidence available.”
“To help address this critical need and increase the number of donations, the FDA is announcing today that based on recently completed studies and epidemiologic data, we have concluded that the current policies regarding the eligibility of certain donors can be modified without compromising the safety of the blood supply,” the notice says.
In addition changing the recommended deferral period for men who have had sex with men from 12 months to 3 months, the FDA informs stakeholders of other changes.
Among them are easing ban on donations for women who have had sex with men who, in turn, previously have had sex with a man. For these women the deferral period has similarly been changed from 12 months to 3 months.
Further, the new policy eases recommended 12 month deferral for individuals with recent tattoos and piercings to three months, and eases from an indefinite ban to a three month ban for donations from people who have a past history of sex in exchange for money, or injection drug use.
Other changes are implemented easing policy related to blood donors who have travelled to malaria-endemic areas, such as countries in Africa, or to European countries where the donors faces potential risk of transmission of Creutzfeldt-Jakob Disease or Variant Creutzfeldt-Jakob Disease.
The FDA issued the notice to stakeholders at the same time it published on its website a 17-page official memo outlining the changes, declaring they were made to address the shortage in the blood supply amid the COVID-19 crisis and therefore would not wait for a public comment period.
“As a result of this public health emergency, there is a significant shortage in the supply of blood in the United States, which early implementation of the recommendations in this guidance may help to address (even though the recommendations in this guidance are broadly applicable beyond the COVID-19 public health emergency),” the memo says.
The three month deferral period is consistent with recommendations from the American Red Cross, which before the coronavirus had called on the FDA to shorten the deferral period.
Without causing alarm, we’d like you to know about a sexually transmitted infection (STI) you probably haven’t heard about but that we’re seeing in people who visit our sexual health clinic Magnet at San Francisco AIDS Foundation. Although the infection Mycoplasma genitalium itself isn’t new, awareness about and testing for this infection is recently on our radar. Here’s what to know.
What is Mycoplasma Genitalium?
Mycoplasma genitalium (we’ll shorten it to MG) is a bacterial infection that can cause symptoms similar to chlamydia. You can get an MG infection in your urethra (penis), vagina and front hole, rectum (butt), and likely in your throat–although there is only testing available for urethral or vaginal infections.
What are symptoms of MG?
Many people don’t get symptoms from an MG infection. If you do have symptoms, they might include burning, stinging or pain when you pee or discharge from your penis. For people with a vagina or front hole, symptoms might include pain or bleeding during sex, pain in your pelvic area, bleeding between periods, and discharge from your vagina or front hole.
How is MG diagnosed?
We diagnose MG by talking to you about your symptoms and sexual history, doing a physical exam, and testing your urine or doing a vaginal swab.
Should you get tested for MG?
If you still have symptoms mentioned above after treatment for gonorrhea and chlamydia, testing of MG may be appropriate. At this time, we are not recommending that people without symptoms get tested for MG. As always, we recommend regular testing for other STIs (gonorrhea, chlamydia and syphilis) even if you don’t have symptoms.
Health care providers might not consider or test for MG infection. So the important thing to know is that if you have symptoms of an STI in your penis, vagina, or front hole, get tested and treated. If you still have symptoms after treatment you might have MG.
If you think you have an MG infection, ask your provider if testing is available for MG, or make an appointment at Magnet if you are in the San Francisco Bay Area.
About MG testing
Testing for MG is done through a urine sample or swab. Once a sample is taken, it is analyzed by a lab for the presence of MG bacteria using the same type of DNA tests that we use for gonorrhea and chlamydia. Usually, it takes 3-5 days for you to find out your result from an MG test.
What is the treatment for MG?
The antibiotic azithromycin can treat MG. About 50% of cases are resistant to azithromycin, which means that the medication won’t cure the infection and you would still have symptoms. In these cases, we use a second type of antibiotic (Moxifloxacin) which requires 7 – 10 days of medication.
Should my partner(s) get tested for MG?
If your partner(s) are experiencing any symptoms, it’s a good idea for them to get tested for STIs. At this time, we don’t recommend that people without symptoms get tested for MG.
Resources
SYMPTOMS OF AN STI?
If you have symptoms of a suspected STI, call our sexual health clinic in the Castro at 415-437-1600.
More than 100 LGBTQ or LGBTQ supportive organizations on March 11 released a joint open letter to health care providers and media outlets urging them to be aware that LGBTQ people may be at greater risk for the Coronavirus than the general public.
D.C.’s Whitman-Walker Health is part of a coalition of six organizations that initiated the letter, according to a statement released by the groups.
Other groups making up the coalition include the National LGBT Cancer Network, Health Professionals Advancing LGBTQ Equality; the LGBTQ senior’s advocacy group SAGE, the New York Transgender Advocacy Group, and the National Queer Asian Pacific Islander Alliance.
“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 letter states.
“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,” the letter says.
“Our increased vulnerability is a direct result of three factors,” the letter continues. “The LGBTQ+ population uses tobacco at rates that are 50 percent higher than the general population,” it says, adding, “COVID-19 is a respiratory illness that has proven particularly harmful to smokers.”
The letter notes that the LGBTQ+ population also 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.”
A third factor making LGBTQ people more vulnerable to the newly discovered virus, the letter claims, is LGBTQ people “continue to experience discrimination, unwelcoming attitudes, and lack of understanding from providers and staff in many health care settings.” As a result, the statement adds, “many are reluctant to seek medical care except in situations that feel urgent – and perhaps not even then.”
The letter recommends that media outlets report on particular vulnerabilities of “any person” with a pre-existing respiratory illness, compromised immune system, or who uses tobacco products. It calls for providing LGBTQ+ individuals with “resource to find welcoming providers” if they are experiencing symptoms like a cough or fever and need to seek medical attention.
The full text of the joint letter and additional information on how LGBTQ people may be impacted by the Coronavirus can be found at cancer-network.org/coronavirus.