Health

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Health and Human Services takes stand against nonconsensual intersex surgeries

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The U.S. Department of Health and Human Services has released its first reporton health equity for intersex people, opposing nonconsensual surgeries on this population and making recommendations for best practices.

There is “growing evidence that surgical interventions on intersex infants can cause lasting harm, including stigma and medical mistrust,” says the report, titled “Advancing Health Equity for Intersex Individuals.” It comes from the Office of the Assistant Secretary for Health, which is headed by Adm. Rachel Levine, the first out transgender official confirmed by the U.S. Senate.

The report notes that being intersex is not synonymous with being trans or nonbinary, although some intersex people may also identify as nonbinary or trans. Intersex is “an umbrella term to refer to people born with differences or variations in their sex characteristics or reproductive anatomy,” the report says. There are about 5 million intersex people in the U.S. and more than 40 identified variations defined as intersex, in addition to some that have not been named.

“Intersex variations are most commonly identified at birth or during puberty, but it is also not uncommon for adults to discover they have intersex traits while seeking fertility care or through unrelated medical procedures,” it continues. “While many intersex individuals may require specialized health care, for many intersex people, their variations in sex characteristics are a healthy part of human diversity and do not pose any threats to overall health. Nevertheless, many intersex individuals report facing medical interventions because their variations in sex characteristics have been treated as a medical disorder.”

“Historic and current medical practices have often focused on surgical interventions on infants to change their sex characteristics to conform with a single sex, rather than the health care needs of the intersex individual,” the report notes. “Research and advocacy from intersex individuals has documented that non-consensual, medically unnecessary interventions for intersex infants can cause lifelong harm. These interventions impact people into adolescence and adulthood, and intersex adults face significant barriers in accessing high-quality care that affirms and meets their needs.”

Negative effects of these surgeries include “significant scarring, loss of sexual function, urinary or vaginal complications, chronic pain, or early-onset osteoporosis,” according to the report. Yet doctors often encourage parents to have surgeries on intersex infants right away so that the child won’t grow up to be “different” and to avoid informing these children that they were born intersex.

Many intersex adults don’t receive proper cancer screenings, sexual health care, or fertility counseling, and they may be reluctant to disclose their intersex status to medical providers for fear of discrimination. Also, they suffer disproportionate rates of trauma and mental health issues due to lack of affirming care.

“To combat medical mistrust, training for the next generation of health care professionals must account for both the medical and interpersonal needs of intersex patients, especially young children,” the report recommends. “When intersex individuals receive appropriate and affirming social support and mental health care, they can thrive.”

Thanks to the activism of intersex people and their allies, practices are improving, but more needs to be done, according to the document. The recommendations include enacting strong nondiscrimination protections; promoting bodily autonomy, informed consent, and inclusivity in health care settings; and “ensuring all non-emergent care is guided by the express wishes of the intersex individual themselves.”

InterACT Advocates for Intersex Youth praised the report. “This report is a victory for the right of intersex children to make their own choices about their own bodies,” interACT Executive Director Erika Lorshbough said in a press release. “Non-consensual surgeries intended to alter a child’s sex traits to fit male or female boxes have major repercussions such as trauma and health complications later in life. interACT is encouraged to see a report by the Department of Health and Human Services acknowledge this fact, caution against these harmful practices, and recommend a whole-health approach to intersex care.”

“With today’s report, HHS clearly recognizes that intersex health equity is thwarted by subjecting infants and young children with variations in their sex characteristics to non-emergency surgical interventions to which they cannot consent,” added Sylvan Fraser Anthony, legal and policy director at interACT. “Those who still perform such procedures must comprehend the direct link between the deprivation of bodily autonomy and the lifelong harm their patients go on to suffer. This report also should prompt medical providers to consider the legal liability inherent in a practice that treats a variation from sex stereotypes as a justification for exposure to harm.”

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Supreme Court will decide if insurance companies must cover PrEP for HIV prevention, cancer screenings

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TheU.S. Supreme Court has agreed to hear a pivotal case that could significantly impact access to preventivehealth care under the Affordable Care Act, including life-saving HIV prevention drugs like pre-exposure prophylaxis or PrEP. The court granted the petition on Friday. The case, which the federal government petitioned for the court’s intervention, is set to be argued this spring, with a decision expected before the Court’s term ends in June.

The Advocate was the first to report on the existence of this case back in 2022 when it was revealed that conservative attorney Jonathan Mitchell was representing Braidwood Management, Inc., aTexas-based business, and other plaintiffs in challenging the ACA’s requirement that insurers cover preventive services like PrEP without cost-sharing. The plaintiffs, claiming that coverage of PrEP violates their religious beliefs, argue that it promotes “homosexual behavior.”

Initially, U.S. District Judge Reed O’Connor sided with the plaintiffs, ruling that the ACA mandate violated their religious rights. However, the Department of Justice swiftly appealed, and the Fifth Circuit Court upheld the district court’s decision butlimited the scope of its effect. The decision meant that while the plaintiffs are exempted, the broader mandate requiring insurance providers to cover preventive services, including PrEP, remains in effect nationwide.

The case is now headed to the Supreme Court, where it will be argued that the ACA’s coverage requirements, which have been instrumental in reducing HIV transmission and improving public health, should be upheld.

At the heart of the case is the structure of the U.S. Preventive Services Task Force, which issues recommendations for preventive services like PrEP. The Fifth Circuit Court of Appeals ruled that the Task Force’s structure violated the Appointments Clause of the U.S. Constitution.

The government maintains that the Task Force operates within constitutional bounds, with members serving as “inferior officers” under the secretary’s supervision, that this structure is consistent with constitutional requirements, and that it is vital to ensure that essential preventive services are covered under the ACA.

The case also raises the specter of rolling back coverage for a range of other critical preventive services, including cancer screenings, diabetes prevention, and vaccinations—services that have long been proven to save lives and reduce health care costs. If the court upholds the Fifth Circuit’s ruling, the federal mandate requiring insurers to cover Task Force recommendations could be significantly weakened, disrupting the health care protections millions of Americans currently rely on.

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CDC Warns COVID Rates Have Tripled In Recent Weeks

CNN reports:

In the week ending December 21, there was nearly three times as much Covid-19 circulating in the US than there was during the week ending December 7, CDC data shows.

This surge happened in all regions of the country, but there has been a particularly sharp uptick in the Midwest, where Covid-19 levels are nearly twice as high as they are in other parts of the country.

Some experts worry that the rapid rise after an unusually long lull could have left many people vulnerable to disease spread at the height of the holiday season.

Read the full article.

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As HHS secretary, RFK Jr. would be a direct threat to LGBTQ+ health

Among Donald Trump’s Cabinet nominees, it’s hard to choose who is the most dangerous to LGBTQ+ rights. But it’s easy to pick out who is the most dangerous to LGBTQ+ health: Robert Kennedy Jr. As the nominee to run the Department of Health and Human Services (HHS), Kennedy has the potential to make literal life-and-death decisions about the nation’s health. But his crackpot ideas are a direct threat to the very issues that can matter most to the LGBTQ+ community. 

Much has been made of Kennedy’s conspiracy-ridden, fringe beliefs. He believes that vaccines cause autism, even though abundant evidence has shown no link. He has said that COVID-19 “is targeted to attack Caucasians and Black people” and “the people who are most immune are Ashkenazi Jews and Chinese.” He thinks fluoride in the water supply, which is proven to reduce dental disease, can cause everything from arthritis to bone cancer. He believes that Prozac is a reason for the outbreak of school shootings. 

But not as much has been made about how Kennedy’s ideas have dire implications for the health of LGBTQ+ Americans. For one thing, the would-be secretary of HHS is an AIDS denialist. In his 2021 book blasting former public health official Anthony Fauci, Kennedy sneers at the “theology that HIV is the sole cause of AIDS.”

“No one has been able to point to a study that demonstrates their hypothesis using accepted scientific proofs,” he says of the thousands of scientists who have demonstrated beyond a doubt the connection between the virus and the disease. 

Perhaps just as disturbing as the stench of homophobia that underpins what Kennedy thinks is the reason for AIDS. He cites “lifestyle exposures,” including poppers, “a popular drug among promiscuous gays.” All in all, it wasn’t the virus killing people but “compulsive homosexual behavior,” Kennedy told podcaster Joe Rogan just last year.

That was the argument that the right wing used during the Reagan administration to delay and deny helping the thousands of gay men who were dying. Kennedy seems happy to revisit it, which is a chilling hint at what he might do as secretary. 

For example, if MPOX comes back with a roar, what would Kennedy do? He’s already suggested that its emergency was a conspiracy among the WHO, Big Pharma, and Bill Gates. He already hates vaccines. Would he mobilize the force of the government to stop the spread of the disease in the gay community, when he seems prone to blame the victim to begin with?

Meanwhile, you can forget about federal help for an AIDS vaccine. Kennedy doesn’t believe in the virus and he doesn’t believe in vaccines, so he’s never going to support more funding for that effort. Worse still, he will be spreading doubt about HIV, potentially leading to unsafe behavior and an increase in infections.

Then there’s transgender health care. Kennedy is blatantly anti-trans. “I am against people participating in women’s sports who are biologically male,” Kennedy said on CNN.

Moreover, his ideas about gender dysphoria are every bit as bizarre as most of his other beliefs. He thinks chemicals in the water are making kids trans. 

“There’s atrazine throughout our water supply,” Kennedy insists. “If you, in a lab, put atrazine in a tank full of frogs, it will chemically castrate and forcibly feminize every frog in there. And 10 percent of the frogs, the male frogs, will turn into fully viable females able to produce viable eggs. If it’s doing that to frogs, there’s a lot of other evidence that it’s doing it to human beings as well.”

Kennedy shares this scientific theory with that well-known medical researcher, Alex Jones. 

It’s one thing for your crazy uncle to share his looney theories with you at the family dinner table. It’s entirely enough for him to have control of the federal apparatus where he can do something about them. 

Kennedy has said that youth experiencing gender dysphoria should not be allowed medical treatment until they are adults.  

“We must protect our children,” he said last May. That puts Kennedy squarely on the side of the rightwing effort to put legal restrictions in place around care for transgender youth. 

As secretary of HHS, he will be in a powerful position to issue guidelines that will make it harder – if not impossible – for trans youth to get medical care. He could take his beliefs a step further and push for even broader restrictions regardless of age. 

This is the man that Donald Trump wants to “go wild on health.” Even the servile Republicans in the Senate are having a hard time with Kennedy’s nomination.

But that doesn’t mean that his nomination won’t be approved. If Trump decides to make a show of his power, Republicans will buckle. 

Americans, especially LGBTQ+ Americans, will be the ones to suffer the consequences.

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Experts detail what LGBTQ+ healthcare may look like under Donald Trump’s new administration

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With President-elect Donald Trump just under two months away from taking office and a slew of troubling cabinet appointments making headlines — including anti-vax crank Robert F. Kennedy Jr. for Health & Human Services (HHS) Secretary — LGBTQ+ Americans are understandably concerned about what a second Trump administration will mean for our rights and healthcare.

In a recent interview with the Washington Blade, Human Rights Campaign (HRC) director of HIV and health equity Torrian Baskerville acknowledged the fears many LGBTQ+ people, particularly those who are Black, trans, and/or living with HIV, are experiencing around healthcare in light of both Trump’s rhetoric and the proposals laid out in Project 2025.

“While we are desiring and hoping for the best,” he said, “the reality is that things that we have seen, at least the rhetoric, hasn’t been hopeful. And so we’re just hoping that there are guardrails in place that help to maintain and control as best as possible some of the things that may be going on.”

Speaking prior to Trump’s announcement of Kennedy as his pick for HHS secretary, and of Marty Makary and former Rep. Dave Weldon (R-FL) to lead the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC), respectively, HRC senior public policy advocate Matthew Rose weighed in on the importance of the incoming President’s choices for those positions.

“HHS will be very important for us,” Rose told the Blade. “Who they put at the Office of Civil Rights at HHS will be incredibly important for us. The Assistant Secretary for Health has, under Democratic administrations, and in Republican administrations, been a champion for us, sometimes.” Admiral Brett Giroir, Trump’s Assistant Secretary for Health during his first administration, Rose noted, “did what he could for us.”

While Rose said he’s less concerned with Trump’s pick to lead the National Institutes of Health — “unless they find someone really, really crazy” — he said that the FDA appointment “is a worry because it could change just how we view drugs and drug regulations and how those get approved.”

Trump’s pick for director of the Office of Management and Budget (OMB) is also a concern, Rose said, “because the people who make the budget decide how money gets spent.”

On Monday, Trump nominated Russell Vought, described as a “key architect” of Project 2025, for his OMB director. In a recent interview with Democracy Now, ProPublica reporter Molly Redden indicated that Vought is likely to use the position to block funding for programs and organizations — like Planned Parenthood — that don’t align with Project 2025’s radical right-wing agenda.

When it comes to HIV care and prevention, Rose looked to the first Trump administration: “The HIV community has continuously reminded Republicans that Donald Trump did create the Ending the HIV Epidemic initiative that has helped move the needle,” he said. “And so there is some promise there. They aren’t all full-on, like, anti-PrEP all the time, but they are wary of it.”

However, Rose predicts potential conflict between efforts to curb the HIV epidemic and Project 2025’s anti-LGBTQ+ agenda. 

“Those same people who said, ‘Wow, these HIV numbers are really bad and we should do something about it’ were like, ‘But we hate all these LGBTQ people and their health, and so we’re not going to have any non-discrimination [rules], and we don’t care if we kick them off their health care, and we don’t care if they’re invisible in society,” Rose explained. “Given where the epidemic has always been in the community, it’s hard to end the HIV epidemic without talking about LGBTQ people and the resources that we use in the community, and the lives that we live, and the lives that we have.”

Rose said he also expects “greater deference” in the new administration to religious exemptions and so-called conscience clauses, which allow healthcare providers to refuse to provide certain services that conflict with their religious beliefs.

Rose also noted that every budget produced during the first Trump administration “decimated funding for the CDC and HRSA and HHS in all of the HIV line items.”

“He didn’t wholesale eliminate anything, but he shaved those things down to bare bones,” Rose said.

Access to PrEP and other contraceptives under the Affordable Care Act’s preventive services coverage requirement could also be in even greater jeopardy. Experts expect the ongoing legal battle in Braidwood vs. Becerra — a legal case challenging the Affordable Care Act’s requirement for insurers to cover preventative healthcare — to eventually reach the Supreme Court, and Rose thinks the new Trump administration could reverse the Biden administration’s position supporting the landmark healthcare law’s requirement that insurance providers cover PrEP.

“We’re actually very concerned about the government reversing its role,” Rose said. “Changing the position on Braidwood is pretty quick and easy for them to do. They can pull out of that pretty fast.”

“It’s still an active case,” he added, “and we don’t know what’s going to happen if the U.S. government switches its position on it. I imagine that state attorneys general, who have been tracking the case, would step in, but we’ll have to see what their capacity looks like.”

Rose indicated that it will likely take a while for the incoming Trump administration to upend healthcare. “There’s just a lot of regulation to get through,” he said. While the new administration is ready to implement its immigration policies on day one, Rose said he expects “less acute pain” in the realm of healthcare in the early day.

But even Trump’s immigration policies will impact public health, causing a “chilling effect” for undocumented immigrants or those living in mixed-status families who need to access care.

Baskerville also noted that concerns about safety that Trump’s rhetoric inspires, particularly among trans people and undocumented immigrants, may be a major roadblock for those communities seeking the care they need in the years ahead. 

“If folks aren’t feeling safe at home, if they’re not feeling safe in their communities,” he explained, “they’re not going to access any of the healthcare, or any of the other things, and feel like they’re empowered to do that.”

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Gays vape at significantly higher rates, surgeon general’s report finds

As vaping’s popularity endures, a report issued by the surgeon general’s office Tuesday shows that LGBTQ Americans are among those helping to keep smoke shops in business.

The surgeon general’s 837-page report on tobacco use found that 37.8% of gay, lesbian and bisexual U.S. adults have tried electronic cigarettes, compared with just 16.5% of their straight counterparts. Electronic cigarettes, also known as e-cigarettes, include e-cigars, e-pipes, e-hookahs, vaping pens and hookah pens.

When broken down further, the data, collected from 2019 to 2021, found nearly half of bisexual adults have tried e-cigarettes, compared with 31.8% of gay men and 26.7% of lesbians. The authors noted that figures on transgender Americans’ tobacco use were not widely available for analysis in all areas of the report.

The report found similar disparities exist among the nation’s youths and young adults: Over 42% of young adults and 56% of high school students who identify as gay, lesbian or bisexual reported trying e-cigarettes, compared with 30.3% and 49.8% of their straight counterparts.

“Tobacco use is a singular health threat to LGBTQAI+ communities,” said Kristy Marynak, a senior science adviser at the Centers for Disease Control and Prevention and a co-editor of the report. “This report finds that nearly 1 in 5 of all deaths in the United States are caused by tobacco, and it shines a light on the disproportionate burden borne by certain communities, including LGBTQAI+ communities.”

Marynak noted that the study — and the federal government more broadly — considers products containing nicotine, including e-cigarettes, to be tobacco products. The exceptions, she said, are therapeutic products, like nicotine gum and patches. 

Long-term research on the health outcomes of e-cigarettes is not available because the products are relatively new. However, there is clear scientific consensus concerning the adverse effects of some of the chemicals commonly found in e-cigarettes. 

E-cigarettes produce a number of dangerous chemicals — including acetaldehyde, acrolein and formaldehyde — that can cause lung and heart disease, according to the American Lung Association. 

Nicotine is also commonly found in e-cigarettes. Not only is nicotine addictive and likely to fuel anxiety or depression, it also can harm brain development, which occurs until age 25, according to the CDC.

Dr. Scott Hadland, the chief of adolescent and young adult medicine at Mass General for Children and Harvard Medical School, said he’s observed greater e-cigarette use among gay, lesbian and bisexual youths. He said that LGBTQ people use tobacco products at higher rates largely because of “long-standing stigma” within health care settings.

“LGBTQ+ people might be afraid to present for care to help support their quit attempts,” Hadland said. “They might be afraid to talk to their doctor about it because they’re afraid to go to the doctor in general.”

LGBTQ adults are twice as likely as their non-LGBTQ counterparts to report having had negative health care experiences over the last three years, according to a report published this year by KFF, a health care research nonprofit formerly known as the Kaiser Family Foundation.

Hadland also attributed higher e-cigarette use among LGBTQ Americans to marketing tactics, as is noted in the report.

Tobacco companies marketed directly to the LGBTQ community in the mid-1990s, including through “Project Scum,” which advertised Camel and Red Kamel cigarettes to “consumer subcultures” in San Francisco, according to the study.

Today, tobacco companies advertise in queer magazines and donate to organizations focused on promoting LGBTQ rights and Pride events, the report noted.

In 1964, the surgeon general’s office released its first report on the hazards of smoking and has since then dedicated vast resources to combat cigarette use. The new report shows that those efforts have largely been successful, as only 11.5% of U.S. adults reported being cigarette smokers in 2021, compared with 42.4% in 1965.

Still, 36 million U.S. adults and 760,000 middle and high school students smoke tobacco products, according to the report. Since 2014, the most commonly used tobacco product among U.S. youths and young adults is e-cigarettes. 

“These and other noncombustible tobacco products such as nicotine pouches have the potential to undermine overall progress in preventing and reducing young people’s use of tobacco products,” the authors stated.

In June, the Justice Department and Food and Drug Administration announcedthey will create a federal multiagency task force to combat the illegal distribution and sale of e-cigarettes.

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California confirms first case of even more deadly mpox strain

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California has confirmed the first case of a new, more lethal strain of mpox in a man who recently traveled to Africa, and public health officials now want to speak with anyone who may met the person.

The new mpox clade I strain has a higher mortality rate than the earlier clade IIb strain that caused a global outbreak in 2022 and greatly impacted gay men. The World Health Organization declared a global public health emergency over the spread of the clade I mpox strain in August after the number of cases exploded in Africa.

“The California Department of Public Health (CDPH) has identified through laboratory testing the first known case of clade I mpox in the United States,” the CDPH said in a press release on Nov. 16. “This case was confirmed in an individual who recently traveled from Africa and is related to the ongoing outbreak of clade I mpox in Central and Eastern Africa.”

The CDPH continued, saying the unnamed individual was receiving care in San Mateo County immediately south of San Francisco. The CDPH did not explain how the individual might have contracted mpox, formerly known as monkeypox.

The CDPH is contacting anyone who may have encountered the individual.

In August, the World Health Organization (WHO) declared the rapid spread of the mpox clade I strain a public health emergency of international concern(PHEIC), the highest alarm level under international law.

“The detection and rapid spread of a new clade of mpox in eastern DRC, its detection in neighboring countries that had not previously reported mpox, and the potential for further spread within Africa and beyond is very worrying,” general director Tedros Adhanom Ghebreyesus said at a press conference called to announce the PHEIC on Aug. 14.

“In addition to other outbreaks of other clades of mpox in other parts of Africa, it’s clear that a coordinated international response is essential to stop these outbreaks and save lives.”

While more lethal and severe than the clade IIb strain, California officials tried to dampen public concerns about a deadly outbreak of the new clade.

“Historically, clade I has caused more severe illness than clade II, however, recent infections from clade I mpox may not be as clinically severe as in previous outbreaks, especially when cases have access to quality medical care,” the CDPH said in its press release.

Related: New mpox clade I explained

The Centers for Disease Control echoed the CDPH’s statements regarding the clade II strain.

“Historically, clade I mpox has caused more severe illness and deaths than clade II mpox,” the CDC said in a press release on Nov. 16. “However, recent data demonstrate that infections from clade I mpox in the current outbreak may not be as clinically severe as in previous outbreaks.”

The CDC recommends the following steps to avoid contracting mpox:

  • Avoid close contact with people who are sick with symptoms of mpox, including those with skin or genital lesions
  • Avoid contact with contaminated materials used by people who are sick (such as clothing, bedding, toothbrushes, sex toys, or materials used in healthcare settings)
  • And if you’re eligible, get both recommended doses of mpox vaccine.

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Sudden syphilis retreat in gay men is most likely tied to preventive antibiotic use

The public health workforce tasked with fighting what has been a long-losing battle against sexually transmitted infections now finds itself confronted with a new, unfamiliar outlook: hope.

After having surged to record levels practically every year this century, overall diagnoses of the three top bacterial STIs have crested since the Covid pandemic. From 2022 to 2023, total diagnoses decreased by 2%, to 2.46 million new cases, according to a Centers for Disease Control and Prevention STI surveillance report published Tuesday.

And importantly, diagnoses of primary and secondary syphilis — the most infectious stages of the infection — dropped 10% last year, to 53,000 cases.

The decline was driven by a 13% drop in such syphilis diagnoses among gay and bisexual men, who are about 2% of the adult population but have historically accounted for nearly half of such cases.

STIs also spread disproportionately among young people and racial minorities. Just under half of the top three bacterial STIs were diagnosed among 15 to 24 year olds last year. Nearly one-third of cases were among Blacks, who are 13% of the population.

Overall, gonorrhea declined by 7%, to 601,300 cases, last year; that followed a 9% decline the previous year. Among all stages of syphilis, cases increased 1%, to 209,250 diagnoses. Chlamydia remained stable from 2021 to 2023, at about 1.65 million cases.

“I think we’re at an inflection point, and it’s important that we push forward and take advantage of innovations and investment of STI prevention going forward,” said Dr. Laura Bachmann, chief medical officer of the CDC’s STI prevention division.

The half-dozen other infectious disease experts who spoke with NBC News about the CDC report said they believed the sudden turnaround in syphilis diagnoses among gay and bisexual men was likely to be an early signal of such men’s eager adoption of a new, proven protocol in which the oral antibiotic doxycycline is used for STI prevention.

“That is huge cause for celebration. And I am a little surprised we see that trend at the national level already,” said Dr. Julie Dombrowski, a professor of medicine at the University of Washington. 

Referring to a recent decline in syphilis among men in Seattle, she added, “We definitely have seen it at the local level.”

Some experts expressed hope that doxycycline use among gay and bisexual men would have a positive spillover effect in women of childbearing age.

Syphilis poses the greatest threat to newborns, among whom it can cause severe congenital defects and death. Whereas cases of the STI in newborns increased by 30% annually in recent years — greatly alarming public health experts — the upward trend has decelerated. Such a promising shift was apparently driven in part by nationwide efforts to increase testing among pregnant women.  

In another hopeful development, a shortage that began in early 2023 of the only recommended treatment for syphilis among pregnant women, Pfizer’s Bicillin-LA, has abated.

In recent years, a trio of randomized controlled trials have shown that instructing gay and bisexual men and transgender women to take one 200-milligram tablet of doxycycline within 72 hours of condomless sex lowers cases of chlamydia and syphilis among them by more than 70% and of gonorrhea by about 50%.

The protocol is known as doxyPEP, which is short for doxycycline post-exposure prophylaxis.

San Francisco’s Public Health Department was the first to recommend doxyPEP for gay and bisexual men and trans women, in October 2022. The CDC followed suit in June. So have health departments in other large cities, such as Chicagoand New York, where LGBTQ community health centers have begun offering doxycycline to patients. 

A study of doxyPEP among cisgender women in Africa failed to show efficacy. There is, however, an ongoing trial in U.S. women. 

Thanks to penicillin, the nation made steady progress in fighting syphilis after World War II. By the mid-1990s, public health leaders were entertaining the possibility that the STI could be eliminated.

But the approval of effective HIV treatment in 1996 reduced the public’s fear of AIDS. That helped trigger a long decline in condom use among gay and bisexual men in particular. The subsequent approval of the HIV-prevention pill — called pre-exposure prophylaxis, or PrEP — in 2012 only hastened the decline. 

Bacterial STIs soared accordingly. 

DoxyPEP offers a promising form of harm reduction. It’s cheap and well-tolerated, and it can easily be folded into many gay and bisexual men’s routines for receiving prescriptions to treat or prevent HIV.  

Early analyses suggest doxyPEP is a sleeper hit in that population. 

A study published this month in the journal Sexually Transmitted Diseases found that San Francisco’s guidance on the preventive tool was tied to a decline in STIs among local men. A study published in next month’s edition of the journal found that among about 900 gay and bisexual men recruited for a survey through hook-up apps, half had heard of doxyPEP and nearly all expressed interest. 

A spokesperson for the PrEP-focused telehealth service MISTR told NBC News that since the company started offering doxyPEP in April, three-quarters of users who have filled PrEP prescriptions since then have also requested and received doxycycline. (The representative declined to provide the number of users that entailed but said MISTR serves “over 450,000 patients in all 50 states, D.C. and Puerto Rico.”) Since then, the overall quarterly STI positivity rate among MISTR users has plummeted from 12% to 6%. 

In November 2023, the Food and Drug Administration approved the first at-home tests for gonorrhea and chlamydia, which public health experts hope might also help combat the spread of STIs. 

And in July, researchers presented findings at a global HIV conference in Munich of studies in which gay and bisexual men in Canada and female sex workers in Japan were instructed to take 100 milligrams of doxycycline daily. The protocol, called doxyPrEP, demonstrated generally comparable efficacy at preventing STIs compared with doxyPEP studies among gay men.

Research is ongoing to address concerns that increased use of doxycycline to prevent STIs might help fuel the burgeoning drug-resistant pathogen crisis. Thus far, researchers have found reassuring signs. 

STI-prevention experts are also concerned that, as with HIV PrEP, doxyPEP will prove disproportionately popular among whites and thus will only widen racial disparities in STI transmission. Research is underway to analyze trends in doxyPEP’s use that could help focus promotion of the intervention where the need is greatest.

Public health experts have attributed this century’s surge in STIs, at least in part, to a steady defunding of state and local public-health clinics.

Dr. Jeffrey Klausner, an infectious disease expert at the University of Southern California who led the first study to demonstrate doxyPEP’s efficacy, called for renewed spending on STI-related care. 

“If Trump is going to make IVF — in vitro fertilization — free,” Klausner said of the president-elect’s emphatic campaign pledge, “he should make STI testing and treatment free.”

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Two new cases of more-infectious mpox strain found in UK

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Two new cases of a more-infectious strain of mpox have been detected in the UK, health officials have said.

The new cases come after the UK Health Security Agency (UKHSA) announced at the end of last month that a single case of Clade 1b mpox had been detected in the country.

Mpox, formerly known as Monkeypox, was first declared a global health emergency by the World Health Organization (WHO) in July 2022 after the number of cases suddenly increased in Europe and the Americas, particularly affecting gay, bisexual and other men-who-have-sex-with-men.

In August, WHO again declared the disease a world health emergency, after a new strain – Clade 1b – caused cases to surge in Africa, most notably in the Democratic Republic of Congo, Burundi and Uganda.

The Clade 1b strain is associated with a more severe disease and higher mortality rates than Clade 2.

A Mpox blood test tube is seen among other blood test tubes
Two new cases of mpox have been identified in the UK. (Hakan Nural/Getty)

Both new UK patients were household contacts of the original patient and are receiving specialist care at Guy’s and St Thomas’ NHS Foundation Trust, in London. 

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Professor Susan Hopkins, the chief medical adviser at UKHSA, said: “The overall risk to the UK population remains low. We are working with partners to make sure all contacts of the cases are identified and contacted, to reduce the risk of further spread.”

When the first UK case of the Clade Ib strain was announced, health secretary Wes Streeting praised the doctors and nurses treating the patient and said the government was “working alongside UKHSA and the NHS to protect the public and prevent transmission”, adding: “This includes securing vaccines and equipping healthcare professionals with the guidance and tools they need to respond to cases safely.

“We are also working with our international partners to support affected countries, to prevent further outbreaks.”

Mpox is a viral infection transmitted through close contact such as sex, touch, talking, or breathing close to another person, and is part of the smallpox family of viruses. Sufferers will often get a rash, along with other symptoms such as high temperature, swollen glands and chills. 

The rash can go through several stages, beginning as raised spots that turn into small blisters filled with fluid that will eventually form scabs and fall off.

WHO previously urged gay and bisexual men to remain vigilant and get vaccinated. 

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Intersex youth have worse mental health, and ‘harmful’ nonconsensual surgeries may play a part

Intersex young people struggle with their mental health at higher rates than their peers, and how they’re treated by their families and doctors seems to play a part. 

Over half of intersex LGBTQ+ youth (55 percent) reported seriously considering suicide in the past year, according to a new report from the Trevor Project, compared to 39 percent of endosex LGBTQ+ youth — those who do not have an intersex condition. 

There are several factors that could be contributing to this disparity, says lead author Jonah DeChants, including a “combination of stigma and misplaced shame and embarrassment among individuals and researchers as well.”

“Historically, intersex identities have been unfortunately very much stigmatized,” DeChants tells The Advocate. “Some of that stigmatization came from poorly informed but well-intentioned families and medical providers who felt like in order for their child to have a ‘normal life,’ it was better for them to not know or to not talk about their intersex identity with other people, just like other LGBTQ identities.”

This stigma has “really contributed to a lack of funding for research, a lack of thinking to ask people about their intersex status or having sex differences,” according to DeChants, which is something his team wanted to begin rectifying. Their report surveyed 18,663 LGBTQ+ young people, some as young as 13, finding 256 who identified as both intersex and LGBTQ+ (1.4 percent). Though small in number, the disparities the group reported were vast.

Among intersex youth, 13 percent reported being subjected to some form of conversion therapy, in comparison to only 5 percent of their LGBTQ+ endosex peers. “That’s a really big disparity,” DeChants says, and it’s especially concerning when 43 percent of intersex youth who were subjected to conversion therapy reported a suicide attempt in the past year, compared to only 22 percent who hadn’t experienced conversion therapy.

“We can’t establish a causal relationship in the survey. It’s really a snapshot. We can’t tell which came first, the chicken or the egg, but the fact that there are more chickens and more eggs is still an important relationship to document,” he explains. “The fact that those rates are double really shows that there’s a harmful association between experiencing these things specifically among intersex young people.”

DeChants also noted the “similarities between coercive medical procedures and conversion therapy,” as 17 percent of intersex youth reported experiencing asurgical procedure that altered their anatomy or their reproductive organs to “fit normative expectations based on the gender binary.” Two-thirds of those respondents said that they had not consented to those surgeries, and the median age for such procedures was less than 1 year old. 

“We really wanted to highlight the fact that most of those folks did not consent and were not able to consent to those procedures,” DeChants said. “The nonconsensual administration of that health care very early in life is showing a detrimental impact on folks later in life.”

It’s important to keep “educating parents and doctors about the potential harm of these nonconsensual early in life procedures and trying to change the medical protocol and the medical culture around sex differences and intersex identities,” DeChant says, pointing to the work of groups such as interACT that advocate for changes in law and policy. 

For those in the lives of intersex youth, he emphasizes that “it would be better to leave that person’s body alone until they have the ability to determine what their gender identity is or decide what medical interventions feel good for them.” 

“You do not have to have a body that fits into the gender binary in order to have a ‘normal life’ or to be a happy and healthy adult,” DeChant says.

If you or someone you know needs mental health resources and support, please call, text, or chat with the 988 Suicide & Crisis Lifeline or visit988lifeline.org for 24/7 access to free and confidential services. Trans Lifeline, designed for transgender or gender-nonconforming people, can be reached at (877) 565-8860. The lifeline also provides resources to help with other crises, such as domestic violence situations. The Trevor Project Lifeline, for LGBTQ+ youth (ages 24 and younger), can be reached at (866) 488-7386. Users can also access chat services at TheTrevorProject.org/Help or text START to 678678.

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