Dr. Anthony Fauci said Tuesday the visibility LGBTQ people brought to themselves during the height of the HIV/AIDS epidemic helped change the tide for public perception.
Fauci made the remarks during the daily White House Coronavirus Task Force briefing when responding to COVID-19’s disproportionate impact on black Americans, saying the disease has “shed a light” on health disparities in the United States much like HIV/AIDS did with LGBTQ people.
“During that time, there was extraordinary stigma, particularly against the gay community,” Fauci said. “And it was only when the world realized how the gay community responded to this outbreak with incredible courage and dignity and strength and activism — I think that really changed some of the stigma against the gay community, very much so.”
As head of the National Institute of Allergy & Infectious Diseases, Fauci was responsible for developing medications to treat HIV/AIDS at the height of epidemic. His efforts resulted in drugs still used today, although that came after activism of groups like ACT UP pushing the U.S. government to release the medication.
The impact of HIV/AIDS on LGBTQ people, Fauci said, is similar to the impact COVID-19 is having on African-Americans.
“When you’re in the middle of a crisis, like we are now with the coronavirus, it really does have ultimately shine a very bright light on some of the real weaknesses and foibles in our society,” Fauci said.
State data on COVID-19 is beginning to reflect African-Americans suffer from the disease at a greater rate than others.
In Michigan, for example, 35 percent of all COVID-19 cases are black or African-American, as are 40 percent of all deceased cases, according to state data. But the black or African-American population makes up just 14.1 percent of Michigan’s population.
Fauci said COVID-19’s has a disproportionate impact on black people not because they’re getting infected more often, but because the population suffers from health disparities.
“When they do get infected, their underlying medical conditions — the diabetes, the hypertension, the obesity, the asthma — those are the kind of things that wind them up in the ICU and ultimately give them a higher death rate,” Fauci said.
Fauci concluded the COVID-19 epidemic “will end,” but when that happens “there will still be health disparities which we really do need to address in the African-American community.”
President Trump expressed indignation over the disproportionate impact COVID-19 is having on the black population.
“What’s happening is we’re trying to find out why is it that it’s three and four times,” Trump said, “Now, maybe that’s not going to be the final number, but why is it three or four times more so for the black community as opposed to other people. It doesn’t make sense, and I don’t like it.”
Trump said his administration would have statistics on COVID-19’s impact on black people in “probably two to three days.”
Asked by a reporter if that pattern of black people being disproportionately affected by COVID-19 will continue nationwide, Fauci hinted that was the case.
“I can’t be confident to predict patterns, but the underlying reason why that is happening doesn’t change from state to state,” Fauci said. “I expect that when African-Americans get infected, given the disproportionate disparity of the underlying conditions that lead to complications like the ones I mentioned, I expect that we will still see the pattern that when you loo at the proportion of people who get into serious trouble and die, again, it’s going to be disproportionate towards the African-Americans. I do expect.”
Fauci affirmed the federal government is now leading the charge in collecting information said it will be public in days or the coming week.
Although states are collecting information on the racial and ethnic identities of COVID-19 patients, they aren’t ascertaining whether patients are LGBTQ. The lack of information has angered LGBTQ advocates, who are calling for greater data collection because LGBTQ are vulnerable to COVID-19.
Multiple transgender organisations have joined calls for the US government to provide urgent funding to support trans people through the coronavirus pandemic.
The California-based groups have written to governor Gavin Newsom proposing the creation of an Emergency Transgender Wellness and Equity Fund to address the urgent and long-term needs of the trans community.
Trans people are among the most marginalised groups in the country, the open letter explains, and face significant barriers in society which have have only been exacerbated by the coronavirus.
“The structural and institutional change that must occur to counter these barriers means an investment in trans-led organisations and services, those that are tailored to address the specific needs of TGI (transgender, gender non-conforming and intersex) people,” the letter reads.
“Because of a lack of services tailored to serve the trans community, this makes this moment especially isolating and difficult.”
There are approximately 220,000 transgender people in the state of California, many of whom are in “dire economic situations”.
The 2015 U.S. Transgender Survey found that 12 percent of adult respondents made less than $10,000 in annual income, compared to 4 percent of the general population in that income bracket.
Add this to the fact that LGBT+ people are more likely to be vulnerable to the coronavirus, and more likely to face difficulties accessing healthcare, the need for tailored financial support during the pandemic is clear.
A specific emergency fund “would help address the immediate needs of TGI people in the midst of COVID-19, but would also help to create long-term services that would prevent the drastic impact on our community in the midst of crisis in the future,” the letter explains.
It was signed by seven groups: TransLatin@, Coalition Unique Women’s Coalition, Transgender Health and Wellness Centre, Gender Justice LA, Transgender Law Centre, El/La Para TransLatinas and the Transgender, Gender Variant, Intersex Justice Project.
They acknowledge that everyone is struggling in the face of the pandemic, but stress the importance of transgender people not being overlooked in relief efforts.
“When we say we are in this together, that obviously includes trans and gender non-conforming people,” Bamby Salcedo, president of The TransLatin@Coalition told Forbes.
“We as leaders in the community are making sure that we address those needs and issues, and so we invite all of us to really understand the meaning of we are in this together and how we are going to together change the narrative and the landscape of our community.”
Lorena Borjas had a wheelie bag, and in the bag she had the world. The first time Lynly Egyes met her, Borjas pulled a birth certificate out of the bag. Egyes was then a lawyer with the Sex Workers Project at the Urban Justice Center and had recently taken the case of a young immigrant transgender woman who was in jail, facing felony assault charges for defending herself against an attacker—an exceedingly common predicament. “Lorena came into my office and said, ‘I hear you need the birth certificate for one of the girls,’ ” Egyes told me on the phone. “I said, ‘Who are you?’ ‘I am Lorena!’ ” Borjas also convinced Egyes to take on a second case that stemmed from the same incident; the proceedings dragged on for about a year, with frequent court appearances. Borjas always came to the hearings and brought supporters. “She felt it was important for the judge to see that these two young women were loved,” Egyes said.
Borjas died on Monday, at Coney Island Hospital, in Brooklyn, of complications from covid-19. She left an orphaned community of transgender women, especially Latina immigrant women in Queens, and countless L.G.B.T.-rights activists who looked to her for guidance, inspiration, and love. About two hundred and forty people gathered for a memorial on Monday night, albeit via Zoom, which added a layer of heartbreak to the mourning of a person whose legacy was one of building community, in the streets and in apartments in her Jackson Heights neighborhood, and of taking close, personal, physical care of people.
Borjas was born in Veracruz, Mexico, in 1960. At seventeen, she ran away to Mexico City, where she lived in the streets. At twenty, she crossed the border into the United States, where she hoped she would be able to receive hormone treatments. She made her way to New York City, where she studied for her G.E.D. and then studied accounting.The New Yorker’s coronavirus news coverage and analysis are free for all readers.
“Back then, the trans community didn’t have spaces,” Cristina Herrera, the C.E.O. and founder of the Translatinx Network, a group for transgender immigrants, told me on the phone. “We met at Port Authority—that was the main place, because you could stay indoors.” Herrera, who is from El Salvador, came to New York in 1985, at the age of fifteen, and met Borjas soon after. “She was like the social worker in our community,” Herrera said. “She was the case worker.” Borjas guided other trans and gay immigrants to the resources she had found: E.S.L. classes, G.E.D. tests, community colleges, H.I.V. screening, immigration lawyers, and research studies that paid for participation.
Borjas was able to obtain legal status under a Reagan-era amnesty. But, in the nineteen-nineties, she developed an addiction to crack, which, Herrera told me, led to more and riskier sex work and, finally, to a relationship in which Borjas was trafficked. She was arrested several times, making her ineligible to renew her green card or apply for naturalization.
In the late nineteen-nineties, Borjas escaped from her abuser. She got clean. Then she got to work helping people who hadn’t been as lucky. “In the morning, she would get up and go to the Department of Health and take free condoms there,” Egyes told me. “Then she might also go to a food pantry. And at night she would walk around with her wheelie bag, distributing the condoms and the food.”
One of Borjas’s closest friends, Cecilia Gentili, who is forty-eight, told me that she met Borjas in a bar in Jackson Heights, in 2005. Gentili, who had come from Argentina five years earlier, was undocumented then and doing sex work. A couple of years later, Gentili got a job at Apicha, a clinic for the L.G.B.T. community, and asked Borjas to help her reach out to potential clients. “She said, ‘Come with me to hand out condoms,’ ” Gentili said. “We started at 11 p.m., up and down Roosevelt Avenue. She said, ‘When you give out condoms, you can give out referrals to your clinic.’ ” They walked the streets until three or four in the morning. At the time, New York police often used possession of condoms as evidence in prostitution cases, and word on the street was that one shouldn’t carry more than three at time. So Borjas considered it her duty to replenish sex workers’ supplies of condoms, a couple at a time, all night long. “She showed people that they had family,” Egyes said of Borjas’s condom-distribution work.
Chase Strangio, the deputy director of the L.G.B.T. and H.I.V. Project at the American Civil Liberties Union, met Borjas more than ten years ago, when Strangio was working at the Sylvia Rivera Law Project. Borjas worked to educate him about patterns of arrests of transgender women of color. “She was so connected to the community that when someone would get arrested, the first phone call was to Lorena,” Strangio said. In 2012, together the two founded the Lorena Borjas Community Fund, which gives bail and bond assistance to transgender immigrants in criminal and immigration proceedings. This was the kind of specific need Borjas’s knowledge of the community could help identify. At the time, the Obama Administration was increasing pressure on local police to coöperate with Immigration and Customs Enforcement; when immigrants ended up behind bars—for whatever reason—they faced the risk of deportation, and so it was essential to get them out fast.
Even while Borjas was advocating on behalf of transgender immigrants, she was at risk for being deported herself. A couple of years into the friendship, Borjas finally asked Egyes to look at her own case. Egyes joined the effort to vacate her convictions—it worked with some but not all of them—and eventually filed a petition for a pardon. In her letter to Governor Andrew Cuomo, Egyes described some of the work that Borjas had done. “At meeting after meeting with law enforcement, many clients explained how Lorena was the reason that they were able to escape their trafficker,” Egyes wrote. “At one point, former Assistant United States Attorney, [name redacted], asked if Lorena was a real person because she seemed to help so many people but wasn’t affiliated with any organization. I explained that Lorena is in fact real and that she helps people because she too was a victim and wanted to ensure that these girls had a way out of bad situations.” Egyes attached a list of more than twenty awards, certificates, and proclamations Borjas had received in recognition of her activism. Governor Cuomo pardoned Borjas in 2017.
Borjas was not paid for most of her work. She cobbled together a living: she was paid for some talks, outreach, and counselling sessions, and sometimes she cleaned houses. “She made the money stretch,” Egyes said. “She gave me hope that people do good things because they are good people, not because they would get anything for it.”
“None of her work was with a ‘rescuing’ mentality,” Gentili said. “It was, We help because we help each other. She was the mother of the trans Latinx community.”
Strangio recalled that, in 2011, Borjas threw a big party for him, complete with a cake. It wasn’t his birthday or a date of any other significance. When Strangio asked what the party was for, Borjas answered that it was a way of giving thanks. “She celebrated people,” he said. A year later, when Strangio and his then partner were expecting a baby, Borjas threw them a baby shower. “She raised money and got us a stroller and a car seat,” Strangio told me. “I mean, we are lawyers! But, no, ‘You are going to have a child, and we are going to take care of you. That’s what we do.’ ”
Last year, Borjas became a U.S. citizen. Her work had inspired several nonprofits, including the one that Herrera runs. “She was starting to see the fruits of her labor,” Herrera said. And Borjas herself was finally safe. “She had made it through the aidsepidemic!” Herrera exclaimed. “She made it through the crack epidemic! She made it through the violence we faced in the nineties and two-thousands, with immigration! I thought we were going to have her until she was in her seventies or eighties.”
There is a particular gut punch that coronavirus deaths pack for people who saw their generation decimated by aids. “When we met, we had a community of fourteen,” Herrera said. “Recently, there were three of us left, two H.I.V.-positive and one negative.” Borjas was positive. “And now there are only two of us left.”
A report published in the medical journal The Lancet has found that access to identity documents that align with an individual’s gender identity correlate with lower rates of suicidal thoughts.
Those who had the ability to change their name and gender marker on birth certificates, driver’s licenses or other forms of identification were 25 percent less likely to experience psychological distress or consider taking their own lives.
The research, led by Drexel University’s Dr. Ayden Scheim and published in mid-March, came to its conclusions by analyzing 2015 data collected by the National Center for Trans Equality, which surveyed more than 27,000 trans individuals at the time.
Dr. Jack Turban, a resident physician in psychiatry at Massachusetts General Hospital, where he researches the mental health of transgender youth, wrote an editorial in The Lancet to accompany Dr. Scheim’s study. Turban said the study’s findings indicate that having documents affirming a trans person’s gender identity “sends a powerful message that transgender people are accepted and valued by society.”
“Gender-congruent identification is a vital aspect of gender affirmation,” Turban told NBC News, while noting that the National Center for Transgender Equality’s survey found that just 11 percent of trans respondents “had fully congruent government identification.”
The studyis prescient given the enactment of the new law in Idaho that blocks the state from issuing birth certificates to trans people reflecting their lived gender. House Bill 509 was one of two anti-transgender bills signed by Gov. Brad Little on Monday. The other, House Bill 500, prevents trans girls from playing on school sports teams in alignment with their gender identity.
Jen Moore, a licensed professional counselor practicing in the state of Idaho, said they have “lost sleep” over how these bills will impact the local trans community.
“The Idaho Counseling Association came out in opposition to the bills that the governor just signed,” Moore said. “These are folks who already lack essential support or who are more vulnerable because the system has historically worked against them. The Idaho government is making my job that much harder.”
According to Moore, having access to an updated birth certificate is incredibly important for the transgender patients that they work with because it “validates a person and the core part of who they are.”
“To hold up a mirror and say, ‘Yes, who you are is right,’ is so important from a mental health standpoint,” she said.
Critics of the Idaho law said refusing trans people the ability to have their lives reflected on their identity documents also opens them up to greater discrimination and abuse. The National Center for Transgender Equality’s survey showed that a third of individuals who showed a birth certificate or ID that did not align with their gender presentation reported experiencing verbal harassment or physical violence as a result.
Kathy Griesmyer, policy director for the American Civil Liberties Union of Idaho, said laws like HB 509 prevent trans people from “maneuvering through daily life without fear of people questioning you and your existence.” When HB 509 was being debated in the Idaho Legislature, she recalled that a trans man testified that he was once refused service at an Office Depot because he didn’t have a driver’s license that reflected his physical appearance.
“Those are small things most of us take for granted that become much bigger hurdles for trans people when their documents don’t match,” Griesmyer said. “This legislation is an attempt to legislate away trans people by not allowing them to have identity documents that match who they are.”
Although HB 509 is set to take effect July 1, it remains to be seen whether it will stand. After it was signed into law Monday, Lambda Legal accused Idaho of “explicitly flouting a binding federal court order.” Magistrate Judge Candy W. Dale, of the U.S. District Court for the District of Idaho, ruled in 2018 that the state’s standing policy of “automatically and categorically” refusing corrected birth certificates to trans people violates the U.S. Constitution.
“This policy was unconstitutional two years ago, and it is still unconstitutional today,” Peter Renn, an attorney for the LGBTQ advocacy group, said in a statement. “Idaho has deliberately set itself on a collision course with the federal courts. It is in open rebellion against the rule of law.”
But while the U.S. court system debates the future of trans rights, experts say greater support is needed for the community. Although access to gender-congruent identity documents lowered the likelihood of suicidal thoughts, it did not eliminate such feelings. According to the Lancet study, 30 percent of respondents who had their name and gender marker updated on all forms of ID still reported thoughts of suicide.
Turban said that more research is needed but hopes the Lancet report is a call to action for lawmakers and medical professionals in how they interact with vulnerable communities.
“We also need to work on other determinants of mental health,” he said, “including lack of access to gender-affirming medical care, widespread gender identity conversion therapy and alarmingly high rates of violent victimization.”
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.
The Transgender Legal Defense and Education Fund has prepared a free online guide, available in both English and Spanish, for transgender and non-binary individuals attempting to navigate life during the coronavirus pandemic.
“A Know Your Rights Guide for Transgender People Navigating COVID-19,” which contains information that was accurate as of March 22, explores both trans-specific concerns and equity concerns that disproportionately impact trans and non-binary individuals, such as issues involving employment, housing and health care. It also features a national appendix of health and advocacy resources.
The guide stresses the existence of a pandemic does not void the fact that trans and non-binary individuals are entitled to receive care and access to services. As TLDEF interprets federal law within this guide, medical providers must address individuals by the names and pronouns that they use and provide individuals access to facilities consistent with their identities.
The guide encourages trans and non-binary individuals to self-advocate by knowing their rights and, if feeling ill, contacting a medical provider or a state health department hotline.
According to the guide, the “extraordinary public health crisis” may lead trans and non-binary individuals to experience delays in receiving transition-related services, including operations that hospitals have classified as “non-emergency surgeries” and business that courts and government agencies has deemed “non-essential,” which may or may not entail changing one’s legal name and gender marker.
If a trans or non-binary individual feels that they are being subject to discrimination; the guide advises that the individual report each incident to the appropriate staff, take notes, obtain names, save copies of any documents and file a complaint.
TLDEF describes itself on its website as “a nonprofit whose mission is to end discrimination and achieve equality for transgender people, particularly those in our most vulnerable communities.”
As of Saturday, there were more than 120,000 confirmed cases of coronavirus in the U.S., with more than 2,000 deaths. Globally, there were more than 650,000 confirmed cases and more than 30,000 deaths.
Organizers of the 2020 International AIDS Conference on Friday announced the event will be held virtually because of the coronavirus.
The conference was scheduled to take place in San Francisco and Oakland, Calif., from July 6-10. International AIDS Society President Anton Pozniak and the conference’s two U.S. co-chairs, Cynthia Carey-Grant and Monica Gandhi, in a statement said the virtual conference “will enable delegates to access and engage with the latest HIV science, advocacy and knowledge traditionally presented at the conference.”
“It will be a compelling combination of virtual sessions and community networking, including exhibitions, workshops, the Global Village, satellites and pre-conferences that will reach audiences around the world,” reads the statement.
The statement notes people with HIV are likely at heightened risk for coronavirus. Organizers also said the decision to make the conference virtual “was informed by advice from the World Health Organization, UNAIDS, leading global and local health authorities, and people living with HIV around the globe.”
“We are acutely aware that there is not yet sufficient data on whether people living with HIV are more susceptible to COVID-19 or more likely to develop severe disease,” reads the statement. “Therefore, we have a special obligation to reduce any potential risk to the HIV community.”
“Furthermore, many of those who were planning to attend are now working on the front lines in the response to COVID-19 around the world,” it adds. “We have a responsibility to not put any of these individuals — or their home communities — at risk, nor redirect their efforts at a critical time in the response to the pandemic.”
The 20112 International AIDS Conference took place in D.C.
Statistics from Johns Hopkins University of Medicine indicate there are 94,238 confirmed coronavirus cases and 1,438 deaths from the disease in the U.S.
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.
For as long as he can remember, Jaceon Cornado has dreamed of having a flat chest.
When he turned 18 in the spring of 2017, the transgender teen eagerly started planning his surgical transition.
”This surgery is something I need to continue to get up in the mornings every day,” Cornado told NBC News.
Just six months after his 18th birthday — and a year after the Obama administration lifted the transgender military ban (which would later be reversed by the Trump administration) — Cornado joined the U.S. Army in a combat role. He decided to surgically transition while in the military, because doing so beforehand would have delayed his enlistment by at least 18 months. Two weeks after arriving at his base in San Antonio, he informed his superiors of his plan.
After a year of paperwork, psychological evaluations, medical intakes, hormone treatments and having his wife prepare to oversee his postsurgical care, Cornado was finally given the green light in July 2019 to undergo top surgery, a masculinizing procedure to remove breast tissue.
This long-awaited surgery, which Cornado describes as the most significant step in his medical transition, was scheduled for March 23. Last week, however, he received a call from the hospital informing him that the procedure had been postponed indefinitely due to the coronavirus pandemic. They said it would be six to eight weeks before they could even discuss rescheduling. He said the call “completely crushed my hopes.”
“I was really mad in the beginning,” Cornado, 20, told NBC News. “It took so much for me to get approval for the surgery, and now I just feel like it’s been yanked away.”
As the coronavirus pandemic has insidiously crept its way around the globe over the past several months, the daily lives of people from Beijing to Berlin to Boston have been upended. And with hospitals scrambling to deal with the influx of COVID-19 patients, surgeries deemed “nonessential” or “elective” have been canceled or postponed indefinitely. Among those surgeries put on the back burner are gender-affirming procedures, which can be lifesaving for transgender people.
Some trans individuals who have had their surgeries canceled or postponed, like Cornado, say they are now facing debilitating levels of gender dysphoria on top of the anxiety and uncertainty spawned by the global health crisis.
“This surgery is not elective for me,” Cornado said. “It’s something that I need to continue to get up in the morning and live a normal life.”
Consequences of delayed treatment
While most health insurance carriers in the U.S. currently consider gender-affirming procedures to be “cosmetic” — with over 30 states allowing providers to exclude transition-related care from coverage— such a distinction is inaccurate, according to Laura A. Jacobs, a licensed clinical social worker, psychotherapist and board chair atCallen-Lorde Community Health Center, a New York-based LGBTQ health center.
“For many trans folks, existing daily in a body that doesn’t match your sense of self isn’t just uncomfortable, it’s traumatic,” Jacobs explained. “There’s a lot of research that shows that delaying treatment for trans people increases levels of depression, anxiety and suicidal ideation.”
A study published in October in the American Journal of Psychiatry found gender-affirming surgical procedures yield long-term health benefits for transgender individuals. Among those who had surgery, the longer ago their surgery, the less likely they were to suffer from anxiety, depression or suicidal behaviors during the study period, the researchers found.
Along with psychological repercussions, Jacobs said, surgical delays can also cause physical repercussions for trans people, including elevated levels of smoking, obesity and substance abuse.
‘It’s not a vanity thing’
Katalina Murrie, a 31-year-old transgender woman living in Ottawa, Ontario, said there is “a clear misunderstanding about the urgency of trans health care.”
“Once this year, I had to take an ambulance to the hospital due to anxiety I’ve been experiencing because of dysphoria,” she said.
Gender dysphoria is a diagnosis that “involves a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify,” according to the American Psychiatric Association. The association notes this type of dysphoria can result in distress, anxiety and impaired daily functioning.
For several months, Murrie had been excitedly preparing to undergo facial feminization surgery, a set of procedures intended to soften one’s facial features and bone structure. Murrie said for her, the surgery is a matter of life and death.
“I’m not gonna last to my 40s if I don’t have this surgery,” she said.
Since gender-affirming surgeries are often not covered by health insurance, many trans people travel internationally in order to access different procedures and to save on out-of-pocket costs. This reliance on international travel complicates matters further for those seeking this type of care — and it certainly has done so amid this current pandemic, which has drastically limited both domestic and international travel.
Although Canada’s national health system covers some gender-affirming procedures, including sex-reassignment surgery, facial feminization is typically not covered. As a result, Murrie had scheduled the procedure for March 27 with a surgeon in Guadalajara, Mexico, where the cost of surgery is lower. Once news of COVID-19 became an impending reality, however, she began to wonder whether her surgery was still going to be a possibility as she would have to travel abroad from Canada.
“What if all the borders closed around the world and I am stuck in a foreign country?” Murrie recalled asking herself. “My face would be covered in stitches. I’d have to travel through popular airports where there have been confirmed reports of staff members with COVID-19. My dream surgery all of a sudden became very stressful.”
Eventually, her surgeon offered her the choice of a refund or a date change at no additional cost; she chose the latter. While Murrie is confident she will be able to undergo the procedure at some point in the future, she is still disappointed that surgeries like hers are not considered essential.
“It’s not a vanity thing,” Murrie said. What makes this worse, she added, is that it is just the latest in a long list of obstacles she has faced along her transition journey, which have included gender dysphoria, anxiety and red tape in order to legally change her name and acquire hormone therapy.
‘It’s about being comfortable enough to function’
For Ashton Onion, a 22-year-old nonbinary transgender man living in New York City, simply finding a doctor able and willing to provide gender-affirming care was a daunting task.
“I did all this research and finally found a doctor I was comfortable with,” Onion told NBC News. “There’s a type of security you look for in all of this.”
Onion is not alone in being cautious when it comes to finding an affirming health care provider. A 2016 report from the National Center for Transgender Equality and the National Gay and Lesbian Task Force found that 28 percent of trans and gender-nonconforming respondents reported being subjected to harassment in medical settings, and 19 percent said they have been refused care outright due to their gender identity or expression.
Onion, who said he has been eagerly awaiting top surgery since he was 13, finally had a consultation scheduled with a surgeon for March 19. He received a call three days before the scheduled appointment informing him the consultation would be canceled for the foreseeable future due to the COVID-19 pandemic.
“To have it taken away makes me uneasy,” Onion said of his long-awaited appointment. Like Cornado and Murrie, Onion said a gender-affirming procedure is much more than “cosmetic” for him.
“Growing up in a Catholic space, I was very religious,” he said. “I remember growing up praying I wouldn’t develop a chest.”
When Onion began to grow breasts during puberty, he initially turned to nonsurgical methods of body modification, including chest binding. Onion said that while binding was helpful in the interim, it has caused physical pain and stress on his body that is not sustainable, including back pain, skin irritation and breathing problems.
“It’s always me deciding which kind of toll I want to experience today,” he said. “A physical pain when I wear the binder or a mental toll when I don’t wear one.”
Onion, who has found support from his girlfriend and among friends in his trans-masculine support group, said moving forward he hopes the broader health care system will begin to recognize the urgency of trans care.
“People don’t realize the daily challenges trans folks have to endure,” he said. “This surgery isn’t cosmetic — it’s about being comfortable enough to function. It’s necessary.”
Doctors in New York and California have diagnosed among homosexual men 41 cases of a rare and often rapidly fatal form of cancer,” the article began. “Eight of the victims died less than 24 months after the diagnosis was made.”
Chris Bartlett was 15 when the article was published.
“Between 1981 and 1995, when the first effective treatments came out … there was quite a bit of uncertainty,” Bartlett, now 53, told NBC News. “Would I become HIV-positive? Would I live? Would I survive? And I really didn’t have answers to that.”
Today, amid the global coronavirus pandemic, HIV health experts, survivors and longtime activists, like Bartlett are reflecting on the early — and undeniably dark — days of the AIDS crisis. Several of them spoke with NBC News about the parallels between the onset of the two public health outbreaks and what lessons learned four decades ago can help us now.
Denial can be deadly
HIV and the coronavirus are very different viruses in terms of contagion and lethality. However, in both cases, early decisions made by government officials and members of the public affected how the outbreaks became global pandemics.
One example of this, according to Cleve Jones, a longtime HIV and LGBTQ activist, was the cavalier attitude displayed by individualsduring the earliest days of both crises toward their chances of contracting the virus.
Jones, a close associate of gay icon Harvey Milk before Milk’s assassination in 1978, stressed “how very difficult it was” at first to tell other young gay men in San Francisco that there was a deadly virus spreading in their community and that “we had to change our behavior.”
“It was not welcome at all,” Jones told NBC News. “I had people spit on me.”
That early refusal to properly reckon with the risk of contracting a new virus is also what stood out to Dr. Howard Grossman, a gay physician currently working in Wilton Manors, Florida, who served his medical residency at a public hospital in New York City when HIV first broke out.
“At first it was, ‘Oh, I don’t do poppers, so I’m not going to get this,’ and, ‘No, I don’t do sex clubs, so I’m not going to get this,’” Grossman recalled.
“This was always an epidemic that was happening to ‘other people,’” Grossman said. “People didn’t have a sense of personal danger for most of the epidemic.”
Examples of cavalier attitudes toward contracting COVID-19 were — and still are — aplenty. Rep. Matt Gaetz, R-Fla., jokingly wore a gas mask to the floor of the U.S. House on March 4, days before a close brush with a coronavirus patient in a Walmart parking lotled him to self-quarantine. On March 13, days before New York City ordered bars to close, they were packed shoulder-to-shoulder with revelers ignoring advice to voluntarily stay indoors. And just this week, as governors banned public gatherings in California and New York, Florida beaches were packed with young people enjoying their spring break.
Be wary of misinformation
In the early days of both outbreaks, the refusal of at-risk individuals to acknowledge their risk was due, at least in part, to government officials downplaying the severity of the situation, according to Grossman.
In October 1982, when hundreds of Americans had already died from AIDS, a journalist asked President Ronald Reagan’s press secretary, Larry Speakes, to comment on the mysterious illness: “It’s known as gay plague,” the reporter said.
“I don’t have it. Do you?” the press secretary snapped back, as the briefing room erupted in laughter.
It wasn’t until the late ‘80s before Reagan himself fully turned his focus to AIDS, which by then had taken the lives of tens of thousands of Americans. “After all, when it comes to preventing AIDS, don’t medicine and morality teach the same lessons?” Reagan asked in 1987, advocating for abstinence.
“Thanks to the president and Fox News, it’s been a similar thing: ‘It’s going to be overblown. It’s just going to be a few old people,’” Grossman said of the early response to the coronavirus.
On March 4, Trump appeared on Sean Hannity’s Fox News program and claimed that the World Health Organization’s COVID-19 death rate — an ever changing figure derived by dividing the number of confirmed deaths by the number of confirmed cases — was “ “false,” citing a “hunch” he had.
And a memo sent two weeks ago by the Trump campaign said the “media’s obsession with weaponizing the coronavirus against President Trump remains at pandemic levels.”
But by last week, the president had changed his tune. NBC News has reported that the administration’s initial response to the outbreak was “a story of missed opportunities, mismanagement and a president who resisted the advice of experts urging a more aggressive response.”
Perry Halkitis, dean of the Rutgers School of Public Health, said similar misinformation circulated early in the AIDS epidemic, with certain populations believing that the virus was a CIA conspiracy or that it could could only infect gay men.
Gil Neary, 62, is a gay real estate broker living in New York City. He contracted HIV in 1987 and said his response to the COVID-19 outbreak has been visceral.
“Holy s—,” he recalled himself thinking upon first hearing about it. “It’s astonishing that we’ve gotten to the point that we’re at, especially considering it started halfway around the world.”
As with the early days of the AIDS crisis, Neary said he thinks “our leaders failed us in a big way,” and this time — as a man in his 60s living with a chronic immune condition in a densely populated city — he’s worried that he’s once again vulnerable.
“It’s very disconcerting, because you think, ‘Here we go again,’” he said.
Follow facts, not fear
Gay urban men, one of the first communities in which HIV/AIDS emerged before becoming a global pandemic, were among the first to receive scientific information that would help them modify their behavior based on facts, not fear. Thanks to community action, gay men were among the first to receive information about condoms reducing the transmission of HIV. The activist drag troupe Sisters of Perpetual Indulgence, for example, distributed safe-sex pamphlets in 1982, over a year before the virus was identified by the U.S. government.
Eventually, behavior modification caught on and helped slow the relentless spread of HIV among gay men.
“We got religious about that,” Peter Staley, a veteran HIV/AIDS activist, said of condom use during the HIV epidemic. “Assume the other person’s positive, assume you’re positive if you haven’t taken a test, and act accordingly.”
At first, many gay men resisted taking the HIV test because there were no treatments for AIDS and no legal protections for those who tested positive. But eventually, after activist groups like ACT UP and Treatment Action Group began to apply wider and more dramatic pressure on government agencies to enhance HIV privacy protections and scale up research spending, testing became more widespread, and the dynamics of how the virus spread began to come into view.
“Eventually we got to the point where we realized you had to really work at it to get it,” Ann Northrop, a lesbian and early ACT UP activist, said of contracting HIV.
Initially, people feared the virus could be airborne or spread through surfaces, like COVID-19. At first, even medical professionals were afraid to be in the same room as some who had the virus, but through the relentless pursuit of factual information, Northrop said she knew HIV was contracted primarily through sex and she was not at risk of contracting it through her activism.
Now, however, with limited and conflicting information about the coronavirus, Northrop said she feels that same “generalized anxiety” that struck many people, particularly gay men, in the early years of the AIDS epidemic.
“I, for the first time in my life as a journalist and complete news junky, am having to limit my news consumption,” Northrop, co-host of the weekly cable news program and podcast “GAY USA,” told NBC News.
While “safe sex” was at first the leading behavior modification to stem the spread of HIV (today, many also take PrEP for HIV prevention), “social distancing” is the recommended way to “bend the curve” of the COVID-19 pandemic.
“Man, people are just eyeing each other with such suspicion — and really making sure not to come in contact with each other,” Northrop said of a recent trip to a pharmacy in New York City, one of the areas hardest hit by the outbreak.
Brooklyn artist John Hanning, 57, knows the fear and anxiety that accompanies a new viral outbreak well. He was diagnosed with AIDS in 1995 and given six months to live.
“My doctor told me I needed to decide what I wanted to happen to my remains,” he said. “It hasn’t been easy, but now I’m undetectable, and I’m pretty healthy.”
Hanning, who was recently featured on the AIDS Memorial Instagram account sharing his story of survival, said an important lesson to take away from the early days of the AIDS crisis is to resist fear and stigma, especially fear and stigma directed toward others.
“We shouldn’t live in fear, and that’s something that happened during the AIDS crisis,” he said. “They were afraid of gay people, because of AIDS or HIV, and hopefully with this coronavirus, there won’t be that stigma.”
Amid this current pandemic, which originated in China, there have been multiple cases where Asian Americans have been targeted in the U.S. Last month, a 16-year-old Asian American student in Los Angeles County ended up in the hospital after he was beaten by peers who accused him of having COVID-19. On March 10, at leasttwo Asian American New Yorkers reported racist attacks: A 23-year-old woman said she was punched in the face and called anti-Asian slurs by another woman, and a 59-year-old man said he was kicked to the ground and called slurs.
Widespread anxiety and fear do not result in superior health outcomes, Halkitis stressed. What does, he added, is proper information and an atmosphere conducive to collecting that information.
During the height of the AIDS crisis, he explained, it took years before people had the proper information needed to protect themselves: information about their status, and information about how to use tools like condoms to make their social/sexual interactions safer.
“People were shooting in the dark, kind of like they’re shooting in the dark right now,” he said, referring to the lack of testing and information about the virus.
“There’s this huge emotional weight that surrounds this situation,” Halkitis said of the public’s attitude toward the pandemic. “We have to acknowledge that, and make it be safe for them to be willing to control this disease and make the right decisions.”
In the late ’80s, once it became easier, safer and more empowering to know one’s own HIV status, more people could take action to either prevent the spread or prevent themselves from becoming infected. That, too, could soon happen in the coronavirus outbreak, but not without the proper information about who has or has had the virus, Halkitis said.
Halkitis said if he had a “magic wand,” he’d test everyone today for coronavirus. “Send it with their census packet,” he added.
Chris Bartlett, now the executive director of the William Way LGBT Community Center in Philadelphia, said the most crucial lesson he learned as an HIV activist with ACT UP was “the importance of being in a community to settle my spirit in times when I felt anxious, disconnected, lonely and isolated.”
Even while practicing social distancing, Bartlett said connection is still possible — albeit a different type.
“One of my goals every day has been to get onto Facebook, Google chat and Skype to reach out and see people through the technology that’s offered to us to make a daily connection,” he said.
Through his decades of activism, it’s this “strong fabric of community interconnectedness” that he cherishes most.
“That gives me enough hope to get through today, without really being clear what’s going to happen tomorrow,” he said.