From a statement by the National Institutes of Health:
The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, has stopped administration of vaccinations in its HVTN 702 clinical trial of an investigational HIV vaccine. This action was taken because an independent data and safety monitoring board (DSMB) found during an interim review that the regimen did not prevent HIV. Importantly, the DSMB did not express any concern regarding participant safety.
The Phase 2b/3 study, named HVTN 702 or Uhambo, began in 2016 and is taking place in South Africa. It was testing an investigational prime-boost vaccine regimen based on the only vaccine regimen ever to show protection from HIV—the regimen tested in the RV144 clinical trial in Thailand led by the U.S. Military HIV Research Program and the Thai Ministry of Health. For HVTN 702, the vaccine regimen was adapted to the HIV subtype Clade C most common in southern Africa, where the pandemic is most pervasive.
“An HIV vaccine is essential to end the global pandemic, and we hoped this vaccine candidate would work. Regrettably, it does not,” said NIAID Director Anthony S. Fauci, M.D. “Research continues on other approaches to a safe and effective HIV vaccine, which I still believe can be achieved.”
“There’s absolutely no evidence of efficacy,” says Glenda Gray, who heads the study and is president of the South African Medical Research Council (MRC). “Years of work went into this. It’s a huge disappointment.” The efficacy study, which began in October 2016, is known as HVTN 702. It enrolled 5407 sexually active, HIV-uninfected men and women between 18 and 35 years of age at 14 sites across the country.
Researchers randomly assigned half of the participants to receive a pair of HIV vaccines used in a one-two punch called a prime boost, whereas the other half received placebo shots. The trial was supposed to last until July 2022. But on 23 January sneak peaks at the data to evaluate safety and efficacy informed Gray and the other leaders of the study that it was “futile” to continue. There were 129 infections in the vaccinated group and 123 in those who received the placebo.
Historically, HIV treatments have included three or more medications (oftentimes combined in one pill) to keep HIV suppressed and help people living with HIV reach and maintain undetectable viral loads. In the spring of 2019, the U.S. Food and Drug Administration (FDA) approved the complete regimen combo pill Dovato (dolutegravir + lamivudine), manufactured by ViiV Healthcare, giving clinicians for the first time a two-drug option to treat individuals just beginning HIV treatment.
“I’m concerned that this will lead to massive amounts of Dovato use, two-drug therapy, that will bite us down the road,” said Gandhi, who is medical director of Ward 86. “We have lots of experience with three drugs, and there is a concern about resistance with a two-drug regimen.”
Gandhi explained that lamivudine (3TC), the NRTI in Dovato, has a low barrier to resistance—meaning that it’s easy for a person to develop resistance to the effects of 3TC so that the drug no longer works. When this happens if a person is taking Dovato, the person is effectively on dolutegravir monotherapy. And, people taking only dolutegravir can develop resistance mutations that would rule out future treatment with dolutegravir and, likely, other integrase inhibitors. Dolutegravir monotherapy, Gandhi said, is “a terrible idea.”
“If you lose [develop resistance to] dolutegravir after some time, you’ve just lost the entire first-line class of drugs that we have to treat HIV [INSTIs],” she said.
Drug resistance can be transmitted (i.e., it’s possible for a person who has never taken HIV medications to already have a resistance mutation), so HIV clinicians test for resistance mutations prior to starting therapy. If a person has a resistance mutation, HIV providers can tailor the drug treatment to work around resistance. Resistance can also develop if someone taking HIV medication isn’t adherent to treatment—for instance if they forget to take or aren’t able to take medications every day as prescribed.
For these reasons, Gandhi urges clinicians to consider adherence when prescribing two-drug regimens—knowing that “we’re just not that good” at estimating how adherent a person can be.
“I would be more comfortable at this point giving people a chance to adhere and do well with a three-drug regimen, and then maybe downgrading them to a two-drug regimen if they are adherent,” said Gandhi. “Patients should be aware of the importance of adherence, which is true of any regimen, but particularly true with a two-drug therapy. I wouldn’t want them to miss any doses. And I would want them to talk to their provider about how to take medication, so that they both could be reassured.”
Gandhi said she worries that health care providers who do not specialize in HIV treatment may miss some of these nuances with the new DHHS guidelines—opting to prescribe a two-drug regimen out of concerns over toxicities in regimens with three drugs.
“Young healthy people probably aren’t going to get toxicities with TAF or abacavir (the third drug in the combo pills Biktarvy and Triumeq, respectively). I think it’s interesting that we are talking about two-drug therapy now due to concern about toxicities. For example, NSAIDS (e.g., ibuprofen) can cause renal issues, but we don’t even think twice before putting people on long-term NSAIDS if they’re young and not at risk of renal toxicity. You want to tailor your toxicity concerns to risk factors of that individual. If they have risk factors for cardiovascular disease, you should be concerned about abacavir. If they have risk factors for renal toxicity, you should be concerned about TAF,” said Gandhi
FDA approved Dovato for the initial treatment of HIV based on the results of the GEMINI 1 and 2 studies, which enrolled over 1,400 people starting HIV treatment for the first time. The studies found that 86% of individuals had undetectable viral loads <50 copies after 96 weeks (compared to 89.5% of people taking a three-drug regimen of dolutegravir + TDF/FTC). 85% of participants were men and two-thirds were white.
Although these study results show that dolutegravir + lamivudine can be a successful treatment option for some, Gandhi said that she questions the extrapolation of one phase 3 study to the entire population of people living with HIV.
“People who get into clinical trials are often very rarified populations. They are adherent, they come in for clinical trial visits. They are often white and they are often men. We need some real-world studies, some demonstration projects, that include women and people who may have adherence difficulties,” said Gandhi.
Also new in the DHHS guidelines is a recommendation that HIV treatment be started immediately or as soon as possible after diagnosis, to decrease the time required to achieve viral suppression and reduce risk of HIV transmission, a recommendation Gandhi supports and said she was pleased to see.
The challenges—and opportunities—of two-drug regimens
Here’s a low-down on HIV drug resistance, including what it is and how you get tested for it. Also, get advice from HIV clinicians on prevention and what to do if you do develop HIV drug resistance.
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San Francisco AIDS Foundation receives funding from corporate partners including those in the pharmaceutical industry. Editorial decisions on our blog and website are made independently. For more information about SFAF funding, please refer to our financial and tax documents.
EMILY LAND, MAEmily Land is the editor-in-chief of BETA blog and content marketing manager at San Francisco AIDS Foundation.
Arielle Clark, 28, grew up in a sober household in Louisville, Kentucky, and was never drawn to alcohol. But when as a teenager she began her process of coming out, alcohol suddenly became ubiquitous in her social life.
“When I was growing up and I was kind of figuring out my sexuality, all of a sudden I was inundated with alcohol,” Clark told NBC News.
Going to Kentuckiana Pride, her home state’s largest gay pride celebration, at 16 was Clark’s “LGBT puberty” moment, she said. While she witnessed the heavy presence of alcohol at the event, she felt accepted. Her next milestone, friends said at the time, would be turning 21 and being able to go to the gay bars.
Clark quickly realized that alcohol use — and, in many cases, dependence — were large parts of the LGBTQ social scene that she had been introduced to. She eventually decided gay bars were not for her, but she had a hard time finding a social alternative.
That’s when she got the business idea for Sis Got Tea, a tea shop that she hopes will provide a safe, alcohol-free social space for Louisville’s black queer community that is accessible to people with disabilities. While she continues to fundraise for the shop’s brick-and-mortar space, she has been hosting pop-up events around the city that aren’t centered on alcohol.
“It took until my mid- to late-20s to finally find a group of black, queer women where I could finally relax my shoulders, and I really want to provide that for the community,” Clark said.
Sis Got Tea, which Clark hopes will open later this year, will be among a new wave of queer, alcohol-free social spaces and traveling events that have popped up over the last few years and serve as alternatives to gay bars. While sober social spaces and events have become popular among younger Americans more broadly, they are particularly noteworthy within the LGBTQ community — where substance abuse is disproportionately high and gay bars have long served as unofficial community centers and safe havens.
‘Third spaces’
Indiana resident Morgan Roddy has been making chocolate truffles and desserts for more than a decade. With the support and encouragement of her wife, Roddy opened the high-end chocolate shop Queer Chocolatier in Muncie, Indiana, in 2017.
She said she decided to make the name of her shop explicitly LGBTQ after the state’s governor, Mike Pence, was elected vice president. She feared his anti-gay track record would force some people to go deeper into the closet — so she wanted to come further out.
“I knew there would be a lot of people who would feel safer if they were quiet about their sexual orientation,” she explained. “I decided to take space and hold it for those who would be feeling vulnerable in these times.”
For Roddy, keeping Queer Chocolatier alcohol-free is a commitment to keeping the space accessible to patrons of all ages and those recovering from substance abuse. She also believes it will foster a better environment for political discourse and community activism.
“As a queer woman with a masters in sociology, ‘third spaces’ are places where ideas are shared and relationships are built,” Roddy said. “Without alcohol, there’s less pressure to engage in sex-centered conversations or hookup culture as well. Allowing for people to thrive and flourish in third spaces without alcohol has the potential to bring about some truly radical changes.”
Across the country in Portland, Oregon, Ori Gallery in 2018 launched a creative and community-organizing space for trans and queer artists of color. The gallery was founded by Maya Vivas, a ceramic and performance artist, and Leila Haile, a tattoo artist and community activist.
Aside from offering a rotating gallery space, Ori Gallery also offers free or low-cost workshops and organizes meetups for LGBTQ artists of color.
Ori Gallery was not originally intended to be a sober space — people are still allowed to consume alcohol at private events — but since the gallery’s organizers prioritize youth in their programming, alcohol is not provided at the venue’s regular events. Maintaining alcohol-free environments is often a way of ensuring that queer spaces are accessible to young people under 21.
In Los Angeles, Cuties has become a popular destination for daytime socializing among the city’s LGBTQ community. Virginia Bauman, the venue’s queer owner, opened the café in 2017 after a successful IndieGogo fundraising campaign. Bauman said she wants Cuties to serve as a casual space that can reduce isolation and promote greater connectivity within the community.
“Having spaces that are accessible from an economic standpoint where people can just be for long periods of time … without having to justify their existence, or without having to justify why they’re there, is one of the biggest opportunities that I still see for queer communities,” she explained.
The absence of alcohol sales, which produce relatively high profit margins, can be a financial obstacle, according to Bauman. In order to compensate, Cuties started a fundraising campaign to bring in additional money to help keep the venue afloat.
‘We’re tapping into a need’
In a number of cities across the U.S. — and beyond — LGBTQ event organizers and online communities are bypassing the overhead of a physical space altogether and are focusing on intentionally alcohol-free social gatherings that are not dependent on a specific location.
Photographer and queer activist Cyrus Golestan is the co-founder of Trans in the Wild, a nonprofit that provides resources to New York’s LGBTQ community. Last month, he hosted his first alcohol-free party in an apartment building basement in Brooklyn. The idea was to “overcome winter gloom” with “sober fun,” according to the party’s promotional flyer.
“We used to have so much fun as kids without any type of substances,” Golestan, 29, said. “Why can’t we just get together and play?”
After posting the promotional flyer, Golestan said he received an influx of positive messages. Many of those who wrote to him expressing interest in the party told him they “do partake in alcohol sometimes” but were “excited that this is a healthier option,” he said.
Golestan said he does not identify as sober, but he recognizes how he has used alcohol in the past to cope, especially during his college years before coming out as trans.
“I was trying to be something that I wasn’t,” Golestan said. “Being closeted even from yourself is this really stressful thing that alcohol let me escape from.”
Golestan’s experience of using alcohol to cope with isolation is not unique. A study published last October in the journal Psychiatric Services found LGBTQ stressors, like discrimination and stigma due to one’s sexual orientation or gender identity, “contribute to the development of substance use disorders among some LGBTQ young adults” between 21 and 34.
Golestan’s first sober party attracted over 30 people, which he considered a success, so he is already in the planning stages for the next one on Feb. 22.
Last month, a new alcohol-free LGBTQ social meetup also debuted in Chicago. Aptly named the Chicago Queer Sober Social, the event was organized by Powerbabe, a sober queer community founded by two tech professionals, Phoebe Conybeare, 30, and Hollie Lambert, 28, who have both been sober and in recovery for two years.
The event, which is scheduled to take place monthly, is not part of a structured recovery program and is marketed simply as an alcohol-free social community. Conybeare said she and Lambert saw the need for a safe space for those who decided to abstain from alcohol for any number of reasons.
“Most sober spaces online and IRL catered to a cisgender, heterosexual and monogamous crowd or were program-based,” Chicago Queer Sober Social’s Facebook page says. “Most queer social events were focused on bars and parties where drugs and alcohol would be present.”
The group’s first event was held in a coffee shop and drew over 100 attendees. Given its success, the next Chicago Queer Sober Social, scheduled for Feb. 18, will be held in a larger venue.
“People were extremely grateful for the space — many were thanking us throughout the night and excited about attending future events and offering to help us organize,” Conybeare told NBC News. “We now have a small list of volunteers just from our first event. Response from the community has been incredibly supportive, and we’re so glad we’re tapping into a need.”
In North Texas, KT Kershen, 27, who has been sober and in recovery for four years, said she started an alcohol-free social group last year due to a “personal need for connection and a sense of community.”
“The experience of intense loneliness that comes at the intersection of being both queer and sober drove me to create a space for myself and for others like me,” she said, noting that as a queer atheist woman she felt like “an outside” in the 12-step Alcoholics Anonymous program.
Kershen said Queer Sober Society initially started as an online group for North Texan LGBTQ people in recovery, but she said it has since morphed into an in-person meetup that connects at least once a month. The group organizes mocktail parties, game nights, bowling outings and other alcohol-free events.
“It is my hope, and I am going back to school to get a bachelors in psychology to prepare for it, that Queer Sober Society will one day be a nonprofit organization that provides a safe space for folks like me,” Kershen said.
The United Kingdom is also seeing queer sober parties pop up. Misery, a queer sober collective focused on mental health and healing, launched in 2019 and hosts events in London and Berlin. Queers Without Beers, which started in 2018, started as an online community and then started organizing sober meetups in different U.K. cities, including monthly pop-up “bars” in London, Bristol and Manchester.
“Everyone is welcome,” Laura Willoughby, the founder of Queers Without Beers, said. “We have people who are going through traditional recovery, the local muslim LGBT group, students who have never really drunk as well as people looking to cut down or just socialize without the pressure of needing to drink all evening.”
‘The possibilities are endless’
Arielle Clark, who in November exceeded her $10,000 fundraising goal for a physical Sis Got Tea space in Louisville, said she’s encouraged by the queer, alcohol-free events she has heard about popping up across the U.S. and abroad.
While she looks for a permanent home for Sis Got Tea, aiming for a 2020 debut, she said she plans to continue hosting pop-up events to provide options for those who don’t want their social life centered on alcohol.
“As we move further into creating these sober spaces, I think we’ll identify more needs within the LGBTQ+ community that intersect with sobriety,” Clark said. “The possibilities are endless.”
A reverend in Ohio revealed a thief has stolen part of his church display honouring the trans people who were killed in 2019.
St Peter’s United Church of Christ in Cincinnati, Ohio, describes itself as a “100 per cent hate free zone”.
According to its website, the church welcomes everyone into its community “no matter your faith background, sexual orientation, gender identity [or] race”.
But Terry told Fox 19 that on Saturday, February 1, he noticed that the two trans Pride flags that made up part of the display were missing. After checking the church’s security footage, he realised they had been stolen.
Terry added that the church has had problems with vandalism in the past, and said: “Anytime you make a stand for anything, there’s always someone who has a different perspective or different idea.
“And so, like I said, this has happened to us before, so I get it, but of course I was angered. I was upset.”
He said he is not sure of the thief’s reason for stealing the flag, but added: “It’s still stealing. It’s still wrong.
To whomever stole our Trans flags at @Stpeterscinci: God saw you and so did our cameras. Once the ground is softer we will have permanent flag poles installed and pride flags will wave 20 feet in the air. When you go low we will go high. #carryon
A New York state park will be renamed to honour the trans activist Marsha P Johnson, New York governor Andrew Cuomo has said.
Cuomo announced that East River State Park in Brooklyn would be renamed at the Human Rights Campaign greater New York gala on Saturday February 1.
Johnson, a black trans woman who worked as a sex worker, is most well-known for her involvement in the 1969 Stonewall uprising, often seen as the beginning of the modern gay rights movement.
She was also a trans rights pioneer, and in 1970 she founded “Street Transvestite Action Revolutionaries” otherwise known as “STAR”, with her friend Sylvia Rivera.
According to AP News, Cuomo said at the gala: “New York state is the progressive capital of the nation, and while we are winning the legal battle for justice for the LGBTQ community, in many ways we are losing the broader war for equality.”
He said that hate crimes against black people, Jewish people, Muslims and the LGBT+ community were on the rise, but that they were driven by “fear and intolerance”.
He continued: “We are fighting back, and we will continue achieving progress and showing the rest of the nation the way forward.”
After the gala, Cuomo added on Twitter: “I’m proud to announce that East River State Park in Brooklyn will be named in honor of Marsha P Johnson, a pioneer of the LGBTQ rights movements.
“New York unequivocally supports the rights of LGBTQ New Yorkers, now and always.”
On the tape, recording in 1970, the pair discuss reactions to their gender from people around them.
Rivera said: “My grandmother completely freaked out for a number of years until she just recently has to be satisfied that I’m, that I’m going to be my way.
“And now she calls me Sylvia. I’m her dear granddaughter… Society keeps on saying, ‘You can’t do this because this isn’t your role.’
“Who is to tell who what role we’re supposed to take?”
Transgender advocates are beginning to fret — and plan litigation — as a new kind of anti-trans legislation has begun to advance in state legislatures aimed at criminalizing transition-related care for trans youth, including one measure that is halfway to becoming law in South Dakota.
Introduced in more than a dozen states at the start of the legislative session this year, the anti-trans legislation was a major point of discussion at a transgender rights panel Tuesday in D.C. hosted by the American Constitution Society.
Harper Jean Tobin, director of policy for the National Center for Transgender Equality said those bills — along with other measures seeking to inhibit participation of transgender kids in sports — represent anti-LGBTQ groups’ latest efforts to thwart LGBTQ rights after previous failures.
“Anti-LGBT groups realize that whatever they’re trying to scare people [with] lately is becoming less effective and so they find a new scary,” Tobin said. “After marriage equality became less effective as a thing to scare people about, I think it was trans people in general. That’s become a little bit less effective. It was bathrooms, and that’s become a little bit less effective, Now it’s, oh my gosh, trans young people in healthcare and trans people in sports.”
In South Dakota, the state House on Wednesday approved legislation known as House Bill 1057, which would criminalize providing transition-related care to youth, including puberty blockers and gender reassignment surgery, making them a Class 1 felony. The penalty would be a maximum of a year in prison and a fine of up to $2,000.
Since its introduction, the bill was amended to reduce its scope to youth under age 16 as opposed to all minors up to age 18, and the penalty was reduced from Class 4 felony to a Class 1 felony. The bill, nonetheless, still carries a maximum penalty of one year in prison and a maximum $2,000 fine. (Tobin referred to the changes to the bill as “small tweaks that are trying to make it seem less awful.”)
Tony Perkins, president of the Family Research Council, commended the South Dakota lawmakers for passing the legislation in an email blast this week to supporters.
“At one time, using cross-sex hormones or performing gender reassignment surgery on minors was rare,” Perkins said. “Now, however, these procedures are also being done at younger and younger ages, making bills like HB 1057 urgent. Cross-sex hormones are associated with a higher risk of heart attacks and blood clots, infertility, loss of bone density, and sexual dysfunction.”
The legislation, introduced by State Rep. Fred Deutsch, passed in the South Dakota house by a vote of 46-23 and now heads to the state Senate, which already has plans to advance the bill. A committee hearing could happen as soon as this week, according to the Washington Post.
Alexis Chavez, medical director for the Trevor Project, condemned the passage of the legislation in a statement shortly after its passage.
“This bill actively contradicts evidence-based medical recommendations and restricts parents’ ability to support their child with best-practice care, which has been shown to decrease suicide risk,” Chavez said. “Medical decisions should be made between doctors and their families — politicians have no role in this intensely personal process.”
South Dakota Gov. Kristi Noem, a Republican, hasn’t indicated whether she will sign or veto it. The Blade has placed a request in with her office seeking comment.
If the South Dakota bill becomes law, anti-trans groups would likely see it as a roadmap to proceed in other states. To head that off, a major transgender rights campaign would likely emerge to convince Noem to veto the bill should it reach her desk.
“There are signs the playbook for post-North Carolina HB 2 is somewhat applicable here in that the South Dakota State Medical Association and Chamber of Commerce have both come out against that legislation, as has the American Medical Association,” Tobin said.
According to a list compiled by Human Rights Watch, more than a dozen bills that would criminalize providing transition-related care to transgender youth are pending before state legislatures.
Bills in Colorado, Florida, Kentucky, Missouri, New Hampshire and South Dakota would criminalize the care, while legislation in Illinois, Missouri, Oklahoma and South Carolina would institute professional discipline, such as revocation of licenses. Lawmakers in Georgia, Texas and Utah have also signaled they’ll introduce similar legislation.
Because all these bills are similar, transgender advocates are looking to the usual suspects of anti-LGBTQ groups, such as the Heritage Foundation and Alliance Defending Freedom, as their source.
Tobin pointed out Deutsch introduced the legislation in South Dakota after flying to D.C. on the taxpayers’ dime for a Heritage Foundation event on “the sexualization of children.”
“They had a panel all about how we have to stop kids from being trans because that somehow is the sexualization of children,” Tobin said. “And this state legislator — apparently several others — came home with this great idea that had been pitched to them at this conference panel, which was let’s make it a crime to provide health care to trans kids.”
Conservative pundits and lawmakers are whipping up support for the legislation by drawing on the recent spike in youth identifying as transgender and stories of youth who underwent a gender transition process, but later expressed regret over the decision. Meanwhile, the Centers for Disease Control has revealed in a recent report puberty blockers can reduce suicide rates of transgender teens, who have high rates of suicidal ideation.
Sharita Gruberg, director of policy for LGBTQ research and communications at the Center for American Progress, said the lawmakers and anti-LGBTQ forces raising concerns are distorting the record.
“It’s always funny to me what the right thinks medical care looks like for trans people,” Gruberg said. “Like the idea that there are doctors who are prescribing surgical care for minors is a widespread thing is absurd, but I think that’s something that’s like latched on in the public imagination as like when we’re talking about what health care for trans youth looks like.”
Meanwhile in other states, including New Hampshire, Georgia, Indiana, Missouri, Tennessee and Washington State, legislation is pending that would restrict the ability of transgender kids to participate in school sports consistent with their gender identity.
Tobin said the sports bills have a unique way of eliciting sympathy because the public has assumptions of athletic performance based on sex, which is difficult to dissuade.
“People think that they understand the relationship between bodies and gender, and especially hormones,” Tobin said. “We talk about sex hormones, even though everyone’s body has testosterone, you can’t ovulate without testosterone, but we still call it a male sex hormone associated with maleness and more of it means you’re born male. We believe that it’s a primary factor in athletic performance across all the different sports that involve a huge variety of different physical skills, and the science doesn’t support that.”
Much of this anti-trans legislation seems based on a situation in Connecticut in which two transgender teens outperformed female athletes in a track event, which excluded the other racers from potential sports scholarships. Alliance Defending Freedom has spearheaded a complaint against the state athletic association in Connecticut, which the Department of Education has agreed to take up.
Gruberg pointed out the transgender athletes in Connecticut were black and girls behind the complaint are white, so race is in play.
“When we’re talking about integrating sports, these are similar arguments that have been made in the past,” Gruberg said. “I don’t want to erase the racial lens either that our opponents are using as they’re attacking trans people’s participation. There’s certain people — who counts as a woman, who is able to — has a lot of dimensions and they’re picking their spokespeople and the woman who placed eighth and could have placed sixth is also white.”
If all else fails and the bills become law, plans are already underway for litigation to enjoin the states from enforcing the anti-trans bills.
Chase Strangio, a transgender advocate and staff attorney for the American Civil Liberties Union, said litigation is being planned in South Dakota, which could be followed by other lawsuits.
“We are prepared to file suit in South Dakota should HB 1057 pass and get signed into law and will continue to assess litigation options in any state where a ban on gender affirming care is pending,” Strangio said. “These measures are a direct attack on the ability of transgender young people to survive and raise serious Equal Protection and Due Process concerns for young people and their parents. I have no doubt that any state that passes one of these laws will have to contend with significant litigation and legal liability on multiple fronts.”
But there’s no assurances the litigation would ultimately be successful in court, especially in the aftermath of President Trump remaking the judiciary with a record breaking number of Senate-confirmed conservative appointments.
At the ACS panel, the Blade asked whether there was any consideration to reaching out to lawmakers behind the bills to craft different legislation that would codify the process by which doctors prescribe transition-related care to youth, thereby allowing lawmakers to say they voted for a ban and trans advocates to say were able to codify the medical process.
Tobin, however, didn’t like that idea, pointing out states already have in place medical malpractice laws that cover a situation in which doctors violate best practices. Further, she said the proposal “is usually a non-starter” for sponsors of the bills pending before legislatures.
“That would be a bad idea, I think, the idea that you’re going to codify into law and especially with the criminal offense what the standard of care is rather than allow, as happens with the rest of the practice of medicine, the standards of care to evolve over time and be defined and updated by the different medical associations, and not have 57 jurisdictions have to update their codes every time clinical guidelines are updated and so forth,” Tobin said. “The Criminal Code is not a place where we should be defining the medical standard of care, we already have laws for that.”
An immigrant advocacy group on Monday said the transgender women who were in U.S. Immigration and Customs Enforcement custody at a privately-run detention center in New Mexico have been moved to other facilities around the country.
The Santa Fe Dreamers Project in a press release said ICE at 3 a.m. on Jan. 21 “without warning” transferred half of the total number of trans women who were detained at the Cibola County Correctional Center in Milan, N.M., to the Aurora Contract Detention Facility near Denver. The Santa Fe Dreamers Project noted ICE on Jan. 25 later transferred the “second half of the group” to the Tacoma Northwest Detention Center in Tacoma, Wash., via a facility in Florence, Ariz.
The GEO Group, a Florida-based company, operates the Aurora and Tacoma Northwest Detention Centers.
Charlie Flewelling, an attorney with the Santa Fe Dreamers Project, on Tuesday told the Washington Blade their organization was in “regular contact with” 29 detainees at the Cibola County Correctional Center. Flewelling said three of them were in solitary confinement or housed with men at the facility, and the remaining 26 detainees were housed in a unit that ICE created specifically for trans women in their custody.
“Santa Fe Dreamers Project is currently working with legal service providers in both locations to ensure a continuity of legal services, including requests for immediate release and legal representation in the event those requests are denied,” said the Santa Fe Dreamers Project in their press release.
Flewelling told the Blade that ICE sent one of the detainees to the Otero County Processing Center, a detention facility in Chaparral, N.M., operated by Management and Training Corporation, a Utah-based company.
“To my knowledge we were in regular contact with everyone housed in the trans unit, as well as every trans woman held in solitary as well as with every trans woman held with the men,” they said.
CoreCivic, a private company once known as the Corrections Corporation of America, operates the Cibola County Correctional Center that is roughly 80 miles west of Albuquerque, New Mexico’s largest city. ICE in 2017 opened the unit for trans women.
The Santa Fe Dreamers Project in its press release suggested ICE “appears to be in the process of closing the unit and transferring all of the women to other detention centers in the U.S.”
An ICE official with whom the Blade spoke on Tuesday confirmed 27 detainees “previously housed at the Cibola County Correctional Center” were transferred “to other facilities throughout the country.” The official said not all of the detainees who were transferred from the Cibola County Correctional Center are trans women.
“ICE routinely transfers aliens for a number of reasons including available bed space, access to specific health care needs, or due to temporary adverse facility conditions,” the official told the Blade.
The official noted ICE “is currently working with its contractor to assess and improve the quality of long-term health care management at the Cibola County Correctional Center.”
“In the interim, ICE has found available bed space in other facilities with existing resources to better manage the needs of certain detainees requiring continuous medical case management,” said the official.
“ICE will continue to work with the facility operators to ensure those in our custody at the Cibola County Correctional Center reside in a safe, secure, humane environment with access to necessary health care,” added the official.
The official did not say whether ICE is plans to close the unit. Flewelling on Wednesday insisted to the Blade it is closed.
“The trans pod is closed, and regardless of if that is permanent or temporary we stand by the statements made in our press release,” they said.
Transgender immigrants ‘not safe in immigration detention’
The Santa Fe Dreamers Project is among the advocacy groups that have sharply criticized the treatment of trans women at the Cibola County Correctional Center and other detention centers around the country.
Roxsana Hernández, a trans Honduran woman with HIV who had briefly been detained at the Cibola County Correctional Center, died at an Albuquerque hospital on May 25, 2018.
More than two dozen trans women at the Cibola County Correctional Center on June 26, 2019, sent a letter to Trans Queer Pueblo, a Phoenix-based group that advocates on behalf of undocumented LGBTQ immigrants, in which they complained about inadequate medical care and mistreatment from staffers. The detainees wrote the letter two weeks after ICE invited this reporter and a handful of other journalists to tour the facility.
The Santa Fe Dreamers Project on Jan. 16 demanded the release of a trans Salvadoran woman in ICE custody at the Cibola County Correctional Center because she is “in a life-or-death medical crisis.”
A 2015 memorandum then-ICE Executive Associate Director of Enforcement and Removal Operations Thomas Homan signed requires personnel to allow trans detainees to identify themselves based on their gender identity on data forms. The directive, among other things, also contains guidelines for a “respectful, safe and secure environment” for trans detainees and requires detention facilities to provide them with access to hormone therapy and other trans-specific health care.
More than 40 Democratic members of the U.S. House of Representatives earlier this month in a letter to Acting ICE Director Matthew Albence and Acting Department of Homeland Security Secretary Chad Wolf called for ICE to release all trans people in their custody. The Santa Fe Dreamers Project and Trans Queer Pueblo are among the more than 80 advocacy groups that made the same demand in their own letter to Albence and Wolf last week.
“Transgender immigrants are simply not safe in immigration detention,” reads the groups’ letter.
For years, a trans woman had been quietly dealing with the abuse a neighbour pelted her with, until the person killed and cut her cat in half.
All for hoisting an Pride flag outside her house.
Angelina Bouros, based in New York, US, discovered her cat Rambo’s body ditched behind her shed. An incident that was the boiling point of unrelenting harassment that stretched back to 2017.
Transphobic neighbour cut woman’s cat in half because she had a Pride flag.
But after sharing the incident on Twitter, Rosendale locals pulled together to support her by transforming her house with the colours of the rainbow to give a strong statement that transphobia will not be tolerated.
“They picked the wrong person to pick on,” Bouros told NowThisNews.
“I had put a rainbow flag on my house and somebody around here didn’t like the fact that the rainbow flag was up.”
‘They picked the wrong person to pick on’ — Trans woman Angie Bouros became the victim of hate speech and violence after flying a rainbow flag outside her home.
A simple flag fluttering in the breeze ignited the fury from a member of her neighbourhood, sending four hate mail letters weighed with profanity and abuse.
The neighbour never identified themselves, but they made it clear that they killed and chopped her beloved cat in half. Leaving his corpse brazenly cast behind her back-garden.
‘When we stick together, we are stronger.’
“I don’t have any children,” she said, “so my cats are my children.
“And I love them as much as a person could love a pet.”
As much as the incident broke her, it only made Bouros more “determined to stand up even more”.
“The only way for me to push back was to paint my house,” she said.
“And not only for my sake, but to let the community know why I’m doing this, that I had to take a stand against hatred and bigotry.”
She took to Facebook in 2019 to first reveal her DIY plans, showing her bungalow spruced up with splashes of colour: “The party is just starting,” she wrote.
The house is painted but the party is JUST starting!
“Linkage to care” is a well-spoken mantra in the field of HIV: Make sure that people who are living with HIV are seeing an HIV care provider and have access to HIV medications. As simple as it may seem, the changing nature of San Francisco’s HIV epidemic means that more and more people are not accessing—or are not able to access—HIV prevention or care from traditional medical clinics.
HIV providers and frontline staff must confront the challenge of bringing HIV care to people—beyond simply linking people to care.
“Access to HIV care is so much more than making sure a person has a place to receive medical treatment and can afford it,” said Julie Lifshay, MPH, PhD, from San Francisco AIDS Foundation.
“Even if a person knows where to go and has insurance or a way to pay for care, they may not be able to afford the bus ride to get there. Or they can’t navigate the health system to make an appointment, they can’t afford their medication copays, or they can’t pick up prescriptions because that would mean missing their place in the food line. It’s complicated, and there are so many things that can put HIV care just out of reach,” said Lifshay.
“People who are unhoused face a lot of barriers accessing care,” said Beth Rittenhouse-Dhesi, MS, from San Francisco Community Clinic Consortium. “It’s not as easy as walking into a clinic and getting needs met. Because of stigma, many people have had bad experiences and so they choose to stay away. The other issue is that people living on the street are dealing with a lot of survival issues. They’re worried about food, water, shelter and clothing. So even very serious health concerns can be put on the back burner.”
In San Francisco, 20% of new diagnoses were among people experiencing homelessness, a proportion which has been increasing in recent years.Getting to Zero SF, San Francisco’s plan to reach zero new HIV infections, zero AIDS-related deaths and zero HIV stigma hinges on the success of reaching and providing services to people experiencing homelessness.
POP-UP is open to people who are homeless or unstably housed, are off antiretrovirals or have a detectable viral load. The program sees people on a drop-in basis without appointments, starts people on antiretrovirals and provides comprehensive medical care, medication storage, food, clothing, housing assessments, mental health care and gift card incentives for staying in care.
“We call it POP-UP because when people come into the clinic, our team grows around them and we work to meet their needs and concerns,” said Elizabeth Imbert, MD, MPH from Zuckerberg San Francisco General Hospital. “We don’t start with the medical stuff—we try to get to know them, figure out what they want, and what’s important to them. We find out what their health goals are, what has gotten in the way [of meeting goals], and how we can help meet them.”
Since January of 2019, over 95% of people in POP-UP have started on ARVs, and more than half (32 out of 59) are virally suppressed, reported Imbert at a Getting to Zero meeting in December 2019.
Street Outreach Services does not provide ongoing treatment for chronic conditions including HIV, but the team does connect people with regular care, help people figure out transportation to medical appointments, and follows up with clients to make sure they receive HIV care.
Rittenhouse-Dhesi said the van frequents neighborhoods that not only have homeless residents but also a low concentration of service providers.
“We provide care to anyone who is unhoused—our goal is to connect with people in their own environment of places where they’re gathering. That may be a camp, or another place outdoors, or at a meal program. The whole objective is to come to people, and not always expect people to come to a four-walls clinic. After you make that initial relationship, you can help people navigate into other services,” said Rittenhouse-Dhesi.
At San Francisco AIDS Foundation (SFAF), a new program reaches Latinx community member immigrants experiencing homelessness through a group of community health educators.
The “Todos Somos Familia” project, though Latino Programs at SFAF, recruited and trained a group of currently and formerly homeless Latinx immigrants on topics such as overdose prevention, accessing social services, HIV prevention and getting into HIV care. In turn, members of the program reached out into the community and into their networks to share HIV and health information and services, facilitating access to case management, drug treatment, testing, PrEP and HIV care.
“There is a lack of investment in reaching immigrants without housing,” said Jorge Zepeda, from SFAF. “These individuals may not be aware of the services they can access, and may not trust them. This project helped SFAF become a safer and friendly space for Spanish-speaking communities, and showed that we can reach people with these services if we do so in culturally competent ways.”
“We’re seeing these great disparities in HIV in San Francisco,” said Lifshay. “It’s because we are dealing with social determinants of health including income disparities, the housing crisis, displacement issues and racism. We have to address those things to get to zero. It’s such a big task, but a smaller piece is making sure our resources go to the people most impacted by these issues. We have to reach homeless folks with HIV care—we must do a better job of that.”
END THE EPIDEMICS
Sign the petition to End the Epidemics, a campaign calling for a statewide plan to end the HIV, STD and hepatitis C epidemics in California. Urge California leaders to make serious investments in public health and help us lead the nation in ending the HIV, STD and hepatitis C epidemics. JOIN US!
HIV SUPPORT & HEALTH NAVIGATION AT SFAF
We offer a range of services that help connect you to HIV treatment, benefits, housing subsidies, and insurance. MORE INFO
STREET OUTREACH SERVICES
SOS provides high-quality, nonjudgmental health services directly to people experiencing homelessness in places where they live and congregate. MORE INFO
EMILY LAND, MAEmily Land is the editor-in-chief of BETA blog and content marketing manager at San Francisco AIDS Foundation.
Transgender individuals who received puberty blockers during adolescence have a lower risk of suicidal thoughts as adults than those who wanted the medication but could not access them, according to a study published Thursday in the journal Pediatrics.
“These results align with past literature, suggesting that pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes,” the study states.
The finding suggests that a major — and politically controversial — aspect of transgender health care for minors could help reduce the trans community’s disproportionate risk of suicide.
“Puberty blockers” are a type of reversible medication injection or implant that pause puberty. These drugs are prescribed to children who experience early onset puberty and for transgender youth experiencing gender dysphoria. Natural puberty resumes when the injection wears off or the implant is removed.
The study’s lead author, Dr. Jack Turban, a resident psychiatrist at the Harvard Medical School, said the findings add to the “growing evidence base suggesting that gender-affirming medical care for transgender youth is associated with superior mental health outcomes in adulthood.”
“It certainly argues against the misguided notion that gender-affirming care is inherently harmful and should be legislatively banned,” Turban said in a statement, referring to a number of recently introduced state bills seeking to limit transition-related care for minors.
The study surveyed 20,619 transgender people and found that 90 percent of trans adults who wanted, but could not access, puberty blockers experienced suicidal thoughts. For transgender adults who had been able to access puberty blockers, it was a significantly lower 75 percent.
Less than 3 percent of trans adults who say they wanted puberty suppression during adolescence actually received it — showing how hard it has been, historically, to access this particular treatment for gender dysphoria.
The study also found that a minority of trans adults — 17 percent — say they ever wanted puberty blockers, suggesting that not all trans youths will seek this particular type of treatment.
Turban has been at the forefront of transgender mental health research. A study he co-authored in September showed a link between suicide attempts and transgender “conversion therapy.” Conversion therapy is the medically discredited practice of attempting to change a person’s gender identity or sexual orientation.
For decades, doctors who treat transgender children have argued that an affirming, supportive gender transition is the best way to help trans people thrive and survive. Norman Spack, the Boston pediatric endocrinologist who in 1998 pioneered the use of puberty blockers in the treatment of gender dysphoria, said doing so can “save lives.”
But as the use of puberty blockers in trans kids has became more mainstream — thanks to endorsementS from major medical associations such as the Endocrine Society and the American Academy of Pediatrics — backlash has grown in Republican-dominated legislatures across the country.
Even as medical professionals have publicly argued that puberty blockers are safe, reversible and likely to help reduce gender dysphoria in transgender kids, conservative lawmakers in states such as South Dakota, Georgia and Kentucky are moving forward with efforts to criminalize the provision of transition-related health care, including puberty blockers, to trans minors.
In these states, the proposed bans on the prescription of puberty blockers would only apply to transgender children. In cisgenderchildren who are prescribed puberty blockers to treat early onset puberty, these bills would not restrict their use.
“Transgender people, our families and our doctors are begging legislators to follow the science when crafting policy that could alter the very path of our lives,” said Gillian Branstetter, a transgender advocate and press officer at the National Women’s Law Center. “Transition-related care is only controversial among people who know nothing about it, and lawmakers must treat the suicide risks faced by transgender youth as the public health crisis it is.”