President Trump’s opposition to trans people serving in the military has sparked protests
A US judge ruling on President Trump’s trans military ban has likened the policy to the discrimination of black people in the armed forces.
Marsha J Pechman, a federal judge in Seattle, is hearing a challenge aimed at blocking the effort to exclude trans people from serving.
This week, in comments reported by Bloomberg, she compared the policy to the historical exclusion of blacks from the military and the ban on mixed units. She said it had been an “error” that the courts signed off on those past decisions.
The judge is being urged to rule that Trump’s controversial policy is unconstitutional.
American LGBT advocates the Human Rights Campaign and the state of Washington argue the government has failed to demonstrate that allowing trans people to serve would damage military readiness or unit cohesion.
Last week, the White House announced it was seeking to formally ban such individuals “except under certain limited circumstances”.
It came after Trump stated last summer that he would ban trans people from serving in the military “in any capacity”.
At the time, the president said that the armed forces “cannot be burdened with the tremendous medical costs and disruption”.
However, his claims have been roundly criticised, including in a letter signed by 56 retired admirals and generals who said the discriminatory policy would harm morale and downgrade military readiness.
Critics have also argued it will force trans members to hide their identities while depriving the military of talent as well as reinforcing harmful and inaccurate stereotypes.
Judge Pechman is expected to make her decision next month, after receiving more information on the proposed ban from the government.
Trump’s policy would overturn a decision made by his predecessor, Barack Obama, in 2016 which lifted a ban on trans people serving openly in the military.
On the first White House news briefing after President Trump reaffirmed his ban on transgender people serving in the U.S. military, White House Deputy Press Secretary Raj Shah declined to address the issue, nor did any reporters from mainstream media outlets ask about it as part of their questioning.
The main focus from reporters on Monday during the 20-minute briefing, characteristically abbreviated for the Trump White House, was instead the “60 Minutes” interview Sunday night with porn star Stormy Daniels and the details she revealed about her alleged sexual affair with Trump. Other questions were about the U.S. expulsion of 60 Russian diplomats as a result of Russia’s apparent use of a military-grade chemical weapon in the United Kingdom, which killed a former Russian spy.
The Washington Blade was seated in the third row and had a hand up during the briefing, but Shah declined to recognize the LGBT outlet for a question. At one point, Shah looked directly at the Blade, but skipped the publication for another reporter. That’s consistent with the Trump White House record of virtually ignoring the Blade during the White House briefings.
Had the Blade been called on during the briefing, the LGBT outlet would have asked about the transgender military ban, which was made public late Friday night just as the weekend started at a time when media coverage was limited and the White House wasn’t taking questions on the issue.
At the close of the briefing, another non-mainstream media standing in the aisle sought comment from Shah on the transgender military ban by shouting out an inquiry. Shah looked at the reporter as he exited the briefing, but had no response.
The Blade followed up with Shah after the briefing by submitting two questions via email to him and other staffers in the White House.
Here are the questions:
1. Did the president, Vice President or anyone at the White House seek to influence the findings in the report from Secretary Mattis made public Friday?
2. Multiple courts have ruled prohibiting transgender service is unconstitutional. Isn’t the policy a non-starter?
Trump announced he’d keep his ban on transgender service in the military following a report signed by Defense Secretary James Mattis recommending limited access to transgender people in the armed forces. The expectation is the policy will be unenforceable because six courts — four trial courts and two circuit courts — have determined barring transgender people from the U.S. military is likely unconstitutional.
Transgender people are born that way, according to a new study.
Researchers at the University of São Paulo’s Medical School have compared the brains of trans and cisgender adults, and discovered that they are significantly different.
In the study, it was found that the insula – a region of the brain – had a distinct volume depending on whether it was in the brain of a trans or cis subject.
The insula plays an important role in people’s body image, self-awareness and empathy.
Giancarlo Spizzirri, first author of the study – which was published in Scientific Reports – said that the result led them to believe that people are trans in the womb.
“We found that trans people have characteristics that bring them closer to the gender with which they identify and their brains have particularities, suggesting that the differences begin to occur during gestation,” he said in a statement.
(Photo by Mark Makela/Getty Images)
Carmita Abdo, coordinator of the Sexuality Research Programme at the university and the study’s principal investigator, emphasised that the study showed being trans was not a product of society.
It found that the term ‘transgender’ “doesn’t just refer to different kinds of behaviour that people develop,” said Abdo.
“We observed specificities in the brains of trans individuals, an important finding in light of the idea of gender ideology, ” she added
“The evidence is building that it’s not a matter of ideology. Our own research based on MRI scans points to a detectable structural basis.”
Professor Geraldo Busatto, who heads the Psychiatric Neuroimaging Laboratory at the university’s hospital, said it would be “simplistic to make a direct link with transgender, but the detection of a difference in the insula is relevant”.
Busatto, an associate researcher, said this was because “trans people have many issues relating to their perception of their own body, because they don’t identify with the sex assigned at birth, and in addition, they unfortunately suffer discrimination and persecution.”
They said it was one of many “internet-exploited sexual fetishes that try to make themselves a rights movement.”
The meeting, called Transgenderism and the War on Women and hosted in the House of Commons, also heard how trans women ‘parasitically’ invaded women’s spaces and were a threat to women’s liberation.
Sheila Jeffreys in 2009 (Photo: Terri Strange / Youtube)
Displaying a presentation entitled ‘transgenderism and the assault on feminism’, Australian academic Sheila Jeffreys opened the event by saying: “Men can’t become women, what’s so difficult about that?”
Jake Bain (right) and his boyfriend (Photo courtesy Jake Bain)
Hundreds of pro-LGBT protesters turned up to drown out the Westboro Baptist Church, when they decided to target a gay high school footballer.
Jake Bain, a popular footballer at John Burroughs School in St. Louis, Missouri, came out publicly as gay last October at an all-school assembly.
His bravery was praised by his coach and teammates – but the young athlete attracted attention from the notoriously anti-LGBT Westboro Baptist Church, which announced it would picket the school.
However, when the protesters turned up to the school on Monday morning, they were met by a crowd of more than 100 pro-LGBT demonstrators, who drowned out their hateful message.
He said: “When the Westboro Baptist Church started rolling in… there was probably already 200 people that were outside, with all kinds of signs in support of my community and in support of the LGBT community as a whole.”
Meanwhile, the school held a special assembly on LGBT issues.
He said: “In the morning in our auditorium, we had a bunch of student speakers come and talk to us, both speakers who are from the LGBT community and also [allies].
“Just to go outside and just get to see all the amazing support, it was really special. … I would say [Westboro] were probably outnumbered 3-to-1.”
Bain added: “They targeted me because they saw that a gay athlete was in the news for the past couple of weeks.
“Honestly, I think they got a little scared that people are starting to realise that it doesn’t really matter if you’re gay, and that everybody should be treated equally.
Pay Off High Interest Debt Now – Get a Quick and Convenient Personal Loan
LendingClub | Need a Loan? Get a Low Rate!
Ad by Lending Club
“I think they realise that the tides are changing, and as this generation and the next generations to come continue to grow and learn, more and more people are becoming accepting. That goes against everything that they stand for.
He added: “They’ve been trying to suppress any kind of person that wants to step out and show that you can be whoever you wanna be. So I think that’s kinda the main reason why they decided to come after me.”
The teen will soon be heading to Indiana State University on a football scholarship.
He said: “Going to Indiana State is gonna be really special. I mean, football has been my passion for as long as I can remember.
“I’ve been playing since I was 11 years old. It’s always been my dream to go on and to play Division I football. So the fact that I’ve kinda been able to fulfill that dream has really been special for me.”
The church, based in Topeka, Kansas, is notorious for its opposition to “fags” and “fag-enablers”, picketing anything related to LGBT equality as part of its quest to spread a message of hatred.
But the Kansas-based cult, run by the Phelps family, has not impressed another contender for the most homophobic man in America.
He made the claim while suggesting that the neo-Nazi rally in Charlottesville were also “in on the conspiracy”.
He said: “It defies reason that these groups aren’t infiltrated by undercover government agents.
“If you’re a war gamer, there’s no better asset on the field than your own agent posing as an enemy extremist.
“I always suspected, without proof, that the Westboro Baptist Church ‘God Hates Fags’ group was their asset in the ‘gay marriage’ battle.
“What better way to hurt the pro-family movement than to have a supposedly ‘anti-gay’ group stage obscene protests at the funerals of combat veterans in front of network television cameras.
“What better way to discredit conservative populists than TV footage of rallies where conservatives mix with Nazis (real or planted) carrying racist and antisemitic signs?”
A shooting at a transgender club has left one person injured.
The Las Vegas Lounge, one of very few specifically trans clubs in the US, was shot at multiple times in the early hours of February 23.
The attack left one clubgoer with a gunshot wound to the leg.
Police have said that the shooter approached the club on foot and fired at the building from outside.
Jennifer Hallie, general manager of the Lounge, wrote on Facebook that “there was no altercation, there was no interaction whatsoever with the suspect.”
She added: “Unfortunately one of our girls was injured but law enforcement assured us she will make a full recovery.
(Facebook/Jennifer Hallie)
“We have had many trying times through the years, and though we may bend we will not be broken by this,” she vowed.
“We are still open for business, and are still proud to serve our community.”
However, she told local station KVVU-TV that it was “scary” to see her club – which has served the Las Vegas trans community for 19 years – be the target of a shooting.
Hallie added: “Your gut instinct is that this is a hate crime, but you just don’t know.”
(GoFundMe)
A GoFundMe campaign has been started to help the victim of the attack, Callie Loubee Haywood, to pay her medical expenses.
The page states that Haywood needs “a major surgery to repair the bones in her leg including steel rods, pins and plates.
“Please help us raise as much as we can to help with her hospital bills and living expenses while she recovers from this disgusting cowardly act,” it adds.
The 2018 IKEA Catalog Is Here! Give Your Favorite Space the Upgrade it Deserves.
Sign up to receive your printed catalog, or download the digital version today!
Ad by IKEA®
(Facebook/the las vegas lounge)
Hallie has donated $500, and the community has pitched in after her, raising more than $6,400 so far.
An event at the Lounge also helped, raising $1,100 towards paying for her medical expenses.
And the day after this fundraising event, the club posted on Facebook to assure its supporters that it was standing strong in the wake of the attack.
(Facebook/the las vegas lounge)
“We’re always here to provide great service for our wonderful community!” the post read. “Thank you all for your love and support.”
Who will speak for you if you can’t speak for yourself?
Live in accord with your beliefs and values. Fulfill the goals that have meaning for you. Enjoy your favorite comforts: Isn’t that how you should get to live right up to your last breath—even if a medical crisis means that you are unable to make decisions for yourself?
In honor of National Healthcare Decisions Day and Week, April 15-22, My Care, My Plan: Speak Up, Sonoma County will hold several free workshopsin Sonoma, Petaluma and Santa Rosa to encourage residents to speak up now about how they want to be treated if incapacitated in a future medical situation.
“What would your most important priorities be if you were very ill and unable to participate in decision-making? What would matter to you most if your time were very limited? Who would you want to be prepared to speak for yourself in such moments? What would you want to be sure your loved ones and health care team knew you would want to avoid, if at all possible? These are some of the important questions to discuss with your loved ones,” says Gary Johanson, MD, Medical Director, Memorial Hospice and St. Joseph Palliative Care Services.
Two workshops on Who Will Decide? will be Wednesday, April 11, 5:30-7:30 p.m. at Hospice of Petaluma, and Wednesday, April 18, 5:30-7:30 p.m., at Memorial Hospice, Santa Rosa.
Friday, April 13, 12:30–1:30 p.m., Steven Pantilat, M.D., Director, UCSF Palliative Care Program, will address Living Well with Serious Illness, at Vintage House in Sonoma. His talk will be followed by two Complete Your Advance Health Care Directive workshops, one at 2 p.m. and another starting at 6:30 p.m.
On Tuesday, April 17, 2-4 p.m., a Who Will Speak for You If You Can’t Speak for Yourself? workshop in Santa Rosa will be led by Dr. Johanson of Memorial Hospice and St. Joseph Palliative Care Services, and Dorothy Foster, MFT and co-chair of My Care My Plan: Speak Up, Sonoma County.
“Documentation of your wishes, through completion of an advance care directive, is part of the process,” says Foster. “It’s not something you do just once, but multiple times over your lifespan, because your priorities at age 25 are bound to be different at age 55 or 85.”
My Care, My Plan: Speak Up, Sonoma County’s (MyCareMyPlanSonoma.org) vision is for every adult in the county to become educated and empowered to express his/her wishes about end-of-life care, to have the opportunity to do so, and to have their wishes honored in a medical crisis. This is an initiative of the Committee for Healthcare Improvement and Sonoma County Health Action, mobilizing community partnerships and resources to achieve equity and improve health for all in Sonoma County. MCMP is a collaborative of organizations and individuals from the private, public, nonprofit, and volunteer sectors, including local health care and social service organizations and other community partners.
###
Free Workshops on Advance Care Planning
Who Will Speak for You When You Can’t Speak for Yourself?
More transgender people in the US are opting for bottom surgery, a report from one of the country’s leading medical schools has revealed.
According to statistics compiled by the John Hopkins University School of Medicine, from 2006 to 2011 83.9 percent of patients asked for the surgery, in comparison to 72 percent in 2000-2006, reported The Independent.
Collated through data of National Inpatient Sample (NIS) from 2000 to 2014, the data covers 95% of hospitals in the States.
The study has emphasised the importance of health insurers not discriminating against trans people who want the surgery – top, bottom, or both.
This is due to the fact that out of 4,118 people who underwent genital surgery, 56.3 per cent did not have any health insurance cover.
Furthermore, for trans people who had Medicare or Medicaid insurance policies, 70 chose to have genital surgery in 2014.
The patients were aged from 26-49, reported the study’s authors, Joseph Canner and Omar Harfouch.
Although the demand for gender reassignment surgery has quadrupled in the UK from 2008-2016, gender reassignment is still a lengthy process under the NHS.
Basic surgeries may be covered by the national health service, but users may wish to embark upon additional surgery in order to alter their appearance.
Yet spite of the rise in people needing access to surgery and a surge in transgender rights activism in the mainstream, it appears that President Donald Trump is still hellbent on making life for trans people as difficult as possible.
As well as scrapping Title IX protections which ensure that trans people’s rights are protected in educational institutions, the US administration was the only country where homosexuality is legal that also voted in favour of the death penalty for gay people at a UN summit.
The cruise ship industry is facing pressure to relocate ships registered in Bermuda, after the territory abolished same-sex marriage.
Bermuda this year passed a law that replaces a ban on gay couples getting married, less than a year after they were allowed to marry for the first time.
The new law has caused chaos in the cruise ship industry, as a large number of ships are domiciled in the British overseas territory for financial reasons and are thus subject to its laws – meaning they can no longer carry out onboard same-sex weddings.
Carnival, a cruise ship conglomerate which operates 24 Bermuda-registered ships under subsidiaries Cunard, Princess and P&O Cruises, is now facing pressure to end the arrangement and move its registrations elsewhere.
Human rights lawyer Jamison Firestone, who is married to his same-sex partner, wrote in an open letter to Cunard: “Moving the ships is the only way possible to dissociate your company from a jurisdiction that has so dramatically flouted the values you profess to uphold, and to show support for your LGBTQ customers and those who support equal treatment for all.
“I therefore urge you to re-register your vessels in one of the many jurisdictions that do support the freedom to marry without discrimination.”
He added: “Bermuda’s new law applies to 24 ships that Cunard, Princess and P&O have registered in Bermuda. Same-sex couples may no longer marry on those ships and can only be offered the lesser status of domestic partnership.
“Carnival Corporation’s ships now contribute to and expand the reach of a regime that has chosen to discriminate against LGBTQ people.”
He added: “No legal or tax bonus gained in Bermuda can possibly be worth colluding with discrimination.
“Make no mistake, a cruise ship line that chooses to be flagged or remain flagged under a nation that has chosen to discriminate becomes complicit in discrimination. Can the ships of Cunard, Princess and P&O proudly fly the flag of Bermuda after this act?
“The right answer is for Carnival Corporation to stand by its values and protect the dignity and rights of all its customers by moving its ships from Bermuda to a jurisdiction that embraces marriage equality.”
Rights campaigner Peter Tatchell added: “Carnival is at risk of provoking a backlash by LGBT+ communities worldwide.
“Not only is Carnival colluding with a homophobic government by continuing to register its 24 ships in Bermuda, it means that same-sex couples can no longer marry on board, even in international waters. This is tantamount to direct anti-LGBT+ discrimination.”
In a response, a spokesperson for Cunard said: “Having been delighted and wholly supportive of the Bermuda Government’s change in law last May, which allowed us to conduct same sex marriages on board our ships we are disappointed with this more recent outcome.
“We will now be working closely with the Bermudan authorities to understand the legalities of ‘Domestic Partnership Act’ and whether we can offer our guests same sex marriages in the future.”
Cunard said it would not be providing refunds to guests who did not want to travel on a Bermuda-registered ship after the decision.
It told Mr Firestone: “We are unable to offer anyone a free of charge cancellation due solely to any personal opinion of the independent laws of Bermuda and must make you aware that a cancellation for this particular reason would not constitute a significant alteration to the package as booked.”
The company did say it would specifically provide refunds to couples who had booked wedding packages if they were unable to go ahead.
However, Bermuda last week confirmed the ban on same-sex weddings would only come into effect from May, allowing existing wedding bookings to go ahead.
BETA: Why is it important to have a good understanding of how PrEP is being used (or not used) by different communities?
Kenneth Mayer, MD
Kenneth Mayer, MD: We know that PrEP works. We have something that can protect people from HIV, but when it comes to implementation, the question now is: Is the glass 1/10 full or 90% empty? We might have more than 10% of people who are at risk for HIV taking PrEP, but we certainly don’t have more than 20% right now.
There’s also data to suggest maldistribution of PrEP. The epidemic is disproportionately affecting African Americans and other people of color, but the relative rates of PrEP uptake are lower than they are for white people. Uptake of PrEP among women is certainly less. Even among men who have sex with men [MSM], there’s still substantial underutilization. PrEP can slow down the HIV epidemic, but it’s not being implemented as widely as it might be. That’s what led us to do this review.
You mentioned the “maldistribution” of PrEP, which is an issue many organizations and people working in HIV prevention want to address. What are some examples of strategies used to better reach people who may not be accessing PrEP because they’re marginalized from the healthcare system?
Anything you can do to promote awareness and reduce barriers to PrEP is going to be useful. In terms of increasing awareness, I know that the New York City public health department has been a leader. They implemented a large, sex-positive community-based education and awareness campaign that promotes PrEP for HIV-uninfected people and HIV treatment for people living with HIV. Campaign ads ran on city busses, on transit shelters, on social media, and in other places.
In terms of minimizing barriers, programs that allow people to access PrEP through pharmacies have been beneficial. People already go to pharmacies to get flu shots or hypertension monitoring. As long as there is renal [kidney] function monitoring, it’s certainly a safe medication to deliver through pharmacists.
PrEP navigators are another way to decrease barriers to PrEP. At a place like Fenway Health, there are probably more than 100 ways that people pay for PrEP. It can be bewildering for professional staff, let alone for people in the community. PrEP navigators help people navigate the insurance and patient assistance system, and figure out how to pay for PrEP.
If you could wave a magic wand and change one thing about the delivery of health care in this country that would improve PrEP uptake, what would that be?
I would transform our fragmented health care system into a single-payer model. Right now, there are disincentives for health insurance companies to pay for PrEP and to offer other preventative health care services. A person who may benefit from these preventative health care interventions may not be insured by the same payer in a few years, so insurers are sort taking the approach of ‘kicking the can down the road.’ With a single-payer system, it would make economic sense to make sure everyone at risk for HIV has good access to PrEP, in order to prevent costly HIV infections that would require triple therapy for life.
Your review highlights the fact that Black women account for two-thirds of new HIV infections in American women, but that PrEP uptake has been slow in this community. What are some of the challenges here, and what might be a solution?
One of the issues is that for Black women in the U.S. is that the mean number of recent sex partners is about 1.1 or 1.2. In other words, there are a small number of women who engage in sex work or have more partners, but the majority of women are serial monogamists. They may not feel they are at risk for HIV, but they’re becoming HIV-infected through their partners, because their partners are either unaware of their status or do not disclose their status.
A no-brainer solution is to make sure that providers who take care of women coming in for reproductive health care, who present with STDs, are given information and access to PrEP. In a lot of cases, this conversation isn’t happening already, so even introducing that conversation into reproductive health care for Black women would be a huge step.
Another thing people are looking at is trying to figure out how to coach women to have conversations with their partners about HIV and risk. It’s important for women to feel that they have the agency to have these conversations with their partners, but a lot of times, there may be cases where there is violence or power dynamic imbalances when this isn’t feasible.
What do you see as the take-home message from your review of PrEP delivery in the U.S.?
I work with a number of young colleagues beginning federally-funded PrEP implementation projects in places across the country. We informally get together and talk about issues related to implementation, in places including St. Louis, Missouri; Jackson, Mississippi; Providence, Rhode Island; and here in Boston. We were able to get different “snapshots” about what is working and what is not working in each of these areas.
One of the things we looked at are the facilitators and barriers of delivering PrEP in different health care settings. For example, STD clinics are a logical place to provide PrEP since they’re seeing people who may be at risk for HIV. If somebody comes in with rectal gonorrhea, it makes sense for the STD clinic to be able to provide PrEP rather than having to refer that person to a PrEP clinic across time. But barriers include limited counseling time and the fact that STD clinics typically don’t offer continuous care.
Community health centers are almost the opposite of STD clinics. They’re used to providing comprehensive care, but a lot of clinicians aren’t trained in sexual health care. They may manage a person’s hypotension or diabetes, but not used to asking people who they have sex with and having nuanced conversations about PrEP.
I think the take-home from the paper is that if you don’t have an integrated health care system, there isn’t going to be one place that’s ideal for PrEP delivery. The epidemic is heterogeneous—what works in Jackson, Mississippi isn’t the same thing that will work in Seattle.
San Francisco AIDS Foundation offers free PrEP services at Strut (470 Castro Street in San Francisco) and at their main office (1035 Market Street in San Francisco). Find more information and make an appointment online.
Askaboutprep.org is a website with information about what PrEP is, how to access and afford PrEP, and San Francisco Bay Area clinics and prescribers.
PleasePrEPme.org is a website linking people seeking PrEP services to PrEP providers across the U.S. The site includes a searchable directory (by state, zip code or street address) for users to find PrEP clinics and PrEP clinicians with hours, contact information and health insurances accepted for each listing.
San Francisco City Clinic offers free and low-cost sexual health care to people in the Bay Area regardless of immigration or insurance status. They offer same-day PrEP enrollment during drop-in hours:
A synagogue has held the first known gender-neutral “B’nei Mitzvah” in the UK for a non-binary teenager.
The Jewish coming of age ritual is typically gendered, with males attending a Bar Mitzvah and females attending a Bat Mitzvah.
When Esther Thorpe, 14, came out as non-binary last year, their mother, Miriam, worried about how the important ceremony would be held.
Miriam Taylor Thorpe explained that despite the traditional routes of the ceremony, she felt strongly that her child should have something that felt right to them.
Miriam said: “I was quite concerned because if something is important in your coming of age, it should reflect who you are in a person and not squeeze you into the traditional two genders that we happen to have just because of history,”
The mother had previously faced fears of acceptance within their Jewish community as a different child had recently come out as gay.
Pride in London celebrated by Jewish people
However, their local synagogue stepped up the game by welcoming the Thorpe family with open arms.
They worked with student rabbi Gabriel Webber at their synagogue in York to adapt the ceremony.
Webber explained that it was “the first” non-binary Mitzvah they have had “on the radar” it was “going to be far from the last one.”
Webber came to the decision to name the gender-neutral ceremony a “B’nei Mitzvah” because “b’nei” is a plural term which could refer to a mixed-gender group of people.
Other options had included “ban”, which combines the Hebrew for boy and girl, as well as “sera”, which means offspring or seed.
Esther explained that it was important for them to get the right terminology “for other non-binary kids in the future”.
“If you have a name that doesn’t give that tie into your family and your history, you are much more isolated, and that compounds isolation that I know Esther still does feel — if you are non-binary or trans and you are the only person in your shul that are already in a different position,” Miriam added.
Esther is now known as Esther chose “Esther mi beit Miriam,” which translates to “Esther from the house of Miriam.”
The gender-neutral service was well accepted by the Jewish community, although some people did purchase typical “bat mitzvah” gifts that would be aimed towards people who identify as a female.
Miriam explained: “It was quite easy to make the service be reflective of [Esther being] non-binary, once you have a rabbi that’s on board with it and you have a congregation that’s prepared to take that through and as soon as you left the service you’re back to it’s either a bar mitzvah or a bat mitzvah and there’s nothing in between.”
“I feel better,” Esther added. “I feel part of a community, accepted and acknowledged.”
In the U.S., the CDC estimates that more than 
