Arkansas Gov. Sarah Huckabee Sanders on Tuesday signed a law prohibiting transgender people at public schools from using the restroom that matches their gender identity, the first of several states expected to enact such bans this year amid a flood of bills nationwide targeting the trans community.
The bill signed by the Republican governor makes Arkansas the fourth state to place such restrictions at public schools, and it comes as bills in Idaho and Iowa also await their governor’s signature. And it might be followed by an even stricter Arkansas bill criminalizing transgender adults using public restrooms that match their gender identity.
Arkansas’ law, which won’t take effect until later this summer, applies to multi-person restrooms and locker rooms at public schools and charter schools serving prekindergarten through 12th grade. The majority-Republican Legislature gave final approval to the bill last week.
“The Governor has said she will sign laws that focus on protecting and educating our kids, not indoctrinating them and believes our schools are no place for the radical left’s woke agenda,” Alexa Henning, Sanders’ spokesperson, said in a statement. “Arkansas isn’t going to rewrite the rules of biology just to please a handful of far-left advocates.”
Similar laws have been enacted in Alabama, Oklahoma and Tennessee, although lawsuits have been filed challenging the Oklahoma and Tennessee restrictions.
Proposals to restrict transgender people using the restroom of their choice have seen a resurgence this year, six years after North Carolina repealed its bathroom law in the wake of widespread protests and boycotts. More than two dozen bathroom bills have been filed in 17 states, according to the Human Rights Campaign.
“They’re singling out transgender people for no other reason than dislike, disapproval and misunderstanding of who transgender youth are,” said Paul Castillo, senior counsel and students’ rights strategist for Lambda Legal. “And the entire school population suffers as a result of these types of bills, particularly schools and teachers and administrators who are dealing with real problems and need to focus on creating a welcome environment for every student.”
The proposals are among a record number of bills filed to restrict the rights of transgender people by limiting or banning gender-affirming care for minors, banning transgender girls from school sports and restricting drag shows. Transgender people have also faced increasingly hostile rhetoric at statehouses.
Another bill pending in Arkansas goes even further than the North Carolina law by imposing criminal penalties. That proposal would allow someone to be charged with misdemeanor sexual indecency with a child if they use a public restroom or changing room of the opposite sex when a minor is present.
“It’s a flagrant message from them that they refuse to respect (transgender people’s) rights and humanity, to respect Arkansans’ rights and humanity,” said Holly Dickson, executive director of the American Civil Liberties Union of Arkansas.
The new Arkansas law requires schools to provide reasonable accommodations, including single-person restrooms. Superintendents, principals and teachers who violate the prohibition could face fines of at least $1,000 from a state panel, and parents could also file private lawsuits to enforce the measure.
“Each child in our schools has a right to privacy and to feel safe and to feel comfortable in the bathroom they need to go to,” Republican Rep. Mary Bentley, the bill’s sponsor, told lawmakers earlier this year.
But Clayton Crockett, the father of a transgender child, described to lawmakers earlier this year how a similar policy adopted at his daughter’s school made her feel further marginalized.
“She feels targeted, she feels discriminated against, she feels bullied, she feels singled out,” Crockett said at a House panel hearing on the bill in January.
Opponents have also complained the legislation doesn’t provide funding for schools that may need to build single-person restrooms to provide reasonable accommodations.
At least two federal appeals courts have upheld transgender students’ rights to use the bathroom corresponding with their gender identity. Supporters of the bill, however, have cited a federal appeals court ruling upholding a similar policy at a Florida school district last year.
The Arkansas measure won’t take effect until 90 days after the Legislature adjourns this year’s session, which isn’t expected to happen until next month at the earliest.
Sanders signed the bill a week after she approved legislation making it easier to sue providers of gender-affirming care to minors. That law, which also doesn’t take effect until this summer, is an effort to effectively reinstate a ban on such care for minors that’s been blocked by a federal judge.
Sanders earlier this month also signed a wide-ranging education bill that prohibits classroom instruction on gender identity and sexual orientation before 5th grade. The restriction is similar to a Florida measure that critics have called the “Don’t Say Gay” law.
Lawmakers in Kentucky have passed an expanded anti-trans bill which targets the rights of vulnerable young trans people in the state.
The American Civil Liberties Union of Kentucky denounced the legislation as the “the worst anti-trans bill in the nation”.
On Thursday night (16 March), the state’s legislature passed the bill in a matter of hours, with approval from a committee and both the state House and Senate.
Senate Bill 150 seeks to ban gender-affirming healthcare for trans youth, requires doctors to detransition young trans people and prevents schools from discussing gender identity or sexual orientation with students of any age.
The bill’s original focus was on schools, with provisions to force teachers and students to misgender their own pupils and classmates, and allow parents to opt their children out of any lessons discussing sexuality.
New additions from another anti-trans bill, House Bill 470, were tacked onto SB 150, widening it to include a ban on gender-affirming healthcare for trans young people, and requiring school districts to form policies that “at a minimum” would prevent trans children from using bathrooms and locker rooms consistent with their gender identity.
SB 150 also specifies that doctors must create a timeline to taper off treatment for children currently receiving hormone therapy or puberty blockers – but only if immediately stopping the treatment could physically harm them – in service of the ultimate goal of detransitioning young people.
Additionally, districts and schools will not be permitted to adopt any policies that aim to keep information about students confidential from parents, a move that could put young people in danger at home if they haven’t disclosed their sexuality or gender identity to caregivers.
Kentucky state senator Dr Karen Berg, who lost her trans son to suicide in 2022, spoke out passionately against the bill, describing the vote on Twitter as one to “to remove basic rights from members of the trans community, their parents, and their doctors”.
She added: “Hate has no shame in this state.”
A ‘dangerous’ and ‘unconstitutional’ bill
The Trevor Project condemned the bill, describing it as “appalling” and “dangerous”.
Director of state advocacy campaigns Troy Stevenson said: “It is appalling to see Kentucky lawmakers work so hastily on dangerous legislation that will only put young LGBTQ+ Kentuckians in harm’s way.
“In the last year, nearly half of LGBTQ+ youth in Kentucky seriously considered suicide – alarmingly, nearly one in four transgender and non-binary youth in the state made a suicide attempt.
“Our leaders are pushing political wedge issues and sidestepping the real challenges like addressing the youth mental health crisis,” he continued. “The Kentucky Legislature should not be inserting itself into critical decisions best left to parents and doctors by imposing a blanket ban on best-practice medical care.
“We urge the governor to reject this harmful legislation and send a message to the young LGBTQ+ Kentuckians watching these debates that they belong in this state.”
In a statement, the ACLU of Kentucky dubbed the bill “unconstitutional” and vowed legal action if it becomes law, while blasting it as “the worst anti-trans bill in the nation” on Twitter.
The Human Rights Campaign (HRC) urged the Kentucky governor to veto and warned that SB 150 would “terrorise transgender youth in schools, in doctor’s offices” and could “put them in danger at home”.
The bill is now moving over to Governor Andy Beshear’s desk to be signed into law or vetoed within 10 days.
It is expected that Beshear will veto the bill, but then the veto is likely to be overridden when the Republican-majority legislature returns for the final two days of the session (29 and 30 March).
This comes as part of a wave of homophobic and transphobic legislation sweeping the USthis year. According to the HRC, more than 410 anti-LGBTQ+ bills – around 180 of them specifically targeting the trans community – were introduced in statehouses across the country during the first few months of 2023.
Suicide is preventable. Readers who are affected by the issues raised in this story are encouraged to contact Samaritans on 116 123 (www.samaritans.org), or Mind on 0300 123 3393 (www.mind.org.uk). Readers in the US are encouraged to contact the National Suicide Prevention Line on 1-800-273-8255.
While the country remains in shock after Tennessee’s recent ban on public drag performances, another, more insidious attack on the LGBTQ+ community has been underway in the state.
A coordinated effort by right-wing media and conservative lawmakers has decimated community-based programs addressing healthcare for LGBTQ+ people in Tennessee, including efforts to combat HIV.
In January, Tennessee Gov. Bill Lee (R) announced his administration was rejecting $8.8 million in federal funds provided by the Centers for Disease Control and Prevention (CDC) for HIV prevention and treatment.
Left unsaid was the fact that some of those dollars had made their way to programs run by groups associated with trans healthcare. After a months-long outrage campaign by right-wing media, Gov. Lee finally threw the baby out with the bathwater.
The pressure campaign started in September, when right-wing provocateurs Matt Walsh and Ben Shapiro set their sights on the transgender care program at Nashville’s Vanderbilt University Medical Center, which Walsh described as “barbaric.”
“They now castrate, sterilize, and mutilate minors as well as adults,” Walsh said at the time.
Walsh amplified the accusations with an appearance on Tucker Carlson’s Fox News show on September 21 publicizing his “investigation,” while the Daily Wire co-founder Shapiro promoted the charges on his YouTube channel and podcast, detailing “nonsense garbage that a boy can be a girl and a girl can be a boy.”
The very next day, Gov. Lee issued a statement calling for a “thorough investigation.”
The accusations ignited a social media firestorm and surfaced the existence of the Tennessee Transgender Task Force, a volunteer team at Vanderbilt focused on trans health and HIV prevention, funded in part by those CDC dollars.
Weeks later, in November, the trans program’s director Dr. Pamela Talley told staff that federal dollars funding the task force, as well as Tennessee Planned Parenthood, would cease at year’s end.
Then in mid-January, the Lee administration announced it would not just end funding for those recipients, which totaled $235,000, but also that it would reject entirely a pair of CDC grants directed at HIV prevention, treatment and monitoring in the state worth more than $8.8 million.
“People have been crying all week,” one Tennessee Health Department staffer told NBC News after the announcement on January 20.
Ashley Coffield, the CEO of Planned Parenthood of Tennessee and Northern Mississippi, said the decision “felt like they were punching me in the gut.”
“I couldn’t believe that the governor would take the nuclear option,” she said, adding that she saw the move as a “political vendetta against abortion rights groups and transgender people.”
On Wednesday, newly appointed Tennessee Health Commissioner Ralph Alvarado told a state Senate committee that money from the grants would be replaced with $9 million in state funds.
Alvarado called the federal grants “cumbersome.”
“I think this is going to allow a bit of innovation, a little bit of liberty,” Alvarado testified. “I think it’s going to help vulnerable populations: people who are in human trafficking populations, mothers, children, first responders.”
But those populations, also identified by the governor’s office, are not the ones most affected by the HIV epidemic in Tennessee, experts say.
“Tennessee is preferring to fight a fictitious epidemic rather than their very real HIV epidemic,” Greg Millett, the director of public policy at amfAR, The Foundation for AIDS Research, told NBC News.
“First responders are just not at risk for HIV anywhere in the United States. Sexual trafficking is awful, but it’s not a major contributor for HIV cases in Tennessee or elsewhere.”
He added: “All of this is willful ignorance on the part of the state government.”
When State Sen. Jeff Yarbro (D-Nashville) asked Alvarado if future state funding would focus on the highest-risk groups, including men who have sex with men and intravenous drug users, the health commissioner was less than definitive.
“I imagine that the same populations they’ve been approaching will continue to receive benefits from this.”
Sanders on Monday signed the new law, which won’t take effect until this summer. It would allow anyone who received gender-affirming care as a minor to file a malpractice lawsuit against their doctor for up to 15 years after they turn 18. Under current Arkansas law, medical malpractice claims must be filed within two years of an injury.
Legal experts have said the change could close access to gender-affirming care for children by making it nearly impossible for providers to get malpractice insurance.
“Arkansas infamously passed the first law in the nation to try to ban gender affirming care for trans youth and after hearing extensive evidence, the courts have blocked that ban,” Holly Dickson, executive director of the American Civil Liberties Union of Arkansas, said in a statement. “This bill is an effort to achieve indirectly what the Constitution prohibits the state from doing directly.”
The new law is among a growing number of bills targeting transgender people, who have faced increasingly hostile rhetoric at statehouses. At least 175 bills targeting trans people have been introduced in statehouses so far this year, the most in a single year, according to the Human Rights Campaign.
The bill was signed as a federal judge is considering whether to strike down a 2021 Arkansas law that would prohibit doctors from providing gender-affirming hormone therapy or puberty blockers to anyone under 18 — or referring them to other doctors who can provide that care. No gender-affirming surgery is performed on minors in the state.
Republican Sen. Gary Stubblefield, who sponsored the malpractice law, said he didn’t know if the measure would face a similar court challenge.
“Anything can create a court challenge in the world we live in today,” Stubblefield said. “I know we did what we thought was best for our children.”
U.S. District Judge Jay Moody temporarily blocked the state’s ban on gender-affirming care for minors in 2021. Arkansas was the first state to enact such a ban, and several states have approved similar restrictions. A ban in Alabama has also been blocked by a federal judge.
Opponents of such treatments argue that minors are too young to make decisions about their futures. But every major medical group, including the American Medical Association, supports gender-affirming care for youths and has opposed the bans.
The malpractice legislation includes a “safe harbor” provision that would give doctors a defense against malpractice lawsuits over providing gender-affirming care for children, but only if they follow restrictions that experts have said are inconsistent with the standard of care for the treatments.
The new law won’t take effect until 90 days after the Legislature adjourns this year’s session, which isn’t expected to happen until next month at the earliest.
The bill is among several targeting transgender youth that have been proposed in Arkansas this year.
Others include legislation that would criminalize transgender adults using the bathroom that corresponds with their gender identity. The bill goes even further than a bathroom bill North Carolina repealed following widespread boycotts.
Dickson urged Sanders to hear from trans youth and those who care from them before signing any more bills affecting the LGBTQ community.
A decade into the era of the HIV prevention pill, called PrEP, efforts to leverage its heralded power to curb new infections have stagnated in the United States.
This shortfall is a key reason the nation lags far behind many others in combating HIV, with a national epidemic long plagued by racial inequities and only a modestly declining new infection rate.
“We are reaching a scientific crisis in HIV prevention,” LaRon Nelson, an associate professor of nursing and public health at Yale University, said last month at the Conference on Retroviruses and Opportunistic Infections in Seattle. Nelson lamented the gulf between PrEP’s impressive performance in major studies and its moderate real-world impact.
On the bright side, PrEP, which is short for pre-exposure prophylaxis and involves taking either oral or injectable prescription antiretroviral medications in advance of potential HIV exposure, has indeed achieved substantial popularity — but only among white gay and bisexual men, who have long seen a dropping HIV rate.
Such inequity persists despite the efforts of a nationwide public-health army and countless millions of dollars spent promoting and facilitating PrEP use among Black and Latino gay and bi men. Of all major intersectional demographics, these groups contract HIV at the highest rates, and transmissions among them have flatlined or barely declined in recent years.
And so, even amid the national reckoning over racial inequity, PrEP has only served to widen HIV-transmission racial disparities among men who have sex with men.
According to the Centers for Disease Control and Prevention, gay and bi men account for 70% of new cases of the virus. Whites in this demographiccomprised 15% of the 34,800 HIV transmissions in 2019, while the much smaller populations of their Black and Latino peers comprised a respective 26% and 23% of new cases.
Additionally, more than a year after the approval of a long-acting injectable form of PrEP, ViiV Healthcare’s Apretude, few are receiving it. Insurers have mostly refused to cover the expensive drug. Consequently, even after clinical trials found injectable PrEPwas dramatically superior to oral PrEP at preventing HIV on a public health level, especially among Black gay men, Apretude’s potential will likely remain untapped for the foreseeable future.
Troubling statistics
Gilead Sciences’ two-drug combo pill Truvada was approved as PrEP in 2012 and was followed in 2019 by a similar drug, Descovy. When either drug is taken daily, this lowers the risk of HIV by at least 99% among gay and bi men and transgender women, according to multiple studies.
PrEP has helped drive down HIV rates in cities where it has achieved a critical mass of popularity, such as in New York, San Francisco andSeattle. But nationally, PrEP has failed to move the needle by much.
HIV prevention drug Descovy, at Pucci’s Pharmacy in Sacramento, Calif., on Oct. 7, 2019.Rich Pedroncelli / AP file
The CDC estimates annual HIV transmissions declined by only 8%between 2015 and 2019. Cases are even rising in some states where HIV prevention investment is lacking, such as Tennessee, where Republican Gov. Bill Lee recently compounded the factors worsening his state’s epidemic by blocking $8.3 million in annual CDC prevention funding.
Approximately 814,000 gay and bi menin the U.S. are good PrEP candidates, the CDC estimates. Between 2017 and 2022, the number of people using PrEP, who have always overwhelmingly been gay and bi men, at any point during each given year increased from 155,000 to 382,000. However, a CDC study presented in Seattle found that in September 2022, just 187,000 people were on PrEP within that 30-day window, suggesting that many people do not take it for long.
PrEP’s increasing popularity likely could have put a major dent in the national HIV rate had its use more closely reflected viral-transmission demographics, according to HIV prevention experts. Of the CDC’s estimate of 21,900 new HIV cases in 2019 (the most recent year for which the agency has produced a transmission estimate) in the three largest racial groups among gay and bi men, a respective 23%, 41% and 36% were in whites, Blacks and Latinos. But a lopsided 69% percent of PrEP users last year were white, while only a respective 9% and 18% were Black and Latino.
Apretude’s approval promised progress
Approved in December 2021, Apretude requires receiving an injection by a health care worker every two months. Compared with providing trans women and men who have sex with men Truvada as PrEP, giving them Apretude was associated with a 66% lower overall HIV diagnosis rate in a major clinical trial.
Apretude’s superior efficacy was driven by the fact that participants adhered better to the injection schedule than to the daily pill regimen.
Dr. Hyman Scott, an HIV prevention expert at the San Francisco Department of Public Health, reported at the Seattle conference that of the 844 Black American participants in the trial, those randomized to receive the injectable drug had a 72% lower HIV rate than those who got Truvada.
His analysis suggests that if 10,000 similar Black gay and bi men and trans women were followed for one year, approximately 50 would contract HIV if given Apretude, while 200 would test positive if provided Truvada.
Such sobering findings about Truvada’s shortcomings are in keeping with previous studies finding relatively low rates of adherence to the daily PrEP regimen among Black gay men. Such data suggests that even if HIV prevention advocates succeeded in vastly increasing oral PrEP access in this population, it might have only limited impact among them.
Referring to Apretude, Scott told NBC News, “Whether we can get this rolled out in communities is the real question.”
Mayor London Breed, right, shakes hands with Dr. Hyman Scott at Zuckerberg San Francisco Hospital on Sept. 10, 2019.Gabrielle Lurie / The San Francisco Chronicle via Getty Images file
Cost is a major rub. Since 2021, Truvada has been available from multiple generic manufacturers and now often costs as little as $25 to $35 per month, although in some cases up to $600. ViiV lists Apretude at $1,878 per month, and few insurers are covering it.
The recent CDC PrEP-use study presented in Seattle found that only about 1 in 200 PrEP prescriptions were for Apretude in September.
“There are patients who are getting Apretude now, but it’s people who have health care access, who have health care literacy, who call their insurance companies and yell at the right people,” said Dr. Anu Hazra, a physician at the LGBTQ-focused Howard Brown Health in Chicago.
Since 2021, almost all insurers have been obliged under the Affordable Care Act to cover oral PrEP with no out-of-pocket costs for the medications or the quarterly clinic visits and lab tests required to maintain a prescription. This is because in 2019, an advisory body known as the U.S. Preventive Services Task Force gave PrEP an “A” rating for being a worthy preventive tool.
In December, the task forceissued a draft decision granting Apretude its own “A” rating. If this rating is made official this year, insurers will be required to cover Apretude, and with no cost sharing — but not until January 2025.
Apretude updates
In addition to the associated burden of having to come in six times per year for injections, Apretude does have a notable shortcoming: Breakthrough HIV cases are apparently much more likely among those taking injectable versus oral PrEP.
Of the 25 people who contracted HIV in the 2,282-person Apretude arm of the injectable-versus-oral PrEP trial among gay and bi men and trans women, six did so after getting their injections on schedule, according to a presentation in Seattle by Dr. Susan Eshleman, a professor of pathology at Johns Hopkins Medicine.
Eshleman’s team has not yet calculated the per capita Apretude breakthrough infection rate, but when these researchers initially reported last year that the trial saw seven breakthrough infections (before revising this figure down to six), their calculations suggested that if 10,000 similar men and trans women were followed for one year, 15 would contract HIV despite receiving on-schedule Apretude injections.
Apretude.ViiV Healthcare
At the same Seattle conference, Hazra reported the first breakthrough HIV case in an Apretude patient outside of a clinical trial. By comparison, nearly four years passed after Truvada’s approval as PrEP before a breakthrough infection was first documented in someone faithfully taking that drug.
All this suggests that for those with a history of taking daily oral PrEP on schedule, switching to Apretude would actually increase their HIV risk; although the absolute risk of infection would remain low.
Optimism in the pipeline
HIV prevention experts report excitement about the PrEP pipeline and expectations that in the coming decade, more convenient and longer-acting forms will be approved.
“I’m wildly optimistic,” said Sharon Hillier, a prominent HIV prevention researcher at the University of Pittsburgh. “We just have to work through how to deliver these interventions and how to be less burdensome for health care systems.”
The Seattle conference heard promising early stage research findings regarding medication-infused suppositories that could be placed into the rectum or vagina up to 48 hours following sex and likely prevent HIV. And researchers are developing implants that could be placed under the skin and emit preventive medication for many months.
Gilead is also running major PrEP trials of the drug lenacapavir, which requires an injection only every six months. Dr. Jared Baeten, who leads Gilead’s HIV strategy, said the company hopes to provide initial study results by 2025.
But if Apretude’s pacing is any guide, it could be 2030 before lenacapavir is both approved and widely covered by insurers.
In the meantime, PrEP advocates continue to express dedication to work with the options currently on the table, albeit within a complex and fractured health care system that proves alienating to many of those most at risk of HIV.
A bill introduced in Uganda’s Parliament criminalizing same-sex conduct and sexual and gender identity, if adopted, would violate multiple fundamental rights, Human Rights Watch said today. Among others, such a law would violate the rights to freedom of expression and association privacy, equality, and nondiscrimination.
On March 9, 2023, Asuman Basalirwa, a member of parliament, introduced the 2023 Anti-Homosexuality Bill in Parliament. The bill is a revised and more egregious version of the 2014 Anti-Homosexuality Act, which reinforced existing prison sentences for same-sex conduct and outlawed the “promotion of homosexuality,” but was struck down by a court on procedural grounds.
“One of the most extreme features of this new bill is that it criminalizes people simply for being who they are as well as further infringing on the rights to privacy, and freedoms of expression and association that are already compromised in Uganda,” said Oryem Nyeko, Uganda researcher at Human Rights Watch, “Ugandan politicians should focus on passing laws that protect vulnerable minorities and affirm fundamental rights and stop targeting LGBT people for political capital.”
Like its predecessor, the 2023 Anti-Homosexuality Bill expands on the criminalization of same sex acts, including broad prohibitions on acts such as touching another person “with the intention of committing the act of homosexuality.” People found guilty of the “offense of homosexuality” may be imprisoned for up to 10 years.
But the bill goes much further by also criminalizing any person who “holds out as a lesbian, gay, transgender, a queer, or any other sexual or gender identity that is contrary to the binary categories of male and female,” with a punishment of up to ten years in prison. In addition, the bill makes it a crime to “purport to contract a marriage with another person of the same sex.” The bill includes a punishment of up to five years in prison for the “promotion of homosexuality.” It also effectively declares all same-sex conduct as nonconsensual.
Uganda’s penal code already punishes “carnal knowledge against the order of nature,” which is interpreted to mean homosexual relations, with a punishment of life in prison, although the provision, a colonial remnant, is rarely enforced. In introducing the bill, Basaliriwa said its purpose was to “look at this colonial law and have it in tandem with the current situation.”
The reintroduction of the Anti-Homosexuality Bill follows months of hostile rhetoric against sexual and gender minorities by public figures in Uganda, as well as government crackdowns on LGBT-rights groups and other human rights groups, government critics, and civil society.
On August 3, 2022, Uganda’s National Bureau for Nongovernmental Organizations banned Sexual Minorities Uganda (SMUG), a prominent LGBT rights organization, for not having officially registered with it. The government had previously refused to approve SMUG’s name – a requirement to register as a nongovernmental organization – saying that a group that advocates for the rights and well-being of LGBT people is “undesirable and unregistrable.”
A January 2023 draft report by the bureau identified 26 nongovernmental organizations, including SMUG, that it accused of “promoting homosexuality” and luring schoolchildren into homosexuality through “forced recruitment.” The report recommends barring any groups identified as “promoting LGBTIQ activities” from operating, and suggests that individual activists should be publicly profiled, to prevent them from any further civil society engagement.
On January 25, the parliamentary deputy speaker, Thomas Tayebwa, urged the Internal Affairs Ministryto investigate the activities of the Human Rights Awareness and Promotion Forum (HRAPF), an LGBT and sex-worker-rights group. Tayebwa alleged that HRAPF facilitated the passingof a Kasese district bylaw that recognizes the need to protect key populations including gender and sexual minorities from HIV and tuberculosis, in keeping with Uganda’s own health policies to combat HIV/AIDS.
On February 5, Maj. Gen. Francis Takirwa the deputy commander of land forces in the Ugandan military, used the handover of a renovated community health facility to call for excluding gay peoplefrom receiving health services, saying, “Don’t use our health facilities to treat homosexuals.” On February 24, the state minister for sports, Peter Ogwang, called for the introduction of the death penalty for same-sex conduct.
The introduction of the 2023 Anti-Homosexuality Bill is not the first time Parliament has attempted to recriminalize homosexuality since the 2014 Act was struck down. In 2021, Parliament approved the Sexual Offenses Bill, which criminalized any “sexual act between persons of the same gender,” as well as anal sex between people of any gender, with up to 10 years in prison. On August 3, 2021, President Yoweri Museveni rejected the Sexual Offenses Bill and returned it to Parliament, stating that it covered offenses already provided for in the Penal Code.
The continued criminalization of same sex conduct and crackdowns on sexual minorities in Uganda has had far reaching impacts, Human Rights Watch said. Within five months of the passing of the 2013 Anti-Homosexuality Act LGBT people faced a notable increase in arbitrary arrests, police abuse and extortion, loss of employment, evictions and homelessness, and scores fled the country.
“The Ugandan government’s targeting of a vulnerable minority and distracting attention from a broader clampdown on rights groups is an all too familiar tactic,” said Nyeko, “What the government is attempting should set off alarm bells among civil society groups in Uganda, and in the international community, as it signals increased repression and the stifling of opposition voices and civil society groups across the board.”
In late 2022, the San Francisco Department of Public Health and San Francisco AIDS Foundation began recommending an STI prevention strategy called “Doxy PEP” to certain groups of people who may be at risk for STIs. The strategy involves taking the antibiotic doxycycline after sex in order to prevent bacterial STIs including chlamydia, syphilis, and gonorrhea from being acquired.
Since we made this recommendation, we’ve received some questions from community members about how this approach may contribute to drug resistance–and if that’s a concern for people to be aware of before beginning Doxy PEP. Here are my thoughts on Doxy PEP and drug resistance.
(And as with any medical decision, we recommend having a conversation with your healthcare provider about the possible benefits and concerns before beginning Doxy PEP.)
First, what is antibiotic drug resistance?
Antibiotic drug resistance refers to instances when bacteria aren’t affected by the medications used to kill or destroy them. When bacteria are able to live and multiply, even in the presence of an antibiotic, we say that the bacteria are “drug resistant” to antibiotics.
How does drug resistance develop?
Antibiotic drug resistance develops when bacteria mutate in response to an antibiotic, often at a low or ineffectual dose (but this can also occur even when the antibiotic is taken as prescribed). Without rigorous testing and treatment, resistant infections can spread throughout populations.
If you’ve ever been prescribed an antibiotic to take for an infection, you’ve probably been asked to take the medication for the entire length of time that it has been prescribed–even if your symptoms seem to go away. That’s partly because if you stop taking the antibiotic early, there’s a risk that some of the bacteria may survive and develop, or acquire from other bacteria around them, defenses to overcome the effects of the antibiotic. These defenses can include genetic mutations to make the antibiotic ineffective, pumps to push the antibiotics out of their cells, or enzymes to destroy the antibiotic before it can work. If this infection then spreads to other people, the infection may not be treatable by the same type of antibiotics.
It’s important to note that drug resistance can and does develop in individual people taking antibiotics, including Doxycycline.
What is the problem with drug resistance?
The problem with drug resistance is that healthcare providers lose the ability to treat drug resistant-infections with the medications available to them. Bacterial infections become harder and harder to treat as drug resistance spreads.
Gonorrhea is one bacterial infection that you have heard about drug resistance toward–over time, gonorrhea bacteria have slowly developed resistance to antibiotics used to treat gonorrhea.
In 2006, CDC had 5 recommended treatment options for gonorrhea. Since 2015, there has only been one recommended first-line treatment (a combination of two drugs), after widespread resistance to a commonly-used medication named cefixime developed and spread. An estimated 30% of new gonorrhea infections in the U.S. are resistant to at least one antibiotic.
Could Doxy PEP cause drug resistance?
A recent review of the impact of oral tetracyclines (the class of antibiotics to which doxycycline belongs) did suggest “modest and transient” evidence of bacterial resistance developing in oral, gut, and respiratory bacteria that were studied. Researchers are currently studying the impact of doxycycline for STI prevention on development of resistance for gonorrhea; as well as other bacteria that may be around and not the target of the antibiotic. Resistance to syphilis and chlamydia is less of a concern, as these bacteria have few mechanisms to develop resistance and significant resistance has not been seen to doxycycline with these two infections (in fact, Penicillin is still first-line treatment for syphilis).
Drug resistance with Doxy PEP is something that is being studied on an individual level with people who are taking Doxy PEP for STI prevention. The broader public health impacts of Doxy PEP on drug resistance is something that current clinical trials will not answer, and highlights the importance of ongoing public health evaluation as this intervention becomes available. This is something that San Francisco AIDS Foundation feels strongly about and contributes to–we share data with public health partners in order to track cases of gonorrhea resistance, as well other infections where resistance may be of concern such as breakthrough infections among people taking PrEP.
Resistance will always be a potential risk. But do the benefits of using antibiotics to prevent infections outweigh the potential costs? For individual clients and patients, the answer to this question is clear in my mind. As a physician, my first priority is ensuring effective, evidence-based care for the clients and people I and my staff see. Offering Doxy PEP to people who are eligible for this intervention is in line with this: we have strong, compelling evidence that Doxy PEP works to prevent STIs that are becoming more and more common in San Francisco. For individual people who either choose not to use condoms, who do not like using condoms, or who find that condoms do not work well in their lives–I as a clinician can offer them all the available STI prevention options by offering Doxy PEP.
On an individual and population level, drug resistance will likely occur with the increased use of Doxy PEP, especially with the amount of doxycycline that will be indicated for many users. The extent to which this happens, and the impact, are still open questions, and must be carefully monitored. It is true that we are taking a calculated risk by rolling out Doxy PEP to people who may benefit from this strategy. But this decision is supported by a very strong belief that our communities will benefit dramatically from Doxy PEP, even though there is a risk of resistance. There is an important balance in these considerations, and one that is not made lightly by the medical community. This new intervention truly has the ability to change the landscape of STI prevention in San Francisco–much as PrEP has changed the landscape of HIV prevention.
A final note I’ll add is that some of the conversation around drug resistance with Doxy PEP is likely fueled by stigma, bias, and homophobia. The idea that we would withhold an effective, evidence-based prevention intervention from gay, bi, and Queer men, and trans folx having condomless sex is simply unacceptable. They may ask the question, “why not just use condoms?” We’ve heard it all before, especially when PrEP rolled out more than 10 years ago. Perhaps you remember concerns around “risk compensation” with PrEP in addition to concerns around drug resistance with increased use of PrEP. Yes, we can and do recommend condoms as one way to prevent HIV and STIs. And yes, at the same time we recognize that many people do not use condoms and will never use condoms. We’re here to meet people where they are–with no stigma or shame–and provide them with the tools they need to live well.
The bottom line
It is possible that Doxy PEP may contribute to drug resistance on an individual and population level, and this is a concern that is currently being studied. Doxy PEP is an individual decision and folks will need to weigh the benefits (STI prevention) with possible risks, as with any medical decision.
Other jurisdictions are taking a more conservative approach on supporting Doxy PEP roll-out, and we are proud that our public health leaders, infectious disease physicians, and community partners in San Francisco moved quickly to translate this new science into implementation. Reducing medical problems from syphilis, gonorrhea, and chlamydia is a top public health priority. These infections can be painful, stigmatizing, and can cause serious medical complications. In short, the overall benefits of Doxy PEP outweigh the risks, and we will continue to support the science, and incorporate new findings, so that we can make the best recommendations for our communities.
The Centers for Disease Control and Prevention is warning about a rise in extensively drug-resistant cases of the bacterial infection Shigella, a major cause of inflammatory diarrhea.
The agency calls the new form of the stomach bug, which causes the diarrheal condition known as shigellosis, a “serious public health threat.” Evidence suggests the illness is spreading among gay and bisexual men in particular, apparently through sexual contact, both in the U.S. and abroad.
The CDC held a call Tuesday with the Colorado Department of Public Health and Environment and the U.K. Health Security Agency to alert doctors about the spread of a form of the bacterium that is resistant to all typically recommended antibiotic treatments.
“We do not have all the answers today,” Dr. LouiseFrancois Watkins, a medical officer at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, said on the call. The agency, she said, could make no official recommendations for antibiotic alternatives.
A parallel outbreak in the U.K., first announced in January 2022, most likely stemmed from an initial single infection, British health officials said on the call Tuesday. That speaks to how widely individual drug-resistant strains can spread and to the importance of infection control.
The CDC said in a health alert Friday that the proportion of the approximately 450,000 annual U.S. Shigella infections that were resistant to all known antibiotic treatments rose from zero in 2015 to 0.4% in 2019 to 5% last year, an indicator of potential greater spread.
Shigella, which is highly infectious, spreads when infected fecal matter enters the mouth or the nose, including through sexual activity or because of poor hand-washing after diaper changes, unsanitary food handling or swimming in contaminated water. The infection is typically seen in young children.
The European Centre for Disease Prevention and Control issued an alert Friday about 221 confirmed and 37 possible cases among people who traveled to Cabo Verde off West Africa since September and returned home to about a dozen nations, including the U.S.
During the CDC call Tuesday, officers from the U.K. health agency reported they had analyzed all but four of 185 cases of the infection in Britain since late2021. Half required antibiotic treatment. The Shigella samples retained susceptibility to four antibiotics: carbapenems, chloramphenicol, fosfomycin and temocillin.
Eighty-seven percent of the cases were in men presumed to have sex with men.
Dr. Stephanie Cohen, the section director for HIV and STI prevention at the San Francisco Public Health Department, told NBC News that Shigella is “a really important and serious pathogen.”
“It can cause really severe diarrhea, sometimes bloody diarrhea, cramps and abdominal pain,” she said.
Shigellosis usuallygoes away without treatment. But physicians may prescribe antibiotics to hasten recovery or otherwise avert complications in more vulnerable patients.
The infection can cause prolonged and debilitating illness, with about 6,400 U.S. patients needing hospitalization each year.
Death from shigellosis is rare, although it is more likely among people who are immunocompromised, such as by untreated HIV or chemotherapy for cancer.
Shigella is considered extensively drug resistant when it is not susceptible to any of the recommended first-line or alternative antibiotics, including azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole and ampicillin.
From May 2014 to February 2015, the CDCidentified 243 U.S. cases of travel-associated Shigella that were resistant to most but not all of those antibiotics.
Now, doctors face a considerable challenge caring for patients with this form of Shigella. Reviewing an extensive roster of potential alternative antibiotics on the call Tuesday, Watkins noted that the medications are largely saddled with one or more limitations, such as unavailability in the U.S., lack of clinical trial data, resistance to the pathogen or the fact that they penetrate the gut lining poorly.
The CDC has called on health care providers to be vigilant for potential Shigella infections and to report suspected cases to state and local health departments, while educating people most at risk about shigellosis.
In addition to gay and bisexual men, antibiotic-resistant Shigella infections have been on the rise among people experiencing homelessness, international travelers and people living with HIV.
Of 232 cases reported from 2016 onward about which the CDC has data, 197, or 85%, were in men. Just one was in a child. Of the 41 of those people who answered questions about recent sexual activity, 88% were men reporting recent sexual contact with men.
Meanwhile, sexually transmitted gonorrhea, chlamydia and syphilis have been rising steadily in recent years and are particularly prevalent among gay and bisexual men. The CDC has issued increasingly urgent warnings that gonorrhea is at risk of losing susceptibility to the last remaining simple and effective antibiotic to treat the infection.
Enterobacteriaceae comprise over a hundred species, including Shigella, Klebsiella, Salmonella and Escherichia coli.Stephanie Rossow / Science Photo Library via Getty Images
People who have shigellosis, the CDC advises, should stay home if they work in health care, food service or child care. The agency also advises that during the illness and for two weeks after, people should avoid preparing food for others, wash hands often, refrain from swimming and abstain from sexual contact, or at least observe rigorous hygiene before and after sexual activity.
The World Health Organization cites drug-resistant pathogens, the emergence of which are largely driven by the misuse and overuse of antibiotics in people and livestock, as one of the top 10 global public health threats facing humanity.
“The clinical pipeline, the drugs that are in human testing, is fragile, and there’s not enough there,” said Kevin Outterson, the executive director of CARB-X, a Boston-based nonprofit group that seeks to spur innovation in early antibiotic research and development.
There are encouraging signs with antibiotic development, at least in early phases, Outterson said.
“If you want a drug that’s going to work against this disease or any other bacteria in 2033, we need to be working on that today,” he said.
The new Shigella raises concerns in the wake of the global mpox (formerly monkeypox) outbreak, which has overwhelmingly spread through sex between men. Cases of the virus, first identified in Britain in mid-May, peaked in the U.S. and internationally in early August and have largely subsided.
Similar to shigella cases, mpox infections, which can be severe, typically resolve without the need for treatment and are rarely fatal. However, a paper published Feb. 21 in The Lancet found an mpox death rate as high as 15% among people substantially immunocompromised by HIV.
Japan’s main opposition party has submitted a bill calling for same-sex marriage to be legalised.
Chinami Nishimura, of the Constitutional Democratic Party (CDP), submitted the bill today (6 March), the South China Morning Post reported.
Japan, which is due to host the G7 summit meeting in May, is the only member of the influential intergovernmental political forum that does not recognise LGBTQ+ marriage.
Nishimura, the acting chief of the CDP, responded: “I think it’s discrimination if marriage is recognised legally for heterosexual couples but not same-sex couples.”
Kishida was also criticised last month after one of his aides reportedly made anti-LGBTQ+ comments, including that he “doesn’t even want to look at” married same-sex couples.
The aide was promptly fired, and Kishida called the remarks “outrageous” and “completely incompatible with the administration’s policies”.
Japan’s prime minister Fumio Kishida has been criticised for his stance on same-sex marriage. (Getty)
The country’s constitution, which dates back to 1947 and which was written mainly by American officials following the occupation of Japan, states that “marriage shall be only with the mutual consent of both sexes”. However, recent polls have found that a majority of people in Japan support legalising equal marriage.
Currently, same-sex couples can only engage in civil unions – and even then, only in certain regions.
While civil partnerships allow couples to register for local government services, they cannot inherit assets or adopt.
PM Kishida has previously stated that the “issue needs to be carefully considered”.
During her performance at Japan’s Summer Sonic Festival, the singer-songwriter, said: “I’m bisexual, but if I try to have a same-sex marriage here, I can’t.
“It’s not allowed in Japan. Out of the G7 countries, it’s the only one that doesn’t have that protection.”
Sawayama, who came out as bi and pansexual in 2018, added: “This is something really embarrassing. Something that would accept me and my friends, my chosen family, a fair law… if you think we should [have equal marriage], please keep on fighting.
“LGBT people are human beings. LGBT people are Japanese. Love is love. Family is family. Let’s fight together.”
Taiwan is the only Asian country where same-sex marriage is permitted, after a new law was passed in 2019.
This is the 7th Annual Gay Travel Awards, and it is our honor to present The Gay Travel Awards Winners!
On behalf of gay travelers worldwide, we congratulate these exemplary travel-related businesses, hotels, destinations, tours, events, and influencers on their accomplishments in making our world a more inclusive and welcoming place! The winners across 38 categories were selected from among hundreds of deserving nominees. Without further ado, it is our honor to present The 2022 Gay Travel Awards Winners!
