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!
Staff at The Trevor Project, one of the largest LGBTQ+ youth advocacy groups in the US, have said that they aren’t being adequately supported with regard to the homophobic and transphobic harassment they face.
Frontline staff, dealing with emotionally draining cases coming through its crisis support hotline, are said to be those suffering the most.
This comes amid a wave of anti-LGBTQ+ moves taken by conservatives in the US, including Don’t Say Gay legislation and various attempts to restrict access to trans healthcare.
A lead crises services digital supervisor at the organisation, Sarah Hallock, told Vice that leadership had “struggled to hear the voices of the people [who] are working on the frontlines and make meaningful changes” amid “a focus on large-scale, rapid growth that has often felt unsustainable”.
Hallock said those providing direct crisis care were regularly forced to deal with prank callers and worse – including people using slurs and threatening violence against the organisation.
This was echoed by Victoria “VT” Tonikian, a goal-setting manager who also co-chairs a transgender affinity group for employees. They said better support for frontline staff was imperative.
Another staff member, Emma Turzillo, wants to see “trauma-informed” policies for those who deal with harassment. She also commented on issues with people in marginalised groups – whether it be race or gender identity – feeling excluded from opportunities within the organisation.
All the comments come as staff at The Trevor Project look to unionise.
Hallock said they hoped to achieve improved support as a result of unionising, highlighting that “people get pretty worn out” helping youth in crisis. “It’s a hard job to do,” she added.
In a statement to Vice News, a spokesperson for The Trevor Project said the organisation respected employees’ rights to form a union and was “open to bargaining”.
Staff manning hotlines for LGBTQ+ youth elsewhere are also facing abuse.
In a tweet, the charity said: “We do not make this decision lightly, but our duty of care towards staff and volunteers necessitates a harm-reduction approach to protect our dedicated staff and volunteer team.”
A leading gay tour operator and the world’s second-largest cruise line company is politely asking gay cruise passengers to stop making porn films during voyages.
LGBTQ+ travel company Atlantis Events and Royal Caribbean signed a joint notice, asking horny holiday-makers on board the Harmony of the Seas ship to stop making adult movies for OnlyFans or Just For Fans, or posting naked photos from the vessel.
Anyone breaking this new rule will be kicked off the gay cruise.
The Fort Lauderdale cruise ship, which is considered to be one of the largest passenger ships ever built, left for a week-long queer trip across the Caribbean on Saturday (4 February).
But, prior to the event, Atlantis Events warned passengers not to share adult videos from any of their ships after several adult videos reportedly went viral in the past.
“While we want everyone to have fun, there are limits and so we ask that you be respectful of all guests and our cruise partners,” a section of the guest handbook read.
“Please do not post anything explicitly sexual on social media in a public forum or other online space,” it continued.
“Any guest who posts or publishes an explicit and publicly visible photo or video will be asked to leave the ship with no refund.”
Royal Carribean is one of the largest cruise companies in the world. (Getty)
Regular cruisers have suggested that the policy was implemented sometime in October 2022, as no handbook prior to the date advised against explicit content during Atlantis Events trips.
It reportedly applies to all forms of social media platforms, including private or paywall accounts such as Onlyfans.
To help combat the apparent wave of cruise ship pornography being taken on the ship, the company said it had hired a “team of volunteers” to monitor the site.
But, as Just For Fans founder Dominic Ford told Buzzfeed News: “If models are careful and smart about filming, they should be fine.
“It’s a shame that sex work and pornography are still marginalised and stigmatised,” Ford continued.
“But we need to find ways of working with our friends and allies to make sure everyone’s safe spaces are protected.”
A policy preventing adult videos was reportedly requested by officials of cruise ship companies, according to Atlantis Events CEO Rich Campbell.
“The cruise lines have asked me to include that and that’s not such a strange request, he said. “They don’t want their brand featured.”
While companies such as OnlyFans have terms of service prohibiting creators from violating intellectual property rights, there are seemingly no laws against non-sexual recreational cruise photos being posted online.
While LGBTQ+ Americans have been subjected to numerous legislative attacks by Republican politicians recently, being queer is also a challenge in the Middle East and North Africa (MENA) region, as most countries enact laws and policies that criminalize, stigmatize, and discriminate against queer people.
However, laws and policies are not the only problems, as being anti-LGBTQ+ has become an integral part of the cultural identity of many people in the MENA region. Like the American far-right, hating queer people has become a badge of honor.
Between 2018 and 2019, the Arab Barometer surveyed six MENA countries asking, “Is homosexuality an acceptable practice?” The highest country answering “yes” was Algeria at only 27%, with the rest ranging from 5% to 20%.
The country’s election is only a few days away – and it’s becoming pretty intense.
In recent years, MENA countries have been working on increasing this social discontent against queer people by detaching LGBTQ+ rights from the human rights discourse by framing it as a cultural issue. By doing so, those countries hope to absolve themselves from their human rights obligations towards their queer populations. While human rights are not negotiable, culture is relevant and diverse and must be respected.
The patriarchs of this framing always claim that fundamental human rights are protected for all, saying they do not promote violence or discrimination against LGBTQ+ people; instead, they only safeguard their societies’ cultural values. In this cultural framing, queer identities are labeled as part of a “Western agenda” that corrupts the region’s youth and introduces foreign concepts to MENA societies.
In 2022, this framing and narrative evolved to co-opt decolonization’s terminologies, as LGBTQ+ people are now considered part of a cultural battle between the West and MENA countries, where “the white man” is culturally colonizing the MENA societies with “ideology.”
In 2022, MENA countries banned several movies depicting queer characters, such as Disney’s Lightyear because it had a brief lesbian kiss. Banning LGBTQ+ films is not new for the region, but authorities used to ban movies without much social notice. This time, there was a massive social outcry. Like in other global anti-LGBTQ+ narratives, this outcry focused on protecting children from the corrupt queer ideology, as Disney’s movies are mainly viewed by children. Other countries like Saudi Arabia also banned “rainbow toys,” fearing it would influence the children to be LGBTQ+.
The uproar around Lightyear resulted in “Fetrah,” an anti-LGBTQ+ social media campaign that originated in Egypt to defend Middle Eastern culture and tradition from Western invasion. Before being banned on Facebook for promoting hate speech, the movement gained millions of followers across the MENA region. The campaign still operates on other social media platforms, and its ideology is prevalent among the people. The social pressure forced Disney to issue a statement vowing not to show any LGBTQ+ content in MENA countries.
Later, several countries issued policies to combat “Western LGBTQ+ ideology” in schools.
In Egypt, the Ministry of Education issued a general directive to “combat the promotion of homosexuality and its ideas in different media outlets,” instructing officials to implement anti-LGBTQ+ awareness campaigns in schools to protect the children and youth from this Western agenda. In the United Arab Emirates (UAE), the Ministry of Education issued a new code of conduct prohibiting “discussing gender identity, homosexuality or any other behavior deemed unacceptable to UAE society.” In Morocco, the Ministry of Education investigated and issued disciplinary actions against officials after the word “sexual orientation” appeared in textbooks.
In Lebanon, where an economic and political crisis is ongoing, “Soldiers of God,” a right-wing Christian group, destroyed a rainbow billboard and vowed to attack any queer persons they could identify. The Lebanese authorities decided to ban all events promoting “LGBTQ+ ideology”, siding with the aggressors. In Iraq, another country with an ongoing crisis, several MPs and political leaders tried to distract the public by introducing new laws that criminalize homosexuality. Those attempts are happening both on the federal level and in the autonomous region of Kurdistan.
The region’s anti-LGBTQ+ actors benefited greatly from the ill-informed discussion around LGBTQ+ people at the event, as the conversation was characterized by Western-centric performative activism and unprofessional and sometimes outright racist coverage by Western media. This discussion enforced the ongoing narrative that queer rights are a cultural ideology the West is trying to force on MENA countries, which harms the region’s LGBTQ+ people the most.
Not even a month into 2023, several anti-LGBTQ+ incidents have already occured. In Algeria, the Ministry of Commerce announced it would ban all rainbow-colored products to “protect society from homosexuality.” In Lebanon, despite removing the ban on queer events, news emerged of rogue members of the security agencies extorting LGBTQ+ people, hunting them online and offline, and requesting a bribe or else they would arrest them.
Anti-LGBTQ+ sentiments will likely continue to rise in the region, with anti-queer figures dominating public speech and mobilizing the cultural framing of LGBTQ+ issues in their favor.
Anti-LGBTQ+ actors seem to have been successful in their goals for now, as LGBTQ+ identities are viewed by a large portion of the MENA societies as an evil corrupt Western ideology. The region’s anti-LGBTQ+ actors are an active part of the global anti-LGBTQ+ rights movement, as seen in the similarities in their discourse. Both capitalize on conspiracy theories feeding into a public moral panic that there is an LGBTQ+ cult attempting to recruit children into their ideology.
What LGBTQ+ people in the region need is a mix of reformed strategies and increased support to assist them with combating the ever-increasing anti-LGBTQ+ sentiments in their countries. That’s what American LGBTQ+ people need too.
