A group of 45 Democratic members of Congress sent a letter to Immigration and Customs Enforcement on Tuesday demanding the agency release all transgender migrants in its custody.
“This already vulnerable population faces a heightened and unique set of injustices while in immigration detention,” the letter stated. “Transgender migrants and asylum seekers are particuarly vulnerable to sexual harassment, solitary confinement, physical assault, and medical neglect.”
At least two transgender migrants have died in ICE custody in the past two years. Roxsana Hernandez Rodriguez, a Honduran, died of complications from untreated HIV in 2018. Rodriguez did not receive antiretroviral therapy while in ICE custody, despite guidelines mandating that all detainees receive the minimum standard of care, which for HIV infection is ARV therapy. Last year, another HIV-positive transgender migrant, Johana Medina León from El Salvador, died shortly after being released from ICE custody, where she had requested medical assistance.
After León died last summer, Kris Hayashi, executive director of the Transgender Law Center, called the two deaths “a direct result of U.S. government policy, and will continue unless we force dramatic change.”
Advocates have long accused ICE of improper treatment of LGBTQ migrants, particularly after Hernandez died from a rare, AIDS-related illness at its Cibola detention center in New Mexico.
The Cibola unit — touted by the agency as its premiere detention facility for trans migrants — failed to treat Hernandez’s diagnosedHIV infection for 12 days, despite what ICE has claimed is a maximum 24-hour turnaround on sick-call requests.
The 45 lawmakers in their letter claim that none of ICE’s detention centers — including Cibola — are contracted specifically for housing trans inmates, a requirement set by ICE’s 2015 transgender detention standards. Speaking on background, a congressional staffer noted that at Cibola, ICE’s “compliance is currently voluntary and their standards could slip at any time with no repercussions.”
The letter notes that the “pervasive use of solitary confinement has caused particular harm to transgender migrants in detention.”
“ICE consistently utilizes solitary confinement for so-called protective purposes or violates its own guidance by using segregation as punishment, placing transgender people at risk of physical and mental health deterioration and vulnerability to sexual assault by ICE guards,” the letter states.
Representative Mike Quigley, a Democrat from Illinois, questions witnesses during a House Intelligence Committee impeachment inquiry hearing in Washington, on Nov. 19, 2019.Jacquelyn Martin / Bloomberg via Getty Images
Rep. Mike Quigley, D-Ill., spearheaded the effort to demand the release of transgender migrants. In a press release shared with NBC News, he said if “ICE cannot provide appropriate and humane accommodations for these migrants, they must release them from detention.”
“Immigrants who have faced fear and violence in their pursuit of a new life in the United States should not be confronted with more fear and threats of violence when they arrive at our borders,” he stated. “Unfortunately, too often, that is exactly what many transgender immigrants face when placed in ICE detention facilities.”
When asked for comment, ICE spokesperson April Grant said in an email that the agency “will respond to Congressional correspondence through official channels and by appropriate officials at the agency.”
Immigration Equality, an advocacy group dedicated to LGBTQ immigrants, called the two deaths “tragic examples of the consequences of ICE’s mistreatment,” and endorsed the demands of the 45 lawmakers: “Transgender immigrants are not safe in ICE custody and must be released.”
“After fleeing horrific persecution in their countries of origin, our transgender clients seek protection in the U.S.,” Bridget Crawford, legal director of Immigration Equality, said. “However, rather than finding safety, our clients are routinely subjected to shocking mistreatment in immigration detention facilities, including sexual assault and harassment, medical neglect and prolonged solitary confinement as a purported means of ‘protecting’ transgender people from abuse.”
The lawmakers’ letter requests a detailed ICE plan by Jan. 27 outlining compliance, and requests semi-monthly updates to “demonstrate such compliance.”
Two transgender women filed a lawsuit against the state of Florida on Monday over its ban on transgender-related health care for state workers, arguing it violates the U.S. Constitution and Title VII of the Civil Rights Act.
“We brought this lawsuit because all people need access to medical care. This is not about special treatment; this is about equal treatment,” said lead counsel Simone Chriss. “Transgender state employees are singled out and explicitly denied coverage for one reason: They are transgender. That is discrimination, and it cannot stand.”
Jami Claire.ACLU Foundation of Florida
The suit, which was brought by Southern Legal Counsel, the ACLU of Florida and Eric Lindstrom, an attorney, seeks to end Florida’s State Plan Exclusion, a rule that prohibits state employer-provided health plans from covering “gender reassignment or modification services or supplies.”
The plaintiffs, Jami Claire and Kathryn Lane, both state employees, have had to delay their transition-related care, which their suit argues worsened their gender dysphoria.
In part because many of the same private insurance plans provided by Florida to its employees would cover transition-related care if the plans were provided by nonstate employers, the suit argues that the State Plan Exclusion “constitutes unlawful sex discrimination in violation of Title VII and the Equal Protection Clause.”
“As a result of the State Plan Exclusion, nontransgender employees receive coverage for all medically necessary health care, but transgender employees do not,” the suit states.
For example, if a cisgender Florida state employee required an orchiectomy as treatment for testicular cancer, it would be covered by his state-provided plan. However, if a transgender woman sought the same surgery to eliminate testosterone production and alleviate gender dysphoria, it would not.
The plaintiffs are both employees of the state of Florida — Claire is a researcher at the University of Florida’s College of Veterinary Medicine, and Lane works in a Tallahassee public defender’s office. Both are covered by employer-sponsored health plans, but since the plans are provided by the state, they are banned from any coverage for transition-related health care.
The suit claims the plaintiffs have also faced additional financial burdens due to the state’s trans health care ban.
Claire began her transition in 1997, but was forced to pause in 2002 after her divorce affected her finances. Claire said she then attempted suicide three times.
“I literally couldn’t see a way financially forward,” she explained. “I went through 10, 14 years of hell.”
She resumed her transition 16 years later, and in 2016 fully transitioned socially. Although she has paid for her private insurance premiums through her employer, the University of Florida, Claire has been barred from any coverage of her transition-related care, and has therefore been forced to pay out of pocket for all of transition-related expenses.
Claire’s experience with her employer has been positive — Claire said the university has been understanding as she has worked through her mental health challenges. However, she said her health plan’s ban on trans-related care has made her feel like “a second-class employee.”
“I pay for my health insurance for 30 years now, but I can’t use all of it,” she said. “Everybody else pays for their insurance and they get to use it like they want, but I don’t get to use mine.”
Billy Huff.ACLU Foundation of Florida
One of the original plaintiffs in the case, a transgender man, Billy Huff, will be called as a witness instead. Huff said he left Florida for a job in Illinois, since staying in the state while subject to the State Plan Exclusion was having too great an impact on his gender dysphoria.
“Part of the impact was having to leave,” Huff told NBC News. “I left my home and my friends.”
Huff was the director of the University of Florida’s LGBTQ center, where he said he promised students that he “would be their best advocate.”
“Knowing that a lot of students that I worked for would go on to work for state offices in Florida, I thought I should try to change it if I could do something,” Huff said of his efforts to start the lawsuit.
“When I was looking to leave, I only applied at universities that were in states that covered transition-related health care,” Huff said. “That was one of my main qualifications.”
In addition, the U.S. Supreme Court is currently reviewing the question of whether Title VII of the Civil Rights Act — which “prohibits employment discrimination based on race, color, religion, sex and national origin” — affords protections to LGBTQ people through its ban on “sex” discrimination.
For years, Ugandan refugee Mbazira Moses has been typing out emails to dozens of international humanitarian organizations and United Nations officials with a message: LGBTQ refugees at the Kakuma Refugee Camp in Kenya need your help.
The Kakuma camp and nearby Kalobeyei Integrated Settlement, both operated by the U.N. Refugee Agency, or UNHCR, are together home to nearly 200,000 refugees from dozens of countries. Many, if not most, have fled overland from Kenya’s conflict-stricken neighbors: Uganda, South Sudan and Somalia.
A protected section of Kakuma refugee camp in northwest Kenya, which is home to LGBT refugees in Turkana County on Oct. 14, 2018.Sally Hayden / SOPA Images/LightRocket via Getty Images file
But according to Moses and experts on refugees and migration, the lesbian, gay, bisexual, transgender and queer refugees in Kakuma — many of whom fled homophobic and transphobic violence in nearby Uganda — continue to face threats and violence from locals and other refugees for the simple reason that they are LGBTQ. While the situation for sexual and gender minorities may generally be more dire in neighboring countries, Kenya is still among the nearly 70 nations that criminalize homosexuality.
On Tuesday night, Moses sent out another such email: Over 50 queer refugees camped outside the UNHCR reception center at Kakuma for safety reasons were again attacked, this time by Turkana-speaking locals and other Kakuma refugees.
“They were kicked out by the UNHCR and forced into the homophobic community with other refugees,” and then local residents from the area, the Turkana, “attacked them some time ago,” Moses wrote in the email sent to human rights officials and journalists.
“They fled to the reception center where they were denied entry,” he wrote. “The two groups hate them badly.”
Kakuma camp refugee injured with what appears to be a bloody nose.
Moses alleged that the refugees were attacked with “knife stabs, stones and clubs,” and included images of people with head injuries. Police hesitated, the ambulance was slow, and the refugees fled through holes and over fences, Moses said. The Turkana locals allegedly blamed the gay refugees for a local drought. Seven refugees were injured.
Kakuma camp is “very hard to administer,” said Bruce Knotts, director of the Unitarian Universalist United Nations office, who has for decades worked in refugee advocacy and relief — including a visit to Kakuma years ago.
“You have got a handful of UNHCR officials, so bad things can happen, and bad things do happen in refugee camps — not only to LGBT people, but women and other people as well, so it’s unfortunately not surprising,” Knotts said.
In June 2018, Moses and Refugee Flag Kakuma, an LGBTQ rights group he leads at the camp, hosted its first gay pride event. The march attracted hundreds of Kakuma onlookers, but soon after it finished, a series of murderous threats were posted around the camp: Leave or be killed “one by one.”
Participants hold rainbow flags during an LGBTQ pride event at the Kakuma Refugee Camp in Kenya on June 16, 2018.Refugee Flag Kakuma
The dire situation at the camp worsened in December 2018, when an attack on LGBTQ refugees at Kakuma injured 20 and was so brutal that UNHCR officials relocated hundreds of refugees to a gated school compound 450 miles south in Nairobi, where some remain today. And yet, according to Moses, new lesbian, gay, bisexual, transgender and queer refugees continue to arrive for registration at UNHCR offices in Kakuma and Nairobi.
In a WhatsApp message sent to NBC News on Friday, Moses said he and other members of Refugee Flag Kakuma question “the logic of returning and housing LGBT refugees in a place where others had been withdrawn because of insecurity.”
“Some of the 200 LGBT refugees who were relocated from Kakuma camp last year were arrested and returned to camp,” Moses said. “At the same time, some new ones have been reporting both in Nairobi and Kakuma. Those who report in Nairobi are always sent to Kakuma refugee camp.”
LGBTQ refugees also routinely accuse the camp’s administrators of turning a blind eye — due to homophobia and transphobia — to their plight and to the continued violence they face.
UNHCR did not respond to NBC News’ request for comment on reports of repeated violence against LGBTQ refugees at the Kakuma camp. However, in an interview with NBC News after the attack on the camp’s June 2018 pride event, Yvonne Ndege, a UNHCR Kenya spokesperson, said, “The community can sometimes feel isolated.”
“UNHCR and the government of Kenya with other relevant stakeholders are striving to promote the rights of all asylum-seekers and refugees and are ensuring partners are trained on how to work with LGBTI in a displacement context,” Ndege said. “Their rights as human beings shall be considered as such.”
While the process of getting a refugee application approved by UNHCR can take years in Kenya and other countries, including the United States, the average stay for a resident of Kakuma camp is 17 years, according to the UNHCR.
More than 25 million people worldwide are currently refugees, according to Amnesty International, and a third are living in the world’s lowest-income countries. The Kakuma Refugee Camp in northwestern Kenya was recently the world’s largest refugee camp — outstripped in late 2019 by Rohingya refugee camps in Bangladesh.
Knotts said UNHCR is “overwhelmed by Syrian refugees, by Rohingya refugees; there are massive refugee situations around the world, and when you are talking about LGBTQ refugees, you’re talking about a small number and nobody wants to talk about that.”
Even so, “the UNHCR has an obligation to do better than this,” Knotts said.
A federal judge has ordered the Department of Homeland Security to return a gay asylum-seeker who was deported to Chad, ruling that the government had not properly considered his asylum claim based on his status as a gay man before deporting him.
Oumar Yaide arrived in the U.S. in 2009 and requested political asylum because he was a member of “a disfavored group,” a Chadian ethnic group called the Gorane. His asylum application was denied in 2014, and in December 2018 a judge denied his final appeal.
In October, however, two months after officers from Immigration and Customs Enforcement, or ICE, removed him from his San Francisco home and sent him to California’s Yuba County Jail, Yaide filed a motion to reopen his asylum case. This request for relief was based upon new information: Chad criminalized homosexuality in 2016 — years after Yaide arrived in the U.S. — and Yaide came out as gay in 2019. This combination, according to court documents, led Yaide to fear “torture and death” if he returned home to the central African nation.
But in early December, while Yaide’s new case was waiting to be seen by an immigration judge, ICE agents removed him from the Yuba County Jail, processed his deportation and sent him to the Sacramento airport, where he and two ICE agents boarded a flight to Chad. Yaide was in handcuffs until a layover in Addis Ababa, Ethiopia. His lawyers said they had no idea where he was during the trip.
While Yaide was making the long journey back to Chad, his attorneys filed an instant habeas petition and temporary restraining order requesting that the government return him to the U.S. Last month, U.S. District Judge Charles R. Breyer granted the request and ordered Homeland Security to return Yaide to the U.S., ruling the “deportation violates his procedural due process right to pursue his motion to reopen.”
“Obviously, imprisonment or death would foreclose Yaide’s ability to pursue his motion to reopen,” Breyer wrote in his order, referring to the possible punishment Yaide could face as a gay man in Chad.
Returning Yaide to the U.S., however, is not without complications. He has an expired Chadian passport, and Homeland Security says it has no jurisdiction to retrieve him from Chad without a valid passport. It is unknown whether Chad’s government will issue him a new one.
Breyer’s ruling directed the U.S. government to work with Yaide’s lawyers to “formulate a mutually agreeable plan to return Yaide to the United States as soon as practically possible.”
Edwin Carmona-Cruz, co-director of Pangea Legal Services, the group representing Yaide, told NBC News on Wednesday that his organization is now “working with federal elected officials to assist in this process.”
Tanya J. Roman, an ICE spokesperson, said the agency is “unable to comment due to pending litigation.”
Chad is one of 68 U.N. member states where consensual same-sex activity is illegal, according to ILGA World, an international LGBTQ advocacy organization. In the United States, asylum-seekers have been successful with claims of potential persecution because of membership in a “social group,” namely the LGBTQ community.
In 1994, Attorney General Janet Reno ordered that the ruling in the case of a Cuban gay asylum-seeker, Fidel Armando Toboso-Alfonso, should be the guidance for future cases, thus cementing an earlier decision finding that Taboso-Alfonso was eligible for asylum because of his membership in the LGBTQ “social group” and the threat of political violence he would face if he were forced to return to his home country of Cuba.
Aaron C. Morris, executive director of Immigration Equality, a nonprofit LGBTQ immigrant advocacy group, said Yaide’s case will have no clear impact on other LGBTQ asylum-seekers. However, he noted that “it’s pretty common” for LGBTQ asylum-seekers, like Yaide, to first seek asylum with a claim other than their sexual orientation or gender identity.
“A lot of our clients, often before they meet Immigration Equality, for various reasons, put forward meritorious claims that aren’t successful, whether that is a religion-based claim or political opinion claim like in this case,” Morris said. “That could be a young person whose parents are paying for a lawyer and involved with their case, a person who is from anti-queer country but living with relatives or living within that community — there are a lot of reasons that are really compelling why someone might only bring a claim based on sexual orientation later in the life of a case.”
The Council of the District of Columbia on Tuesday introduced legislation that would strip gendered and “patriarchal” terms from the D.C. code and replace them with gender-neutral language.
The Gendered Terms Modernization Amendment Act of 2020 would change instances of “he” or “she” in the law books to “the individual” or “they.” The bill was introduced by David Grosso, an at-large independent member of the council who has been a leader on LGBTQ legislation during his council tenure.
“We believe very strongly that language matters, that it actually holds power, and that the language of our laws matters,” Grosso told NBC News. “And it’s incredibly important that people feel included in the District of Columbia code to the fullest extent.”
The 43-page bill contains a list of “suggested” terms, Grosso said, “because for me it’s important that we have a hearing and listen to the public fully on what they think we should change it to as well.”
“His” would become “the individual’s,” “men” would become “individuals” or “humans,” “brother” and “sister” would become “sibling” and so on.
“Although we have done a lot of research and a lot of work on this, it is not something we should put out there and say: ‘We’ve got all the answers,’” Grosso said.
Among dozens of other proposed changes, the bill supports modifying the D.C. Charter and Home Rule Act so, for example, “chairman” of the District of Columbia Council would become “chairperson.” Modifications to the Charter and Home Rule Act would need to be approved by Congress.
The bill is co-sponsored by 10 of the 13 council members, and was introduced on a tense day during which member Jack Evans offered his resignation instead of facing a disciplinary hearing over an alleged ethics violation.
D.C. is not the first city to undergo a “linguistic cleansing,” according to Fern Johnson, a Clark University English professor. In a recent interview with the Atlanta Journal Constitution about the efforts of Berkeley, California, to make its city code more gender inclusive, she said “Albuquerque, Detroit, Memphis, Minneapolis, New York and Seattle have all made language less gender-specific, but these changes are usually incremental and happen without much fanfare.”
The broadening use of gender-neutral language in everyday vernacular and official documentation is accelerating. In 2017, the Associated Press Stylebook endorsed the use of the singular pronoun “they,” and this year, “they” was Merriam-Webster’s “word of the year” because of high public interest in the word’s definition and use as a singular pronoun.
At the dawn of the year 2010, few Americans could predict that the coming decade would revolutionize the legal and cultural landscape for lesbian, gay, bisexual, transgender and queer people. After all, it was only in 2003 that homosexuality was decriminalized across the country, thanks to a landmark Supreme Court ruling.
Over the past 10 years, the United States saw the nationwide legalization of same-sex marriage, the emergence of transgender rights as the central frontier in the LGBTQ rights battle and the introduction of PrEP to fight the HIV epidemic. The decade also saw tragedies and setbacks, like the Pulse nightclub shooting in Orlando and the trans military ban.
As the 2010s come to a close, NBC Out looks back to some of the decade’s many LGBTQ milestones.
Following through on a campaign promise, President Barack Obama on December 22, 2010, signed the repeal of “don’t ask, don’t tell,” the 1994 Clinton administration policy that banned military service by openly gay people. DADT was a compromise after Clinton failed to deliver on a 1992 campaign promise to allow gay and lesbian Americans to join the military. The repeal went into effect in September 2011.
Governor Andrew Cuomo signed the bill into law on June 24, 2011, just hours after the New York State Senate passed the Marriage Equality Act. Spontaneous celebrations erupted across the state and particularly at New York City’s Stonewall Inn, the birthplace of the modern LGBTQ rights movement.
Hillary Clinton: ‘Gay rights are human rights’
In an echo of her iconic 1995 speech in Beijing as First Lady, where she declared that “human rights are women’s rights and women’s rights are human rights,” Secretary of State Hillary Rodham Clinton delivered a speech on Dec. 6, 2011, to the United Nations declaring, “Gay rights are human rights, and human rights are gay rights.”
Ahead of President Obama’s widely telegraphed “evolution” on same-sex marriage, Vice President Joe Biden in a May 2012 appearance on NBC News’ “Meet the Press” announced that he was “absolutely comfortable” with same-sex marriage.
FDA approves Truvada as HIV PrEP
TruvadaAnthony Correia / NBC News
In July 2012, the Food and Drug Administration approved Truvada as HIV pre-exposure prophylaxis, or PrEP, to prevent HIV acquisition in high-risk individuals, particularly gay men and transgender women. PrEP was controversial when approved but has grown more widely used and accepted as cities, states, and the federal government have moved to widely promote its use as a tool to end the HIV epidemic. In places like New York City that have high rates of PrEP uptake, HIV infection rates have begun to decline.
Wisconsin’s Tammy Baldwin became the first LGBTQ person ever elected to the U.S. Senate in November 2012. But even then, Baldwin — who was first elected to political office more than three decades ago at 24 — was no stranger to making history. In 1998, when she was elected to the House of Representatives, she became the first gay woman and the first openly LGBTQ nonincumbent elected to either chamber of Congress.
-2013-
Supreme Court axes Defense of Marriage Act
Edie Windsor on June 23, 2014 in New York City.Bryan Bedder / Getty Images for Logo TV
The Defense of Marriage Act, or DOMA, passed in 1996 in response to Hawaii’s brief flirtation with legalizing same sex-marriage, was ruled unconstitutional by the Supreme Court in the June 2013 landmark U.S. v. Windsor decision. The ruling allowed federal benefits to flow equally to same-sex married couples in Washington, D.C., and the 12 states where gay marriage was then legal.
-2014-
Laverne Cox appears on cover of Time
Laverne Cox on cover of TIME in 2014.TIME
Laverne Cox, best known for her role in the hit Netflix series “Orange Is the New Black,” became the first transgender person to appear on the cover of Time magazine in June 2014. A month later, she became the first trans person to be nominated for an Emmy.
-2015-
Caitlyn Jenner comes out as transgender
Caitlyn Jenner on Vanity Fair cover in 2015.Vanity Fair
In a coming out heard ’round the world, Olympic gold medalist Caitlyn Jenner came out as transgender in a glamorous June 2015 Vanity Fair cover photo shot by photographer Annie Leibovitz.
Citing its 2013 decision that overturned the Defense of Marriage Act, the Supreme Court in the landmark June 2015 Obergefell v. Hodges decision found a constitutional right to marriage that included same-sex couples, legalizing gay marriage nationwide. In an iconic image beamed around the world, the White House was lit in the colors of the LGBTQ pride flag to celebrate the ruling.
A gunman opened fire in the Orlando LGBTQ nightclub Pulse on June 12, 2016, killing 49 people. The shooting was briefly the deadliest mass shooting in U.S. history. In a subsequent trial of the shooter’s wife, details emerged showing that the gay club Pulse was chosen randomly after heterosexual clubs appeared to be too securely guarded.
On June 30, 2016, Secretary of Defense Ash Carter announced that transgender Americans would be permitted to serve in the armed forces, sealing President Obama’s legacy as a leader in LGBTQ equality in the military. “This is the right thing to do for our people and for the force,” Carter said.
Kate Brown elected governor of Oregon
Oregon Gov. Kate Brown speaks to the crowd of supporters in Portland after being elected on Nov. 8, 2016.Steve Dykes / AP
Kate Brown, an out bisexual, made history in November 2016 when she became the first openly LGBTQ person to ever be elected governor of a U.S. state. She had become the governor by default the year prior, after the state’s longest-serving governor, John Kitzhaber, resigned amid a scandal.
-2017-
‘Moonlight’ wins Best Picture Oscar
Trevante Rhodes in “Moonlight.””Moonlight” – A24 / IMDB
The 2016 film tracks Chiron, a young black man, who is coming to terms with his homosexuality. “Moonlight” dazzled festival audiences and critics before becoming the first ever LGBTQ-centered film to win an Academy Award for best picture in 2017.
In a series of early morning tweets on July 26, 2017, that reportedly took the Department of Defense by surprise, President Donald Trump announced that he was reinstating the repealed ban on transgender military service.
Sharice Davids, Jared Polis and Angie CraigWhitney Curtis, Rick T. Wilking, Craig Lassig / Getty Images / AP Images for Human Rights Campaign
The LGBTQ candidates who saw victory in November 2018’s “rainbow wave” included Democrat Jared Polis, who became the first openly gay man elected governor in the United States, and DemocratSharice Davids, who flipped her district in Kansas against a four-term incumbent to become the first openly LGBTQ member of Congress from Kansas and one of the first two female Native Americans elected to Congress.
I launched a presidential exploratory committee because it is a season for boldness and it is time to focus on the future. Are you ready to walk away from the politics of the past?
In a video posted to Twitter on Jan. 23, 2019, Pete Buttigieg announced the formation of his presidential campaign exploratory committee. The millennial mayor spoke to NBC News and said he once “believed that coming out might be a career death sentence.” Buttigieg is the first openly gay man to ever appear in a Democratic primary debate.
On June 28, 2019, the 50th anniversary of the New York City riot that sparked the modern gay rights movement, #Stonewall50transformed into a giant global celebration of LGBTQ rights. New York City even hosted dueling, record-breaking LGBTQ pride marches
‘They’ is Merriam-Webster’s word of the year
The word “they” is displayed on a computer screen on Dec. 6, 2019, in New York.Jenny Kane / AP
In a “data-driven” decision guided by internet users’ searches, the dictionary brand announced in mid-December that the word of the year is the nonbinary singular pronoun “they,” which preferred by some transgender and nonbinary people. Merriam-Webster added the entry in September.
When HIV first tore into America’s gay male community in the early 1980s, quotidian questions of sex, love, lust and trust transformed into weighty decisions with potential life-or-death consequences.
The decision to stop using condoms with a serious partner? Only as reliable an HIV-prevention method as your partner’s fidelity. A single instance of cheating? An indiscretion that carries the risk of an incurable and deadly disease. A random hookup? A nagging sense that, perhaps, this time was the time.
Todd Faircloth, 52, remembers those days well. In 1987, when gay men were still dying from AIDS in large numbers, Faircloth moved to New York City from North Carolina to start his big, gay life. He was just 17.
“I didn’t know anyone that lived past the age of 30, I didn’t anticipate anyone was going to live that long,” Faircloth, who now lives in Georgia with his husband, said. “It got to the point where people just assumed they all had a death sentence over their heads.”
He said he endured “hundreds” of AIDS funerals with a lot of dark humor, but still, “it was really scary to be out there.”
Amidst all the death, the human immunodeficiency virus caused understandable fear and anxiety among gay men, and Faircloth said this even influenced the relationships people entered into. “If you meet someone, you got with them, you were more likely to want to stay with them, not because you wanted to be with them, but because you’re scared to go back out,” he said.
Today, more than three decades after Faircloth moved to New York, HIV is controllable with medication and need not lead to death. In addition to condoms, first approved to stop HIV in 1987, people at risk of acquiring HIV today can take medications like Truvada to prevent the virus’ transmission, namely pre-exposure prophlyaxis (PrEP), and post-exposure prophylaxis (PEP), which are taken before and after sex, respectively, to prevent HIV transmission. And for those who already have the virus, treatment as prevention, or TasP, makes it impossible to transmit the virus in sex when taken regularly, according to the Centers for Disease Control and Prevention.
One unintended benefit of this new array of pharmaceutical prevention options, according to a new study, is a reduction in “HIV anxiety.” Anxiety about HIV transmission, which the study’s authors describe as a “common” experience of gay and bisexual men — especially those who, like Faircloth, lived through the darkest days of the AIDS epidemic — can compromise their “emotional well-being and create barriers to HIV testing.”by TaboolaSponsored StoriesTHE MOTLEY FOOL5 Stocks that Could Set You Up for Life2019 GIFT GUIDE27 Christmas Gifts That Are Selling Like Hot Cakes
Fifteen years ago, if the condom broke, I would be freaking out about it, and there really wouldn’t be anything you could do for three to six months except just passively hoping you don’t get HIV.
TIM PETLOCK THE OLD DAYS
“For many men, fear of HIV transmission led to anxiety about sex with other men, even in situations where transmission was impossible,” the authors note. Half of respondents worried about whether their sexual encounters were “safe,” and thought about HIV before sex, while a full quarter of study respondents, all of whom were HIV-negative, reported thinking about contracting HIV during sex. And the study found that taking PrEP “was independently associated with lower levels of HIV anxiety.”
The study suggests that this PrEP-associated reduction in HIV anxiety could “be promoted as part of demand creation initiatives to increase PrEP uptake,” a key goal of the U.S. government as it seeks to end the HIV epidemic by 2030.A sea change
Tim Petlock, 49, a gay man living near Dallas, said that so much has changed since he came out as gay in the early 1990s.
“Fifteen years ago, if the condom broke, I would be freaking out about it, and there really wouldn’t be anything you could do for three to six months except just passively hoping you don’t get HIV” Petlock told NBC News, referring to the monthslong window of early HIV tests.
“Now, you can go to treatment the day after to reduce the risk,” he said of post-exposure prophylaxis, or PEP. And today’s HIV tests can tell if a person is infected in about seven days. “You know that much sooner, whether you’ve got it or not, so it does kind of change the calculus of the whole thing.”
Today, Petlock takes PrEP and said that he worries much less about contracting HIV than he used to. Now he’s more focused on avoiding sexually transmitted bacterial infections, such as syphilis and chlamydia, which are on the rise in America.
“I know there’s some risk, but it’s likely not going to be life-altering,” he said.Ghosts of the epidemic
While PrEP has been shown to reduce HIV anxiety in some gay and bisexual men, the unease has by no means dissipated among this population.
“When you are bombarded your adult life with HIV and seeing death, I don’t care how much we advance biomedical technologies — that emotional reaction to the disease is still going to be the same,” Perry Halkitis, dean of the Rutgers University School of Public Health and author of “Out in Time,” told NBC News. “I unfortunately think that the way we deal with HIV in this country still to this day is very rooted in the responses from AIDS.”
It got to the point where people just assumed they all had a death sentence over their heads.
TODD FAIRCLOTH SURVIVING THE EPIDEMIC
One of the people for whom the memory of the epidemic’s darkest days is still fresh is Craig Lenti, a New York City-based media producer.
Lenti moved to Manhattan in 1996 at age 18 to attend college, one year after AIDS deaths peaked in the United States. He said he learned about homosexuality and AIDS at the same time, and during his late teenage years, AIDS was the top killer of young American men.
“They were always, for me, intrinsically linked,” Lenti said. “That was what I had in my head. That is what the media told me. And so from that point on, there really was no way of disconnecting those two concepts.”
For years, Lenti avoided taking an HIV test because of his fear that it would return positive.
To this day, Lenti said, it is hard for him to take an HIV test and to trust potential partners because of his fears from the epidemic’s early days.
“It was a foregone conclusion that I would become infected,” Lenti said of his thinking at the time. Yet despite all that worrying, he remains negative.
“I think the biggest fear that I had about HIV was not the fear of being sick. It was always the fear of dying alone,” Lenti said. “It’s just very hard for me to trust people, and I think you could argue that a lot of that stems from my fear of becoming infected, even though now there’s so many different ways to combat that.”‘I don’t think it just changes overnight’
While Lenti no longer takes Truvada for PrEP because he suffered from its rare gastrointestinal side effects, he said he counsels many of his friends to take the daily medication.
“If you can take a pill that has a 99 percent effective rate, why wouldn’t you do that?” he said.
Levi, a 19-year-old college student in Ohio, is among the nearly 1 million Americans recommended to take, but not taking, PrEP. Because he’s a man who has sex with other men and is 28 or younger, he’s considered at high risk of contracting HIV, according to the CDC risk assessment worksheet for doctors (the worksheet is based on a point system and uses a variety of risk factors).
Levi is no stranger to HIV anxiety. He recalled a recent incident after he performed oral sex where he began to worry, “Do I need to get a test?”
“I spent the night basically in a hypochondriac fit running around looking if there are any sort of symptoms I should be looking for,” he said, telling an all-too-common tale. However, he needn’t have worried, as there is “little to no risk” of acquiring HIV through oral sex, according to the CDC.
Levi, who asked not to have his full name printed because he is still on his parents’ insurance and worries they would object to PrEP, said he’s just starting to think about taking the HIV prevention pill. He said the man he is dating is HIV-negative, and even though they plan to be monogamous, he doesn’t know if he can fully trust him, because the stakes are so high.
“Is there anything that I could even ask for?” Levi wondered. “Could you show me a paper or something? And could I even believe that?”
Levi’s struggle to answer this question is as old as the virus, Halkitis said.
“You have two sets of problems: a generation that has no clue and hasn’t seen death,” he said, “and a generation that is older that is completely bombarded.”
“I think there’s a whole negotiation morphing period going on right now as we get embedded in these technologies more and more,” Halkitis continued, referring to HIV prevention medications. “I don’t think it just changes overnight.”
A California inmate was sentenced to death Thursday for the 2013 killing of his transgender cellmate in a shocking case that shined a light on the dangers of sexual assault and violence trans people face when they are not housed according to their gender identity.
Miguel Crespo, 48, was housed with Carmen Guerrero, a trans woman, at Kern Valley State Prison for just eight hours in October 2013. During that time, Crespo bound, gagged, tortured and murdered Guerrero in their shared cell.
A California jury last month found Crespo guilty of first degree murder and assault.
Miguel Crespo.Kern County DA’s office / via KGET
At his sentencing, Crespo made it a point to tell officials that he’s not gay and that he had told officers in 2013 that he was incompatible with Guerrero before the prison housed them together anyway.
The issue of transgender people in California’s prison system is fraught and even became a topic in the Democratic presidential primaries, with former candidate Sen. Kamala Harris facing questions over her stance on granting state-funded, gender-reassignment surgeries to transgender inmates.
In May, the California Senate passed a bill that would require transgender prisoners to be housed according to their gender identity, not their sex assigned at birth. The bill has yet to be signed into law.
“Incarcerated transgender people deserve to be housed in facilities consistent with their gender identity,” California State Sen. Scott Wiener said at the time. “When we house trans people based on their birth-assigned gender, we place them at high risk of sexual assault and violence.”
According to the 2015 U.S. Transgender Survey, transgender people are nine times more likely than the general prison population to be sexually assaulted by other inmates.
Crespo’s sentencing statement — in which he said he didn’t want to be housed with a “gay” prisoner — would not stand up as a defense in a California court, because the state is one of eight that has banned the so-called gay and transgender panic defense, which means defendants cannot claim to have been motivated to commit violence by a person’s sexual orientation or gender identity.
Even among the non-incarcerated population, transgender Americans face high rates of violence. LGBTQ advocacy groups have said violence against trans women in particular is at epidemic levels, and the Human Rights Campaign has reported that at least 22 transgender people have been killed in the United States so far this year, but advocates say that is likely an undercount.
The U.S. government will start a national HIV prevention program that will distribute free HIV pre-exposure prophylaxis medication, or PrEP, to uninsured Americans at risk of acquiring the virus, the Department of Health and Human Services announced Tuesday. Activists, however, say the plan doesn’t go far enough.
Health Secretary Alex Azar called the new “Ready, Set, PrEP” program a “historic expansion of access to HIV prevention medication” and a “major step forward” in President Donald Trump’s Ending the HIV Epidemic plan, which was announced in February and seeks to reduce HIV transmission by 90 percent by 2030.
“Thanks to Ready, Set, PrEP, thousands of Americans who are at risk for HIV will now be able to protect themselves and their communities,” Azar said in a statement.
According to a risk index devised by the CDC, men who have sex with men should be advised to start PrEP if they have multiple risk factors, such as having more than one partner per month or being between 18 and 28. One risk factor — having condomless receptive sex once in the past six months — results in an automatic PrEP recommendation, according to the guidelines.
Azar noted that just 18 percent of the 1.2 million Americans who might benefit from HIV PrEP are actually taking the medication. That low level of access is in part because of the $2,000 monthly list price of Truvada and Descovy, the two Gilead Sciences drugs approved for HIV prevention, as well as the absence of a generic alternative. A generic version of Truvada is set to be released in September 2020.
This new national program is a win for activists, like those involved in the PrEP4All Collaboration, who have for years called for a national PrEP program to end the U.S. HIV epidemic.
However, the program has one glaring loophole: Ready, Set, PrEP does not cover the blood work required for PrEP, which advocates call “a barrier to PrEP access.”
The CDC’s 2017 PrEP provider guidelines state all sexually active PrEP users should receive multiple blood tests annually in order to initiate and continue taking PrEP. These tests can easily cost hundreds of dollars per visit, and with no federal coverage for them, it remains unclear how users would pay for them. In a conference call, Azar said community health centers could provide these tests for free, though this is not an official part of the government plan.
PrEP4All Collaboration member James Krellenstein said Ready, Set, PrEP leaves much to be desired, because it is “poised to repeat the errors of Gilead’s own Medication Assistance Program, which donated free PrEP to qualified uninsured individuals, albeit on a much smaller scale.”
“Similar to the HHS program, the Medication Assistance Program did not cover lab costs or associated clinical care,” Krellenstein wrote in an email. “As a result, people who access PrEP through the Medication Association Program were found to have a statistically significant lower rate of PrEP initiation and a longer time between PrEP prescription and initiation.”
While PrEP access is weak nationwide, there are areas where it is more widely used and supported by government health care services, like New York City and San Francisco. In those municipalities, the rate of new HIV infections has declined since the introduction of PrEP and is now reaching a level where there are few HIV-positive people who are at risk of transmitting the virus and few HIV-negative people who are at risk of contracting it.
HHS launched a website — GetYourPrEP.com — and a telephone number — 855-447-8410 — to help guide potential patients to PrEP resources.
The global fight against the human immunodeficiency virus is poised to make important advances thanks to three experimental HIV vaccines that are entering the final stages of testing at sites across the globe.
While any of these three late-stage HIV vaccine trials — known as HVTN 702, Imbokodo and Mosaico — could fail, scientists say they are more hopeful than at any time since 1984, when Secretary of Health and Human Services Margaret Heckler raised hopes by predicting that there would be a test-worthy HIV vaccine within two years.
This is “perhaps one of the most optimistic moments we have been in,” said Dr. Susan Buchbinder, director of the Bridge HIV research program at the San Francisco Department of Public Health and a chair of both the Imbokodo and Mosaico trials.
“We have three vaccines currently being tested in efficacy trials,” she said, “and it takes quite a bit to actually be promising enough in the earlier stages stages of trials to move you forward into an efficacy study.”
HVTN 702
The oldest ongoing HIV vaccine trial, known as HVTN 702, is based on a prior vaccine candidate, RV144, that was effective, but not effective enough. In 2009, the RV144 clinical trial released findings showing that the vaccine lowered the rate of HIV infections by about 30 percent. To this day, RV144 remains the only HIV vaccine that have ever demonstrated any efficacy against the virus.
While RV144, at 30 percent effective, did not suffice for global distribution, it pointed the way forward for vaccine researchers, who adapted RV144’s successes to create HVTN 702. Buchbinder said even a partially effective vaccine would be “a tremendous breakthrough,” and “would really have the power to change the trajectory of the epidemic.”
Dr. Anthony Fauci, director of NIAID and a longtime advocate for a vaccine that is at least 50 percent effective, said he feels “even more strongly now” that a partially effective vaccine would be worth deploying. He said that is because prevention strategies like pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) “are being so successfully used, even in the absence of a vaccine, that if one or more of these vaccines look good, have a 50-60 percent efficacy, I think that’s going to be the game changer for turning the epidemic around.”
HVTN 702 completed enrollment this summer, and clinical results are expected in late 2020 or early 2021.
Imbokodo and Mosaico
Imbokodo, the second trial, began in five southern African nations in 2017 and completed enrollment of 2,600 women this summer. In southern African nations, heterosexual women are at extremely high risk of HIV infection.
“It’s almost unbelievable, but it’s true, women between the ages of 18 and 25 — the prevalence of infection is well over 50 percent,” Fauci said. “If ever you wanted to get a population that, if the vaccine works, you’re going to know pretty quickly, then you want to go in women.”
Unlike HVTN 702, Imbokodo uses “mosaic” immunogens, which are “vaccine components designed to induce immune responses against a wide variety of global HIV strains,” according to the National Institutes of Health.
“The presumption is that a mosaic is going to give you broader coverage,” Fauci said.
In November, the third vaccine trial, Mosaico, marked its informal start after the first study participant received an injection. Mosaico is based on Imbokodo’s unique mosaic immunogen approach.
Imbokodo and Mosaico are largely identical and consist of six injections, with slightly different vaccine formulations administered during the final two clinic visits.
In addition, while Imbokodo is only being tested in African women, Mosaico will recruit 3,800 gay men and transgender people for its clinical trials at 57 sites in the United States, Latin America and Europe. For any HIV vaccine, Fauci said there’s a need to prove it works in different at-risk populations.
Imbokodo completed enrollment of study participants this summer, marking the formal end of the recruitment process. Results from Imbokodo are expected in 2021, and results from Mosaico are expected in 2023.
Challenges ahead
Fauci noted that there has been a rapid pace of vaccine-related developments in recent years, with these three vaccine trials starting in 2016, 2017 and 2019.
“In all of these trials, intermittently the data and safety monitoring board takes a look at the data, and either says the data are so bad you have got to stop, or the data are so overwhelmingly good that you have got to stop,” Fauci said. So far, after several reviews of the data in HVTN 702 and Imbokodo, “there’s nothing there to say stop the study,” which happened in 2007 when a Merck vaccine trial was shut down after the monitoring board determined that it had no impact on prevention.
“None of these vaccines is a particularly simple regimen,” Buchbinder said, “so it’s going to require quite a bit of effort to deploy.”
“They require multiple injections, and so each one would require a minimum of four different doses in its current configuration,” Buchbinder said. But an effective vaccine could be a “stepping off point” to potentially create a simpler and more effective vaccine in the future.
And if these vaccine trials all fail, public health officials say enough tools currently exist to stop the spread of HIV — if only people would, or could, use them.
PrEP, the daily pill that prevents HIV infection, is safe and effective, but not enough people are using it to slow HIV transmission and end the epidemic. And successful treatment of people living with HIV results in an undetectable viral load that they cannot transmit the virus via sexual activity, known as “treatment as prevention” or TasP.
“It goes exactly to what I have been saying for years and years — if you implement the tools that you have, you will definitely see an impact on the dynamics of the epidemic,” Fauci said. “I have been talking about this for well over a decade. If you implement, the incidence is going to go down. It happened dramatically in San Francisco, and it is happening right now in New York.”
