A transgender woman in New Hampshire has filed a discrimination complaint against her employer for denying her healthcare coverage for gender-affirming care.
Lillian Bernier, 31, has been an employee of New Hampshire-based manufacturing company Turbocam since 2019. She began transitioning in 2020. According to the complaint, filed on December 16 with the New Hampshire Human Rights Commission and the U.S. Equal Employment Opportunity Commission (EEOC), the company’s self-funded health coverage plan says that no benefits will be paid for “gender dysphoria treatment, including but not limited to, counseling, gender reassignment surgery or hormone therapy, and related preoperative and postoperative procedures, which, as their objective, change the person’s sex and any related complications.”
Bernier, the complaint says, suffers from gender dysphoria and requires hormone replacement therapy, counseling, and medically recommended surgeries. As a result of Turbocam’s refusal to cover gender-affirming care, Bernier said she has paid out of pocket for medical care and put off treatment.
The complaint alleges that the company and Health Plans Inc., which administers Turbocam’s health coverage plan, are violating employment nondiscrimination provisions of the New Hampshire Human Rights Act, Title VII of the 1964 Civil Rights Act, and the Americans with Disabilities Act.
“I’m proud of my work as a machinist at Turbocam,” Bernier said. “Like everyone else I rely on the pay and healthcare coverage from my job to support myself and my family. I’m just asking for fair coverage and to be treated the same as my coworkers.”
“It’s frustrating and overwhelming not to be treated equally and not to receive the full benefits my coworkers do,” she said in a statement. “I’m paying into the employee health plan like everyone else, but I have to pay completely out-of-pocket on top of that for my healthcare, which is a stress on me and my family. I take pride in my job and work hard, but no matter how much extra effort I put in, I’m not getting the full benefit of my work.”
Bernier’s lawyer, Chris Erchull, of GLBTQ Legal Advocates and Defenders (GLAD) in Boston, said that she is simply asking “to be treated with the same dignity, humanity, and fairness as other employees of the company.”
“By maintaining a blanket exclusion of coverage for any health care related to transgender transition, the company is providing Lillian and any other transgender employees, presently or in the future, a lesser tier of benefits,” Erchull said. “It sends a message that her healthcare needs are not legitimate.”
“Turbocam sees Lillian and all employees as created in God’s image and is providing as much support as possible consistent with its Mission, faith, and the law,” Jordan Pratt, senior counsel at First Liberty Institute, a Christian legal group representing Turbocam, said in a statement.
According to the company’s mission statement, Turbocam “exists as a business for the purpose of honoring God, creating wealth for its employees, and supporting Christian service to God and people.”
Pratt said that all Turbocam employees “have the option of taking a substantial cash bonus that they can use to choose any health insurance or medical services they desire. This should resolve the issue.”
But Erchull called the bonus a “red herring” and said that it is “insufficient to purchase other coverage.”
“A company like Turbocam does not have a legally protected right to provide lesser benefits to transgender employees simply because of the owner’s religious belief,” Erchull said.
In a statement, Health Plans Inc. said that “While we understand and empathize with the issues raised by GLAD, this employee is not insured by Health Plans Inc.” According to the statement, Health Plans Inc. processes health benefit claims for employers, but Turbocam has control over its health plan design and benefits.
As the Associated Press notes, depending on how the New Hampshire Human Rights Commission’s investigation proceeds, Bernier’s complaint could evolve into a lawsuit in state or federal court.
Same-sex married couples handle stress better than different-sex spouses do, according to a new study.
The study, published in the Journal of Social and Personal Relationships by researchers at the University of Texas Austin, found that while stress is common in all kinds of marriages, same-sex couples are able to deal with it better together.
By analysing survey responses of 419 couples on dyadic coping – coping as a couple – in both same-sex and different-sex marriages, researchers revealed that same-sex spouses were able to be more positive and collaborative in handling stress compared to their counterparts.
Same-sex married couples handle stress better than different-sex spouses do, according to a new study.
The study, published in the Journal of Social and Personal Relationships by researchers at the University of Texas Austin, found that while stress is common in all kinds of marriages, same-sex couples are able to deal with it better together.
By analysing survey responses of 419 couples on dyadic coping – coping as a couple – in both same-sex and different-sex marriages, researchers revealed that same-sex spouses were able to be more positive and collaborative in handling stress compared to their counterparts.
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The differences, researchers said, stem from links between gender and coping strategies.
For example, women married to men said that their spouses were more ambivalent and hostile in responding to stress compared to women married to women.
According to study author Yiwen Wang: “This research shows that while there are some gender differences in dyadic coping efforts, the effects of supportive and collaborative dyadic coping as well as of negative dyadic coping on marital quality are the same for all couples.
“Our findings also emphasise the importance of coping as a couple for marital quality across different relationship contexts, which can be an avenue through which couples work together to strengthen relationship wellbeing.”
The study’s authors believe that because the stress was handled better by both male and female same-sex couples, the key to their dyadic coping is their ability to work together to deal with stress, using their similarities in stress responses and their shared gender-related experiences.
Debra Umberson, Wang’s co-author, said that coping with stress collaboratively may even be more important for same-sex couples, who are less likely to have familial and institutional support compared to straight couples.
“Including same-sex spouses and looking at how they work with each other to manage stress as compared to different-sex spouses can help us better understand the ways in which gender dynamics unfold in marriages,” she said.
“Same-sex couples face unique stressors related to discrimination and stigma. Coping as a couple may be especially important for them as they do not receive as much support from extended family, friends or institutions as different-sex couples do.”
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Many of us have been cut from our usual networks of care, affection, pleasure and exchange during the COVID-19 pandemic. In the context of queer life, this seems especially palpable: So much of how we engage with each other centers around community, contact, and proximity, conditions which now might evoke potential danger and anxiety, risk even. One of the many transformations undergone in the pandemic, then, relates to the amount of time we’ve been forced to spend in isolation, barred from care and kin.
I, like others, found myself yearning anxiously for the outside world. And yet, in those same conditions, I also discovered an opportunity to go inward and cultivate a relationship that often faded into the background of an exciting and rich social life I longed to return to. I discovered a new relationship with mind, and this reinvigorated relationship has extended bountifully towards the shared queer life I practice with others in the world. Here, I seek to make a case for mindfulness as a vital aspect of queer communal care, one that is not separate from the concrete societal equity, justice, and health we so passionately strive towards.
Mindfulness and meditation tend to conjure up a wide variety of images that often distract us from what it actually is and how one could actually integrate such a thing in everyday life. On the one hand, there’s a tendency to associate meditation with a predominantly white and affluent “wellness fanatic” eager to jump on board with the latest form of cultural theft. On the other, there’s a mystified idea of meditation as the solemn activity of monks, a thing utterly incompatible with the busy and dynamic lives we often lead.
To address the first misconception: meditation and mindfulness (terms that serve as umbrellas for a rich and diverse set of culturally-specific practices) should not be considered the sole purview of the rich and trendy. Despite the aggressive forms of marketing and branding that have sought to make meditation yet another signifier of class, this practice does not belong to them. Arguably, it doesn’t belong to anyone at all, even if it is a central aspect of a variety of non-Western spiritual and cultural systems. This urge to brand and create the marketable “identity” of the “meditator” is antithetical to meditation itself.
The second misconception might be harder to overcome at first, given our tendency to relate to things by measuring up our insufficiency, to feel like these things are not for us, that our lives are anything but solemn. But, for all the truly spiritual potential that mindfulness can bring to one’s life, meditation should not become an untouchable, sacred, and pure thing.
Meditation essentially describes our relationship to mind, and our relationship to mind is truly all we have. All we do and say––all the ways in which the world, our environment, and our communities arrive at us and beckon our attention––passes through this elusive thing we call mind.
To be mindful, or to practice mindfulness, is not to sit and become anxious at the failure to block out all thoughts and be completely “blank.” It is, however, to slow down our reactiveness to these thoughts and external stimuli. To allow, to let be. It can involve breathwork or mantra repetition. But it can also look like informally taking the first five minutes of the morning and, instead of sprinting for the phone, to become aware of those first instances of consciousness as we emerge from sleep, before our attention scatters to the many things that are or appear to be urgent. To tend to our minds with the same care we seek for the world.
Perhaps more fundamental than the term “meditation” in a meditation practice is the word “practice” itself. It’s easy to forget that a practice already implies that we will struggle and falter a bit. It means, importantly, that we begin again and that we surrender the usual reflex of harsh judgment. It also implies that meditation is not a thing to be conquered, dominated, and perfected once and for all. To begin again, fresh and new each time, carries with it a very subtle but transformative teaching: mindfulness is a practice of recurring and insistent self-compassion.
The more we are able to allow ourselves––in those five or two or ten minutes of sitting in silence with our mind––to return to the breath even as we inevitably trail away (and we will, many times, even as “advanced meditators”), the more we become aware of how we can practice this compassion and non-judgement in other spheres of our lives, the spheres we inhabit in common with the consciousness of others, in the communities we hope to build and rebuild justly. A softness with self engenders a softness with the world in turn, but it must be practiced gently first within, then without. How could this not be but a building block of more compassionate and present communities, this care turned inward?
This was probably one of the early insights I gained from starting a meditation practice. Being part of that great social world outside my mind also meant being constantly at the mercy of comparison and harsh self-critique regarding the adequacy of my body or my social status. Queer people of color, especially, experience this kind of isolation and self-comparison in disproportionately higher levels given a world predicated on neutral whiteness and upward social mobility, where “queer” has often implicitly meant access to capital and to normative ideas about embodiment and attraction. We pursue these without question and seemingly to no end.
Mindfulness––the initial failure, the distraction and restlessness, their invitations to begin again––interrupted and made me aware of these habitual patterns of violence to the self. It has made all the difference to cultivate and nurture this inner space, a space I then am able to practice in community with others, where I become more present for those with whom I share and practice love queerly, and where I have so much more to offer.
Undoing these silent violences living in our mind is not separate from our communal efforts to eradicate violence in our relationships, encounters, and communities. During the first major lockdown in 2020, I attended a virtual community sliding-scale meditation with Rev. angel Kyodo williams, a Black writer, activist, and ordained Zen priest. This moment also coincided with the powerful wave of anti-racist activism and protest in the wake of the murder of George Floyd. Rev. Williams, predicting our tendency to criticize our attention span and our relationship to meditation, reminded us midway through the session that the undoing of carceral and police logic begins with a commitment to its undoing in ourselves. In meditation, this undoing looks like an ability to begin again, without shame or harsh discipline. I felt, in the BIPOC-centered space that seemed so opposite to social action, the seeds of compassionate and equitable futures to come.
Mindfulness matters to a queer communal future because this future stems precisely from the very now in which we live and breathe, from the very selves that dream up utopian possibility. A gentle and personalized daily practice of meditation is not antithetical to societal change. Rather, it paves the way for a sturdy foundation of compassion with self, one that puts us in a place where we are able to work towards holistic and all-encompassing health. There is no equity in common until we are all afforded space for the mind to relax, for the breath to settle, and for the openness required for empathy––one of the fundamental aspects of health, justice and equality––to thrive.
A note on some resources: here’s the website to sign up for rev. angel’s amazing and financially-accessible sessions, which happen at several moments throughout the year. I would also highly recommend her book Radical Dharma: Talking Race, Love, and Liberation. Meditation apps like Waking Up, for example, will give out renewable free one-year subscriptions on the basis of self-reported need. The meditation app Liberate has a wealth of Black-centered guided meditations.
Humans often want to fix things about ourselves that aren’t broken. From foot-binding to plain old circumcision, our species has historically been obsessed with altering our bodies — which I can’t help but think about today as it’s Intersex Awareness Day. The observance commemorates the first protest by intersex people — those of us born with atypical sex characteristics — against the practice of subjecting intersex infants and minors to cosmetic, sex trait-altering medical procedures, on October 26, 1996.
The impetus for fixing is so prevalent regarding the intersex population that it’s often come to define us, via statements such as “Intersex? You mean those people who are operated on as babies?” that I’ve heard countless times as a longtime advocate for the intersex community. While I’m thrilled that awareness about these nonconsensual medical procedures is growing, it’s notable that we don’t define other populations this way. For example, although circumcision is the most common surgery performed on males, imagine how weird it would sound to hear males defined as “people whose penises are operated on in infancy.”
Humans often want to fix things about ourselves that aren’t broken. From foot-binding to plain old circumcision, our species has historically been obsessed with altering our bodies — which I can’t help but think about today as it’s Intersex Awareness Day. The observance commemorates the first protest by intersex people — those of us born with atypical sex characteristics — against the practice of subjecting intersex infants and minors to cosmetic, sex trait-altering medical procedures, on October 26, 1996.
The impetus for fixing is so prevalent regarding the intersex population that it’s often come to define us, via statements such as “Intersex? You mean those people who are operated on as babies?” that I’ve heard countless times as a longtime advocate for the intersex community. While I’m thrilled that awareness about these nonconsensual medical procedures is growing, it’s notable that we don’t define other populations this way. For example, although circumcision is the most common surgery performed on males, imagine how weird it would sound to hear males defined as “people whose penises are operated on in infancy.”
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Given said weirdness, today I’d like to highlight the fact that intersex people are much more than just the medical procedures that we are often subjected to — and that we’ve been around way before they even existed. Take, for example, Gen. Casimir Pulaski, born in Poland in 1745 and known as the “Father of the American Cavalry.” As the Smithsonian documentary The General Was Female? details, when the monument marking Pulaski’s grave was temporarily removed, his remains were discovered to have certain female characteristics. After years spent analyzing his skeleton and DNA, a team of researchers concluded that Pulaski was probably born intersex, with XX chromosomes.
Despite his XX chromosomes, Pulaski appeared male at birth because of his intersex variation, Congenital Adrenal Hyperplasia (CAH), which often masculinizes genitalia, Pulaski was able to serve in the military, becoming an American Revolutionary War hero after relocating from Europe. He is believed to have saved George Washington’s life in the Battle of Brandywine and is one of only eight people to be awarded honorary American citizenship, along with notables such as Winston Churchill and Mother Teresa.
Pulaski’s story illustrates that intersex people have been thriving for centuries before the surgeries used to change us existed, and it’s also a stark reminder of the harms and limitations of our current “fix it” approach. For today, in situations like Pulaski’s — where an individual has XX chromosomes and a variation known as congenital adrenal hyperplasia — medical experts routinely recommend surgical reduction of the phallic structure and estrogen hormone therapy to feminize the child’s body and assign them female. The assumption is that, due to their XX chromosomes, these individuals are “really” girls and should thus be made to look it. Yet there’s Pulaski, a man more successful than most of his counterparts.
We can only speculate about the countless other intersex people throughout history because, as with other LGBTQI+ folks, most of our history has been lost due to the fact that we’ve only recently been able to live openly as who we are. For example, when the news broke that Hollywood film legend Rock Hudson was gay, my mother, like many, had a hard time believing it. Had it not been verified after Hudson became the first major celebrity to die of AIDS-related causes, in 1985, he would have lived and died being misperceived as heterosexual. Similarly, had Pulaski’s remains not been uncovered, we would have never known that the prominent military hero was intersex.
Today, the vast majority of intersex people are still living this way — with their intersex status publicly unknown. It’s easy for me to understand why because until I was 28 I’d been living the same way. Although I’d been “out” as a lesbian for a decade, since college, everyone but my lovers and a handful of friends believed I was a non-intersex female. I knew I was different because my physical differences are very visible, but coming out as intersex in a world that only acknowledged males and females just didn’t seem like an option in the 1980s and early 1990s.
I came out precisely when and because I was asked, in 1996, to do so by a survivor of childhood surgeries, sometimes referred to as intersex genital mutilation. She had learned that I like my intersex body and feel blessed that I wasn’t subjected to IGM, and she thought it would be useful for people to hear this perspective. Having learned about the lifelong physical and psychological harms that often result from IGM — which can involve involuntary sterilization or the loss of sexual sensation, I agreed. I wanted the world to know that doctors’ claims that intersex children need to be altered in order to be happy are, in my experience, false.
Those who’ve watched me explore my intersex-ness since my 20s have, like me, viewed it as a positive aspect of who I am — one friend just recently called it my “superpower.” While I reminded her that millions of intersex people have not been afforded these experiences due to IGM and that even for me it wasn’t always easy due to societal ignorance about intersex people, the irony of her statement wasn’t lost. For me, being intersex has been a beautiful adventure, full of unexpected sexual pleasure and a rich understanding of both male and female experiences that I feel privileged to have known — which is essentially the opposite of what doctors who promote IGM predict intersex people will experience.
Incidentally, proponents of IGM like to dismiss my experience as an exception. Perhaps I just want to be different, some speculate, which makes me laugh out loud. As the queer child of Latinx immigrants in a white neighborhood and school and having a name so unusual I grew up hearing, “Hida, what’s that?” I often longed to blend in. Or, some speculate, perhaps I’m just unusually self-confident, in a way that we can’t expect normal people to be. Far from it! As those close to me know, I suffer insecurities as much as everyone else.
The true reason I like being intersex is simple: When you don’t raise a child to believe they’re defective, they’re more likely to end up feeling good about who and what they are — and it’s my hope that all future generations of intersex people are given the chance to experience this. On that note, a growing number of medical associations have begun to listen to intersex people. They are honoring their oath to “first do no harm” by recommending that no cosmetic surgeries be performed unless intersex people seek them out for themselves, as other adults sometimes do, and we couldn’t be more grateful.
Hida Viloria is the author of Born Both: An Intersex Life and is a long-term intersex advocate.
Views expressed in The Advocate’s opinion articles are those of the writers and do not necessarily represent the views of The Advocate or our parent company, Equal Pride.
ONE, a condom and lubricant company, is distributing the first and only condoms approved by the U.S. Food and Drug Administration for use in anal sex. After the approval, ONE partnered with Walmart on new packaging to highlight the FDA clearance.
Walmart stores in the U.S. will exclusively carry the ONE Backdoor pack, a condom kit that is a “butt stuff approved” sampler of the different styles available from ONE.
The pack will feature products like the ONE Vanish, which is 25 percent thinner than the standard ONE condom. It works best with the ONE Move lube, according to the company. The ONE Super Sensitive line — thin, smooth condoms with 50 percent more lubricant — will also be included in the kit. Also included are different samples from the MyONE Custom Fit, which includes condoms of various sizes to accomodate appendages of different shapes and girth.
The Backdoor Pack’s Vanish and Sensitive condoms are sized via the company’s MyONE size method, which is based on popular purchasing habits and is slightly shorter and wider than a regular condom. The included FitKit measuring tool will also help buyers find their perfect cut.
Walmart will also carry 12-count packs of ONE Vanish and ONE Super Sensitive condoms, both with packaging that highlights “FDA cleared for anal use.”
The popular ONE Move silicone lube and the Oasis Silk lubricating lotion are also available in Walmart stores.
While monkeypox (MPV) cases are declining nationally, health officials are learning new details about who’s at greater risk and why. It’s shining urgent new light on known challenges to health and well-being and how they’re not only a risk to a person but to public health overall.
Alarming data has emerged linking severe cases of MPV in people living with untreated HIV who are also experiencing homelessness.
In a recent study by the Centers for Disease Control and Prevention (CDC), outlined in an early release of the Morbidity and Mortality Weekly Report (MMWR) on October 26, 82% of study participants with severe MPV were also people living with HIV. And 23% were people experiencing homelessness. The study also found that 72% of the severe MPV cases among people living with HIV also had fewer than 50 CD4 cells, indicating a damaged immune system and disease progression from HIV to AIDS. Only 9% of people were taking antiretroviral medication at the time of their MPV diagnosis.
Housing Opportunities for Persons With AIDS (HOPWA) is responding to the intersecting health crisis of MPV, HIV, and homelessness. HOPWA is a long-time federal program providing grants to local communities, states, and non-profit organizations to assist low-income people living with HIV. HOPWA is directing grant partners to utilize funds to secure immediate housing for people impacted by the current MPV outbreak.
Rita Harcrow, Director, Office of HIV/AIDS Housing, U.S. Department of Housing and Urban Development, which manages HOPWA, tells GLAAD that along with medical interventions, health professionals invested in reducing occurrences of MPV and HIV must also prioritize housing.
“Housing equals better health outcomes, period. There are all these great medical interventions available, but if someone is experiencing housing instability, they don’t benefit from that,” Harcrow says. “They usually cannot focus on the medical resources available because they’re focused on where they will lay their head tonight.”
According to Harcrow, if a person is experiencing homelessness and is impacted by HIV and MPV, HOPWA is ready to intervene. The organization provides immediate hotel or motel resources for no more than 60 days over six months until more permanent housing is established, which often means placement on a waitlist.
“But while they’re in crisis mode, getting them out of that unsheltered homelessness is really important,” she says.
Black gay men, homelessness, and MPV
Housing instability is a vital concern, particularly for Black gay and bisexual men disproportionately impacted by HIV and severe cases of MPV. In 2019, Black people accounted for 13% of the U.S. population but 40% (479,300) of people with HIV. According to the CDC, Black gay and bisexual men accounted for 82% of HIV acquisitions. Black gay and bisexual men also account for the largest share of MPV cases, with 70% attributed to people of color.
“When we continue to look at the population most vulnerable for infection or inequities, I think [Black] people are at the front of that line,” says Daniel Driffin, Project Manager & Community Monkeypox Coordinator, HIV Vaccine Trial Network.
Driffin points to the social and structural determinants of health—income, health access, housing, and transportation as contributing factors.
“More than 70% of healthcare is connected to your employment. So, if you don’t have a full-time job, you probably won’t have health benefits. Not having a full-time job directly relates to where you can afford to live, which also directly relates to public transportation and other access components,” Driffin adds.
Leisha McKinley-Beach, a veteran Atlanta-based National HIV Consultant, tells GLAAD from a public health perspective, the holistic needs of Black gay and bisexual men have yet to be prioritized in working to achieve better overall health outcomes.
“You’ve got these systems that were never designed to impact Black people, especially Black same-gender-loving men, in ending this epidemic,” she says. “When the reality is if Black people weren’t diagnosed with HIV, if Black people weren’t achieving viral suppression, the money would dry up. It wouldn’t be a need if half of the epidemic is gone.”
McKinley-Beach says a different level of action needs to occur, focusing on the stigma attached to HIV and MPV. According to McKinley-Beach, stigma causes Black gay and bisexual men to not engage in care as often as their white counterparts, leaving them susceptible to disease progression and homelessness.
“When we talk about what stigma looks like in Black communities…that thing is so heavy, and it is impacting our decisions to access and sustain HIV care and treatment,” she says.” There won’t be viral suppression for Black communities until we address the people who are experiencing homelessness.”
“The barriers to housing are already there for LGBTQ [people], especially gay and bisexual men of color,” Harcrow says. “The stigma is there for HIV already, which we try to combat regularly. Discrimination is illegal in housing. If someone is experiencing housing discrimination because of their gender or perceived gender or orientation, that’s reportable,” she adds.
Driffin and McKinley-Beach are concerned that Black gay and bisexual men will continue to bear the brunt of poor health outcomes if public health professionals remain committed to utilizing the same playbook.
“As long as there is a tinge of other-ing involved in how we deliver services, not only healthcare-related services but social services, I think we will continue to see folks falling through the gaps,” he says.
Driffin’s observation bolsters HOPWA’s commitment to identifying and addressing the prevalence of HIV and homelessness experienced by Black gay and bisexual men diagnosed with severe MPV.
“We’re trying to help communities make the connection that housing can and should be used to address the needs of folks in the highest need of services,” Harcrow says.
People needing immediate housing assistance should contact a homeless provider in their area to connect to available resources. According to Harcrow, many communities have funds reserved for short-term rent, mortgage, and utility assistance.
“We have to have city [and public health] officials who understand HIV, housing, and the larger continuum of care,” Driffin says. “If we are placing folks in housing, but we’re not encouraging them to be the healthiest they can be—what are we doing?”
After five hours of tense testimony and protests, the Florida Board of Medicine voted Friday to start drafting a rule that would bar all minors in the state from receiving puberty blockers, hormone therapy or surgeries as treatment for gender dysphoria.
Florida’s medical board is the first in the country to pursue such a rule, but Florida is among a wave of states where officials have attempted to restrict gender-affirming medical care for transgender minors.
By the end of Friday’s five-hour meeting, protesters began yelling “Shame!” at the board members, and some of them staged a “die-in” in the lobby of the Orlando International Airport, where the meeting was held.
Protesters stage a “die-in” in the lobby of the Orlando International Airport on Oct. 28, 2022.Courtesy Kat Duesterhaus
The vote is the latest update in a months-long effort led by Gov. Ron DeSantis’ administration to restrict transition-related care for people under 18.
The effort to restrict such care began in April, when DeSantis and Florida Surgeon General Joseph Ladapo issued nonbinding guidancethrough the Florida Health Department that sought to bar both “social gender transition” and gender-affirming medical care for minors.
Despite that support, Florida’s Agency for Health Care Administration issued a report in June that “found that several services for the treatment of gender dysphoria — i.e., sex reassignment surgery, cross-sex hormones and puberty blockers — are not consistent with widely accepted professional medical standards and are experimental and investigational with the potential for harmful long-term affects.”
Just hours after the report’s release, Ladapo sent a letter to the Board of Medicine and asked it to establish a standard of care “for these complex and irreversible procedures.”
The board held its first meeting on the issue in August, and on Friday it officially voted to draft a ban on certain gender-affirming therapies for minors. The meeting began with expert testimony in favor of and against such care.
Dr. Michael Laidlaw, an endocrinologist in Rockland, California, cited often-criticized research that found 50% to 90% of children whose gender identity isn’t consistent with their assigned sex at birth grow out of the condition by adulthood.
“The basic problem with this treatment as I see it is: ‘What happens when you force a square peg into a round hole?’” he said. “You end up injuring or destroying the peg in the process.”
However, Dr. Meredithe McNamara, an assistant professor of pediatrics at Yale School of Medicine who treats transgender people between the ages of 10 and 25, told the board that the research Laidlaw cited and the June report issued by the Florida Agency for Health Care Administration are methodologically flawed.
“Neither of the authors of the state’s review is a subject matter expert,” McNamara said. “One individual is a dentist. The other is a post-doctoral fellow in biostatistics. At a bare minimum, the systematic review should be conducted by those who are qualified to assess the literature. I wouldn’t trust a dermatologist review of the literature on a neurosurgical procedure, for instance.”
After expert testimony, the board began the public comment period, which was scheduled to last two hours, according to multiple attendees.
The first nine attendees who spoke were in favor of restricting gender-affirming care for minors. Eight of them said they have detransitioned, or come to identify with their assigned sex at birth after having previously identified as trans. Only one of the eight had received gender-affirming medical care as a minor.
Chloe Cole, who described herself as an 18-year-old detransitioned female from California, said she began transitioning at 12 and received a double mastectomy at 15. At 16, she said, she realized she regretted her transition.
“All the talk about mental health, self perception, pronouns and ideology leads me to the question, why is a mental health epidemic not being addressed with mental health treatment to get at the root causes for why female adolescents like me want to reject their bodies?” Cole said.
The board also heard from the parents of transgender youths. Hope McClay, who has a 9-year-old trans daughter, said that she used to have to force her daughter to get short haircuts before she came out as trans.
“At one point she came up to me, at about three-and-a-half years old, and begged me, crying, and said, ‘Please, don’t make me be this way anymore. This is not who I am. I want to die,’” McClay said.
She said she and her family have consulted with medical professionals on medical care for their daughter, and they have found that allowing her to go through male puberty would be “psychologically damaging.”
“So we do not make these decisions lightly, but these are the decisions that should be made by the families, not by the state, and not by a board,” McClay said.
Jude Spiegel, the only transgender person to testify at Friday’s meeting, read the names of 17 trans teens who died by suicide “over living in a world that refused to acknowledge or accept them.”
With about 45 minutes left in the public comment period, board member Dr. Zachariah P. Zachariah said only one more person would be allowed to testify. The crowd protested, and he offered to provide an email where they could share their testimonies.
At one point, an audience member yelled that trans youths would suffer if the board voted to bar care: “The blood is on your hands!” To which Zachariah responded, “That’s OK.”
Emile Fox, a trans nonbinary person from Orlando who uses “they” and “he” pronouns, said they signed up to testify and weren’t able to, which frustrated them after the first eight people who testified were all in favor of restricting care, but none of them were from Florida.
“What was so appalling to me is how obviously staged this all was,” Fox said, adding that the board members didn’t appear to know that much about gender-affirming therapies. “They’ve been fed a narrative, and they ate it up.”
A spokesperson for the board said the committee “heard from subject matter experts and allowed for members of the public to speak on the issue at today’s workshop.”
“The content of public comment is not ‘stacked’ by Boards,” the spokesperson said in an email Saturday. “Any members of the public who were unable to provide comment can submit written comment via email to BOMpubliccomment@flhealth.gov within 24 hours of the conclusion of the workshop. These comments will be included in the rulemaking record and reviewed just as all other public comments.”
After the public comment period, the board attempted to come up with a rough draft of a rule. Initially, members considered making trans youths who were already receiving gender-affirming medical care exempt from the ban if they underwent an informed consent process, but they decided to cut that proposal.
Then, in a rushed exchange that attendees described as confusing, Zachariah pushed for a vote even as some board members asked for the proposal to be read aloud once more. He then said the motion was passed without saying what the final tally was.
Florida Rep. Anna Eskamani, a Democrat whose district includes parts of Orlando, said that there would be another meeting on Nov. 4 at the Holiday Inn, Disney Springs, to discuss the drafted rule, and then there would be a 28-day approval process that would include additional time for public comments.
She believes the timing of the rulemaking process — just ahead of the election — is intentional.
“It’s so clearly intentionally designed to create a news cycle that further polarizes and politicizes gender-affirming care to distract from the affordable housing crisis, to distract from the impact of Hurricane Ian and property insurance rates,” she said. “We have some actual real problems to solve, big health disparities that we need to address and yet, instead of talking about those real-life concerns, trans issues are going to be front and center, and that’s truly designed to continue to divide us.”
Since a peak in August, the number of reported daily cases of the monkeypox virus has declined 85%.
That’s the latest seven-day average data from the Centers for Disease Control, indicating a drop from 443 reported cases at the height of the outbreak on August 6, to 60 cases reported on October 12.
As of yesterday, 27,022 cases of the monkeypox virus have been reported in the U.S.
Experts attribute the drop to a variety of factors. The monkeypox vaccine, with an 85% efficacy rate, helped slow the virus down. Men who have sex with men reduced their partners following the rise of cases in the wake of large gatherings around Pride month in June. And the virus, spread by close skin-to-skin contact, was self-limiting, unlike the airborne coronavirus, finding fewer places to spread as potential hosts reduced their exposure and the vaccine proved effective.
Centers for Disease Control
Another factor was a change in communications strategy. As cases began to rise sharply, it became clear that the virus was disproportionally affecting men who have sex with men, but officials at all levels of government were reluctant to highlight the fact, fearing the stigmatizing effect of a virus mislabeled as a “gay disease.”
In the middle of July, the New York City Health Department debated a strategy calling for gay men to reduce partners, issuing a statement that counseled caution: “For decades, the LGBTQ+ community has had their sex lives dissected, prescribed, and proscribed in myriad ways, mostly by heterosexual and cis people,” the statement read. New York would offer direction cognizant of “how poorly abstinence-only guidance has historically performed with this disgraceful legacy in mind.”
“Telling people not to have sex or not to have multiple sex partners or not to have anonymous sex is just a no-go, and it’s not going to work,” longtime AIDS activist and Housing Works chief executive Charles King told The New York Times at the time. “People are still going to have sex, and they’re going to have it even if it comes with great risk.”
In San Francisco, local officials decided the data should do the talking, expanding eligibility for the vaccine to all men who have sex with men who’d had multiple sexual partners in the previous 14 days. On July 28, the city announced a public health state of emergency, in an effort to prompt a more urgent response from the federal government and to put the city’s most at-risk population on high alert.
New York City followed suit with their own monkeypox state of emergency, at about the same time the World Health Organization’s director general recommended that men who have sex with men should consider limiting their partners. The CDC highlighted that guidance not long after.
At the federal level, in the beginning of August, the White House enlisted Dr. Demetre Daskalakis to help lead the administration’s response to the growing crisis and rectify a stumbling rollout of the vaccine. Daskalakis, who is gay, responded with a strategy directly targeting the MSM community, through outreach at large events attracting gay men, and even participating in a live Grindr forum addressing the issue, with explicit guidance for men who have sex with men to reduce their number of sex partners.
The new messaging seems to have worked. According to the CDC, by the middle of August, men who have sex with men reported changing their behavior because of the monkeypox outbreak: 48% reported reducing their number of sex partners, 50% reported reducing one-time sexual encounters, and 50% reported reducing sex with partners met on dating apps or at sex venues.
Centers for Disease Control
“The strategy worked,” Daskalakis told LGBTQ Nation, describing what he calls “a three-part trick that always works in addressing outbreaks and epidemics: community engagement, science and political will.”
“I think that the really frank, direct information that we generated through governmental public health, and then saw the community alter, magnify, and contextualize, got out,” said Daskalakis. “Seeing people who reduced their behaviors that could potentially expose them to monkeypox was definitely a part of this.”
Daskalakis added: “What’s important is that you don’t associate a virus with an identity, but rather talk about the behaviors that are associated with transmission of virus, and make sure the right people know.”
“I think the Biden administration kind of got its act together, but it was slower than it should have been,” Supervisor Raphael Mandelman, who pushed hard for San Francisco’s monkeypox emergency declaration, told LGBTQ Nation. “It was not a pleasant exercise, seeing this health crisis that the federal government was not adequately addressing, and seeing how slow the country was to get this vaccine, that had already been discovered, distributed into people’s arms.”
But, says Mandelman, “It seems like the gays have done a good job of getting their monkeypox vaccines, and it seems like we’ve kind of turned a corner. I can say this cautiously.”
During the four months of the monkeypox outbreak, health care providers, researchers and an anxious public have scrambled to determine how the virus transmits, how to prevent it and how the infection plays out in the body.
Little attention has been paid to what comes after the infection clears.
Following recovery from this skin lesion–causing virus, people often find themselves waiting anxiously over the course of months to see whether monkeypox will leave them with permanent scarring. And in interviews with more than a dozen people who have had the virus and as many health care providers and researchers, NBC News learned that in some people, the lingering scars are not only physical but psychological. Troublingly, it’s also possible the virus could cause permanent damage to sensitive internal tissues and give rise to persistent pain or other onerous long-term symptoms.
“Just because you’re cleared and no longer contagious, it doesn’t mean you’re totally back to normal,” said Matt Ford, 30, a bicoastal actor who contracted the virus at the beginning of the summer and hopes that his scarring, including pockmarks on his face, will continue to dissipate. “It did a number on my body, especially in more sensitive areas.”
Unfortunately, people looking to doctors or health agencies for answers about what to expect post-pox are typically met with an information vacuum. This is the result of the notorious dearth of research conducted prior to the outbreak about a virus that until this spring largely only circulated in western and central Africa.
“I just want there to be more concrete information, but maybe that’s asking too much,” said Brad, 33, a New York City area resident who preferred to use only his first name to protect his medical privacy.
In an emailed statement, the New York City health commissioner, Dr. Ashwin Vasan, acknowledged this lack of health guidance, saying, “It’s still early in the outbreak and the kinds of long-term studies needed to understand these issues better have not been completed yet. We continue to learn from what people who’ve experienced infection and recovery are reporting.”
Since the unprecedented global outbreak was first detected by health authorities in mid-May, 65,415 cases have been diagnosed worldwide, 24,846 of them in the United States, the Centers for Disease Control and Prevention reports. While the weekly case count both nationally and worldwide has declined in recent weeks, raising hopes that the outbreak might be brought under control, concerns remain that at least a fraction of those who have had the virus might suffer long-term impacts of the infection.
For gay men, who comprise the overwhelming share of global monkeypox cases and among whom the competitiveness to look good is famously Olympian, worry over sustaining noticeable scarring in the wake of the infection can be particularly taxing.
“Especially for people who already have body dysmorphia or are hypersensitive to how others see them, there is this hypervigilance” of such cosmetic effects, said Preston Wholly, managing clinical director of behavioral health services at the LGBTQ-focused nonprofit health care provider Harlem United in New York City.
The marks are also signals of an infection that because it largely transmits through sex between men, can be highly stigmatized.
“I think it’s important to be aware of the effect of stigma regarding the route of monkeypox transmission, at-risk groups and disfiguring skin lesions — all of which could contribute to psychological distress,” said Dr. James Badenoch, a physician at the Queen Mary University of Medicine in London and the co-lead author of a paper published Sept. 8 in eClinicalMedicine on neurological and psychiatric conditions linked to monkeypox.
Harun Tulunay, 35, was hospitalized with a particularly severe case of the virus in July. In addition to experiencing extreme proctitis, or inflammation of the rectal tissues, and an inability to swallow, he developed an atypically large purple-black lesion that covered his entire left nostril. The lesion has since healed but has left behind pockmarked scar tissue.
“I am very obsessed with the little scar on my nose and am using lots of creams, scared it won’t go away,” said Tulunay, who, like a substantial proportion of people who contract monkeypox, has HIV.
Harun Tulunay.Courtesy Harun Tulunay
Dr. Howa Yeung, an assistant professor of dermatology at the Emory University School of Medicine in Atlanta, said that while guidance on care for monkeypox lesions may be lacking, what is known about treating smallpox, which like monkeypox belongs to the orthopoxvirus family, can serve as a guide.
Yeung recommended the use of what are known as hydrocolloid dressings on lesions, which help keep them moist and promote healing while minimizing scarring. For thicker scars, silicone gel or patches may help improve their appearance, he said—especially if such treatment is started shortly after the scabs fall off. Later on, lasers and microneedling may further improve their appearance, although such interventions can be expensive.
The dermatologist noted that people with darker skin tones are likely at higher risk of monkeypox lesions leaving lasting dark marks, which he estimated could take three to 12 months to fade.
“Some scars will be permanent,” Yeung said.
He advised the use of skin-lightening agents, which a dermatologist can prescribe, as well as a high SPF sunscreen to keep the sun from further darkening the pigment.
Gerald Febles, 25, reported grappling with such marks, which, although they have been improving, still greatly bother him. Hoping they will recede over the coming months, he’s tried various scar-treatment creams, which don’t come cheap.
Gerald Febles points to a scar left from his monkeypox outbreak.Benjamin Ryan / NBC News
“I was very confident in my own skin before,” said Febles, who is an employee relations manager for the urgent care company MedRite. He said he now has “a lot more insecurity about my body in general. I’ve even gone to bars and some people have asked, ‘Oh, what’s that on your neck?’ So it’s something I’m reminded of whether or not it’s on my own terms.”
Febles was keen to assert that he sees no reason to be ashamed of having had monkeypox. But recalling that the infection caused him excruciating pain, he nevertheless characterized such questions from people as “a trauma trigger.”
The potential for lasting damage
Proctitis, experienced by 1 in 4 people with the virus in a Spanish study and 16% of U.S. cases about which the CDC has data, is one of the most devastating potential monkeypox symptoms. It can cause excruciating pain, in particular when defecating. What’s more, such symptoms might portend longer-term consequences of the infection.
During a July 14 Infectious Diseases Society of America call with reporters, Dr. Mary Foote, a medical epidemiologist at New York City’s health department, raised an early alarm that monkeypox lesions might cause permanent internal damage in some people. This, she said, could include the formation of scar tissue or strictures in the anorectal or urethral tissues, which could affect bodily functioning.
“It’s quite concerning,” Foote said of these potential outcomes, which she recently told NBC News might prompt the need for surgery or other interventions.
Dr. Boghuma Titanji, an infectious disease specialist at Emory University, reported seeing urethral damage or overall pain in the penis, including difficulty retracting the foreskin, due to scarring from monkeypox.
Dr. Boghuma Titanji.Courtesy Dr. Boghuma Titanji
“When we see these cases with urologic involvement, we consult urologists,” Titanji said, noting that “early urinary catheterization and other interventions may prevent complications down the line.”
Brian Rice, 43, reported suffering from a host of bothersome health problems, including the flu, since recovering from monkeypox in mid-August. Having endured penile pain, swelling and discharge during the infection, the attorney has since experienced pain in his pelvic area and the frequent need to urinate. These symptoms eventually resolved themselves, Rice said, following pelvic floor myofascial release treatments. But he’s also experienced a persistent rash in his pubic area that is only recently starting to clear up.
“Nobody knows whether these other symptoms I’m experiencing are related in any way to monkeypox,” said Rice, who is HIV positive and lives in Cliffside Park, New Jersey. “It could be stress and anxiety; it could just be triggering other things.”
Dr. Peter Shalit, who runs an LGBTQ-focused primary-care medical practice in Seattle, reported that one of his patients had a mild case of monkeypox in July, with only skin lesions. Then, in August, the man relapsed and suffered from worse disease symptoms, including proctitis. Three weeks after recovering the second time, his rectal symptoms returned once more, causing him severe pain. Shalit treated both the second and third waves with the antiviral TPOXX, which appeared effective at battling symptoms.
The eClinicalMedicine paper published this month reported that in rare cases people with monkeypox develop neurologic symptoms, including encephalitis, confusion or seizures.
“Encephalitis can cause long-term problems with disability, mood and memory problems,” said Dr. Jonathan Rogers, a psychiatrist at University College London and a co-lead author of the paper. He stressed, however, that he and his coauthors don’t have the necessary follow-up data to determine any extended effects of this condition among people who have recovered from monkeypox.
The CDC reported Sept. 13 the cases of two previously healthy men in their 30s who after contracting monkeypox developed encephalomyelitis, or inflammation of the brain and spinal cord. The men have recovered from the infection, but a month after the start of their neurologic symptoms, they each still require an assistive device to walk.
A difficult transition
Arriving during the Covid crisis denouement, the monkeypox outbreak has triggered pandemic-related anxieties that had only recently begun to abate, by sending people with the virus right back into isolation for the few weeks the infection takes to resolve. And as they grapple with recovering from such a stigmatized virus, many of those who spoke with NBC News said it has taken time for them to regain their confidence and calm within the outside world — be that interacting with colleagues, seeing friends and family, or getting back into dating and sexual intimacy.
These people report having a particularly difficult time disentangling the misery of monkeypox from the joys of sex.
“I just feel like I lost my mojo,” said Harun Tulunay, who, similar to Febles, finds men constantly striking up conversations with him about monkeypox, especially given how much media coverage his case received.
“They don’t seem much interested in dating me after,” he said, ruefully.
In the meantime, Tulunay, who is a training and volunteer coordinator at the HIV nonprofit Positively UK, is trying to get his semen tested to determine if he might still harbor the virus. Monkeypox has indeed been found in seminal fluid, and the World Health Organization has recommended that men wear condoms for 12 weeks following recovery from monkeypox out of concern, pending further research, that the virus might remain in semen and be transmissible for that long.
John Farrey, 32, said what he missed most while isolating with monkeypox was going out dancing with friends. So he thought he’d be jazzed to jump right back onto the dance floor once he recovered.
But, the Brooklyn tech worker said, “I felt very terrified of my own skin” during the immediate aftermath of his infection. Being around other people, he said, “still felt unsafe.”
“It really took me a long time to be comfortable having close contact again,” Farrey said.
For Brad, the New Yorker, having monkeypox was “totally traumatic,” sending him off-kilter emotionally. He’s been struggling to regain his equilibrium since then. A scar on his penis has made him self conscious and has caused him to worry that sexual partners will ask intrusive questions about it.
“Then it’s ‘bye-bye mood,’” Brad quipped of such a scenario.
“I’m still kind of afraid of sex, because my last sexual experience resulted in this, and it still carries so much weight,” he said of contracting monkeypox. “Sometimes it turns into this source of shame that I’ve never experienced before about sex.”
Then there’s the question of when the body is once again ready for the rigors of intercourse. Proctitis, said Dr. Chris Beyrer, director of the Duke University Global Health Institute, “is going have a very big impact on subsequent sexual functioning” for those who engage in receptive anal sex.
“I think the question is: ‘When have you sufficiently healed?’” Breyer said—which, he acknowledged, “is not a question that people have good answers for.”
The importance of support
Given the traumatic ripple effects that monkeypox can unleash, experts highlight the need to provide people who contract the virus with support that doesn’t end when the scabs clear up.
“The anguish experienced by many patients cannot be underestimated. It can be a truly horrible time,” Dr. Hans Kluge, regional director of WHO Europe, said at an Aug. 30 news conference about monkeypox. He called for buttressing “both the physical and mental health of patients during the entire course of the disease, and after. It remains of critical importance.”
Harlem United’s Preston Wholly said he works with his clients who have contracted the virus to cut through the harmful stigma tied to contracting monkeypox.
“We really want to process that it wasn’t their fault and work through the guilt and shame and kind of normalize it,” he said.
Jeffrey Galaise, 41, who said he has persistent nightmares about the infection —“I imagine myself having pox and pain,” he said — is among the many people who have contracted the virus and then established their own support networks. He founded a Zoom-based monkeypox support group for people with the virus he met mainly through social media. This outlet, he said, has been invaluable as he tries to move on.
“I need to get back to my normal life,” said Galaise, who works for a New York City governmental agency. “It has certainly been a transition. I certainly think I’m getting there.”
Brad, who has also found a supportive community of others who have had monkeypox through social media, said he yearns to have the lingering physical and emotional effects of monkeypox behind him.
“I would like there to be a day when I don’t worry about this anymore,” he said. “I just want to be done with it.”
A recent study from the Centers for Disease Control and Prevention (CDC) has found that monkeypox disproportionately affects people with HIV and sexually transmitted infections (STIs).
The study looked at HIV and STI rates among 1,969 people with monkeypox in eight U.S. jurisdictions.
Of that sample, 38 percent of people with monkeypox had also contracted HIV in the last year. About 41 percent of people with monkeypox also had an STI in the preceding year. About 61 percent of the sample had contracted either an STI or HIV in the previous year.
Researchers said this correlation doesn’t necessarily mean that having HIV or an STI means you’re more likely to contract monkeypox.
In fact, the higher number may be due to a “self-referral bias,” meaning that people who visited a medical professional due to monkeypox symptoms may also already have established healthcare for HIV and STIs. Either that, or sexual health providers may be more likely to recognize and test for the monkeypox virus among men who’ve had HIV and STIs over the past year.
“Persons with monkeypox signs and symptoms who are not engaged in routine HIV or sexual health care, or who experience milder signs and symptoms, might be less likely to have their Monkeypox virus infection diagnosed,” researchers wrote.
HIV-positive people in the study sample were also twice as likely to be hospitalized due to monkeypox compared to HIV-negative people with monkeypox, WTTW reported.
This could mean that people with compromised immune systems — the kinds associated with advanced and under-treated forms of HIV — are more likely to exhibit severe monkeypox symptoms. Despite this, people with HIV aren’t more likely to exhibit worse monkeypox symptoms than HIV-negative people in the general population, according to Dr. Aniruddha Hazra, assistant professor of infectious disease and global health at UChicago Medicine.
The study also found HIV was more prevalent among Black and Latino people with monkeypox, with rates of 63 percent and 41 percent, respectively. These rates were higher than the 28 percent of white people and 22 percent of Asian people who have both HIV and monkeypox.
These racial disparities are particularly concerning considering that numerous studies have shown that Black and Latino men are less likely than white men to be vaccinated against monkeypox and to have access to HIV-related medical care.
In response to the study’s findings, the CDC recommended that medical professionals prioritize people with STIs and HIV for monkeypox vaccination. Additionally, the CDC recommended offering STI and HIV screenings for people who are evaluated for monkeypox.
This last week, White House health officials voiced their belief that “we’re going to get very close” to eradicating monkeypox. As of September 23, there were 24,846 total confirmed monkeypox cases in the United States, the CDC reported.
