Nearly 50 percent of transgender people travel outside of their state of residence to get gender-affirming genital surgeries, according to a new study from Oregon Health and Science University (OHSU). The percentage could increase as more states put bans against gender-affirming healthcare for trans people in place, the study’s authors say.
The study, published Wednesday in JAMA Surgery, looked at 771 transgender patients who had a vaginoplasty or phalloplasty between 2007 and 2019. It found that 49 percent left their state of residence to get the procedure. People who lived in southern states were more likely to have to leave their home states in order to receive the surgery.
That’s because there’s a lack of surgeons who provide such care in the South. A 2020 studyfound that just 11 doctors in the South could provide such surgeries, and four of the doctors resided in Florida.
The number of such doctors could decrease as more Southern states ban gender-affirming care for trans youth. Genital surgeries aren’t typically performed on young trans people, but some doctors could choose to locate their practices outside of states with such bans in place because the bans increase doctors’ legal and financial liabilities if they treat young patients.
Of additional concern, the OHSU study found trans people who left their states to get surgery ended up paying up to 50 percent more in out-of-pocket medical expenses than those who were able to obtain surgeries in their home states. This included costs for post-surgical visits and foll0w-up care.
Only one of the 771 patients included in the study had their surgery paid for by their commercial health insurance provider, The Hill noted. This suggests that the life-saving surgical procedures may not be affordable for many trans people. Trans people living in transphobic states will face even greater financial and time costs just to receive gender-affirming care.
“We already knew that traveling for health care requires patients to take time off work and pay for travel and lodging on their own, and that it can make receiving follow-up care from qualified providers who are familiar with each patient’s unique needs challenging,” Jae Downing, the study’s lead author, said in a press release.
“This study helps quantify how severely we need more gender-affirming surgeons,” Geolani Dy, an assistant professor of urology and plastic and reconstructive surgery at OHSU School of Medicine, added.
On a sultry Tuesday evening in New York City, Luke Brown excitedly opened a newly delivered bottle of black-and-orange pills, popped his first dose in his mouth, and washed it down with root beer.
Having contracted monkeypox this month, the lanky, bespectacled 29-year-old project manager had been suffering from what he called “the most severe pain of my life” for over a week before he finally was able to obtain a course of antivirals — a treatment he hoped would soon clear up his lesions and alleviate his suffering.
For Brown, this was cause for celebration. But it was also a sobering moment for him to reflect on how, to gain access to this medication, he had to leverage high degrees of personal privilege, medical literacy and self-advocacy that he said he was guiltily aware most people at risk for monkeypox probably lack. Because to join the fortunate few who have obtained this prized medication, called TPOXX, he had to navigate what he characterized as the exasperatingly byzantine maze of the medical and public health system.
“Here we are in the epicenter of an outbreak primarily affecting gay men in the city,” Brown said of his hometown, New York, which as of Thursday had 778 confirmed monkeypox cases out of 2,593 nationwide. “The city that of anywhere in the world should have the most impressive and robust infrastructure to respond to the health care needs of gay men. And at every level it has fallen flat on its face.”
Luke Brown points to a monkeypox lesion on the knuckle of his thumb.Benjamin Ryan for NBC NewsAnother lesion is visible just above Brown’s right eyebrow.Benjamin Ryan for NBC News
Like many of his fellow gay and bisexual men — a demographic that comprises the vast majority monkeypox cases in the global outbreakthat has ballooned to 15,848 cases — Brown said he has grown increasingly appalled and infuriated by the nation’s response to a virus spreading so swiftly that many epidemiologists now believewill likely become endemic in the U.S. and around the world.
Supply of the antiviral is not the problem; there are 1.7 million courses in the nation’s Strategic National Stockpile, according to Dennis Hruby, chief scientific officer of the U.S. pharmaceutical company SIGA, TPOXX’s manufacturer. But the drug, also known as tecovirimat, is not approved by the Food and Drug Administration to treat monkeypox as it is by regulators in the United Kingdom and the European Union; the drug is approved only for smallpox in the U.S.
This is bad news for the Americans with monkeypox who like Brown suffer from excruciating physical pain or other severe outcomes from the infection and who are desperate for treatment to speed their healing. They, and the health care providers who care for them, are up against the U.S. regulatory system.
Even as the Centers for Disease Control and Prevention continues to reduce the red tape that impedes TPOXX access, announcing new changes Friday, public health experts pointed to a complementary means of leveraging the drug’s potential power to alleviate suffering: large clinical trials of the antiviral as a monkeypox treatment.
Plans for such trials are already in advanced stages in Canada, the U.K. and the European Union, according to Hruby. The National Institutes of Health is also planning one in the Democratic Republic of the Congo. But the federal agency’s efforts to launch such research in the U.S. are only in the earliest planning stages.
“This points to a persistent issue we saw during Covid,” said James Krellenstein, a public-health activist and cofounder of the activist group PrEP4All, “where the United Kingdom and European researchers were really able to mount much quicker clinical studies than the United States was.”
Excessive barriers to prescribing
In addition to Brown, NBC News spoke with a dozen people who have taken TPOXX, all of whom suffered from extreme pain before starting the antiviral. They generally reported that within a few days of treatment, their monkeypox symptoms — the pain in particular — began to ease, much to their relief. Most reported no bothersome side effects, or, in one case at least, not bad enough to discontinue treatment. While they all acknowledged that they could not be certain how the course of the disease might have unfolded had they not taken the drug, they generally believed it had been effective for them.
The FDA approved TPOXX as a treatment for smallpox in 2018 based on studies that had infected rabbits with rabbitpox and nonhuman primates with monkeypox. (Smallpox and monkeypox are close viral relatives, so treatments for one are expected to work for the other.) Researchers had to rely on these proxy models of similar viruses because there is no smallpox to investigate, as the virus has been eradicated; and even if there were, it would be unethical to study such a lethal pathogen in humans.
The data indicating the drug is safe for humans comes from a studyof 449 healthy people.
Typically, physicians may use their own judgment to prescribe medications off label for purposes other than those for which they were granted explicit FDA approval.
But given the lack of research on TPOXX’s efficacy in humans, federal health regulations dictate that health care providers may only prescribe the drug for monkeypox through a compassionate-use system overseen by the CDC. Physicians such as Dr. Marshall Glesby, an infectious disease specialist at Weill Cornell Medicine in New York City, said that these strict rules are excessive, including the need to review a more than 100-page treatment-protocol document to qualify as a TPOXX prescriber and to thoroughly document each case.
Dr. Marshall Glesby, an infectious disease specialist at Weill Cornell Medicine in New York City, said the strict rules around prescribing TPOXX are excessive.Benjamin Ryan for NBC News
Such burdens sharply limit the number of health care providers who are willing and able to prescribe TPOXX, according to clinicians who have gained such authority.
“It’s a cumbersome process,” said Dr. Anu Hazra, a physician at Howard Brown Health in Chicago who recently began prescribing the treatment.
“Because we don’t yet know how well this drug is going to work for monkeypox patients,” said Dr. Jennifer McQuiston, who leads the CDC’s monkeypox response, “it is important to ensure we have some data from patients who use it, so we can better understand the risks and benefits and ultimately help other people as well.”
Responding to health care providers’ recent complaints about the TPOXX compassionate-use system, the CDC has, for example, made optional previous requirements that clinicians submit photographs of patients’ monkeypox lesions and ship viral specimens to the agency.
In a July 15 letter to the heads of various federal health agencies, PrEP4All and the nonprofit Partners in Health called on the CDC and FDA to end all restrictions on TPOXX’s use and to allow health care providers to freely prescribe it for monkeypox.
Friday, the CDC announced further revisions to the compassionate-use system, including plans to reduce the 100-plus-page document to under 50; pare back the number of reports physicians must fill out about each patient from six to two; and to permit virtual appointments.
“We have reduced the data we need down to the most critical pieces,” McQuiston said “and have worked to make using this drug simpler, in order to ensure doctors can get the drug to patients who need it.”
Dr. Jason Zucker, an infectious disease specialist at Columbia University Department of Medicine whose team has prescribed the antiviral to 45 patients, said that the U.S. should launch a large randomized clinical trial including people with mild monkeypox disease. If anyone in the placebo arm should progress to severe disease, he proposed, they could be switched into a parallel compassionate-use group. This would not only address the crucial question of the drug’s efficacy but also expand access to treatment while also collecting data on people receiving it in a much more rigorous and organized fashion than he said occurs through the current system.
Jumping through hoops to get TPOXX
Luke Brown said that he first tried to gain access to TPOXX through his primary care provider, who submitted the request to New York City’s health department. The request was denied on the grounds that his case wasn’t serious enough. But then he began to suffer pain so severe all he could do was pace around his apartment for hours; even then, his physician delayed in resubmitting the request. So the well-connected Brown tapped into his contacts on social media and finally found someone who linked him to a local doctor with prescribing authority.
Get the Morning Rundown
Get a head
“It’s infuriating,” he said of the hoops he had to jump through to obtain the drug.
Boomer Banks, an online content creator in New York City, said that he went through a maddening ordeal to obtain TPOXX.Benjamin Ryan for NBC News
“I had to fight for the TPOXX meds,” said an online content creator known as Boomer Banks, also a New Yorker, about what he said was a maddening ordeal finding someone at the city’s health department who could help him access the treatment. “I had no privilege to leverage, just my mouth,” said Banks, who did not want to use his real name used to protect his privacy. “I’m a brown immigrant, 42-year-old HIV-positive sex worker with no insurance. I didn’t take ‘no’ as an answer.”
A recent nonpeer reviewed study posted to a pre-print server found that in laboratory experiments, TPOXX was highly effective at neutralizing the monkeypox strain circulating in the global outbreak.
Under current CDC guidelines, TPOXX is reserved for those with severe disease, including those who are hospitalized or at high risk of a severe outcome because, for example, they are immunocompromised. Those suffering from a common symptom of the virus, intense anorectal or genital pain, qualify for TPOXX, Zucker said.
Brooklyn resident Sebastian Kohn, 39, who had a particularly severe case of monkeypox, said that days after he started TPOXX, the difference in his anorectal pain was “night and day.”
“I can wash myself without wanting to cry,” Kohn said.
Luke Brown holds his bottle of TPOXX pills.Benjamin Ryan for NBC News
Where is the U.S.-based clinical trial?
Asked about the NIH’s plans to back a U.S.-based clinical trial of TPOXX, Judith Hewitt, deputy director of the Office of Biodefense, Research Resources and Translational Research at the National Institute of Allergy and Infectious Diseases, said that “it’s super early days” for such plans.
“There are now just beginning to be discussions about a trial in people living with HIV or at risk of HIV,” she said.
In an email, Dr. Judith Currier, a professor of medicine at the UCLA Division of Infectious Diseases and the chair of a major HIV-related clinical trial network funded by the NIH, confirmed that a trial is being discussed. “I think the holdup is identifying the funding for this work.”
“Money is obviously the real issue here,” Hewitt said. “And so people are scrambling to do what we can do with the resources at hand.” She said the agency is debating whether, for example, to fund a study examining whether a lower dose of the Jynneos vaccine would be highly effective against monkeypox. “So that’s within the same treatment area. But then we’re still up to our eyeballs in Covid.”
Krellenstein, the activist, said, “It’s bizarre, given that we have such large supply in the strategic national stockpile and TPOXX was approved without any human efficacy data, that there weren’t ready-to-go plans for actually doing a U.S. clinical study in the event that we needed to use it.”
According to SIGA’s Hruby, the company might not even look to U.S.trial data on TPOXX to submit to the FDA. Instead, they might rely on the combined findings of the trials already primed to launch in other nations, along with safety data from compassionate-use programs worldwide.
As for how long before the company would submit the drug for FDA approval, Hruby wouldn’t speculate.
“These things always take longer than expected, especially when working with large teams,” Hruby said.
Even on a drug given priority review, the FDA typically takes six months to reach a decision.
TPOXX could help blunt monkeypox’s impact
If approved, TPOXX would offer a future in which the antiviral complements widespread vaccination among at-risk individuals to mitigate monkeypox’s impact on public health, experts said.
The virus could be treated at the very first sign of symptoms, and possibly even during the asymptomatic incubation period if testing technology advances to permit detection at that stage. Such early medical intervention would not only prevent pain and suffering, but would also very likely block transmission of the virus by shortening or eliminating the disease’s infectious period.
Treatment could also save people from the personal and financial hardship of isolating at home for what can be weeks of illness with monkeypox that’s left to resolve on its own.
What’s more, TPOXX could be used as post-exposure prophylaxis among people exposed to monkeypox, either among unvaccinated people or those who cannot be vaccinated, such as the immunocompromised, according to Columbia’s Zucker.
The U.S. Army Medical Research and Development Command does have an established study to assess such a preventive use of this drug. And while a listing of the trial indicates participants must be Department of Defense–affiliated personnel, according to Hruby, there actually is no such restriction.
Friday morning, Luke Brown said his pain had begun to subside and he was watching in wonder as his lesions were steadily sinking back into his skin — “like magic.”
Reflecting on the ordeal monkeypox has been for him, he said it had inspired him to become a public-health activist.
“I’m resolved to see that no one suffers like I did, because no one needs to,” he said.
Anticipating that the U.S. monkeypox outbreak will only continue to expand, he said, “We are just at a crest of avoidable pain unless access to this drug becomes easier.”
Greece’s parliament has banned “sex-normalizing” surgeries on babies born intersex, with atypical chromosomes that affect their bodies in a way that does not fit with the normative definitions of male or female.
Under a new law approved by parliament on Tuesday, surgeries that seek to ensure a child ascribes to traditional notions of male and female on people under the age of 15 years are banned in Greece, unless there is a court decision stating otherwise.
The bill stipulates fines and a prison term for doctors conducting such surgery.
Operations, including corrective surgeries or hormonal therapies to change face or body characteristics, on intersex people over the age of 15 years will be permitted if the teenagers consent, according to the law.
Rinio Simeonidou, mother of an intersex teenager and secretary general of Intersex Greece, told parliament before the vote that the approval of the bill would be “a truly historic moment for all intersex children in Greece” and a good start in eliminating violations of intersex people’s rights.
Malta, Portugal and Germany have already banned such surgeries, which in the past have led intersex people to sterilization, loss of sexual sensation, psychosomatic trauma and health problems, Simeonidou said.
Earlier this year, Greece banned so-called conversion therapy for minors, practices aimed at suppressing a person’s sexual orientation or gender identity and which health experts have condemned as psychologically harmful and unethical.
“I was truly saddened by the mistakes of the past that led to dramatic situations because we were lacking the knowledge and courage,” Prime Minister Kyriakos Mitsotakis, who faces elections next year, told parliament before the vote as he urged lawmakers to endorse the legislation.
Days after the U.S. Supreme Court ruled that states can prohibit abortion, Alabama has seized on the decision to argue that the state should also be able to ban gender-affirming medical treatments for transgender youth.
The case marks one of the first known instances in which a conservative state has tried to apply the abortion ruling to other realms, just as LGBTQ advocates and others were afraid would happen.
Critics have expressed fear that the legal reasoning behind the high court ruling could lead to a rollback of decisions involving such matters as gay marriage and birth control.
The state is asking a federal appeals court to lift an injunction and let it enforce an Alabama law that would make it a felony to give puberty blockers or hormones to transgender minors to help affirm their gender identity.
In its historic ruling last Friday, the U.S. Supreme Court said terminating a pregnancy is not a fundamental constitutional right because abortion is not mentioned in the Constitution and is not “deeply rooted in this nation’s history and tradition.”
In a brief filed Monday, the Alabama attorney general’s office argued similarly that gender transition treatments are not “deeply rooted in our history or traditions,” and thus the state has the authority to ban them. Alabama contends such treatments are dangerous and experimental, a view disputed by medical organizations.
Shannon Minter, legal director of the National Center for Lesbian Rights, said it is the first case he is aware of in which a state cited the abortion ruling on another issue, but added, “It won’t be the last.”
Supreme Court Justice Samuel Alito wrote in the majority opinion that the abortion ruling should not cast “doubt on precedents that do not concern abortion.” But Justice Clarence Thomas wrote that the same legal reasoning should be used to reconsider high court rulings protecting same-sex marriage, gay sex and contraceptives.
“It is no surprise that Alabama and other extremely conservative states are going to take up that invitation as forcefully as they can,” Minter said. “Justice Thomas’ concurrence was a declaration of war on groups already under attack, and we expect the hostility to be escalated.”
He said a rethinking of such constitutional protections could affect things like birth control and parental rights.
Get the Morning Rundown
Get a head start on the morning’s top stories.SIGN UPTHIS SITE IS PROTECTED BY RECAPTCHA PRIVACY POLICY | TERMS OF SERVICE
“They are not just talking about LGBT people,” Minter said.
Alabama Attorney General Steve Marshall was unavailable for comment Thursday, a spokesman said.
Jeff Walker, who has a 15-year-old transgender daughter, said this spring that it felt as if Alabama were attacking families like his with legislation targeting transgender kids’ medication and dictating their choice of school bathrooms, locker rooms and sports teams. He said the state’s argument in this case is worrisome for everyone.
“I think everyone should be concerned by the wording of this appeal. By this logic, any health care the state feels isn’t in line with its morals or beliefs should be banned,” Walker said.
The Alabama case could become be an early test of where judges stand on the scope of the abortion ruling. The appeals court granted the state’s request for an expedited schedule for submitting briefs, and a decision could come as early as this fall.
While Alabama was already appealing the injunction in the transgender medication case, the state quickly incorporated the abortion decision into its filing.
Alabama Gov. Kay Ivey this spring signed the law making it a crime punishable by up to 10 years in prison to dispense certain medication to minors to help with their gender transition.
A federal judge in May issued a preliminary injunction blocking the measure, siding with parents who said the law violates their children’s rights and their own rights to direct their youngsters’ medical care.
Members of the LGBTQ+ community in the United States have spoken out about their own abortion experiences after Roe v Wade was struck down.
The Supreme Court overturned the landmark 1973 Roe v Wade ruling which legalised abortion across the country, on 24 June, meaning that it will now be up to individual states to decide their own abortion laws.
In a 213-page majority opinion, the Supreme Court justices wrote: “The Constitution does not confer a right to abortion; Roe and Casey are overruled; and the authority to regulate abortion is returned to the people and their elected representatives.”
he ruling mobilised protests across the US, and several LGBTQ+ people have raised the point that trans men, queer women, and non-binary people sometimes also need abortions, and they do not want to be left out of the conversation.
Nikki, a 38-year-old queer woman from Colorado, said she told her religious family members about her experience with abortion after the Roe v Wade ruling was announced. She is “terrified” that her “rights as a queer woman will be eroded next”.
She told PinkNews: “I’m livid about the ruling. I’m mad that it happened. I’m furious at the Democrats for not getting it together quickly enough to use their majority to protect Roe federally.
“I’m exhausted of having my rights and freedoms dictated by a bunch of old white men (and the occasional woman).”
Nikki added that she is now concerned that LGBTQ+ rights could be at risk, after Judge Clarence Thomas, in his legal opinion coinciding with the overturning of Roe v Wade, called on his colleagues on the Supreme Court to “reconsider” rulings that currently protect the right to contraception, same-sex relationships, and same-sex marriage.
She said: “Trans men and non-binary people have been left out of the conversation almost entirely, even by supposedly ‘progressive’ voices.
“I’m currently dating a trans woman. I worry for her safety, and I worry that I won’t be able to marry who I love unless it falls within a ‘hetero-looking’ relationship.”
(Mario Tama/Getty Images)
Theo, 20, from Minnesota, said that they are considering moving to a “safer state” after the Roe v Wade news.
Theo is trans-masculine and non-binary, and as well as going through an abortion at aged 14, they worry about further law changes affecting same-sex marriage, or their ability to access gender-affirming surgeries.
“Just because we no longer align with the gender that we have were assigned does not make us irrelevant in a conversation that regards our own bodily matters,” they told PinkNews.
Theo added: “My concern immediately came after Ruth Bader Ginsburg passed; she was a strong and ever-present voice in women’s rights… I always knew that Roe v Wade was on the docket despite what people told me.
“Since I have begun transitioning and started to pass more as man, I have lost my voice in this movement. I have had an abortion… butpeople have told me that my voice doesn’t matter… that I am safe because no one is coming for LGBTQ+ people next. Roe v Wade is just the beginning.
“I am also extremely fearful for the overturn of same-sex marriage as well… I fear that I will never be able to be with someone that I love because of this.”
Amit Paley, CEO and executive director of LGBTQ+ charity The Trevor Project said in a statement: “The Supreme Court’s decision… is causing many people to experience a wide range of concerns for bodily autonomy, LGBTQ rights, and public health, including mental health.
“The Trevor Project’s polling has found that nearly 70% of LGBTQ+ young people say efforts to restrict access to abortion often gave them stress or anxiety.
“Overturning Roe v Wade will allow states to further restrict and regulate essential health care and reduce access to the already limited number of LGBTQ+ competent providers in many parts of the country, posing a threat to the health and safety of young LGBTQ people.
“The Trevor Project will not stop fighting to establish true, lived equality for LGBTQ+ people.”
As cases of monkeypox virus surge in the U.S., the Biden administration will start distributing the monkeypox vaccine across the country, focusing on people most at risk and communities with the highest numbers of cases, White House officials announced Tuesday.
The U.S. Department of Health and Human Services will send 56,000 doses of the Jynneos vaccine immediately to areas with high transmission. An additional 240,000 doses will be distributed over the next few weeks, with even more to come this summer and fall. Officials expect to make at least 1.6 million doses available by the end of the fall.
States with the highest numbers of cases include California, New York, Illinois and Florida, as well as Washington, D.C., according to the latest count from the Centers for Disease Control and Prevention.
People lined up outside of Department of Health & Mental Hygiene clinic on June 23, 2022 in New York, as NYC makes vaccines available to residents possibly exposed to monkeypox.Tayfun Coskun / Anadolu Agency via Getty Images
“We are recommending that vaccines be provided to both people with known monkeypox exposures who are contacted by public health and also to those people who’ve been recently exposed to monkeypox,” the CDC’s director, Dr. Rochelle Walensky, said at a news briefing Tuesday.
The CDC is prioritizing initial access to the vaccine for people who have been in close contact, including sexual contact, with someone who has diagnosed with the virus. The agency will also provide vaccines to men who have sex with men who report having had multiple recent sex partners at a venue or party where the virus is known to have spread, or who have had sex with multiple partners in an area of the country with elevated spread.
The vast majority of confirmed monkeypox cases, both in the U.S. and in the global outbreak as a whole, have been among men who have sex with men.
While case numbers continue to rise in the U.S., the White House Covid-19 coordinator, Dr. Ashish Jha, seemed hopeful the U.S. could contain the outbreak and said it was important to remain vigilant.
“Monkeypox is not novel,” Jha said at the briefing. “We as a global community have known about it for decades. We know how it spreads. We have tests that help identify people who are infected. We have vaccines that are highly effective against it.”
The U.S. monkeypox outbreak was first detected in Massachusetts in May, after a person who had been traveling tested positive. Since then, the virus has been spreading around the country, with more than 306 cases in 28 states, according to the CDC. But because of limitations with testing for the virus, it’s likely the U.S. is significantly undercounting the numbers of infections, experts say.
“We’ve already lost control of this outbreak,” said David Harvey, the executive director of the National Coalition of STD Directors. “We think there’s many more cases, and we need to act now to get control of this outbreak.”
New York City and Washington, D.C., were among the first cities to begin vaccinating at-risk groups for monkeypox, including men who have sex with men reporting multiple partners or at least one anonymous partner within 14 days. With just 1,000 doses from the CDC to distribute at one clinic, New York, which began administering shots on June 23, quickly ran out.
It was a similar situation in Washington, where health officials announced Monday that they would also start vaccinating at-risk groups. The 300 available appointments were taken in less than an hour after the online booking system went live.
Health officials on Wednesday recommended that men in Florida who have sex with other men get a meningococcal vaccine following what the Centers for Disease Control and Prevention called “one of the worst outbreaks of meningococcal disease among gay and bisexual men in U.S. history.”
The CDC said in a statement that there have been at least 24 cases and seven deaths among gay and bisexual men caused by the bacteria in Florida recently. The CDC also recommended that gay and bisexual men traveling to Florida should ask their health care provider about getting the vaccine.
A federal court in Georgia ruled Thursday that employers who categorically exclude gender-affirming medical care from health insurance coverage violate federal law.
Anna Lange, a transgender woman and sheriff’s deputy in Houston County, Georgia, sued in 2019 after she was denied coverage for a vaginoplasty in November 2018.
The Sheriff’s Office provides health care coverage to employees through the county plan, which, beginning in 1998, excluded coverage for talk therapy related to gender dysphoria, gender-affirming hormone therapy and gender-affirming surgeries, according to the opinion released Thursday.
Chief Judge Marc Treadwell, of the U.S. District Court for the Middle District of Georgia, wrote in the opinion that the exclusion “plainly discriminates because of transgender status,” and as a result violates Title VII of the Civil Rights Act of 1964, a federal law that prohibits employment discrimination based on race, sex, religion, national origin and other protected categories.
He pointed to evidence that showed Houston County’s health care plan, provided through Anthem Blue Cross and Blue Shield, would provide hormone therapy for menopause and surgery for breast cancer, but it would not provide the same procedures as treatment for gender dysphoria.
“The undisputed, ultimate point is that the Exclusion applies only to transgender members, and it applies to Lange because she is transgender,” Treadwell wrote, citing a landmark Supreme Court decision in June 2020, which found that Title VII’s protection from discrimination based on sex also includes gender identity and sexual orientation discrimination.
The opinion also noted that, in 2016, Houston County’s insurance broker, who acted as a liaison between the county and Anthem, informed the county that Anthem would no longer categorically exclude coverage for treatments related to gender dysphoria as a result of the Affordable Care Act’s Section 1557, which prohibits discrimination based on sex and other characteristics.
“Despite Anthem’s recommendation to do so, the County chose not to accept the nondiscrimination mandate,” according to the opinion.
A representative for Houston County did not immediately return a request for comment.
Lange, who was represented in part by the Transgender Legal Defense and Education Fund, said in a statement that it’s “a huge relief to know that I can finally receive the medically necessary care that I was repeatedly and unfairly denied.”
“I can confidently move forward with my life knowing that gender affirming care is protected under federal law,” she said. “This decision is not only a personal victory, but a tremendous step forward for all transgender Southerners who are seeking insurance coverage for medically necessary care.”
LGBTQ survivors of sexual abuse are often blamed for causing their own abuse or are subsequently accused of wanting to molest kids, a new report has found.
The U.K.-based Independent Inquiry into Child Sexual Abuse (IICSA) — a non-governmental investigative organization that recommends policies to protect children — interviewed 31 LGBTQ survivors of child sexual abuse and 31 organizations that aid LGBTQ survivors to better understand their experiences.
The IICSA report found that when queer people reported being sexually abused as kids, they received “poor responses” based on “stereotypical attitudes about sexual orientation.”
Some victims and survivors were told that their gender identity or sexual orientation either caused the abuse or resulted from it. If a queer person is targeted by a predator while exploring LGBTQ identities in an online forum — something queer youth do in response to the lack of LGBTQ resources in communities and schools — victim-blamers will say that the queer person “brought it on themselves” for being curious about their identities.
“If we are LGBTQ because a man abused us [then] ‘we are blaming all men’ or if we got abused by a woman we ‘are confused’,” one female survivor of sexual abuse told the IICSA.
“I’ve been asked whether I’m non-binary specifically because I experienced child sexual abuse, and whether I’m turning my discomfort with my body from the sexual abuse into a gender issue that isn’t really there,” another non-binary person told the inquiry.
Even worse, there’s a myth that abused people go on to abuse other kids, something that keeps gay and straight men from reporting their own abuse for fear of being considered a pedophile.
Sex abuse can force LGBTQ survivors to have to reckon with their gender identities and sexual orientations before they’re ready. This, combined with internalized queerphobia and the societal stigma remaining from the HIV epidemic, all make life much harder for survivors.
Some people won’t disclose their experiences with traditional support networks like family, friends, religious peers or work colleagues for fear that they’ll be rejected or shamed for their queer identities. The media also perpetuates narratives about “gay pedophiles”, cis-male perpetrators and cis-female victims being the norm.
Additionally, few mental health professionals are specifically trained to work with LGBTQ survivors, raising the risk that survivors will face additional stigma and shame even if they do seek out counseling services.
The report noted that queer people in the U.K. still live under the shadow of Section 28, a now-repealed law that banned “promoting the teaching of the acceptability of homosexuality as a pretended family relationship.” One of the key arguments used to pass the law was that queer people sexually prey on children.
The U.S. is undergoing a similar cultural shift, in which anyone who wishes to acknowledge the existence of queer people in classrooms is labeled as a “groomer.” Actual “grooming” occurs when sexual predators use manipulative behaviors to gain access to potential victims, coerce them to agree to the abuse, and reduce the risk of getting caught, according to the Rape, Abuse & Incest National Network.
Abuse survivors in the U.S. have complained that the right-wing labeling of LGBTQ people and allies as “groomers” is doing nothing to help actual survivors of childhood sexual abuse. But then again, the right-wing’s “grooming” attacks aren’t meant to protect children from predatory teachers — something that rarely happens. They’re meant to demonize queer people.
A World Health Organization (WHO) expert has suggested that monkeypox may have been present in the UK for years.
Officials confirmed on Wednesday (25 May) that UK cases now stand at 78, a rise of 58 in just under a week.
Monkeypox has caused alarm in many Western countries. It has typically been a disease found in west and central Africa, with only eight previous cases ever reported in the UK, all since 2018 and related to travel to or from Nigeria, according to WHO.
While the first official case of the current outbreak was reported on 4 May, professor David Heyman, a WHO expert who chairs the infectious disease group, told The Guardian that the virus has possibly been circulating undetected in the UK since between 2018 and 2019.
“It could hypothetically be that the virus transmission amplified from this low level of transmission when by chance it entered the population that is at present amplifying transmission,” he said.
Monkeypox lesions. (Getty/ CDC)
Professor Heyman stressed that this theory was not yet conclusive and more research would be required.
A virologist from the University of Leuven in Belgium, Professor Marc Van Ranst, backed Heyman’s theory. He told The Guardian: “This may be a virus that’s been circulating undetected for quite a while.”
He added: “They all have a common ancestor and that common ancestor probably dates back to 2019, though it’s too early to date with any kind of accuracy.”
The UK Health Security Agency has confirmed that a large proportion of cases have been detected among gay, bisexual and men who sleep with men.
WHO has reiterated in statement that “monkeypox is not limited to men who have sex with men”.
Monkeypox is spread through close physical contact which can include kissing, oral sex, penetrative and even simply touching someone who has symptoms.
Symptoms include swollen lymph nodes, a rash, headaches, muscle aches and low energy.
The UK is contacting tracing cases, and those at risk are being advised to isolate for 21 days.
Those in close contact with a person with monkeypox symptoms can protect themselves by washing their hands, wearing a mask and avoiding skin to skin contact, WHO says.
