Health authorities in Spain have attributed the majority of monkeypox infections in the country to a single outbreak in a now-closed gay sauna in the Madrid region.
At least 30 cases of monkeypox have so far been confirmed across Spain – with Britain, Portugal and the US also reporting a surge in cases of the rare viral infection.
The UK Health Security Agency noted that cases have predominantly been found in gay and bisexual men, but have been clear that monkeypox usually poses little risk as the majority of patients make a full recovery.
Twenty-three new cases were confirmed in Spain on Friday (May 20), with regional health chief Enrique Ruiz Escudero telling reporters that most of the cases had been traced from a single adult sauna, used by queer men for sex, according to Reuters.
Escudero confirmed that the Public Health Department of Spain will be carrying out further analysis to “control contagion, cut the chains of transmission and try to mitigate the transmission of this virus as much as possible”.
Fifteen of the cases in Spain are in the Madrid region, with another 18 suspected cases under investigation across the country. The Extremadura region confirmed its first case on Friday and 23 cases have been noted in neighbouring Portugal.
“The health department of the Belgian government has confirmed three cases of the monkeypox virus linked to visitors at Darklands,” read a statement on the festival’s website.
“There’s reason to assume that the virus has been brought in by visitors from abroad to the festival after recent cases in other countries.
Around 100 cases of monkeypox, which is rarely found outside parts of Central and West Africa, have been detected across Europe. While some have been associated with overseas travel, UK health officials believe that local cases are a result of transmission throughout the LGBTQ+ community.
As the summer approaches, Dr Hans Kluge, the World Health Organisation(WHO) regional director for Europe, is “concerned that transmission could accelerate” with “mass gatherings, festivals and parties as the cases currently being detected are among those engaging in sexual activity and the symptoms are unfamiliar to many”.
“I would like to emphasise that individuals contracting monkeypox must not be stigmatised or discriminated against in any way” he continued. “Timely risk communication with the general public is important, and public health bodies should widely disseminate accurate and practical advice on prevention, diagnosis and treatment.”
Dr Kluge urged anyone who is “concerned about an unusual rash” to consult their healthcare provider.
The Centers for Disease Control and Prevention on Monday alerted gay and bisexual men that monkeypox appears to be spreading in the community globally, warning people to take precautions if they have been in close contact with someone who may have the virus and to be on the lookout for symptoms.
Dr. John Brooks, a CDC official, emphasized that anyone can contract monkeypox through close personal contact regardless of sexual orientation. However, Brooks said many of the people affected globally so far are men who identify as gay or bisexual. Though some groups have greater chance of exposure to monkeypox right now, the risk isn’t limited only to the gay and bisexual community, he cautioned.
“We want to help people make the best informed decisions to protect their health and the health of their community from monkeypox,” Brooks said.
A section of skin tissue, harvested from a lesion on the skin of a monkey, that had been infected with monkeypox virus, is seen at 50X magnification on day four of rash development in 1968. CDC | Reuters
Monkeypox is not a sexually transmitted disease, which is generally passed through semen or vaginal fluid, but it can be transmitted through sexual and intimate contact as well as through shared bedding. The virus spreads through contact with body fluids and sores, Brooks said.
He added that it’s important for physicians and individuals to be aware of the symptoms associated with monkeypox, particularly anal or genital lesions that can be confused with herpes, syphilis or chickenpox.
“Anyone with a rash or lesion around or involving their genitals, their anus or any other place that they have not seen it before, should be fully evaluated, both for that rash but particularly for sexually transmitted infection and other illnesses that can cause rash,” Brooks said.
Monkeypox usually begins with symptoms similar to the flu including fever, headache, muscle aches, chills, exhaustion and swollen lymph nodes. It then progresses to body rashes on the face, hands, feet, eyes, mouth or genitals that turn into raised bumps which then become blisters.
However, the rash has appeared first in some of the recently reported cases, according Dr. Jennifer McQuiston, a CDC official. While the virus has a long incubation period, patients are considered most infectious when they have a rash, McQuiston said. Though monkeypox can spread through respiratory droplets, the virus comes from infected lesions in the throat and mouth that can expel it into the air. But transmission from respiratory droplets requires prolonged face-to-face contact, according to the CDC.
“This is not Covid,” McQuiston said. “Respiratory spread is not the predominant worry. It is contact and intimate contact in the current outbreak setting and population.”
The U.S. has confirmed one case of monkeypox in Massachusetts and four cases of orthopox in New York City, Florida and Utah, according to McQuiston. State labs have tests that can identify orthopox, which are presumed to be monkeypox, but they have to be sent to the CDC in Atlanta for further analysis to confirm that diagnosis, McQuiston said.
The cases identified in the U.S. are a milder West African strain, McQuiston said. Most people who catch the virus recover in two to four weeks without specific treatments, she said.
The World Health Organization has identified about 200 confirmed or suspected monkeypox cases across at least a dozen countries in Europe and North America in recent days.
It’s unusual, though not unheard of, for monkeypox cases to be found outside a handful of West and Central African nations where the virus is endemic. The U.S. had an outbreak of more than 70 cases in 2003 that stemmed from people keeping infected prairie dogs as pets.
There has been a surge of cases in Nigeria in recent years, but the cases identified around the world over the past two weeks are unusual because most of the patients did not have recent travel history to Nigeria or another country where the virus is usually found, according to McQuiston.
The smallpox vaccine appears to be about 85% effective at preventing monkeypox, based on research in Africa, according to the CDC. The U.S. has a stockpile of 100 million doses of an older generation vaccine called ACAM2000 that is approved by the Food and Drug Administration for people at high risk of smallpox, according to McQuiston. However, the vaccine can have significant side effects and any decision to use it widely would require serious discussion, she said.
The U.S. also has more than 1,000 available doses of a vaccine called Jynneos that is FDA approved for people ages 18 and older at high risk of monkeypox or smallpox. It is administered as two shots and doesn’t have the same risk of severe side effects. McQuiston said the number of doses should increase quickly in the coming weeks as the vaccine maker boosts production.
“We are hoping to maximize vaccine distribution to those that we know would benefit from it, so those are people who have had contact with a known monkeypox patient, health-care workers, very close personal contacts and those in particular who might be at high risk for severe disease,” McQuiston said.
Heather Peto had been feeling run down for a while before she realised there might be something wrong.
At first, she blamed her recent experience with COVID for her feelings of exhaustion – but gradually, she started to notice other, more troubling symptoms creeping in. Eventually, she realised that she was exhibiting some of the signs and symptoms of prostate cancer.
Getting to that realisation wasn’t easy. As a trans woman, Heather often has to fight to access the healthcare she needs. Some doctors and specialists are unaware of the specific symptoms trans women might experience when they have prostate cancer, while others don’t even know trans women can get prostate cancer.
Right now, Heather is undergoing tests to determine what’s causing her prostate issues. In the mean time, she wants to speak out about the symptoms she is experiencing so others will know what they need to watch out for.
Aside from the exhaustion, the first thing Heather noticed was that she started to experience urinary incontinence during sex.
“It was only a small amount, but that had never happened before,” Heather tells PinkNews. “It then started to happen regularly… One of the key things to get across is that if you’re noticed a change in your urinary habits, whether that’s incontinence or other things, then it’s important to get it checked out.”
Increasingly worried about her symptoms, Heather went to her GP for blood tests.
“The blood test measures something called prostate-specific antigen (PSA), and if you’ve got higher levels of that it tends to mean there’s something wrong with the prostate – it could be cancer, could be prostatitis,” Heather explains. Prostatitis refers to the inflammation of the prostate gland.
Heather Peto pictured with Keir Starmer. (Provided)
“Mine was quite high for my age,” Heather says. The tests were evidence enough that something was wrong, but that’s where Heather’s issues with the healthcare system begin. As a trans woman who has had hormone treatment, she should in general have lower PSA levels than a cis man would have.
The result is that some trans women and non-binary people with prostates can show lower levels of PSA in blood tests, but they could still have prostate cancer. According to Prostate Cancer UK, some experts believe a PSA level above 1 ng/ml in a trans woman should warrant further investigation.
Trans women can experience different symptoms of prostate cancer
Another barrier to treatment and diagnosis for trans women is that the symptoms can be different. One of the symptoms most commonly associated with prostate cancer is the need to get up and urinate frequently during the night – but that’s largely based on the experiences of cis men. Heather noticed some different symptoms.
“One of those symptoms is that there’s a form of incontinence by which you go to the toilet for a wee but you don’t expel all your wee… so you have that little residual amount that you can’t seem to expel. You know it’s there but it’s not completely gone. When it discharges, which it does, it ends up leaking all at once.”
Something else Heather experienced is that she would orgasm spontaneously during urination. “It’s very awkward,” she says. Unfortunately, Heather experienced some “disinterest” from medical professionals when she raised concerns about the symptoms she was experiencing – although she stresses that the care she has received has generally been good.
I’m left in this never-never of not knowing if it’s cancer that’s getting worse or if there’s another, more benign explanation such as prostatitis.
After noticing those symptoms, Heather went to her GP and was referred to a specialist. She was supposed to have a urine test in November 2021, but it was subsequently pushed back several times.
“I’m left in this never-never of not knowing if it’s cancer that’s getting worse or if there’s another, more benign explanation such as prostatitis, or if it could be another form of cancer that’s affecting the area. My health is getting worse, I’m OK but not OK in terms of living a normal live. So that’s my experience.”
Heather is speaking out about her experience because she wants both the medical field and the wider public to have greater awareness about the fact that trans and non-binary people with prostates are susceptible to developing prostate cancer too.
Heather Peto pictured on the left. (Provided)
“There is this list on the NHS website of symptoms that you might experience with prostate cancer, but it does seem to me to neglect certain things trans and non-binary people with prostates might experience, and it possibly neglects people who have sex with men.
“There needs to be more research and more guidance around trans people with prostate cancer,” Heather says. “I don’t want to be too alarmist, but I think we need to communicate this – there are people who are needlessly being treated further along in their prostate cancer than is necessary.”
Heather says there’s a level of ignorance in the medical field about the reality of prostate cancer for trans people. That’s not necessarily anybody’s fault, she points out – but she would like to see better education and training for GPs and other medical professionals. Right now, trans and non-binary people with prostates often have to educate healthcare professionals themselves.
“People need to talk more broadly about the problems trans people have,” she says. “We need to make sure GPs know about it, but also patients know about it so they can go to their GP in the first place… Your life is in their hands.”
Heather still doesn’t know what her symptoms mean, but she’s trying to remain optimistic while she waits on a firm answer.
“There’s always that nagging feeling in the back of my mind that it’s something worse that’s not being tackled, that I’ll end up dying from it, or that I’ll end up being more seriously ill than I need to be.”
What’s worse is that Heather knows she will likely experience transphobic abuse online because she’s daring to speak out about her experience. She has received brutal, cruel messages on social media over the years – all because she’s a trans woman. Some of those have wished cancer on her.
This culture of abuse only further silences trans people and makes them less likely to seek the support they need.
There needs to be greater awareness in the medical field about trans women’s medical needs
Heather’s experience is echoed by Suzanna Hopwood, also a trans woman. She developed prostatitis a number of years ago – she went to her GP and was referred to a consultant. The care she received was excellent.
“They don’t want to do any surgery on me, they’re just treating it with drugs. They didn’t think there was anything sinister lurking in my prostate and it wasn’t hugely big. That’s the process that I went through and I came out the other side reasonably satisfied,” Suzanna says.
“On the other side, you can fall into a bit of a hole really and not get properly diagnosed.”
Heather Peto. (Provided)
That’s why Suzanna worked with Prostate Cancer UK to help help bring its information on prostate cancer in trans and non-binary people up to date. She reached out to the charity when she started having issues with prostatitis and learned that the charity was already working on updating its information to make it more inclusive.
Today, Prostate Cancer UK provides in-depth information about the realities facing trans women and non-binary people with prostates. Worryingly, the charity points out that many people don’t even know that trans women and some non-binary people have prostates, meaning they’re less likely to seek and access the right supports.
For Heather and Suzanna, the path forward is education – both for medical professionals and for trans and non-binary people. Without that, lives could continue to be needlessly lost.
If you’re trans or non-binary and are worried about prostate cancer or prostatitis, you can visit the Prostate Cancer UK website to find out more.
Contrary to the belief that many films have portrayed, attraction is not bound to romantic feelings. Instead, it can be an interest, a desire, or an affinity that’s emotional, romantic, physical, sexual, or aesthetic in nature.
With many feelings qualifying as an attraction, it comes as no surprise that it’s possible to experience more than one type of attraction simultaneously and that these desires come in spectrums rather than single points. And it’s in one of these “gray area” middle grounds where we’ll find alterous attraction.
Let’s explore its nuances to gain insight into our own feelings and understand and express ourselves better.
Alterous Attraction Definition: What Does It Mean?
To define alterous attraction, we first need to understand where the term comes from.
The term is derived from the same roots as “to alter” or “an alternative,” which all come from the Latin word “alternare,” which means “to change” or “to interchange.” Given this, we could define alterous attraction as “describing an alternative type of attraction” or, simply, “other attractions.”
The term is often used in the aromatic or asexual community. These individuals don’t experience a romantic or sexual attraction toward others and often have low to zero interest in related activities. Since romance and sex are commonly linked, alterous behavior is prevalent in both groups.
Aromantic and asexual individuals experience alterous attraction or intense feelings that cannot be categorized as a platonic or romantic attraction. Instead, their emotions land somewhere in the middle, where they want emotional closeness in a personal relationship without it being romantic or having the desire to explicitly act on or address it.
Alterous attraction can be a basis for your orientation and also exist alongside other orientations. For example, you can be heterosexual, bisexual, aromantic, or panalterous and still have an alterous orientation where you experience emotional depth not adequately described by romantic or platonic attraction.
Shutterstock
What Do You Call Someone You Have An Alterous Attraction For?
You can use helpful terms to describe someone you have alterous feelings for. Two of the common ones are “squish” and “mesh”:
Squish: A squish is a non-romantic crush. Unlike a crush where you want something romantic to happen with someone, a squish is someone you want to have a strong, non-romantic connection with.
Mesh: Mesh is something in between crush and squish. In other words, a mesh is someone you want to have an alterous relationship with – not exactly platonic, not wholly romantic, but somewhere in between.
Both terms are used in describing alterous attractions, although mesh might be more applicable in most cases. This makes it easy for you to refer to someone you have more than platonic attraction for without struggling with the romance-related crush term.
Shutterstock
What Does Alterous Attraction Tell Us About Love?
Alterous attraction is an important nuance in the aromanticism spectrum, as individuals with such orientation experience a different kind of romantic attraction than most of us are used to. Instead, they experience varying degrees of complex emotional desires to form an emotional relationship that goes beyond platonic connections.
Many people are used to separating platonic and romantic attraction in binary terms. But alterous attraction challenges the two confining classifications, proving that platonic and romantic love can exist together.
Our society is not bound to such amatonormative beliefs anymore, but rather, welcomes and values varying types of emotional closeness to the same degree.
The gray area captured by alterous attraction means that one can experience attraction without conforming to the norm or any cultural preconceptions and still have in-depth personal relationships. Just like how everyone often describes the color blue-green inconsistently, different people have different emotional boxes in life.
Alterous partnerships can also be somewhat of a substitute for “platonic soulmates” or “life partners,” where both individuals are attracted and attached to each other but without being wholly romantic.
Shutterstock
Romantic Attraction Vs Alterous Attraction: How Are They Different?
Most of us crave emotional closeness. But when does that elevate to romantic attraction?
The answer may differ from one person to another. In general, however, romantic feelings often have more intense emotions, where people describe it as having nervous energy, heart-tugging pain, and butterflies in their tummy. They may also be more inclined to the stereotypical “relationship escalator” such as committing to a lifelong partnership.
Alterous attraction, on the other hand, is more relaxed, where an individual may wish that they can date someone, but also be completely fine to just spend time with them in whichever way. They want to be emotionally close to the other person, get to know them, and spend every waking moment with them, but without any expectation or need that it’ll involve dating or romance.
In other words, it’s to have the feeling that you want to date someone but also know that it’s nothing romantic, sensual, or sexual. And you won’t be heartbroken to have your feelings go unreciprocated.
Shutterstock
How Will I Know If I’m Alterously Attracted To Someone?
The hard part about identifying this type of attraction is that it’s defined more by what it isn’t rather than what it is, and those things that “aren’t” are quite difficult to define themselves. So, the simplest way to find out if you have alterous attraction for someone is to first ask yourself the following questions:
How do you define a platonic relationship?
How do you define a romantic relationship?
As these questions might be difficult to answer, you can refer to your past or current friendships and romantic relationships to help you pinpoint your personal experience with different kinds of feelings.
Once the archetypes are clearer, answer these questions in relation to the person you have in mind:
What do you want to do with them?
What don’t you want to do with them?
Do you consider them only as your best friend?
Do you want your feelings to be reciprocated?
Do you want to have sex with them?
Do you want them to see you as a friend or a lover?
These guide questions are to give just a sense of what kind of emotional attraction you possibly feel towards others. You can also try putting “filters” on so you can see if you feel more comfortable having them as a friend or as someone romantically involved in your life.
Shutterstock
More Than Friends, Less Than Lovers: Alterously Attracted To Each Other
Alterous attraction is a new concept for many. But it’s necessary, especially for the asexual and aromantic community. Terms like these exist to help you identify and describe your experiences, so you’re more comfortable with yourself and have an easier time explaining to others.
Moreover, even if you do feel that the term aptly describes your orientation and feelings towards others, it may take some time for you to accept it as part of your identity. That is completely normal, and you have nothing to worry about.
If they don’t serve you well, you don’t have to use them. But if they do, then you can now proudly proclaim the feelings you had towards others that were once unnamed.
Transgender medical treatment for children and teens is increasingly under attack in many states, labeled child abuse and subject to criminalizing bans. But it has been available in the United States for more than a decade and is endorsed by major medical associations.
Many clinics use treatment plans pioneered in Amsterdam 30 years ago, according to a recent review in the British Psych Bulletin. Since 2005, the number of youth referred to gender clinics has increased as much as tenfold in the U.S., U.K, Canada and Finland, the review said.
The World Professional Association for Transgender Health, a professional and educational organization, and the Endocrine Society, which represents specialists who treat hormone conditions, both have guidelines for such treatment. Here’s a look at what’s typically involved.
Puberty Blockers
Children who persistently question the sex they were designated at birth are often referred to specialty clinics providing gender-confirming care. Such care typically begins with a psychological evaluation to determine whether the children have “gender dysphoria,″ or distress caused when gender identity doesn’t match a person’s assigned sex.
Children who meet clinical guidelines are first offered medication that temporarily blocks puberty. This treatment is designed for youngsters diagnosed with gender dysphoria who have been counseled with their families and are mature enough to understand what the regimen entails.
The medication isn’t started until youngsters show early signs of puberty — enlargement of breasts or testicles. This typically occurs around age 8 to 13 for girls and a year or two later for boys.
The drugs, known as GnRH agonists, block the brain from releasing key hormones involved in sexual maturation. They have been used for decades to treat precocious puberty, an uncommon medical condition that causes puberty to begin abnormally early.
The drugs can be given as injections every few months or as arm implants lasting up to year or two. Their effects are reversible — puberty and sexual development resume as soon as the drugs are stopped.
Some kids stay on them for several years. One possible side effect: They may cause a decrease in bone density that reverses when the drugs are stopped.
Hormones
After puberty blockers, kids can either go through puberty while still identifying as the opposite sex or begin treatment to make their bodies more closely match their gender identity.
For those choosing the second option, guidelines say the next step is taking manufactured versions of estrogen or testosterone — hormones that prompt sexual development in puberty. Estrogen comes in skin patches and pills. Testosterone treatment usually involves weekly injections.
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
Guidelines recommend starting these when kids are mature enough to make informed medical decisions. That is typically around age 16, and parents’ consent is typically required, said Dr. Gina Sequiera, co-director of Seattle Children’s Hospital’s Gender Clinic.
Many transgender patients take the hormones for life, though some changes persist if medication is stopped.
In girls transitioning to boys, testosterone generally leads to permanent voice-lowering, facial hair and protrusion of the Adam’s apple, said Dr. Stephanie Roberts, a specialist at Boston Children’s Hospital’s Gender Management Service. For boys transitioning to girls, estrogen-induced breast development is typically permanent, Roberts said.
Research on long-term hormone use in transgender adults has found potential health risks including blood clots and cholesterol changes.
Surgery
Gender-altering surgery in teens is less common than hormone treatment, but many centers hesitate to give exact numbers.
Guidelines say such surgery generally should be reserved for those aged 18 and older. The World Professional Association for Transgender Health says breast removal surgery is OK for those under 18 who have been on testosterone for at least a year. The Endocrine Society says there isn’t enough evidence to recommend a specific age limit for that operation.
Outcomes
Studies have found some children and teens resort to self-mutilation to try to change their anatomy. And research has shown that transgender youth and adults are prone to stress, depression and suicidal behavior when forced to live as the sex they were assigned at birth.
Opponents of youth transgender medical treatment say there’s no solid proof of purported benefits and cite widely discredited research claiming that most untreated kids outgrow their transgender identities by their teen years or later. One study often mentioned by opponents included many kids who were mistakenly identified as having gender dysphoria and lacked outcome data for many others.
Doctors say accurately diagnosed kids whose transgender identity persists into puberty typically don’t outgrow it. And guidelines say treatment shouldn’t start before puberty begins.
Many studies show the treatment can improve kids’ well-being, including reducing depression and suicidal behavior. The most robust kind of study — a trial in which some distressed kids would be given treatment and others not — cannot be done ethically. Longer term studies on treatment outcomes are underway.
Florida’s health department has issued chilling guidance to block medical care and even social transition for trans kids in the state.
The guidance, issued by Florida’s department of health on Wednesday (20 April), contradicts federal guidance and guidance from the World Professional Association for Transgender Health and states that “anyone under 18 should not be prescribed puberty blockers or hormone therapy”.
It also appears to promote conversion therapy, stating that trans “children and adolescents should… seek counselling from a licensed provider”.
The guidance has echoes of a directive released by Texas governor Greg Abbott in March, which urges Texans to report families providing their trans kids with gender-affirming medical care, framing it as “child abuse”.
However the Florida guidance, signed by governor Ron DeSantis and state surgeon general Joseph Ladapo, takes the attack on trans kids a step further, declaring that even social transition, for example a change in name, pronouns or dress, “should not be a treatment option for children or adolescents”.h
It is currently unclear what the real-life impact will be on trans kids in Florida, but considering DeSantis’ record on legislating against the existence of LGBT+ people, the guidance has activists and the wider trans community deeply concerned.
Equality Florida described the guidance as “non-binding”, but said in a statement: “Once again, Ron DeSantis seeks to replace science and the safety of young people with political propaganda… The guidance demonizes life-saving, medically-necessary care, and asserts that the government, not parents, knows best when it comes to health care for our kids.
“DeSantis wants government to intrude into doctors’ offices to pander to extremists in service to his ambitions.”
The attack on the rights of the parents of trans children is ironic, considering that DeSantis recently signed into law the “Parental Rights in Education” bill, also known as the “Don’t Say Gay” bill.
DeSantis has claimed that the bill gives parents greater control over what their children are taught in school, but it bans the discussion of LGBT+ topics in classrooms, regardless of parents’ wishes.
Equality Florida continued: “Parents should be deciding, in partnership with their child’s doctor, based on science, not politics, what is best for their children.
“DeSantis’ runaway agenda of banning books, muzzling teachers, censoring history, and pushing government control is putting a handful of extremists in charge of every aspect of the lives of Floridians and is making the state less safe for LGBTQ families, especially trans kids.”
The ACLU added: “This is a desperate effort to sow lies and fear about transgender youth, their parents, and their health care.
“Trans youth know who they are. We’re ready to do everything in our power to defend the fundamental rights of trans youth and their families.”
The Biden administration is preparing to scrap a Trump-era rule that allows medical workers to refuse to provide services that conflict with their religious or moral beliefs, three people familiar with the deliberations told POLITICO.
A spokesperson for the Department of Health and Human Services confirmed that the policy change is underway, saying: “HHS has made clear through the unified regulatory agenda that we are in the rulemaking process.”
The move, which HHS could propose as soon as the end of this month, comes as many GOP-led states are moving to limit access to abortions and transgender care, and as progressive advocacy groups are calling on the federal government to do more to protect the rights of patients.
Read the full article. Photo: HHS Sec. Xavier Becerra.
For years, Mandy (not her real name), a trans sex worker, used to commute two hours from Bristol to London just to access non-judgemental sexual healthcare.
“When I went to Bristol’s central clinic for a sexual health check-up, they told me they ‘don’t know how to deal with people like me,’” she tells PinkNews. “I even experienced having a student nurse brought in to look at my post-operative vagina.” This humiliating experience made her determined to find more inclusive services, but doing so was far from easy.
In Mandy’s eyes, “finding clinicians that are able to handle my trans body and my sex work was an uphill struggle”.
“I basically had to travel 100 miles just to get tested in an environment and a situation that didn’t traumatise me,” she says.
At first, she sought out sex worker-friendly clinics, like the Spittal Street Women’s Clinic in Edinburgh. These were a marked improvement, she says, but nothing compared to the care she received at CliniQ, a trans-led sexual health and wellbeing service based in London.
Services like these are still all too rare, but the last few years have seen a tiny handful of other openly trans-inclusive sexual health services crop up across the UK, many of them trans-led.
A handful of these services only have limited hours, but they still represent a vital step forward in the fight for accessible trans sexual healthcare. More importantly, they demonstrate a clear demand for such services.
The Butterfly Clinic first opened its doors back in 2018. After briefly closing throughout the pandemic, the Liverpool-based service is now open every Monday and Tuesday. “We offer a wide range of services,” a representative explains, “including vaccinations for Hepatitis A, B and HPV where appropriate. We can also initiate and manage [HIV prevention medication] PEP and PrEP.”
(Pexels)
Clinic lead Hayley cites an appointment with a trans sex worker as a landmark moment in her decision to spearhead the Butterfly Clinic. “The patient was using sex work to fund their transition, and they spoke about the barriers they had faced,” Hayley recalls. “I asked them why they had decided to come for a sexual health screening after so many years of avoiding appointments, to which they replied: “I’ve always looked after myself from a safety and security point of view, but I had neglected my health.”
It was an epiphany of sorts for Hayley, who hadn’t previously recognised the dire need for a trans-specific service.
The Butterfly Clinic is provided by axxess sexual health, who were immediately supportive of the idea. “After being given the go-ahead, I first reached out at Liverpool Pride, which got a great response,” continues Hayley. Since then, she’s worked with local support groups and other trans-led organisations to ensure a gold standard of trans-specific care.
For trans people long accustomed to feeling let down by professionals, the feeling of being treated fairly and taken seriously can be hugely affirming.
The first time 25-year-old Harry went to 56T in London, he found himself amazed that practitioners actually knew how to help him. “My questions were mainly around whether or not the pill (which I thought must have some kind of hormone in it) would interact with my testosterone, what contraceptives would be available to me other than condoms and what would be my risks of HIV exposure as a a gay trans man,” he tells PinkNews.
Previously, Harry had broached some of these concerns with other sexual health clinicians, but he was told he would have to seek out a “specialist” – a gender clinic practitioner in other words.
But of course, gender clinics have endless waiting lists, and their practitioners aren’t specifically trained to answer sexual health questions. As a result, Harry found himself at a loss for answers.
(Pexels)
This wasn’t the case at 56T. “I don’t have periods, so the clinic was able to offer me a pregnancy test if I was worried I might be pregnant,” he explains. “They really knew their stuff and made me feel at ease. I was told – through their trans-inclusive practice and approach – that my body wasn’t odd, unusual or strange. For the first time, professionals had answers to my questions. That felt really important.”
Perhaps unsurprisingly, given the context of these backstories, plenty of trans people have long been reluctant to seek care.
According to 2019 research published in the British Medical Journal, “trans people were less likely to have attended a sexual health clinic in the past 12 months compared to cisgender people,” and those who did were “more likely to report experiencing discrimination in a medical setting [than cisgender people]”.
This discrimination often isn’t mild, either. The statistics show that “over four-fifths of trans participants had high or very high levels of psychological distress”.
At trans-led clinics, we’re treated with the care and attention we deserve.
Harry has found himself feeling anxious about the potential quality of care he’ll receive. “I’ve had sexual health professionals say ‘I’ve seen it all, nothing can surprise me, love!’” he says. “In my experience though, that’s not the case.”
In the past, Harry has had multiple clinicians say he’s the first trans person they’ve come into contact with. He recalls: “One time, the sexual health practitioner got confused and said that her manager would have to do the consultation instead.”
Chris Higgins, a fellow clinic lead at The Butterfly Clinic, has heard plenty of these horror stories. “The first we need to address is the high likelihood that the trans patients coming to us have previously had negative experiences. Without giving anecdotes, let’s just say these patients definitely need to have their trust earned.”
Sensitivity is key. “Being able to take a sexual history from a trans patient without them feeling the exercise is voyeuristic is important,” continued Higgins. “We ask questions that are necessary for best care, not out of a sense of personal interest or curiosity.”
Crucially, these environments also don’t treat trans people as “other,” which is rarely the case elsewhere. In fact, when it comes to mainstream healthcare providers helping trans people, it’s often too much about luck. There are online resources like trans subreddits and advocacy groups like Action for Trans Health to point people in the right direction, but largely, access to good trans healthcare relies on word-of-mouth recommendations from other trans people in the know.
Trans-led clinics are looking to remedy these issues. CliniQ in particular is known for taking a holistic approach; although it’s not a gender clinic, practitioners can give advice on hormones, mental illness and point people in the direction of peer mentoring schemes. The website also contains a valuable list of external resources, which feature advice on everything from homelessness to support for LGBT+ survivors of domestic violence.
In these trans-led sexual health clinics, there’s an understanding that trans bodies often work differently to cis bodies. “For us, our genitals are sometimes a source of trauma or difficulty,” continues Mandy, “and our bodies after surgical intervention don’t always operate the same as, or look the same as, their cis counterparts.”
These differences aren’t sensationalised in trans-led clinics, nor do they lead to intrusive, potentially triggering lines of questioning. “In these spaces, you’re able to say, as a man with muscles and a beard, ‘I’ve had some discoloured, unusual discharge from my vagina’ and nobody bats an eyelid,” says Harry. “We’re treated with the care and attention we deserve.”
(Pexels)
Funding these services is no easy feat, though. It’s no secret that grassroots organisations have long been forced to plug holes in government provision; as a result, a handful of these clinics can only operate during strict opening hours due to funding restrictions, or they’re partially reliant on donations.
According to Mandy, a potential solution is to acknowledge the overlap between trans and sex worker populations, and to work to more closely integrate their services. “The two communities are intrinsically linked, and our lives often intersect in difficult ways,” she explains. “Sometimes it’s impossible to access a trans-specific clinic in places where there’s a sex worker clinic, and vice versa. Therefore, it’s vital that these services are able to cater to our needs.”
The rise of at-home testing
At-home testing has made a huge difference, too. Last year, a UK study found that HIV testing rates had trebled amongst trans communities due to the increased accessibility of at-home tests. “That doesn’t surprise me in the slightest,” says Harry, who believes “most people – not just trans people, or people who are anxious about their bodies – will find it easier to do tests in the comfort of their own home.”
However, there’s more to good sexual healthcare than just testing –– from PrEP and birth control to informed practitioners able to answer questions about hormones, treatment and much more, there’s still a huge need for more trans-specific clinics.
These healthcare issues are often reduced to hot-button, clickbait “debates” about inclusive language by right-wing commentators, but there are actual lives at stake when it comes to conversations around healthcare access.
At-home testing and trans-led clinics may be plugging vital gaps in UK healthcare, but there’s more funding, more education and more awareness needed to ensure more trans people can access them.
“I definitely welcome at-home testing,” concludes Harry, “but it can’t be treated as a replacement for good care and trans-inclusive training.”
The Bisexual Resource Center (BRC), America’s oldest national bisexual organization, will celebrate the 9th annual Bisexual+ Health Awareness Month (#BiHealthMonth) social media campaign throughout March 2022.
#BiHealthMonth, founded and led annually by the BRC, raises awareness about the bisexual+ (bi, pansexual, fluid, queer, etc.) community’s social, economic and health disparities; advocates for resources; and inspires actions to improve bi+ people’s well-being.
This year’s #BiHealthMonth theme is “Connection.” This theme has been chosen to highlight the importance of connecting bisexual+ people to each other, to supportive communities and to health care resources that are affirming of their identities.
While there are many different ways that bi+ people can connect, the goal of connection is to build safe, inclusive spaces — in-person and online, locally and globally — for bi+ people to share their experiences and create meaningful relationships. When bi+ people are connected, it greatly improves their physical, mental and social health, particularly for bi+ people living in historically oppressed, marginalized or isolated communities.
“This year’s #BiHealthMonth is all about connection,” said Belle Haggett Silverman, president of the Bisexual Resource Center. “How are we connected as people? As communities? As a movement? We know that, while connection comes in many forms, it is always crucial for people to thrive individually and collectively. When we create spaces for bi+ people to come together and support each other, we can build a healthier, happier bi+ community and improve health outcomes for bi+ people worldwide.”
Throughout the month of March, the BRC will partner with a diverse array of leading organizations, including #StillBisexual, AIDS United, Athlete Ally, the Battered Women’s Justice Project, BiArtsFestival, Bisexual Queer Alliance Chicago, Bi Women Boston, Fandom Forward, Fenway Health, Howard Brown Health, Human Rights Campaign, LGBT Center of Wisconsin, Los Angeles Bi Task Force, Magic City Acceptance Center, Mini Productions, Milwaukee LGBT Community Center, NARAL, North Shore Pride, the NYC LGBT Center, PFLAG National, the National LGBTQ Task Force, SAGE, SpeakOUT Boston, Step Up For Mental Health, TAIMI, the Visibility Impact Fund and others to feature engaging and informative content, events, research, resources and actions. The BRC invites individuals, organizations, media outlets, companies and anyone interested to participate all month long by posting online using #BiHealthMonth, hosting local community events, donating to the Bisexual Resource Center and more.
Some #BiHealthMonth highlights this year include a screening of the short film “Treacle,” hosted by April Kelley; panels on bi+ health featuring conversations with BRC board members Gabby Blonder, Andrea Holland, and River McMican; new, original content from bi+ advocates, including Robyn Ochs; and a full calendar of BRC-hosted online events including a Bisexual Social and Support Group (BLiSS) meeting (March 2), a Bi+ Crafternoon (March 6); and an in-person Bi/Pan Guyz+ Social Night (March 23).
For more on #BiHealthMonth, follow the Bisexual Resource Center on Twitter, Facebook and Instagram.
###
The Bisexual Resource Center works to connect the bi+ community and help its members thrive through resources, support, and celebration. Through this work, we envision an empowered, visible and inclusive global community for bi+ people. Visit www.biresource.org for more information.
While the One Male Condom is not markedly different from the hundreds of other condoms on the market, it is the first that will be allowed to use the “safe and effective use” label for reducing sexually transmitted infections during anal sex. It is also approved for use as a contraceptive and as a means to reduce STIs during vaginal intercourse.
“This landmark shift demonstrates that when researchers, advocates, and companies come together, we can create a lasting impact in public health efforts,” Davin Wedel, president and founder of Boston-based Global Protection Corp, maker of the One Male Condom, said in a statement. “There have been over 300 condoms approved for use with vaginal sex data, and never before has a condom been approved based on anal sex data.”
Courtney Lias, director of the FDA’s Office of GastroRenal, ObGyn, General Hospital and Urology Devices, noted that the risk of STI transmission during anal intercourse is “significantly higher” than during vaginal intercourse.
“The FDA’s authorization of a condom that is specifically indicated, evaluated and labeled for anal intercourse may improve the likelihood of condom use during anal intercourse,” Lias said in a statement. “Furthermore, this authorization helps us accomplish our priority to advance health equity through the development of safe and effective products that meet the needs of diverse populations.”
Anal sex poses the highest risk for contracting HIV, with the risk of HIV transmission from receptive anal sex about 18 times higher than receptive vaginal sex. Gay and bisexual men accounted for 69 percent of the 36,801 new HIV/AIDS diagnoses in the U.S. in 2019, according to the Centers for Disease Control and Prevention. Queer men of color were overrepresented within this group, with Black men representing 37 percent, Latino men representing 32 percent and white men representing 25 percent of these new diagnoses, according to the CDC.
One Male Condoms are available in standard, thin and fitted versions, and the fitted version is available in 54 different sizes.
A clinical trial of 252 men who have sex with men and 252 men who have sex with women found the One Male Condom has a failure rate of 0.68 percent for anal sex and 1.89 percent for vaginal sex, according to the FDA, which defined condom failure as condom slippage or breakage.
Dr. Will DeWitt, clinical director of anal health at the Callen-Lorde Community Health Center in New York City, said the newly approved condoms could be a helpful tool for HIV/AIDS prevention.
“The hope would be that people would be more willing to use condoms for anal sex and to have that direct encouragement would increase the rates of people using them,” DeWitt said. “Condoms still remain an important tool for people who don’t want to or can’t use PrEP.”
PrEP, or pre-exposure prophylaxis, is typically taken in the form of a daily pill to prevent HIV/AIDS in people who are not diagnosed with the virus. Last year, the FDA also approved an injectable PrEP shot that can be given every two months.
DeWitt did, however, add that he is worried the One Male Condom name and marketing could alienate those who engage in anal sex but do not identify as male.
“Anal sex really does belong to everyone,” DeWitt said. “Even if it’s the perspective of who has to wear the condom, it’s not just male bodies and male identified folks who need to use it.”
While health experts have long encouraged the use of condoms for STI prevention through anal sex, DeWitt said FDA’s official approval is long overdue.
“Here we are in 2022, and we are only now getting condoms approved for anal sex,” DeWitt said, noting that it’s been more than three decades since the start of the HIV crisis. “It’s a little frustrating that it’s taken this long to have this kind of official endorsement.
