More than half (56%) of LGBTQ adults and 70% of those who are transgender or gender non-conforming report experiencing some form of discrimination, including the use of harsh or abusive language, from a health care professional. The first American Heart Association Scientific Statement to address LGBTQ heart health, “Assessing and Addressing Cardiovascular Health in Lesbian, Gay, Bisexual, Transgender and Queer (or Questioning) Adults,” published today in the Association’s flagship journal Circulation, suggests improving the cardiovascular health of the LGBTQ population will require a multi-faceted approach that includes researchers, clinicians and public health experts.
In terms of health, LGBTQ orientation is considered a “sexual minority,” and transgender or gender non-conforming is considered a “gender minority.”
The statement examines existing research about LGBTQ-specific links to cardiovascular health disparities, identifies gaps in the body of knowledge and provides suggestions for improving cardiovascular research and care of LGBTQ people.
“This is particularly important now, at a time when there is increased awareness of health inequities related to unequal treatment and discrimination in the U.S.,” says Billy A. Caceres, Ph.D., R.N., FAHA, chair of the writing group for the statement and an assistant professor at the Columbia University School of Nursing in New York City. “LGBTQ individuals are delaying primary care and preventative visits because there is a great fear of being treated differently. Being treated differently often means receiving inadequate or inferior care because of sexual orientation or gender identity.”
LGBTQ populations face unique stressors, such as family rejection and anxiety over concealment of their sexual orientation or gender identity. Multi-level minority stressors and general stressors often interact in complicated ways to impair LGBTQ health. In addition, LBGTQ adults in historically underrepresented racial or ethnic groups experience higher poverty levels, insecure housing and fewer health care options compared to their white LGBTQ peers.
The writing group noted trust toward health care professionals is still lacking among many members of the LGBTQ community, and health care professionals need more education on how to provide appropriate care for LGBTQ patients. Caceres says, “It is paramount to include content about LGBTQ health in clinical training and licensure requirements in order to address these cardiovascular health disparities.”
Accrediting bodies and organizations responsible for health care professional curricula have not specifically required LGBTQ-related content, thus very little exists in health professional education training. A 2018 online survey of students at 10 medical schools found approximately 80% of students did not feel competent to provide care for transgender patients. Another study of more than 800 physician residents across 120 internal medicine residencies in the U.S. found no difference in knowledge between the baseline and post-graduate years when it came to LGBTQ-specific health topics. The statement notes that the Accreditation Review Commission on Education for the Physician Assistant began requiring LGBTQ curricular content in September 2020.
The writing committee suggests assessment and documentation of sexual orientation and gender identity information in electronic health records could provide an opportunity to address specific health concerns for LGBTQ patients, and to strengthen our ability to examine cardiovascular health of LGBTQ adults more broadly. They also note basic understanding of the terminology of LGBTQ identities is important. The statement includes a glossary to detail and clarify the various key words and terms used to describe members of the LGBTQ community such as bisexual, transgender, gay, gender nonbinary, etc.
“Health care systems need to play a significant role – to enact policies to encourage and support researchers and health care professionals to ask these questions in a respectful manner and to implement structures that emphasize the clinical importance of understanding the many layers related to caring for people with a minority sexual orientation or gender identity,” said Caceres.
The statement also notes that while there’s limited information on the cardiovascular health of LGBTQ people, a few risk factors stand out from existing data. They identify areas that require specific cardiovascular health efforts focused on the LGBTQ population:
LGBTQ adults are more likely to report tobacco use than their cisgender heterosexual peers.
Transgender adults had lower physical activity levels than their cisgender counterparts, according to a systematic review.
The statement suggests gender-affirming care might play a role in promoting physical activity among transgender people.
Transgender women may be at increased risk for cardiovascular disease due to behavioral and clinical factors (such as the use of gender-affirming hormones like estrogen).
Transgender women and non-binary persons are more likely to binge drink.
Lesbian and bisexual women have a higher prevalence of obesity than heterosexual women.
Future research is needed across the entire spectrum of the LGBTQ community to better understand the complex and multiple levels of psychological and social stressors that can impact the cardiovascular health of LGBTQ people and to develop and implement appropriate interventions that support improved cardiovascular health and overall well-being.
In addition, data is also lacking about differences in risk for cardiovascular disease by race and ethnicity and by socioeconomic level for persons who are members of the LGBTQ community. This is because most previous studies have relied heavily on samples from white, educated LGBTQ adults.
“There is much work to be done to understand and improve the cardiovascular health of LGBTQ adults,” Caceres said. “We need more robust research that allows us to draw stronger conclusions, as well as initiatives to increase clinicians’ knowledge, thereby improving care and health outcomes for LGBTQ adults.”
The Scientific Statement was developed by the writing group on behalf of the American Heart Association’s Council on Cardiovascular and Stroke Nursing; the Council on Hypertension; the Council on Lifestyle and Cardiometabolic Health; the Council on Peripheral Vascular Disease; and the Stroke Council.
Co-authors are Carl G. Streed, Jr., M.D., M.P.H., FACP, Vice Chair; Heather L. Corliss, M.P.H., Ph.D.; Donald M. Lloyd-Jones, M.D., Sc.M., FAHA; Phoenix A. Matthews, Ph.D.; Monica Mukherjee, M.D., M.P.H.; Tonia Poteat, Ph.D., PA-C, M.P.H.; Nicole Rosendale, M.D.; and Leanna M. Ross, Ph.D. Author disclosures are in the manuscript.
The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association’s overall financial information is available here.
About the American Heart Association The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.
A majority of LGBTQ youth reported experiencing symptoms of anxiety or depression amid the pandemic, according to poll released Friday by Morning Consult and The Trevor Project, an LGBTQ youth suicide prevention and crisis intervention organization.
The poll surveyed 1,200 people across the U.S. between the ages of 13–24 in late July, including 600 lesbian, gay, bisexual, transgender and queer youth and 600 non-LGBTQ youth.
Stay-at-home orders have led to some LGBTQ youth being stuck inside in unsupportive households, which could lead to adverse mental health affects, as well as limited opportunities to get needed care, according to the survey. Nearly 1 in 4 LGBTQ youth who responded said they were unable to access mental health care because of the pandemic.
Three-fourths of LGBTQ respondents said they were suffering from increased loneliness since the pandemic began, with 55 percent reporting symptoms of anxiety and 53 percent reporting symptoms of depression in the two weeks preceding the poll. The survey found non-LGBTQ respondents were 1.75 times more likely than LGBTQ youth and 2.4 times more likely than trans and nonbinary youth to exhibit no signs of either anxiety or depression.
Over one-third of LGBTQ youth surveyed said they were unable to be themselves at home, and nearly one-third of transgender and nonbinary youth reported feeling unsafe in their living situation since the start of the pandemic.
“This year has been difficult for everyone, but it has been especially challenging for LGBTQ youth, and particularly Black LGBTQ youth, who have found themselves at the crossroads of multiple mounting tragedies,” Amit Paley, CEO and executive director of The Trevor Project, said in a statement.
Paley said that since the onset of the pandemic, the volume of youth reaching out to his organization’s crisis services programs has, at times, been double its pre-Covid-19 volume.
“We’ve known that LGBTQ youth have faced unique challenges because of the countless heartbreaking stories we’ve heard on our 24/7 phone lifeline, text, and chat crisis services; but these findings illuminate the existence of alarming mental health disparities that must be addressed through public policy,” he stated.
Compounding the negative effects of stay-at-home orders related to the public health crisis are the ongoing news reports and social media videos of violence against Black Americans and reports of police violence against people of color.
A majority of LGBTQ youth said the ongoing unrest had negatively affected their well being, with 78 percent of Black LGBTQ youth saying they had been negatively affected. Of that, 44 percent of Black LGBTQ youth said their well being had been negatively affected “a lot.”
Only 8 percent of Black LGBTQ youth said police in their neighborhood were there to protect them, which reflected a larger trend of 71 percent of LGBTQ youth in total reporting that they deeply distrust the police.
If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.
If you are an LGBTQ young person in crisis, feeling suicidal or in need of a safe and judgment-free place to talk, call TrevorLifeline now at 1-866-488-7386.
Transgender children who receive gender-affirming medical care earlier in their lives are less likely to experience mental health issues like depression and anxiety, according to a new study published in the journal Pediatrics.
“The study highlights that timely access to gender-affirming medical care is really important for youth with gender dysphoria,” said the study’s lead author, Dr. Julia C. Sorbara, a pediatric endocrinologist at the Hospital for Sick Children in Toronto. Gender dysphoriainvolves a conflict between an individual’s sex assigned at birth and their gender identity.
The study found that transgender youths who sought that type of care — which, for minors, most commonly includes puberty blockers, hormones or both — at a later age and further into puberty were more distressed and more likely to suffer from mental health issues.
“A major part of puberty is developing physical changes, and for youth with gender dysphoria, they begin to develop physical changes that are not in keeping with the gender they identify,” Sorbara said. “This can be very distressing for these young people.”
The study included 300 transgender minors aged 10 to 17 who were being treated at the Hospital for Sick Children. The researchers tracked their ages at the time they first sought care at the Toronto clinic and their reported difficulties with mental health.
More than three-quarters of the youths who went to Sorbara’s clinic reported mental health problems, including depression and anxiety, according to the study.
“The most common were depressive and anxiety disorders, as well as having considered suicide at some point — unfortunately not so out of keeping with what’s been reported from other clinics,” Sorbara said.
Researchers found that those issues were more likely the older the children were when they arrived at the clinic. When compared to children ages 10 to 15, children older than 15 were more likely to have reported diagnoses of depression (46 percent vs. 30 percent) and to have self-harmed (40 percent vs. 28 percent), considered suicide (52 percent vs. 40 percent), attempted suicide (17 percent vs. 9 percent) and required psychoactive medications (36 percent vs. 23 percent).
Sorbara’s study follows another study, also published in Pediatrics, that found that transgender individuals who received puberty blockers during adolescence had lower risks of suicidal thoughts as adults than those who wanted the medication but could not get access to it.
Suicide is a significant problem facing transgender children and adults. The 2020 National Survey on LGBTQ Youth Mental Health by The Trevor Project, an LGBTQ youth crisis intervention and suicide prevention organization, found that 40 percent of LGBTQ youths said they have “seriously considered” attempting suicide in the past year.
A 2019 report from the Williams Institute at the UCLA School of Law found a connection between experiences of discrimination, including in medical care, and suicidality for transgender adults, with participants who had experienced discrimination being twice as likely to have attempted suicide compared to those who had not experienced discrimination.
Another recent study found that almost 60 percent of transgender adults were close to someone who has attempted suicide and 25 percent knew someone who had committed suicide and that such exposure has negative impacts on their mental health.
Sorbara also noted that participants in her team’s study were only those “who want to and can access care.” She said many transgender children and adolescents may want or would benefit from such care but are unable to get access to it. She said she hopes her study lends “support to efforts to ensure this care is readily available for the youth that need it.”
The ability of transgender youths to receive gender-affirming medical care has become a political issue, with several states considering measures this legislative session to block access to that type of care. Republican legislators in at least eight states have introduced proposals that would punish doctors and other medical professionals who provide the kind of gender-affirming medical care described in Sorbara’s study. Bills in Missouri and New Hampshire called such care “child abuse.”
In February, over 200 medical professionals signed a letter opposing the bills on the grounds that they “violate the rights and freedoms of transgender young people.”
“Many credible studies of trans youth populations have demonstrated that gender-affirming care is linked to significantly reduced rates of depression, anxiety, substance abuse and suicide attempts,” the letter says. “To put it plainly, gender-affirming care saves lives and allows trans young people to thrive.”
Lesbian, gay and bisexual people are significantly more likely to get migraines than straight people, and scientists believe the stress of bigotry could be one reason why.
A survey of 10,000 Americans aged 31-42 by San Francisco’s University of California found that almost a third of LGB people experienced migraines, a figure 58 per cent higher than in heterosexual participants.
And although the researchers were unable to pinpoint the exact reason behind the painful and disabling headaches, we can only assume that the constant strain of dealing with cis straight nonsense is a contributing factor.
“There might be a higher rate of migraines in LGB people because of discrimination, stigma or prejudice, which may lead to stress and trigger a migraine,” the study’s lead author Dr Jason Nagata told the Thomson Reuters Foundation.
“Physicians should be aware that migraines are quite common in LGB individuals and assess for migraine symptoms.”
Migraines can be accompanied by sensitivity to light and sound as well as blurred vision, nausea and vomiting. The throbbing headaches are the most common reason for emergency room visits in the US, and while there are many different triggers, the cause is still unclear.
The study found that the increased risk of migraines was seen even in those who identified as “mostly heterosexual but with some same-sex attractions”.
It’s possible that the prevalence in the queer population is connected to the rise in hate crimes, which have reached the highest levels in a decade in the US. LGBT+ people are among the most frequently targeted groups, alongside Jews and Black people.
Dr Nagata also considered that another reason LGB people may be more likely to get migraines could be the barriers of receiving healthcare.
Other studies have shown that women are much more likely to experience migraines than men, and up to 85 per cent of American migraine sufferers are female.
Migraines also appear to be more common among Black Americans and Americans with lower socioeconomic status, according to the National Headache Foundation.
A gay lawmaker and coronavirus survivor tried to donate plasma to help others – but he was turned away because of his sexuality.
Shevrin Jones, a Democratic member of the Florida House of Representatives, went to a blood drive on August 7 with his mother Bloneva Jones and his father Eric Jones.
The three decided to donate blood because they had recently recovered from COVID-19 and wanted to help others by donating their antibody-rich blood.
Writing on Twitter, Jones said: “I was blessed to get through COVID, and it’s only right that we bless someone else and give them a fighting chance to live also.
“It’s the right thing to do.”
Florida lawmaker Shevrin Jones was told he can’t donate blood because of his sexual orientation.
But Jones’ dreams were quickly shattered when he was turned away by OneBlood because of a government policy that requires queer men to practice celibacy for three months before donating blood.
After he was turned away, Shevrin wrote on Twitter that he was “disappointed” he could not donate blood because of his sexual orientation.
“I was ‘deferred’ for another time. The good news is, my mom, dad, brother and over 20 other people saved a life today!”
He added: “Too bad my blood plasma isn’t good enough.”
To make matters worse, the incident was later turned into a campaign tactic in an anonymous homophobic text campaign.
I was ‘deferred’ for another time. The good news is, my mom, dad, brother and over 20 other people saved a life today!
Jones, who is currently running to become Florida’s first Black gay senator, was shocked to discover that texts were sent out to voters in Senate District 35 last week saying he had been discriminated against for “homosexual contact”.
The text linked to a website set up where an article about his blood donation ban was copied word-for-word.
“It’s a shame that my opponents have stooped to this new low to try and win,” Jones told the Miami Herald.
“Rather than running off the issues that matter to the voters of our community, they have chosen to lob desperate attacks based on antiquated, discriminatory FDA policy… Hate never wins.”
Experts have urged the United States to overturn its ‘scientifically outdated’ blood donation ban.
Gay and bisexual men have been banned from donating blood in the United States since the 1980s, when the AIDS epidemic was at its height.
The original ban prevented any man who had ever had sex with another man from donating blood for life – but it has been relaxed considerably since then.
Earlier this year, the food and drug administration (FDA) reduced the deferral period – meaning the amount of time a man must remain celibate before donating blood – from 12 months to three months.
In April, more than 500 doctors and experts in the United States wrote to the FDA urging them to overturn the “scientifically outdated ban”.
“While the FDA’s recent decision to shorten the prohibition window to three months is a step in the right direction, it does not go far enough in reversing the unscientific ban,” the letter said.
It had been several years since professor Joseph Palamar had seen that unmistakable “caveman face,” the telltale sign of an imminent overdose of gamma-hydroxybutyric acid, or GHB.
Standing among throngs of concertgoers at a Brooklyn music venue last year, Palamar spotted the bulky man with the contorted face nearby. He was struggling to remain conscious.
“I’ve noticed that when people are meant to pass out and they keep forcing it, they make these very strange, primitive faces,” Palamar, an epidemiologist and associate professor of population health at New York University’s Grossman School of Medicine, told NBC News. “They look like they are in such euphoria it’s almost painful.”
Within minutes, the man succumbed, apparently to the suppressive effects of the drug, and collapsed to the floor. Security staff raced over and carried him away.
The ordeal reminded Palamar of New York’s sweaty nightclubs at the turn of the millennium, the same venues that had sparked his interest in studying drug use. Back then, overdoses, particularly on GHB, were so common that some clubs hired private ambulances to avoid 911 calls and police scrutiny. One club allegedly hid unconscious patrons in a back room without medical assistance.
Despite these efforts, the clubs didn’t go unnoticed. After a rash of overdoses across the United States in the late ’90s, Congress scheduled GHB as a controlled substance in 2000. Exposures to GHB reported to poison control centers fell almost immediately.
But 20 years on, a new generation of recreational users — a disproportionate number of them gay and lesbian, according to researchers — has rediscovered the drug. Recent indictments in a Texas federal court reveal that today’s networks for distributing GHB aren’t spread over local dealers but far-flung markets linking buyers to legal businesses with dubious motives. Social media and the world’s largest online marketplace are also tangled in this web. This illicit network generates millions of dollars each year and has spurred a small but growing crisis, for which federal regulators and the medical community appear ill-equipped and unprepared.
GHB 101
Occurring naturally in the body, gamma-hydroxybutyric acid was first synthesized in a lab in the 1960s. Although its application in medicine has always been limited, GHB has had various recreational uses. In the 1980s, health food stores marketed the compound as a dietary supplement. Then, in the ’90s, the drug found its way into American nightlife.
In small doses — mere milliliters — GHB produces feelings of relaxation and confusion and heightens sexual arousal, lending to its allure as a party drug. It can also cause amnesia and hallucinations.
While not particularly addictive, the drug has a steep dose-response relationship, meaning the difference between experiencing euphoria and losing consciousness is a matter of a few drops of the clear, viscous liquid. It is this quality of GHB that gives it the nickname “the date-rape drug,” although the compound is rarely a factor in sexual assault. Overdoses can result in coma and respiratory arrest, which to an unaccustomed observer may appear as if the affected person has only fallen asleep.
GHB (gamma hydroxybutyrate) is a depressant, which means it slows down the messages traveling between the brain and the body.The Alcohol and Drug Foundation
GHB overdoses surged in the United States during the 1990s. In 1995, the Drug Abuse Warning Network recorded 145 emergency department visits for GHB-related illness in a single year. By 2000, this number was nearing 5,000. That same year, the American Association of Poison Control Centers logged some 2,000 exposures to GHB and its analogues as well as six deaths.
In reacting to the growing crisis, Congress passed the Hillory J. Farias and Samantha Reid Date-Rape Drug Prohibition Act of 2000, which authorized the attorney general to list GHB as a Schedule I controlled substance. The law, named after two teenagers who allegedly died from GHB overdoses after unknowingly ingesting the drug, also targeted GHB analogues, or chemicals that are “substantially similar” to the illegal compound. Two of these — gamma-butyrolactone (GBL) and 1,4-butanediol (BDO) — were named in the act’s text.
Once ingested, GBL and BDO metabolize into GHB and have similar clinical effects. But unlike GHB, both chemicals have widespread use in industrial manufacturing, which prevents them from being regulated as controlled substances. Under the Farias-Reid act, GBL became subjected to greater control by the Drug Enforcement Administration, while BDO was left unregulated. Even so, under the new law, the sale and distribution of either GBL or BDO could result in criminal prosecution if the seller knew the buyer would consume the chemical.
New market for an old drug
After the federal government targeted GHB, reports of its use began to fall. By 2005, poison control centers in the U.S. only recorded some 550 exposures to GHB and one death.
During that same period, online retail grew to offer new avenues for buying and selling GHB and its analogues under the guise of legitimate business.
In 2002, in its first major action against the sale of GHB, codenamed Operation Webslinger, federal agents busted four drug-trafficking rings that had used the internet to connect with buyers. One of these operations, a mother-son team in Missouri, was accused of setting up a limited liability company called Miracle Cleaning Products to deal BDO online. Through their business, the duo could legally purchase the chemical in bulk from two U.S.-based suppliers and then distribute smaller quantities to their customers throughout the U.S. When law enforcement finally arrested the family, federal agents recovered 2,200 gallons of BDO and seized $300,000 in cash. Ultimately, the court sentenced the mother to 14 years in federal prison and the son to more than eight years.
Congress again took action by passing the Adam Walsh Child Protection and Safety Act in 2006. In addition to establishing the national sex offender registry, the law made it illegal to use the internet to sell GHB or its analogues to any person without a legal prescription to use the drug or any business not authorized to handle the chemical. Anyone convicted of using the internet to sell these compounds to unauthorized buyers could face a fine and 20 years imprisonment.
The new law also authorized the attorney general to develop regulations for record-keeping and reporting by anyone handling BDO. To date, the Department of Justice has not established these requirements.
A spokesperson for the U.S. Drug Enforcement Administration, which is part of the DOJ, told NBC News the it “has not promulgated any regulations that were authorized but not required by legislation,” adding that “1,4-butanediol is produced in large volumes for a multitude of legitimate industrial uses, none of which are intended for human consumption.”
Last month, federal agents raided Right Price Chemicals, a wholesaler in Texas, and arrested nine individuals who were accused of distributing BDO for human consumption beginning in 2015. According to the DOJ, the defendants had used the internet to sell the compound to buyers in 48 states. Some of these buyers then dealt smaller quantities to other users.
In just four years, sales of BDO generated $4.5 million for Right Price Chemicals, according to the Department of Justice. Prosecutors also claim that the product caused at least two deaths.
A lawyer for one of the defendants told NBC News that Right Price Chemicals warned customers on its website and its products that BDO was not for human consumption.
“Simply because people misuse a product does not place criminal liability on the retailer of that product,” Ryan Gertz, the lawyer, said. “Right Price Chemicals is a legitimate business that maintained thorough records, paid taxes, employed experts to advise them about proper practices and openly consulted with the government about its operations.”
The defendants in the case have pleaded not guilty and attest that they only distributed BDO for legitimate, legal purposes. If convicted, they face a minimum of 20 years, and up to life, in federal prison.
This BDO “cleaner” was for sale through the Amazon and Walmart online marketplaces as recently as early August. “Not for human consumption” is printed on the bottle. In the interest of public health, NBC News has blurred the company’s name from the label.
Right Price Chemicals is not the only business that has cashed in on BDO. Companies purportedly based in Europe, China and India market the compound on English-language websites. Stateside, companies have also found success by selling BDO on Amazon, the world’s largest online marketplace. As of last week, two third-party sellers offered consumer-sized quantities of BDO on Amazon (Amazon removed these products after NBC News reached out to the company for comment).
In the interest of public health, NBC News has chosen not to name the companies or share their websites and social media accounts.
One of these sellers markets its products as an “organic reagent” and “heavy-duty cleaner” with multiple at-home uses, though the Drug Enforcement Administration maintains that 1,4-butanediol “has no household applications.”
On Amazon, the companies’ products were much pricier than traditional cleaning supplies. Whereas most heavy-duty cleaners on Amazon retail for about $15, BDO of a comparable size went for over $100.
Both sellers are legally registered in different Midwestern states as limited liability companies. The name of one suggests it is a chemical wholesaler; however, it only distributes 1,4-butanediol. The other began as an all-natural soap company in 2015 but switched to selling BDO via its website and Amazon last year.
Prior to early August, buyers could also purchase BDO through the website of one of the sellers using cryptocurrencies, like Bitcoin.
One seller included a legal disclaimer on its Amazon product page stating that its BDO was not for human consumption. Nevertheless, commenters on several blogs, including Reddit, have discussed purchasing BDO as a GHB substitute through Amazon.
NBC News attempted to contact multiple people who allegedly purchased BDO from one of the third-party sellers on Amazon. Only one agreed to speak on the condition of anonymity. This buyer confirmed purchasing 1,4-butanediol on Amazon in order to ingest it and said the seller did not ask for justification when placing the order. The buyer said that the day after consuming the BDO, they felt “absolutely terrible.” The compound, this individual said, caused them to feel fatigued, nauseous and confused.
Shortly after NBC News began contacting these alleged buyers, the third-party seller removed images of BDO bottles and packaging labels from its Instagram account. The company also removed its offering of BDO from its website and instead provided links directing customers to its product pages on the Amazon and Walmart marketplaces.
Amazon prohibits third-party sellers from using its marketplace to sell scheduled controlled substances, like GHB, and List I chemicals, like GBL. BDO is neither. Still, Amazon specifies that its list of restricted products is “not all-inclusive” and the sale of “unsafe” products is strictly prohibited.
“Third party sellers are independent businesses and are required to follow our selling guidelines when selling in our store. Those who do not will be subject to action including potential removal of their account,” an Amazon spokesperson told NBC News. “The products in question are no longer available.”
Walmart also prohibits third-party sellers from selling controlled substances and “products that are subject to regulatory action or criminal enforcement.” Like Amazon, Walmart removed 1,4-butanediol products from its website following NBC News’ request for comment.
In a statement, a Walmart spokesperson said: “We strive to make our third-party Marketplace a trusted destination for safe, high quality products. We require our third-party sellers to comply with all applicable laws and our prohibited products policy. We removed the product 1,4-butanediol from Marketplace and have taken steps to prevent sellers from listing similar items going forward.”
NBC News tried to contact both companies that formerly sold 1,4-butanediol on the Amazon and Walmart marketplaces. Neither responded.
One of the sellers, however, appears to have moved to another major online marketplace after being removed from Amazon and Walmart.com. This marketplace, whose name NBC News will not publish in the interest of public safety, makes sellers’ purchase histories publicly available and shows the seller earned over $2,670 in just 48 hours this week from selling 35 units of BDO.
The comeback of a ‘party drug’
As the online market for GHB and its analogues has grown in recent years, researchers have seen an uptick in the drugs’ recreational use.
From 2016 to 2019, Palamar and Katherine Keyes, an epidemiologist at Columbia University, surveyed adults at electronic dance music parties in New York City to track relative changes in drug use. In that three-year span, they found that the rate of GHB use increased from one in 100 to roughly one in 25, a relative increase of 300 percent.
But for certain demographic groups, the use of GHB is far more widespread. In another survey taken from 2016 to 2018, Palamar and a group of researchers at NYU and Rutgers University found that both gays and lesbians at electronic dance parties were at higher odds for GHB use than straight patrons. According to the study, gay men were nearly 12 times more likely than heterosexual men to self-report GHB use within the past year. Lesbians were nearly seven times more likely than straight women. While gays and lesbians reported comparable or higher rates of use across most surveyed drug types, the difference in GHB use between gay and straight attendees was by far the greatest.
It was in nightlife that Jon, who spoke on the condition of anonymity to protect his privacy, discovered GHB.
As a newcomer to New York City in 2013, Jon, like many young gay men, found a community in nightclubs where he began taking GHB with friends. At first, the drug was only a cheap weekend indulgence.
After drinking one glass of water mixed with GHB, “I wouldn’t need to drink for the rest of the night,” Jon said. “That’s a very attractive selling point.”
But the party didn’t always end on Monday. What had started as only a weekend exploit soon became a weekday occurrence and eventually a physical dependence on the drug.
For several years, no one — including Jon’s boyfriend at the time — knew of this dependence. Even when Jon acknowledged his problem to himself, he still didn’t reveal it to others.
“I wanted to detox without anyone knowing, because at that point I knew I was only doing it for maintenance,” he said. “I was only doing it to curb the withdrawals.”
These were often debilitating. If Jon didn’t ingest GHB on a regular basis, his body would begin to show symptoms akin to alcohol withdrawal. He would sweat and shake. His anxiety would soar to the point of confusion. As a young person trying to make something of himself in New York, Jon needed to maintain his dependence on GHB. The alternative — abruptly stopping his GHB use — was to risk a coma and even death.
So, Jon continued to consume 1.25 milliliters of GHB every two hours for three and a half years.
When he finally sought help at a rehabilitation center last summer, Jon encountered a different problem altogether.
“They had never heard of the drug,” he said of the rehab’s staff. “They had no idea what it was. They didn’t know how to treat it. They didn’t know how to deal with it. Nothing.”
Ultimately, Jon’s doctors treated him with diazepam, which has been shown to be effectivein treating GHB dependence. As of today, Jon has been in recovery for over a year.
The ignorance around GHB that Jon experienced in rehab is not unique to a single health care provider or institution. It pervades the entire society.
“It’s called ‘generational forgetting,’” said Palamar, using a term coined by the social psychologist Lloyd Johnston. “One generation could be fully aware of the potential adverse effects of a drug, but then the next generation just doesn’t know.”
This “forgetting” may also contribute to the apparent rise in GHB use among gays and lesbians.
“In the gay community, people don’t tend to go out for a very long period of their lives,” said Guy Smith, producer of the popular gay Pines Party on New York’s Fire Island. “A gay generation in nightlife is about 10 years, so the conversation that people have about a drug in any particular place will only last that long. There is no conventional wisdom.”
Like Palamar, Smith came of age in New York nightlife at the turn of the millennium when GHB overdoses spiked. In recent years, Smith said, use of the drug has started peaking again.
Spurring this rise are industries, like online retail and social media, which came of age in that same timeframe and which therefore lack experience with the drug.
In such a lax environment, the front lines for addressing GHB abuse have shifted to unlikely places. Several nightclubs and parties, including Guy Smith’s events, now enforce a zero-tolerance policy on GHB. The move is not without its naysayers.
But Smith and Palamar stress that these policies save lives.
Both men witnessed GHB devastate New York nightlife when clubs ignored problematic drug use in the early 2000s. Young opponents of zero-tolerance policies, Palamar said, were “not around when people were dropping like flies” and “not there with all the deaths.” And he hopes they never will be.
Sex education may be starting too late to help young gay men, according to new research.
A study from Rutgers University, published in the Journal of Sex Research, highlights a disparity between young gay men and the straight population when it comes to the age at which people first engage in sexual behaviours.
Queer men become sexually active at an earlier age, researchers find.
Based on a sample of 600 young men who have sex with men, researchers found that on average, same-sex sexual encounters first happen at 14.5 years of age – before straight teens are typically sexual active. Queer men have their first experiences of penetrative sex at age 16 on average – one year earlier than their straight peers.
The researchers wrote: “We found that the mean age of same-sex sexual debut was between 14 and 15 years old, with mutual masturbation occurring earliest on average among this sample, followed by oral sex performed and received occurring at approximately age 15.
“Notably, we found that the debut of same-sex anal intercourse was approximately age 16, which is younger than the national mean of 17 for vaginal intercourse among heterosexual men in the United States.”
Queer Black and Hispanic men are also more likely to report an earlier age for the start of sexual activity.
Men who have sex with men are sexually active from an earlier age on average
The study, which includes only “self-identified consensual behaviours,” also found that approximately 19 per cent of young men who have sex with men indicated that their first sexual intercourse before age 13 – more than double the upper range of national estimates.
Caleb LoSchiavo, doctoral student at the Rutgers School of Public Health, said: “As many schools are forced to redesign their classrooms and curricula to accommodate socially distanced or remote learning for COVID-19, this may be the perfect time to consider implementing comprehensive sex education programming to provide age-appropriate sexual health education for people of all genders and sexual orientations.”
The research also concludes that providers working with young gay men of all ages should consider beginning routine testing for HIV and other sexually transmitted diseases at earlier ages than previously indicated, particularly among youth of colour.
Perry N Halkitis, dean of the Rutgers School of Public Health, said: “Our results suggest that health care providers can play an active role in mitigating sexual and health behaviours that are associated with the early onset of same-sex sexual behaviours; to date the medical profession is ill equipped to address the needs of LGBT+ people.”
Even as we move through the stages of reopening here in California, that won’t mean the risk of contracting COVID-19 disappears. Until we get a vaccine, every day will probably involve some type of risk weighing, so we asked a medical professional what the riskiest activities are right now.
Dr. Jahan Fahimi, emergency department medical director at UCSF, assessed the risk of some common activities (some of which aren’t even allowed yet in the Bay Area, though they could be soon), with the caveat that all situations will vary slightly in risk level based on time and the number of people involved. “The more people you’re with and the longer amount of time you’re with them, the riskier the behavior becomes,” Fahimi said. “That’s the best way to assess your risk.”
Going to a class at a gymFahimi called this the riskiest activity on the list, especially since it’s likely indoors in a small space. Not only is it difficult to maintain a strict six-foot distance apart from others in a gym studio, but it’s also very tough to wear a mask while exercising. “People are exerting themselves and as they do that they’re breathing faster and there is forced exhalation, which can spread droplets,” Fahimi said. “The six-foot rule is based on when someone coughs, but there’s now some evidence that the radius goes beyond that six feet in some instances.”Fahimi also said a gym is a high-risk place because of the number of surfaces you touch while in a gym, including both the equipment and in the locker room. “It’s summertime and there are plenty of outdoor ways to stay healthy.”Indoor barsWhen you’re eating and drinking, you’re unable to wear a mask, which makes bars a particularly risky endeavor. Couple that with poor ventilation and lowered inhibition and you could be at a higher risk of infection. “Bars are traditionally packed, people are close together and there is rarely good ventilation,” Fahimi said. “People are drinking things, they’re touching things. If people get intoxicated they get disinhibited and may get further lax from the guidelines. It’s just something we need to go without for now.”Large gatherings indoors at people’s houses“People might think ‘if I’m going to the house of someone I know it must be fine,’ but generally speaking if you do want to socialize with friends and family, just try and do it in an outdoor setting rather than indoors,” Fahimi said.The more people gathering, the higher the risk, he said, especially when people aren’t wearing a mask and are touching several surfaces. Even if you’re attending an outdoor gathering at someone’s house, Fahimi said to be careful when going to the bathroom inside and make sure you’re washing your hands. If you’re hosting the outdoor gathering, he recommends having hand sanitizer available to guests, wipe down surfaces often and even use disposable plates and utensils. Going to an amusement park“The problem with an amusement park is you’re taking people from all over and packing them in with other people from all over,” Fahimi said. “It wouldn’t take very many positive cases to cause a cluster and then these people go back to their homes and take the virus with them. It creates a hotspot for viruses to take off.”He said especially because we know there are so many asymptomatic cases, even doing temperature checks upon entry wouldn’t ease his fears of going to a crowded place like Disneyland.Churches“We’ve already seen a lot of cases of spread within churches, so while I think in troubling times it’s even more important that people have a faith-based outlet if that’s important to them if that’s going to put your health in jeopardy maybe there’s a better way to express that,” Fahimi said.He suggests sticking to virtual services if you can.
My phone buzzed the other day with a long missive from a friend to a group Facebook chat we share with my husband and his fiancé. Earlier in the day, he had invited me and my husband over for dinner at their apartment. In the spirit of social distancing, I responded by suggesting maybe we do something outdoors—perhaps a picnic or a walk in the park?
He was furious. He felt like we were avoiding their “COVID germs.” After a series of angry messages, he left the group chat—the digital equivalent of a gauntlet-drop.
I looked at my husband, speechless. Had COVID-19 just caused a different kind of loss, our friendship?
We all manage and respond to risk differently—and with varied emotions. Most of us are becoming well acquainted with the small daily frustrations of encountering people engaging in behaviors once considered perfectly normal but now labeled as risky: shopping for groceries without a mask, walking too closely to others, or coughing without covering your face. But as my friend made clear, we can also find frustration in others we believe are being overprotective or too risk-averse.
As a sociologist who has studied how gay men practice and manage HIV risk, I think a lot about the way diseases shape our behaviors, emotions, and, ultimately, our social worlds. HIV is fundamentally different from COVID-19 in that it cannot be transmitted through casual contact like handshakes or shared Uber rides. Nonetheless, in order to navigate HIV risk, we engage in a similar kind of mental calculus.
Some gay men think the risk of contracting the disease is well worth the potential pleasures of eschewing condoms with a one-night stand. Other gay men recoil at the thought, so wary of HIV that they meticulously practice condom use or even avoid casual sex altogether (indeed, that recoil can at times translate into shame projected onto anyone who doesn’t take the same precautions). As anyone who has spent time cruising for sex online knows well, clashing views on risk and pleasure can lead to plenty of hurt feelings and libidinous disappointment.
HIV and COVID-19 risk can both put distance between us, but the pleasures interrupted are of a different stripe. For HIV, we take risk in search of human connection and sexual pleasure. For COVID-19, even the most ordinary of behaviors have become suddenly risky: sharing a meal, taking a walk, going to a movie. Avoiding COVID-19 is forcing us to deprive ourselves of all the many pleasures of life, both sexual and platonic.
Our new marching orders for our now-COVID-ridden lives seems straightforward enough: avoid gatherings, wear masks in public, wash your hands vigorously. But for most of us, the truth is more complicated. We are faced with a social isolation that hurts. And the promise of connection is not trivial or superfluous: we crave it. We need it.
Whether we are aware of it or not, we’ve all been doing a sort of risk-calculus in our heads these last few weeks. Is it OK to take a walk with my friend? Do we need to wear masks? Should I say yes to the invitation from my parents to come stay with them for a long weekend? For those of us that are single, is dating even possible anymore?
A tipping point in those risk-equations we all have been making these last few weeks is coming. As the loss of human connection and intimacy takes an ever-greater emotional and psychological toll, the potential risk of contracting COVID-19 won’t be enough to keep us away from those we love. For some, especially those suffering from depression, isolation will become unbearable to the point of even becoming deadly.
As restrictions lift and we come out of our isolation, many of our phones will buzz with eager invitations from friends asking to get together and connect—for dinner, a walk, or to get coffee. But we won’t all be ready to take those risks at the same time.
Try not to take it personally. The truth is we are all aching from the pain of isolation. We miss you. And in the words of Queen Elizabeth, I long for the day that “we will meet again.”
Lyon-Martin Health Services in San Francisco has served the health needs of lesbians, transgender women and other underserved women in the Bay Area since 1979. Named after pioneering lesbian activists Phyllis Lyon and Del Martin, the clinic had until recently been seeing 3,000 patients a year for such needs as physical exams, gynecologic services and consultations for gender-affirming surgeries.
Now, however, it is fighting to keep its doors open amid the coronavirus pandemic. Thanks to emergency funding from the city and private donors, it will be able to operate until July 1 without deep cuts to its services — which now include screening for COVID-19 — but its future is uncertain after that.
“The city needs to see how long COVID is going to play out,” J.M. Jaffe, the transgender health manager at Lyon-Martin, told NBC News. “They wanted to do a short-term contract so that we could re-evaluate what the situation will be in two months. I think they were just wary to make a commitment to continue to support us, but we did get kind of like a wink and a nod that they would like to support us to the end of the calendar year.”
Lyon-Martin Health Services is one of over 200 LGBTQ health clinics across the United States that provide affirming and competent care to lesbian, gay, bisexual, transgender and queer patients. And like Lyon-Martin, a number of these centers are struggling to adjust to — and in some cases survive — the new normal spawned by the global pandemic.
‘A gap of a support network’
Approximately 13 percent lesbian, gay and bisexual individuals in the U.S. reported getting their regular health care from an LGBTQ-centered clinic, according to a 2019 study from UCLA’s Williams Institute. A separate study found nearly 40 percent of transgender people reported having been to an LGBTQ clinic in the previous five years.
“We provide services to a population that may not seek care elsewhere or even if they do seek it elsewhere, they may not get what they need,” Jaffe said.
Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, said if some of these clinics do not survive the pandemic, the void will be felt deeply, especially in areas of the country where LGBTQ people face high levels of discrimination.
“It leaves a gap of a support network, but also may not provide another opportunity or option in some communities to get nondiscriminatory care, which is a concern,” she told NBC News.
LGBTQ discrimination in health care is not uncommon. A 2018 studyfrom the liberal Center for American Progress found 8 percent of lesbian, gay, bisexual and queer people and 29 percent of transgender people reported that a doctor or health care provider had refused to see them because of their sexual orientation or gender identity. The study also found that 9 percent of LGBQ people and 21 percent of trans people reported having a health provider use harsh or abusive language when treating them.
The Callen-Lorde Community Health Center in New York City, the epicenter of the U.S. pandemic, is doing all it can to stay open and provide patient care amid stay-at-home orders and declining revenues.
The COVID-19 crisis has forced the center, which sees over 17,000 patients annually, to pivot to virtual health care and cut a number of services, leading revenues to plummet nearly 60 percent, according to Executive Director Wendy Stark. But with many of their patients not feeling comfortable seeking care elsewhere, Stark said she and her team are “being innovative” to stay open.
“We have lived through traumas and pandemics. We know how to take care of ourselves and each other.”
CALLEN-LORDE EXECUTIVE DIRECTOR WENDY STARK
Callen-Lorde is currently helping clients by providing a number of online services, including video visits for primary medical care, behavioral health and counseling, along with legal aid and insurance consultation services by phone. The center’s in-person services include appointments for those who do not have access to smartphones or internet connections, and those who are pre-authorized for in-person visits.
The clinic is also working to protect its own front-line workers, approximately 20 percent of whom contracted the coronavirus, according to Stark. She said regular floor nurses are now “acting as intensive care unit nurses,” and everyone’s “being stretched to their maximum clinical capacity” and “having to learn on the spot.”
“I’m sure, deeply rewarding but also deeply frightening,” she added.
While providing health services, Stark and her team are also applying for “every possible” relief fund or grant available to help make it through the crisis.
“We are shapeshifters,” she said. “We have lived through traumas and pandemics. We know how to take care of ourselves and each other.”
In Philadelphia, the Mazzoni Center, which typically sees over 7,500 patients a year, is also trying to adapt. This has meant a combination of limiting in-person appointments on a case-by-case basis, implementing and expanding its remote health care offerings and finding ways to continue as many community programs as possible online.
Larry Benjamin, a spokesperson for the center, said the clinic has had to furlough some staffers and reduce the hours of others to keep it viable “in the short term”.
The center is still allowing abbreviated in-person appointments for things like HIV services and gender-affirming care, but Benjamin said staffers have been careful to ensure “the risks associated with exposure to the coronavirus” from patients to staff and vice versa don’t outweigh the benefit of in-person visits. Behavioral health services, such as medication management, support groups and counseling services, are being offered exclusively online, as are counseling for COVID-19 stressors. Most community programs have also been moved online, but those that cater to the “most vulnerable clients” and their basic needs, like food and shelter, are still operating in-person, according to Benjamin.
Fenway Health in Boston.Courtesy of Fenway Health
Fenway Health in Boston, which saw 33,500 patients in 2019, has also seen a loss in revenue amid the pandemic, leading it to furlough some staffers and operate at an “unsustainable deficit,” according to Chris Viveiros, a spokesperson for the center. To help weather the storm, he said the center has increased its virtual offerings.
“Some medical patients have chosen to reschedule nonurgent appointments, but we have ramped up our medical telehealth capacity so that we can provide care remotely to patients who don’t require an in-person visit,” he said. “We have also moved our behavioral health and addiction and wellness care to telehealth.”
Fenway Health has also changed its Access Drug User Health program from being held in drop-in centers to having staff visit at-risk people in the community to limit contact.
There have been some drawbacks to Fenway’s remote health services: Some patients are sheltering in place with unsupportive people and have nowhere to privately participate in a video visit, while others may be skeptical of a new platform for accessing health services altogether.
“Many of our community served have a history of medical mistrust and ongoing mistrust of the health care system due to structural discrimination and victimization,” explained Dr. Alex Keuroghlian, director of the Fenway Institute’s National LGBT Health Education Center and Massachusetts General Hospital’s Psychiatry Gender Identity Program.
However, Keuroghlian said there have been some silver linings to Fenway’s new remote offerings. Primarily, many patients are able to access health care from the safety and comfort of their own home without having to venture outside, potentially exposing themselves to anti-LGBTQ abuse — or the coronavirus.
“By and large, I have found it has worked really well,” he said. “I’ve had almost no no-shows in my schedule, and patients are answering the phone very appreciative that we can give them care despite what’s happening.”
