The study included 2,981 mainly gay and bisexual men. Researchers published their results in the Journal of the American Medical Association.
They found there was an increased risk of acquiring an STI while on PrEP compared to before starting PrEP. But they also found there was no link between that increase and the rate of condom use.
Researchers found it ‘surprising’ that ‘condom use was not a significant predictor of acquiring an STI when using PrEP’.
So, why more STIs?
The study found that an increase in casual sex partners and group sex lead to the STI diagnoses. But also like previous studies found that more regular testing explained the increase in STI diagnoses. But results of the study also showed that about 25% of participants accounted for a majority of the diagnoses and that group experienced high rates of STIs.
‘It’s important to understand that when people start taking PrEP, they also get tested more frequently, so STIs are more likely to be detected anyway,’ said lead author, Burnet PhD student Michael Traeger.
He argued the study results should help better guide STI prevention campaigns for people who take PrEP. Those campaigns should not just focus on condom use, but also reducing the time to STI diagnosis through frequent testing.
‘But as PrEP uptake increases, identifying individuals most at risk of STIs will become increasingly important for informing effective and focused STI prevention,’ Traeger said.
End the PrEP backlash
PrEP sceptics often cite the increase risk of STIs while to criticize the medical treatment.
Associate Professor Edwina Wright argued the findings ‘are a rebuttal to the backlash against PrEP users for reducing condom use’.
Wright is the principal investigator of the PrEPX Study, an infectious diseases physician and clinical researcher. She is also the co-head of the HIV Elimination Program at Burnet Institute.
‘The findings are also important because they highlight the need to target our sexual health messaging about STI risks to a relatively small proportion of PrEP users to help reduce their STI rates,’ she said.
‘We need to address these findings by engaging in more research to prevent STIs including STI vaccines and antibiotics that may prevent STIs.’
Ahead of Pride Day 2019, ForLikeMinds.com (www.forlikeminds.com) is pleased to announce that it has launched the first online peer-based support community dedicated to mental illness and substance use conditions in the LGBTQ+ community. ForLikeMinds empowers members to connect and communicate one-on-one and in groups to support, inform, and inspire each other’s recovery from mental illness and substance use. Recovery is not a cure, but living a full and meaningful life with mental illness.
ForLikeMinds was inspired by the recovery journey of its founder Katherine Ponte, who was diagnosed with bipolar I disorder over 15 years ago. It also reflects the experiences of her spouse and main supporter. ForLikeMinds uses peer-based support, an evidence-based approach, to help people affected by mental illness and substance use overcome stigma and pursue recovery. ForLikeMinds is the only dedicated mental health platform tailored to the needs of both members living with a condition and their supporters. It allows people to anonymously connect one-on-one and in groups and create groups. ForLikeMinds offers this service for free to users who sign-up at its website.
Greater awareness of mental health and substance use issues in the LGBTQ community is of critical importance. According to the National Alliance on Mental Illness, in the general population, one in five adults have a condition, but LGBTQ individuals are almost 3 times more likely to experience a mental health condition, particularly depression or generalized anxiety disorder. The LGBTQ also reports higher rates of drug and alcohol abuse. An estimated 20-30% of LGBTQ people abuse substances, compared to about 9% of the general population, and 25% of LGBTQ people abuse alcohol, compared to 5-10% of the general population.
Disparities in the LGBTQ community stem from a variety of factors including social stigma, discrimination, prejudice, denial of civil and human rights, abuse, harassment, victimization, social exclusion, and family rejection.
Thoughtful examination of these circumstances and issues especially given the severity of the situation requires more than just an “LGBTQ+ umbrella” approach. According to The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding Report, “Lesbian, gay, bisexual, and transgender (LGBT) individuals experience unique health disparities. Although the acronym LGBT is used as an umbrella term, and the health needs of this community are often grouped together, each of these letters represents a distinct population with its own health concerns. Furthermore, among lesbians, gay men, bisexual men and women, and transgender people, there are subpopulations based on race, ethnicity, socioeconomic status, geographic location, age, and other factors.”
ForLikeMinds is the only mental health and substance use peer support community to thoughtfully consider this reality. While ForLikeMinds allows the broader LGBTQ+ community to connect, we also allow people to connect based on specific gender identities and sexual orientations. For example, a bisexual person can connect with a bisexual person, a trans man can connect with a trans man, etc. This allows for highly relatable exchanges.
Recent research shed a light on the alarming reality of bisexual service members and veterans.
According to MedicalXPress, US service members and veterans who identify as bisexual may be at higher risk for mental health issues than their gay, lesbian or straight peers.
Bisexual individuals represent the largest segment of the LGBTI community. Interestingly, both bi men and women are overrepresented among those who have served in the military, MedicalXPress further reports.
The research is led by Katie McNamara, a US Air Force captain and third-year doctoral student at the USC Suzanne Dworak-Peck School of Social Work.
McNamara has identified a lack in research covering bisexual vets.
‘There’s quite a bit of research on military and veteran mental health and LGBTI health, but very little that combines the two. And before this project, there was absolutely nothing specifically focusing on the sexual minority subgroup of bisexual military-affiliated individuals,’ she explained.
McNamara teamed up with professors Jeremy Goldbach, Sara Kintzle and Carl Castro of the USC Military and Veterans Programs, as well as Air Force clinical social worker Carrie Lucas, PhD.
In terms of active duty service members, 2% of men identify as gay and 2% identify as bisexual. As for women, 7% identify as lesbian and 9% identify as bisexual.
Research also shows bisexuals (28%) are less likely to be out than gay (71%) and lesbian (77%) soldiers. This means they are less likely to have a community of like-minded individuals and allies to rely upon.
McNamara believes there’s a connection between this lack of support and the mental health of bi vets.
Bisexual veterans, in fact, are 2.5 times more likely to suffer from severe depression. They are also 2.3 times more likely to suffer from PTSD than their straight peers.
Furthermore, bisexuals are also three times more likely to suffer from depression than their gay and lesbian peers. Research highlighted they’re nearly twice as likely to experience PTSD than gay and lesbian vets.
McNamara set out to conduct a thorough statistical analysis using a multi-city sample.
‘Even when I controlled for a wide range of specific demographic and military-related variables that might put some populations at higher risk for certain mental health issues, the results still indicated that bisexual veterans fare more poorly in terms of mental health outcomes,’ she said.
Sarah Spiegel, a third-year med student at New York Medical College, is pushing for more comprehensive LGBTI health training.
After being disappointed in the brief information about LGBTI health given to her in her first year of med school, Spiegel decided to make a change.
By her second year, she became president of the school’s LGBT Advocacy in Medicine Club. Spiegel and a group of peers approached the administration about the lack of LGBTI content in the curriculum.
According to Spiegel, the administration was ‘amazingly receptive’ to the idea. Thus, the school went from an hour and half of LGBTI-focused content to seven hours. Spiegel does not think this change would have happened had the school’s LGBTI group not pushed for it.
Spiegel went on to join The American Medical Student Association’s Gender and Sexuality Committee as the LGBTQ Advocacy Coordinator. Her job in this role was to bring curricular change to other medical schools in the New York area.
Numerous studies have shown that medical schools do a poor job of training future doctors to understand the LGBTI population’s unique health needs. This is especially true when it comes to transgender and intersex people. A 2017 survey of students at Boston University School of Medicine found their knowledge of transgender and intersex health to be less than LGB health.
However, LGBTI people, especially transgender individuals, face a disproportionately high rate of mental illness, HIV, and other intersecting issues. A poll conducted by NPR found that 1 in 5 LGBTI adults have avoided medical care out of fear of discrimination.
‘The health of disparity populations is something that really should be the focus of health profession students,’ Dr. Madeline Deutsch, an associate professor at the University of California, San Francisco, tells NPR.
‘Sexual and gender minorities have historically been not viewed as a key population. That’s unfortunate because of the size of the population, and because of the extent of the disparities that the population faces.’
While the amount of time medical students spend on LGBTI-related issues varies, a 2011 study found the median amount of time spent on the topic was a mere five hours. Topics most frequently addressed were safe sex, sexual orientation, and gender identity. However, topics like gender transitioning weren’t often spoken of.
‘There’s not really a consistent curriculum that exists around this content,’ says Deutsch.
Activists doing the work
But with activists like Sarah Spiegel, LGBTI health is being spoken about more and more.
‘We’re getting there, but it’s slow,’ Spiegel tells NPR.
Planned Parenthood, the 102-year-old organization providing sexual health care, is expanding their mission. The organization is introducing programs specifically for gay men and trans people.
Tell me more
For gay men, Planned Parenthood (PP) is now offering PrEP (pre-exposure prophylaxis). This is a type of regimented medication to prevent HIV infection.
‘We’ve just started doing PrEP fairly recently,’ Phebe Brandt, a Philadelphia-based Planned Parenthood clinician, told Philadelphia Gay News.
‘We do all the counseling around it,’ Brandt continues. ‘We do all the testing that’s necessary, we actually provide prescriptions. And if people don’t have insurance and need to go through the program through Gilead to pay for it, we facilitate the applications for that.’
Gilead
Brandt is referring to Gilead’s in-house program created to help uninsured people access these medications, despite the huge out-of-pocket cost. While Gilead, a pharmaceutical company, has come under fire in the past for their high drug costsand accusations of withholding safer drugs, Brandt had nothing but good things to say about this program.
‘Gilead is actually pretty great about helping people afford their drugs,’ she said. ‘They have a very good program for uninsured people. You have to know about it, of course. But you just have to fill out the application for it and you get a pretty quick approval.’
Trans programs
This new PrEP program at Planned Parenthood inspired another expansion — offering treatment to transgender people.
‘We started providing hormone therapy for trans folks over a year ago, the summer of 2017,’ Brandt explains. ‘We soon realized that we were doing a disservice to our patients. Because we realized that trans folks who have sex with men are at such high risk for acquiring HIV, it was a disservice to them to not offer PrEP.’
While these services are currently only available at Brandt’s PP location in the Norristown area of Philadelphia, she expects other locations will begin offering PrEP to trans people soon.
Brandt notes that this new PrEP program was not the first time PP has catered to the LGBTI community, specifically gay men.
‘We’ve always provided services for gay men,’ she stated. ‘We’ve always provided STD testing and treatment for many, many years [and] we’ve been providing HIV testing for as long as it’s been available. We offer rapid testing, too.’
Counseling & Education
But one of the most needed programs, which PP has introduced, is counseling, education, and clinical services to trans people beginning hormone therapy.
‘We have everybody on their first visit meet with a social worker,’ Brandt said of the process. ‘They make sure that the client is in a good place to be starting hormone therapy. Make sure that they’re safe and also go over with them what changes to expect and other things they need to know. Most clients are already very well-educated about all this before they come to us, but we have to be sure. It’s very rare for the social worker to say the client is not in a good place to start the therapy. But we want to check just to make sure that everything’s good for them.’
‘If everything checks out, if everything is good, we actually have the medication in house to get them started on the hormone therapy. So, once again, if somebody doesn’t have insurance, then we can provide the medication on a sliding-fee scale.’
‘We’ve always felt that, as an organization, it was very important to be open to everybody, and to give understanding and excellent care to just anybody that walks through our doors,’ Brandt said.
As it explains, the purpose of the report is to ‘identify potential gaps in attitudes, knowledge, and institutional practices toward LGBTQ patients’.
In order to complete their survey and find results, the authors took a random sample of 450 oncologists from 45 cancer centers from the American Medical Association’s Physician Masterfile.
Promsingly, a majority of the oncologists affirmed the importance of knowing their patients’ identities and receiving LGBTQ education.
Regarding identities, more believe it’s important to know a patient’s gender identity (65.8%) compared to sexual orientation (39.6%). A large majority (70.4%) expressed interest in receiving education specifically about LGBTQ patients.
Following the survey, however, confidence dropped among oncologists about their own knowledge.
53.1% said they were confident about LGB health needs and information before taking the survey. That number dropped to 38.9% after the survey.
The numbers were even lower about transgender knowledge (from 36.9% to 19.5%).
A promising fact is that a majority of these doctors (83%) feel comfortable treating trans patients, but only 37% felt like they know enough to actually do so.
‘With this research, we’re really interested in looking at how discrimination affects not only patient health but also how can we intervene at the provider level to have an impact on quality of care,’ one of the author’s, Megan Sutter, told CBS News.
Another author of the study, Gwendolyn Quinn, revealed some of the questions they asked the oncologists.
They asked the doctors if they knew the LGBTQ community is more likely to spend time in the sun, use tobacco, and have substance abuse. They also inquired if women who have never had sex with a man are still at risk for HPV.
‘The answer to these questions is that they’re true, but many of the doctors in the survey didn’t think that,’ Quinn said.
She continued: ‘It’s not a patient issue. We should not expect people who identify as LGBTQ to train us about what their needs are. It is our obligation as institutions and providers of care to figure out how we can best serve them.’
A new study suggests that 1 in 5 non-binary people in the U.S. are denied healthcare due to their gender identity.
The study, published in the New England Journal of Medicine in December, described a need for medical professionals to improve the care of non-binarypatients.
“As our society’s concept of gender evolves, so does the visibility of contemporary nonbinary people,” said researchers at the start of the paper.
“Yet many members of the medical community may not know how to interact with nonbinary patients respectfully or recognize their unique needs and barriers to care.”
The paper, Persons of Nonbinary Gender — Awareness, Visibility, and Health Disparities, states that 19 percent of non-binary patients were refused medical treatment because of their gender identity. In the past year, 22 percent of these individuals avoided medical care due to fears of discrimination.
“Our findings really highlight that there’s a lot of scepticism and hesitancy around nonbinary and gender nonconforming patients to engage with healthcare professionals,” said Walter Liszewski, MD, University of Minnesota Medical School Dermatology Resident and author of the article.
The research also identified how non-binary individuals were more likely to have higher rates of psychological stress, higher rates of domestic abuse, higher rates of poverty and higher rates of unemployment compared to patients who don’t identify as non-binary.
Liszewski suggested that the health disparities could be associated with the levels of discrimination faced by non-binary patients by medical professionals.
“The medical literature in the medical communities is not keeping up to date with society,” Liszewski said.
“My hope is that physicians who read the article will become aware of nonbinary patients, and realize we need to do a better job of allowing these individuals to access quality healthcare.”
Protesters rallied against the Trump administration’s comments on gender. (Chip Somodevilla/Getty)(Drew Angerer/Getty)
The study is released after legislation came into effect in New York City allowing residents to select a third gender on their birth certificates. California also recently adopted a self-ID gender recognition law allowing transgender and non-binary people in the state to update the gender listed on their state ID cards and driver’s licences.
Many medical forms still only provide male or female gender options, which can not only cause distress to non-binary patients but can also result in medical professionals misgendering them.
Despite this progress, the Trump administration announced in October it was considering re-defining gender as a “biological, immutable condition determined by genitalia at birth,” which led to protests from activists.
New analysis has confirmed that LGBT youth are far more likely to attempt suicide than other adolescents their age.
A report in JAMA Pediatrics collated data from 35 other studies. The studies included responses from 2.4 million heterosexual adolescents and 113,468 non-straight students aged between 12 and 20 from 10 countries.
Researchers told Thomson Reuters Foundation that LGBT youth struggle to come to terms with sexual and/or gender identity because of social stigma.
‘Adolescents facing “non-conventional” sexual identity are at risk of higher self-threatening behaviors, independent of bullying and other risk factors,’ said the study’s lead author, Dr. Ester di Giacomo from the University of Milano-Bicocca.
‘I think that a difficulty in self-acceptance and social stigmatization might be keys for understanding such elevation in the risk of self-threatening behaviors.’
Suicide was the second leading cause of death for all adolescents with the risks increased for LGBTI people.
This analysis helps get the ‘best estimates of the disparity of suicide risk due to sexual orientation’, according to Brian Mustanski.
He is the director of the Institute for Sexual and Gender Health and Well Being at Northwestern University’s Feinberg School of Medicine in Chicago.
Mutanski and his team researched LGBT youth for more than 10 years and welcomed the latest analysis.
‘We already knew (LGBT) teens were at risk, but this study gives a more precise estimate of that risk,’ he said.
But Mutanski stressed the importance of remembering not all LGBT youth are suicidal.
‘We read about this community being at risk, but there are plenty of LGBT teens who are happy and thriving and doing great,’ he said.
If you or someone you know needs mental health support please visit this list of global resources.
The National LGBT Cancer Network is the newest recipient of a $2.5 million five year award from Centers for Disease Control and Prevention to expand resources for their grantees serving LGBTQ people at risk for tobacco-related cancers.
“The LGBTQ communities smoke at rates significantly higher than other populations. That alone increases our cancer risks dramatically,” said Liz Margolies, the Executive Director of the National LGBT Cancer Network.
The Cancer Network’s new award will expand their NYC presence to Providence, RI, the base for their Principal Investigator, Dr. Scout. For more than a decade, Dr. Scout has led this CDC health priority at other agencies. He emphasizes that the next five years will bring a new vision for this work: “We are really looking to expand the online knowledgebase and toolbox for LGBTQ community members at risk for cancer, living with cancer, and policymakers serving us. Watch our website at www.cancer-network.org; each month we will be adding new resources, building a robust library of information and tools everyone can access.”
The CDC award leverages a trusted network of organizational members who specialize in tobacco-related cancers and/or serving LGBTQ people. The Cancer Network reports early membership commitments from a wide range of LGBTQ serving national organizations, including the Human Rights Campaign, the National LGBTQ Task Force, the Gay & Lesbian Medical Association, the Equality Federation, and more. Likewise, many states health departments and national health organizations have already signed on as members: American Cancer Society, The Truth Initiative, Association of State and Territorial Health Officers, and more. “The American Cancer Society has a longstanding commitment to addressing cancer in the LGBTQ communities. We are very excited about this new award and look forward to helping further reduce the cancer impact for this population,” said Tawana Thomas-Johnson, Vice President, Diversity and Inclusion at ACS.
Ms. Margolies added, “We are particularly excited to have members work with the state health departments, who collectively are the second largest health funder in the United States.”
The National LGBT Cancer Network works to improve the lives of LGBT cancer survivors and those at risk, through education, training, and advocacy. They recently created the most comprehensive LGBTQ cultural competency training program available, which has been used to train thousands people across the country to date. Learn more at www.cancer-network.org.
We don’t talk much about chlamydia, gonorrhea, or syphilis, in part because it can seem like they’re not big health issues anymore. But it turns out more and more Americans may be quietly suffering from these once nearly eliminated STDs.
According to a new report from the Centers for Disease Control and Prevention, there were nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis reported in the United States in 2017 — the highest cumulative number ever recorded, and one that surpassed a 2016 record high.
The leap in cases over the last few years are truly eye-popping. Between 2013 and 2017, the rate of:
Gonorrhea increased by 67 percent to 555,608 cases
Syphilis increased by 76 percent to 30,644 cases
Chlamydia increased by 22 percent to 1.7 million cases
To appreciate just how astonishing the trends are, consider that as recently as a decade ago, these STDs were at historic lows or near elimination, with more and better screening and diagnostics to help identify cases and get people into treatment.
Syphilis can show up on the body in sores and rashes. Gonorrhea and chlamydia can lurk with no symptoms. They’re all generally easy to cure with a timely antibiotics prescription, but when left untreated, they can lead to infertility or life-threatening health complications. That’s what makes screening and access to health care so important.
The increase in cases between across all three diseases was significant, and represents changing disease dynamics.“We are sliding backward,” said Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, in a statement. “It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point.”
African Americans and men who have sex with men have traditionally been the populations most plagued by gonorrhea and syphilis (and they’re still disproportionately affected). But other groups are now catching up too, especially women and babies in contracting syphilis.
So what’s behind the spread of these diseases here? There’s no single explanation. Like most health trends, it’s complicated. But here are a few ideas, according to experts:
1) There’s been a rise in condomless sex among men who have sex with men: Gay, bisexual, and other men who have sex with men are generally more at risk for STDs than women and men who have sex with women only. (The majority of new syphilis and gonorrhea cases occurred among men, and in particular, men who have sex with men.) And there’s been some concern about a shift toward riskier sexual behaviors in this group — like not wearing condoms — that may be contributing to the rise in STDs.
The reason for this shift has been explained by everything from the success in treating HIV (and therefore making sex less scary) to the advent of PrEP (pills that can prevent HIV). A systematic review published in the journal Clinical Infectious Diseases found that some PrEP users are having more risky sex — and are being diagnosed with more sexually transmitted infections.
HIV and syphilis are also interlinked: Some half of men diagnosed with a new syphilis infection also have HIV. And as these diseases spread in particular populations, like men who have sex with men, there’s a greater risk of them moving even further.
“The fear, which I share, is that we won’t contain syphilis among men who have sex with men,” Matthew Golden, director of the Public Health for the Seattle and King County HIV/STD control program, told Vox in 2017. “And if the epidemic in men who have sex with men gets big enough, which is what is happening, there are enough people who have sex with both men and women that it won’t be possible to contain it.”
2) STDs are spreading more broadly and into populations that weren’t traditionally affected — like babies: A 2017 CDC report on STDs in America showed that more women are getting syphilis these days, and they’re passing it to their babies. When an expectant mother is infected with the disease, and goes undiagnosed and untreated, the bacteria can get into her bloodstream and move through her placenta to her baby. Congenital syphilis is associated with serious health consequences, like stillbirths and neonatal deaths.
In 2016, there were 628 cases of congenital syphilis, an increase of 27.6 percent from 2015 — and that number includes 41 related deaths. According to the CDC, much of the rise was driven by increases in cases in the Western US. Between 2012 and 2016, Western states saw an astounding 366 percent rise in congenital syphilis.
The large increase has to do, in part, with the fact that many Western states have recently had few syphilis cases in women. “We were starting from almost nothing [in Washington],” said Golden. But that’s changing, and with more women getting the disease, their babies are at risk too.
Rates of reported cases of primary and secondary syphilis by state in the United States, 2016.CDC
3) With the rise of dating apps, sex is more readily available and more anonymous — and that makes it harder for health investigators to track outbreaks: Health experts increasingly view apps and sites such as Tinder, Grindr, and OkCupid as enablers of high-risk sex, helping people meet and hook up more efficiently than ever before. The impact of these sites is so profound they are also transforming the way health officials track and prevent outbreaks.
“We used to think about what we can do with bathhouses and sex clubs to make sure people’s risk was reduced,” said Dan Wohlfeiler, director of Building Healthy Online Communities, a public health group that works with apps to support STI prevention, told Vox in 2017. These places, after all, had become important meeting points for men who have sex with men — the group most affected by the HIV epidemic.
Today, the public health focus has shifted to “digital bathhouses.” Wohlfeiler said, “Now that dating sites and apps have become so common, we know we need to work with them.”
But many of the major dating networks don’t want to be involved in STD prevention, nor have they acknowledged the impact they’re having on public health, health experts told Vox.
4) The numbers may be higher because we may be better at detecting cases in some groups: The rise in chlamydia — which overwhelmingly causes no symptoms but can lead to infertility in women — may be an artifact of better detection and screening. The CDC keeps finding that rates of chlamydia are highest among young women, the group that’s been targeted for routine chlamydia screening. So an increase could just mean more testing.
5) Cuts to public health funding mean fewer STD clinics: Public health in the US — which includes operating STD clinics where people can get tested and into treatment — is historically underfunded. (As of 2012, only 3 percent of the health budget went to public health measures; the rest went mostly to personal health care.) And since the global financial crisis, public health funding has really taken a battering. There are 50,000 fewer public health jobs since 2008, and many STD clinics have had to reduce their hours or shut down.
STD clinics were a traditional safety net for people with these diseases. If those clinics continue to be harder to reach or vanish, finding and treating STDs will become even more difficult — and the diseases will continue to spread.
So in some ways, the STD increases across the country may have less to do with a changing sexual landscape, and more to do with more limited access to sexual health care. With Trump’s proposed public health budget cuts, the problem may be poised to get worse.
“It’s not a coincidence STDs are skyrocketing — state and local STD programs are working with effectively half the budget they had in the early 2000s,” said David Harvey, executive director of the National Coalition of STD Directors, in a statement today. “If our representatives are serious about protecting American lives, they will provide adequate funding to address this crisis. Right now, our STD prevention engine is running on fumes.”
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