The LGBT Foundation said there has been a recent rise in cases of shigella among men who have sex with men.
Shigellosis, or shigella, is an intestinal infection caused when bacteria found in poo gets into your mouth.
Last month, health officials in San Diego issued an advisory over the sexual transmitted infection. It said that gay and bisexual men, homeless individuals, and people with compromised immune systems could be at an increased risk for the intestinal disease.
In 2017, San Diego recorded the highest number of cases in 20 years, including a disproportional increase in the gay and bisexual community and among the homeless population.
How do you get it?
Shigella can be caught from rimming, oral sex, or putting your fingers in your mouth after handling used condoms, douches or sex toys, the LGBT Foundation says.
Signs of infection include having an upset stomach, fever, stomach ache, and diarrhoea which might have blood in it.
These symptoms can last for around a week. Shigella is closely related to the E.coli bacteria.
Disease and infections magazine outbreaknewstoday.com reported that the number of cases typically increases in the late summer and fall.
How to lower risk of shigella infection
The LGBT Foundation says you can lower your risk of infection by washing your hands, bum and genitals after sex.
You could also use dental dams, condoms, and fisting gloves to protect you when having oral sex, fisting, and fingering.
It is also recommended that you change condoms between partners, and between anal and oral sex, whether they’re on a penis, hands, or sex toys.
Hygiene as prevention: Wash often and don’t re-use condoms. Photo: Mark Johnson
Shigella treatment
Shigella is treated with a course of antibiotics, the Foundation says. However, the US Centers for Disease Control and Prevention warned last month of an increasing number of antibiotic-resistant shigella infections.
If you think you have shigella, go to a sexual health (GUM) clinic or your GP and explain your symptoms. You may also want to say that you think you may have picked up an infection from sex.
A new report by Human Rights Watch (HRW) has revealed the state of accessing healthcare for LGBT people in the United States.
The research indicates that queer and trans populations encounter significant barriers, including facing discrimination from insurers or providers and long waiting lists for specialist services.
Additionally, the report found that LGBT people have restricted options when facing prejudice as there isn’t federal legislation which prohibits healthcare discrimination based on sexual orientation or gender identity.The majority of the 81 interviewees told HRW that they had little or no access to LGBT-friendly healthcare providers in their area.
The head of one community center in rural Michigan said: “I do not know of any trans-affirming healthcare providers in the area. And I’ve talked to many trans people in the area.”
Some interviewees described driving two hours to attend a support group for gender-expansive youth, and others travelling two hours to attend therapy or meet with a trans-affirming doctor.
Other findings revealed some interviewees knew of very few providers in their areas who would prescribe PrEP, a medication that significantly lowers the risk of HIV infection by preventing HIV from taking hold in the body.
A psychologist in Knoxville, Tennessee, explained: “There are only two providers who’ll prescribe it—in a community this large. And the doctor we like, we overload him—we’re like, you have one option, and if you don’t have insurance, you’re pooched, because he’s expensive.”
While in Memphis, Tennessee, a healthcare provider similarly said that, in a city of a million people, the hospital they worked with was aware of three doctors who would handle PrEP referrals.
The report also highlighted struggles for same-sex couples looking for reproductive health providers.
A lesbian woman in Mississippi recalled that, when she and her wife sought a fertility doctor in 2012, they were unable to find options in their area and contacted a clinic in Alabama. When that clinic informed the couple that they only treated heterosexual, married couples, they did not find an LGBT-friendly provider for a year.
The report primarily focused on LGBT people living in Mississippi and Tennessee, two of the states where statewide antidiscrimination protections do not prohibit discrimination based on sexual orientation and gender identity and where lawmakers have recently enacted exemptions permitting some providers to refuse service to LGBT people because of their religious or moral beliefs.
A new study has suggested that the legalisation of same-sex marriage in the US has improved the health of gay men.
The latest research – by professors at Vanderbilt University – found that equal marriage had led to increased health insurance coverage and better access to health care for men living in same-sex households.
The study revealed that gay marriage “increased the probability” of a man in a same-sex household having health insurance by 4 percent.
These men, it found, since equal marriage became law in the US, were 4 percent more likely to have a “usual source” of healthcare, and 7 percent more likely to have had a health check-up in the past year.The new research, distributed by the National Bureau of Economic Research, did not ask respondents about their sexual orientation – but instead researchers calculated an estimate for number the number of gay or bisexual men and women living in same-sex households with one other adult.
They found that one in ten women and four in 10 men in these same-sex households were not likely to be heterosexual.
The academics then looked at the changes in health insurance and and healthcare for these people, following the legalisation of equal marriage in the US in June 2015.
Still, the results did not find that the impact of gay marriage was notable for women. Researchers pointed to deficiencies in their statistics as an explanation for this.
They said that women were more likely than men to have children from previous relationships – making them more likely to travel to another state where same-sex marriage was legal, before it became law in all the US states.
The researchers said their data did not record this prior residences or the location of same-sex marriages.
However, researchers pointed to previous studies that concluded that the legalisation of equal marriage had had a positive impact on the health of lesbian and bisexual women.
For both men and women in same-sex households, the new study revealed that gay marriage did not affect the rates of substance use and preventative health care.
The findings support the the results from previous research into the impact of equal marriage on gay couples.
In 2012, another study in Massachusetts, focusing on gay and bisexual men in same-sex marriages, revealed that same-sex marriage decreased their need to visit the doctor, and resulted in lower health-care costs.
Pierre-Cédric Crouch, nursing director of the sexual health clinic Magnet at San Francisco AIDS Foundation, said that this method “has some promise,” but that it’s definitely not a perfect solution and that more research is needed on the effectiveness of STI prophylaxis before it can be recommended.
Pierre-Cédric Crouch, PhD, ANP-BC
“Syphilis can cause a lot of harm and anything to help reduce the increasing rates would be helpful,” he said. “We don’t know the impact this would have on drug resistance and I would be concerned people would get complacent and not get tested for STIs as often. Gonorrhea is not covered by this strategy so it’s definitely not perfect. If someone came in to the clinic asking for it, I would counsel that this is still being studied and we would need more data before STI PEP [post-exposure prophylaxis] can be recommended.”
Jared Baeten, MD, PhD, director of the Center for AIDS Research at the University of Washington shared a similar view. “I absolutely would at least consider prescribing now, but I’d love to see some strong science to help me know if I should set aside my reasons to give pause. There isn’t a perfectly right answer right now.”
Keith Henry, MD, from Hennepin County Medical Center shared a more conservative view. “I don’t think prophylactic doxycycline is ready for prime time. Regularly testing for all STDs every three months and treatment for STDs diagnosed is my recommendation for sexually active men [who do not use condoms].”
Jeffrey Klausner, MD, MPH, who has conducted research on STI prevention with doxycycline, views this strategy as appropriate on a case-by-case basis.
Jeffrey Klausner, MD, MPH
“I have a few patients who are using doxycycline in addition to PrEP,” he said. “On an individual level, this method of STI prevention might be right for someone, for instance, who has had syphilis twice, and doesn’t want to get it again,” said Klausner.
For people interested in this method of STI prevention, Klausner said he encourages people to talk to their health care providers. “I’ve talked about this with other providers in urban areas,” said Klausner. “Doctors understand there is a role for this, and see it as an opportunity for select patients.”
What are the pros and cons?
Baeten counted four reasons to consider prescribing doxycycline to someone at high risk of STIs (e.g., a person with a history of STIs and frequent condomless sex). Namely, that STI rates are on the rise among men who have sex with men in the U.S. (with rates as high as 25-50% each year among people taking PrEP in research studies); evidence that doxycycline prophylaxis works to prevent chlamydia and syphilis; the opportunity to synergistically deliver STI prevention with PrEP; and, the fact that—other than condoms—there are not many effective ways to prevent STIs.
“If you’re a sexually active—if you have multiple partners in a given week, if you’re in a situation where you enjoy group sex, if you visit sex clubs, this could be a real solution for you,” said Klausner. “Obviously, it should be used in addition to condoms, but condoms don’t work for some people for various reasons.”
Baeten also counted four “reasons to pause” in using antibiotics to try to prevent STIs. First, he said that “it isn’t totally clear if prophylaxis is that much more beneficial than frequent screening and treatment.” It would be a waste of resources to prophylactically treat everyone for STIs, if increased screening and treatment are as effective in curbing new infections. Pill fatigue is another concern, as is drug resistance.
Jared Baeten, MD (Photo: Liz Highleyman)
“There’s legitimate concern that regular use of an antibiotic can result in resistance developing to that antibiotic—in this case, resistance to doxycycline and related antibiotics, for STI organisms and potentially for other bacteria that live naturally in our bodies and occasionally cause disease. The type of bacteria that causes gonorrhea already is often resistant to many antibiotics, including doxycycline, when it once was not, for example,” said Baeten.
“Everyone raises concerns about drug resistance,” said Klausner. “In some ways it’s a non-conversation when you talk about gonorrhea because we haven’t used tetracycline or doxycycline to treat gonorrhea since the mid-1980s, and it’s already resistant. The amount of tetracyclines that would be introduced by the increasing use of this practice and into the whole population—who already exposed to massive amounts of tetracyclines in the food industry, human health, acne treatments, malaria prophylaxis—is actually miniscule. I don’t think it would have a substantial impact.”
The research on STI chemoprophylaxis
Two studies with men who have sex with men have evaluated the efficacy of doxycycline to prevent sexually transmitted infections.
The first study, published in Sexually Transmitted Diseases by R. K. Bolan and colleagues, found that HIV-positive men who have sex with men who took 100 mg of doxycycline daily reduced the risk of contracting syphilis, chlamydia or gonorrhea during the study by 70%.
A total of 30 men were randomized to either take the antibiotic for 36 weeks or not. At each study visit (at baseline, 12-, 24-, 36- and 48-weeks post-baseline) participants received rectal and urine gonorrhea and chlamydia tests, a pharyngeal (throat) gonorrhea test, and a syphilis blood test.
During the study, there were 15 cases of any STI (gonorrhea, chlamydia and syphilis) among men not taking the antibiotic, compared to six cases of STIs among men taking doxycycline. This translated into a risk reduction of 70%.
The second study, published in Lancet Infectious Diseases, tested whether doxycycline prevented STIs in HIV-negative MSM taking PrEP. In this study, 232 participants were randomized to take 200 mg of doxycycline “on demand” (within 72 hours of having sex), or to not take an antibiotic.
A total of 73 participants presented with a new STI during the study period, 45 in the no-antibiotic group and 28 who were taking doxycycline. This translated into a risk reduction of 47%, with the antibiotic significantly reducing the number of chlamydia and syphilis infections (but having no effect on the number of gonorrhea infections).
The take-away
Overall, the clinicians who shared their thoughts with BETA recognized the potential benefits—to individuals and on a population level—of allowing people to take doxycycline preventatively to treat STIs, but were acutely aware of the issues raised by this approach as well.
Although STI prophylaxis is not (and may not ever be) a strategy that health care providers recommend for people to reduce their risk of STIs, there are a number of things you can do if you’re concerned about STIs.
What comes to mind when you hear the term “harm reduction”? Many people in public health or in the community may think of needle exchanges or safer sex practices. PrEP can be a form of harm reduction, since it can allow you to enjoy the sex you want to have while at the same time reducing the harms that can come from condomless sex.
Damon Jacobs, LMFT
Because I’m an advocate for the health of people in the LGBTQ community, I’m also concerned by harm coming from something else in our community: tobacco. Did you know that LGBTQ people smoke at a higher rate than heterosexual people, and people living with HIV smoke at rates two to three times higher?
I probably don’t have to tell you that smoking tobacco causes many kinds of cancers and health problems. Interestingly, it’s the tobacco—and not nicotine—that is the source of those health concerns. Which means that other forms of nicotine-delivery agents, like vaping products and e-cigarettes, can be better for your health (harm reduction!) if they’re used instead of cigarettes.
What do e-cigarettes have to do with public health?
E-cigarettes are battery-operated devices that deliver nicotine to users in heated liquid vapors instead of smoke. After hitting the market in 2006, they became quite popular among consumers because they satisfy nicotine cravings without delivering the toxic carcinogens and combustibles found in tobacco that are known to cause so much damage. Although e-cigarettes are not completely harmless (there have been cases of burns and poisonings), there is no tobacco in vaping products.
We can think of vaping as a form of harm reduction—a practical public health philosophy that, at its heart, empowers people to reduce potential harms from sex, drugs or other substances without requiring abstinence. Vaping gives people the drug—nicotine—without the carcinogens and tobacco found in cigarettes.
For the same reasons that we encourage people who inject drugs to use sterile needles and other clean injection equipment—and provide people with those supplies freely—we can recognize that people may want the option to use vaping products to quit or reduce harm from nicotine addiction.
The problem I have with San Francisco’s Proposition E
On June 5, 2018, voters in San Francisco will vote on Proposition E which stands to ban the sale of flavored tobacco products, including products like menthol cigarettes and cigarillos, as a strategy to prevent “Big Tobacco” from appealing to children and hooking new users.
To be clear, I’m not against policy changes that may prevent people from starting to smoke or help people reduce the amount they smoke. I’m well aware of the devastating impact that tobacco is having on my community. But there’s a stunning flaw in this proposed ordinance that compels me to speak out against it: The ordinance lumps in e-cigarettes as a flavored tobacco product that would be forbidden from sale.
Proponents of the ordinance argue that tobacco companies have unfairly targeted LGBTQ adults, communities of color and children with flavored products. They say that children must be protected from the dangers of smoking. They want to stop new people from starting to smoke. Yes, I agree! But are there ways to do this without blocking a method of harm reduction from people who already smoke?
I take issue with denying adults, who already consume nicotine, the opportunity to use harm-reduction tools to do so.
Let’s be real. Quitting smoking cigarettes is DIFFICULT. Only about 6% of adults can successfully quit smoking, although about 70% report wanting to quit. The drug in cigarettes, nicotine, is highly addictive. For those people who are using electronic cigarettes as an alternative to smoking—what happens if the product is taken off the shelf?
San Francisco can proudly call itself a leader in providing harm reduction tools for its communities. Volunteer groups in the late 1980s were one of the nation’s first to successfully use needle exchange programs to prevent HIV. More recently, the city’s Getting to Zero consortium has committed to being the first to reach zero new HIV infections, with PrEP and treatment as prevention being critical strategies to reach this goal. These groundbreaking approaches share the common approach of harm reduction—meeting adults where they are to offer interventions that improve health and quality of life. The proposed ordinance runs counter to these harm reduction approaches.
E-cigarettes do need to be regulated and prevented from getting into the hands of children, but banning all flavored vaping products for adults just doesn’t make sense. It is quite possible to prevent nicotine addiction in children and help adults stay alive at the same time. I ask people to use science, logic, and compassion when going to the polls on June 5th.
The opinions expressed in this article are those of the author alone. They do not reflect the opinions or positions of BETA or of San Francisco AIDS Foundation. BETA serves as a resource on new developments in HIV prevention and treatment, strategies for living well with HIV, and gay men’s health issues. Our goal is to inform, empower, and inspire conversation.
With affordable, highly-effective hepatitis C (HCV) direct acting antiretroviral medications now available, innovative programs in San Francisco are reaching people who inject drugs with hepatitis C cure support and treatment. Clinicians and advocates who recognize the benefit of treating everyone with hepatitis C—regardless of their substance use—are advocating for a non-judgmental approach to this deadly infection.
Pierre-Cédric Crouch, PhD, ANP-BC
“We recently expanded our hepatitis C treatment program to the 6th Street Harm Reduction Center, which primarily serve people who are homeless or marginally housed, and who use substances including injection drugs,” said Pierre-Cedric Crouch, PhD, ANP-BC, nursing director of San Francisco AIDS Foundation.
“We are one of the only centers in the U.S. who are prioritizing people who use substances in hepatitis C treatment work. We’re proving that this approach works and that it’s helping the right people who need access to hepatitis C medications.”
“If we want to make a dent in this epidemic, you have to treat people who are actively injecting drugs,” said Annie Luetkemeyer, MD, from University of California San Francisco, at a recent HIV grand rounds at San Francisco General Hospital. “If you want to avoid new cases, you’re going to double the reduction in hepatitis C cases averted if you treat PWID [people who inject drugs] as opposed to just focusing on non-PWID.”
With these comments, Luetkemeyer addressed the resistance that some providers may have about treating people who are at risk for re-infection (through injection drug use) or who have difficult lives that may stand in the way of adherence (for instance, because they are homeless).
Erica*, a 22-year old from San Francisco, is one person who has been cured of hepatitis C through the San Francisco AIDS Foundation program at the 6th Street Harm Reduction Center.
“It was like I had the whole healthcare system behind me—all I had to do was show up to my appointments. Nobody judged me when I relapsed. I was still able to take the meds. Sometimes you relapse, but you still want to be cured of hep C. I think that’s very important that you can still be using and still get the meds,” she said.
There are likely three to four million people in the U.S. living with chronic hepatitis C, with about 34,000 new hepatitis C infections occurring every year. Hepatitis C kills more people in the U.S. than any other infectious disease that is reported to the CDC (including HIV). In 2015, nearly 20,000 people dying from hepatitis C-related causes. Most people living with hepatitis C have been infected through injection drug use (this blood-borne virus can live in needles and syringes but also on other equipment like drug cookers and filters).
In San Francisco, the End Hep C SF initiative estimates that there are 12,000 people with active hepatitis C virus in their bodies. These are people who are able to transmit hepatitis C to other people and who would benefit from treatment.
End Hep C SF recommends that you talk to your medical provider about testing for hepatitis C (HCV) if you have ever injected drugs, are a man who has sex with men, are a trans woman, or were born between 1945 – 1965.
New hepatitis C medications can lead to a cure with eight weeks of treatment, and are now priced more affordably for patients and health plans. Yet barriers stand in the way for people who use drugs which may prevent them from accessing hepatitis C medications and care.
What keeps people who use drugs from getting cured of hepatitis C?
Katie Burk, MPH, viral hepatitis coordinator for the San Francisco Department of Public Health, said that there are a variety of factors that can stand in the way of people accessing hepatitis C treatment.
People who have unstable lives—because of substance use but also from things like homelessness—can make accessing any kind of medical care seem out of reach.
“If you don’t have the basic necessities of life secured, it’s hard to take on any new goal or health intervention,” said Burk. “If you’re homeless, it’s difficult to make appointments or hold on to medications. It’s difficult to work on any goal besides your immediate survival, because you’re just figuring out where to eat and a place to sleep.”
On top of that, health systems barriers may prevent people who want to access treatment from actually being able to do so.
“Our systems aren’t really designed to accommodate the needs of people who need our services the most,” said Burk. “There are all these bureaucratic and logistical barriers inherent in traditional medical care. Maybe somebody is ready to see a doctor, but they can’t get an appointment for a couple of weeks. If folks are actually ready to take medication, they might have to go through a lot of time-consuming hoops in order to get them. Re-establishing insurance in a particular setting can be difficult for people who may be homeless and moving frequently from county to county.”
Burk also said that people who use substances oftentimes have “tenuous relationships” with the medical system. If people have been mistreated, stigmatized or dismissed by medical providers it he past, they may be less willing to seek treatment for hepatitis C even if it is available to them.
How can we make hepatitis C treatment accessible to people who use drugs?
Innovative programs in San Francisco are finding ways to bridge the gap between people who use substance and hepatitis C treatment—making cure regimens more accessible than ever before. Meeting people where they already are is one strategy being used to reach more people with medications and care.
“There are so many people who we would love to go to primary care, but it’s just not going to happen right now,” said Burk. “They won’t or can’t go consistently. But there are places in our system where they may be meaningfully engaged. It might not be where hepatitis C treatment has traditionally been offered, but if we can bring treatment to those places, then we have opportunities to treat folks where they’re already showing up. In San Francisco we’re developing treatment models in drug treatment programs, syringe access programs, sexual health clinics, and homeless shelters to meet these needs.”
With the right support, people living with hepatitis C who still use substances and who may also be experiencing homelessness do well in hepatitis C cure programs.
Although re-infection is a risk for people who use IV drugs, the rate of reinfection is relatively low (between 1 – 2%), and worry over re-infection shouldn’t prevent people from being able to access hepatitis C medications, said Luetkemeyer.
At San Francisco AIDS Foundation, 24 people have started hepatitis C medication through the Hepatitis C Wellness Program, with 11 people who have completed treatment. The program, which began in July 2017, enrolls clients at the 6th Street Harm Reduction Center, which serves high-needs clients accessing harm reduction and safer drug use supplies.
“Everyone who has reached week four has been fully suppressed, which shows that the program is working well,” said Crouch. “Many people we see are homeless and out of medical care. We’re treating people who would never get treated for hepatitis C otherwise. There are a very small number of people doing hepatitis C cure programs at syringe access sites, but this is absolutely the right place to meet people who need access to treatment.”
In addition to access to hepatitis C medications, people enrolled in the program meet once a week with Pauli Gray, hepatitis C program coordinator for San Francisco AIDS Foundation, to share breakfast and health and wellness information. On-site lockers are available to hold people’s medications, to eliminate the risk that people’s medications get stolen or lost.
Gray said that in addition to being cured of hepatitis C, clients have used the meetings to work on other goals related to health and well-being.
“I set a goal with each client early in the process, and stay in constant touch with them. Almost everyone makes a goal and meets it. We’ve seen people who have already been able to do things like find housing, stop or reduce their substance use, and re-connect with their children. Getting cured changes the trajectories of people’s lives. The efficacy of it is amazing. It shows them that life can be different. They feel so much better—usually very quickly—and get excited at being able to do things they couldn’t before,” said Gray.
“Pauli told me that he would help me do everything,” said Erica. “He made appointments for me, he told me when to show up. He made it so easy for me. At the beginning, I was in [drug] treatment, so it was really easy for me to get to my appointments. At the end, I started relapsing, but Pauli went out of his way to make sure I was still taking my meds.”
Erica’s* story
Erica found out she had hepatitis C when she was 18, and undergoing chemotherapy for uterine cancer. She contracted HCV from IV drug use with her then-boyfriend, who didn’t reveal to Erica that he had HCV.
“I was living in Sacramento at the time, and tried to get into treatment. But I wasn’t ready,” she said.
So Erica moved back to San Francisco, and spent two years without housing—living in a tent under an overpass. She quit heroin to finish chemotherapy, and then relapsed when her cancer treatment ended.
She connected with Gray at the 6th Street Harm Reduction Center when she was accessing safer drug use supplies, and sought help for an abusive relationship.
“He didn’t pressure me with the hepatitis C treatment right away,” she said. “He was just like, ‘let’s get you safe and stable, and then we’ll go from there.’ Pauli helped me reconnect with my mom, and he also helped get me into [drug] treatment.”
About a year ago, Erica decided she was ready to pursue hepatitis C treatment.
Gray set up the medical appointments, helped her access the three-month course of treatment for free, and checked in on Erica daily. When Erica started using again, Gray continued to check in on her and make sure she continued to take her medication. Erica attended the weekly support groups at the 6th Street Harm Reduction Center, and received individual counseling and support as well.
In July, Erica finished the course of medication, and found out that she was cured of HCV.
“I noticed that I have way more energy now. For [the medication] to be free, that was huge. I’m so young. I was so worried that this would affect my long-term health. So for me to have it treated so quickly was amazing.”
The 6th Street Harm Reduction Center offers syringe access and disposal, overdose prevention and naloxone, counseling, suboxone treatment, walk-in medical care, hepatitis C treatment. Visit Monday – Friday, 9 am – 5 pm, and Saturdays 7 pm – 11 pm at 117 6th Street at Mission Street in San Francisco.
LGBT people are eight times more likely to be targeted by revenge porn, a study has revealed.
One in 25 Americans have either been threatened with or made the victim of revenge porn, but this includes just two percent of straight people.
On the other hand, a huge 17 percent of LGBT people have been targeted with threats or actual posts of pornographic images or videos of them which they did not consent to being online.
Amanda Lenhart, one of the report’s authors, said that the study – conducted by the Data & Society Research Institute and the Centre for Innovative Public Health Research – was crucial.
“Nonconsensual pornography can have a devastating and lasting impact on victims, so it’s vital that we understand how common this is and who is affected,” she said.
The news comes as YouPorn releases a powerful video to combat the dangerous phenomenon.
(Pexels)
In association with women’s rights organisation the Danish Women’s Society, the porn site has created a video which looks like an adult film – and that’s exactly the point.
The video, called “Ex doesn’t know I put this online!”, features a woman stripping while her boyfriend films her.
He asks her to take her trousers off, but she tells him: “I don’t like that you’re filming this.”
The faceless man asks why, to which she responds: “I’m just afraid that someone is going to see it.”
He reassures her, lying to her face until she smiles and goes along with his request.
But when she has removed her trousers, she straightens up, looks straight into the camera, and asks: “What the f**k do you think you’re doing?”
Shocked, he asks who she’s talking to, to which she replies: “I’m talking to the person who’s watching this.
“You know this is revenge porn, right? You saw the title of the video. You heard what my boyfriend just said – that no-one would see this.
Seething with completely justified anger, she continues: “What the f**k are you doing?
“You know I’m a human being, right? That I have feelings?
“Can you imagine what I’m going through, what victims of revenge porn go through every single day, and you are just sitting there watching this? Sharing this?
“You don’t even care. F**k you!”
She ends with the sobering fact that “victims of revenge porn, they suffer anxiety, they go through depression, and some have even killed themselves.”
Signe Vahlun, vice president of the Danish Women’s Society, said: “For the last year we have talked to victims and have come to understand how damaging being the victim can be.
“For several people, this literally destroys their lives. In order to avoid this, we need to put focus on the problem.
“The fact that YouPorn agrees with us on this issue and wanted to partner together to launch this campaign sends a clear message that revenge porn has to be stopped,” she added.
In the midst of a national opioid crisis, are gay men partying cleaner?
While this might seem like the conclusion of a new study by two Manchester Metropolitan University criminology employees, Drs. Rob Ralphs and Paul Gray, the actual data points to a less optimistic outcome.
Gray and Ralphs’ study, taking place over a period of six months, involved interviews with over 50 drug users and 30 staff members at Mancunian clinics and treatment centers.
What its findings showed was an overwhelming preference among gay males for trendier chemsex drugs and synthetic cannabinoids, such as the drug “spice,” resulting in a significant dip in crack, heroin, and ecstasy usage.
Although gay men are going for a more complicated high through the pursuit of drugs associated with luxury and expense, this doesn’t translate to a reduction in terms of dangerous drug use. Crystal meth is still popular via injection, or “slamming,” as well as other “party” drugs offering hallucinogenic or psychedelic effects. What Ralphs and Gray’s study shows is that these men are using their preference for luxury drugs as a reason to stay away from traditional clinics and treatment centers due to stigma and preconceived notions about treatment courses.
“Despite complex and often interrelated needs, it was apparent that users of Spice and chemsex substances had a lack of knowledge of existing service provision and, perhaps most concerning, outdated views and perceptions of who treatment services are targeted at and what services could offer,” Dr. Ralphs stated.
The study is interesting in light of West Hollywood’s own decision to legalize recreational marijuana use, potentially leading denizens of the city’s overwhelmingly gay male population to seek out legal highs in favor of synthetic ones. Amidst the criticism surrounding West Hollywood’s new “party city” reputation, there’s a streak of concern for how its gay male citizens will cope with newer, more experimental drugs like “Spice” coming on the scene. Although the idea of marijuana as a gateway drug is outdated and widely disproven, the sense of a city without limits could create new interactions between West Hollywood’s LGBTQ+ community and the chemsex drug wave. New research on why gay men pursue chemsex drugs was recently published in the academic journal “Cultural Studies,” pointing overwhelmingly to a sense of loneliness and isolation among the study’s London-based participants.
“I was feeling really lonely. I was looking for company. I was really depressed living in London…you don’t have friends, you don’t have family,” said one of the interviewees. “You’re living in a big city…you have the weekend to yourself and you don’t know what to do.”
Another participant in the study noted: “In a way, you’re enjoying a private club…everyone thinks the same as you think. You don’t have to worry about anything because you’re going to be in an environment where you feel safe and whatever you do, whatever you think, whatever you say you’ll be very much accepted.”
Drs. Ralphs and Gray’s study points, more than anything else, to a division of class and wealth when it comes to chemsex use in the gay community. The danger, as they see it, is in gay men foregoing free treatment or neglecting to seek help due to not wishing to be seen in the same light as the traditionally poorer populations of heroin and crack addicts are. While neither loneliness nor drug use will be going away anytime soon in the gay community, both new studies point to a trend that might benefit from a closer look in a local context.
The Trump administration has banned multiple divisions within the Department of Health and Human Services including the Centers for Disease Control from using certain words or phrases in official documents being drafted for next year’s budget. The banned words are “Vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based.”
Rush Holt, chief executive of the American Association for the Advancement of Science, said: “Among the words forbidden to be used in CDC budget documents are ‘evidence-based’ and ‘science-based.’ I suppose one must not think those things either. Here’s a word that’s still allowed: ridiculous.”
“To pretend and insist that transgender people do not exist, and to allow this lie to infect public health research and prevention is irrational and very dangerous, and not just to transgender people,” Mara Keisling, executive director of the National Center for Transgender Equality told the Washington Post.
David Stacy, the Human Rights Campaign’s (HRC) director of Government Affairs said HRC would fight the ban, “The Trump-Pence administration’s effort to eliminate entire communities from its vocabulary is a dangerous attack on LGBTQ people, women, and fact-based policy making. The move is reminiscent of a time not long ago when the government tried to ignore the reality of the HIV and AIDS crisis to the detriment of millions. This kind of erasure has potentially catastrophic consequences beyond the words used by the CDC — it could impact the very programs most vital to the health of women, transgender people, and others. But we will not be erased. The Human Rights Campaign will fight this and other politically-motivated policies, and this decision will ultimately backfire on the Trump-Pence administration.”
Shin Inouye, director of communications and media relations of The Leadership Conference on Civil and Human Rights, issued the following statement on news of the ban,
“President Trump and his administration have launched the latest salvo in their all-out war on truth and science. This latest tactic could be taken from a George Orwell novel, or taken by an oppressive authoritarian regime. Banning the use of words like transgender, science-based, and diversity will only harm the public health as the CDC carries out its important mission.
“We applaud the journalists who have brought this latest abuse to light. Trump may decry these stories as fake, but these reports show the continuing disdain of this administration to facts. The public relies on our government to provide accurate information, and these steps undermine that important trust.”
Medicare, though not at the forefront of the healthcare debate like the Affordable Care Act and Medicaid are, is still a big concern in some circles.
What is the true status of Medicare? Is it good, bad, or somewhere in between? What would happen if Medicare was eliminated?
In this post, we’re going to discuss some pros and cons of Medicare.
Pros of Medicare
Medicare Provides Coverage to Those Who Wouldn’t Have Coverage
In many senses, Medicare does “work.” Thanks to the program, millions of aging adults have been able to receive coverage when they otherwise wouldn’t be able to afford it. Prior to 1965, when Medicare was created, around 9 millions older adults didn’t have health coverage. That number is significantly higher than the 400,000 seniors who were uninsured in 2014. Medicare also covers many younger Americans with disabilities who would not be able to get healthcare otherwise.
Consider the implications if Medicare didn’t exist. Older Americans, who typically need the most medical treatment, would find themselves paying exorbitant medical costs directly out of pocket. The total paid every year would be staggering, most likely exceeding their annual income.
Individuals with disabilities would be totally dependent on their caretakers, who may or may not be able to afford medical care.
Clearly, Medicare is useful because it covers so many people.
Medicare Costs Very Little Every Month
Medicare enrollees generally are qualified for free Part A but must pay a small amount out of pocket every month for Part B. This number is estimated to cost around $134 per month. When you compare this to the out-of-pocket cost of operations, prescriptions, and other associated costs, the savings are huge.
More and more Americans enroll in Medicare Advantage plans each year, and enrollment is expected to keep growing in the future. If fact, enrollment was at 17.6 million in 2016, tripling from 5.3 million in 2004. Part C enrollees made up 31 percent of the 57 million Medicare recipients as of 2016.
MA plans offer beneficiaries an alternative way to get Medicare benefits through plans sold by private insurance companies that contract with the Centers for Medicare & Medicaid Services (CMS).
You get all the Medicare program benefits of Part A hospital insurance and Part B medical insurance, together known as Original Medicare*, when you enroll in Part C (Medicare Advantage). Plus, Medicare Advantage plans may provide additional benefits (dental, vision, etc.) at a minimal cost.
These services are essential to older Americans who would suffer otherwise.
Medicare Has Led to Prescription Innovations
The inception of Medicare created a massive market for drug companies. Suddenly, millions of Americans had access to prescriptions they wouldn’t have had otherwise. When pharmaceutical companies saw the untapped potential in the Medicare market, they began investing billions of dollars in the development of drugs tailored specifically for seniors.
As John Holohan, fellow at the Health Policy Center at the Urban Institute, notes, “A market began for drug companies and medical device manufacturers; when you have a market willing to pay for [products], it’s worth making the investment.”
The addition of Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug Plans—both sold through private insurance companies—also gave Americans wider access to prescription medicines. Medicare beneficiaries have had access to these plans since 2006, and enrollments have increased every year since. In 2006, 22.5 million (52 percent) people on Medicare were enrolled in Part D compared to 40.8 million (71 percent) in 2016, according to the Kaiser Family Foundation. With millions of Americans receiving Medicare prescription drug benefits, this may have given pharmaceutical companies more opportunities to develop drugs for this market.
Medicare Has Resulted in Increased Medical Standards
With the creation of Medicaid and Medicare, Congress created a set of standards for hospital enrollment in the programs. As time went on, the government become more and more involved in overseeing these standards and now requires public reporting on things such as hospital infection rates and readmissions.
This public accountability forces hospitals to perform due diligence in ways they might not otherwise.
As Karen Davis, director of the Roger C. Lipitz Center for Integrated Health Care at the Johns Hopkins Bloomberg School of Public Health, notes, “When hospitals find out they aren’t as good as other hospitals, they get serious about improving. When they find out it’s possible to have lower rates of infections, for instance, they try to find out what good practices are and follow them to get good results.”
Cons of Medicare
Medicare Costs a Huge Amount to Administrate
In 2016, Medicare spending totaled $588 billion. Currently, that’s approximately 15% of the overall federal budget. That number isn’t expected to get smaller, with many estimating that the percentage will go up to around 18% over the next decade.
When you consider that this staggering amount could be spent on other valuable programs, such as education, eliminating poverty, mental illness cures, and social justice, it at least causes you to question the overall efficiency of the program.
Poor Health Can Actually Cost More
The Kaiser Family Foundation says that those who reported themselves to be in poor health and on Medicare had out-of-pocket costs 2.5 times higher than the healthier beneficiaries.
While it’s somewhat hard to evaluate what this statistic means given that self-reporting isn’t always reliable, it does raise questions.
Granted, Medicare does offer a significant number of free preventive programs to enrollees that can cut down on health problems. And, many of the individuals on Medicare suffer from preventive conditions (particularly before the implementation of ACA).
Hospital Stays Still Cost a Lot
Even for those enrolled in Medicare, hospitals stays can still be extraordinarily expensive, easily running into the thousands. This highlights several issues.
As noted, many of those on Medicare suffer from preventable conditions and are hospitalized for those conditions. This places an increased burden on hospitals, which can then drive up the prices across the board for all patients.
Additionally, because many Medicare enrollees are in a low-income bracket, they can’t afford these stays, placing a crushing burden on them and putting the hospital in a difficult spot.
While Medicare certainly helps those who are struggling medically, it also creates significant strain on the overall healthcare system in the United States.
Older Enrollees See Costs Skyrocket
“Medicare enrollees 85 and older spend three times more on healthcare than those aged 65 to 74,” according to a Kaiser Family Foundation report. In some ways, this should be expected because more medical issues arise as a person gets older.
However, it also reveals that Medicare doesn’t adapt well for the oldest adults. A truly efficient system would take the increased costs into account and spread those across all enrollees.
Medicare Attracts Fraudulent Doctors
In 2017, the United States charged 412 doctors with medical fraud, amounting to $1.3 billion. Unfortunately, much of this fraud was connected directly to the opioid epidemic currently happening in the country. As the New York Times reported, “Nearly one-third of the 412 charged were accused of opioid-related crimes. The health care providers, about 50 of them doctors, billed Medicare and Medicaid for drugs that were never purchased; collected money for false rehabilitation treatments and tests; and gave out prescriptions for cash, according to prosecutors.”
In addition to the Medicare funds lost through fraud, the government must also employ a significant task force to investigate potential crimes, adding yet more expenses to the Medicare program.
Medicare Costs Taxpayers a Huge Amount
In 2014, an astonishing 38% of Medicare funds came from payroll taxes. With the current Medicare tax rate set at 2.9% (split between employers and employees) — and an additional 0.9% for those making more than $200,000 — this represents a significant amount of money coming out of each paycheck.
While it’s certainly understandable that Medicare funding must come from somewhere, it raises the issue of whether private insurance companies could be more efficient in terms of funding their programs.
Conclusion
The Medicare debate isn’t going anywhere anytime soon. It’s been part of the landscape for over 50 years and will probably continue to be around in one form or another for many years to come.
When enrolling in an insurance plan, your best bet is to do plenty of research. Find out what’s available and what benefits are offered. You may be able to get a better, equally affordable plan through a private insurance company.
If you could take a pill to prevent sexually transmitted infections (STIs) like gonorrhea, chlamydia and syphilis—would you?
Medicare, though not at the forefront of the healthcare debate like the Affordable Care Act and Medicaid are, is still a big concern in some circles.
The inception of Medicare created a massive market for drug companies. Suddenly, millions of Americans had access to prescriptions they wouldn’t have had otherwise. When pharmaceutical companies saw the untapped potential in the Medicare market, they began investing billions of dollars in the development of drugs tailored specifically for seniors.
With the creation of Medicaid and Medicare, Congress created a set of standards for hospital enrollment in the programs. As time went on, the government become more and more involved in overseeing these standards and now requires public reporting on things such as hospital infection rates and readmissions.
In 2016, 
“Medicare enrollees 85 and older spend