Health

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CDC says vaccination could protect the U.S. from more dangerous mpox virus

As concerns mount about a large outbreak of an especially virulent form of mpox in central Africa and an uptick in U.S. cases since early last year, the mpox vaccine appears to give long-term protection, the Centers for Disease Control and Prevention reported Thursday.

In a separate report, the CDC indicated that overall new mpox infections across the U.S. have remained at a steady, low level —–  about 60 cases weekly, compared with 3,000 cases a week at the outbreak’s summer 2022 peak —– in recent months. However, cases so far this year are elevated nationally compared with the same period in 2023 and have seen a sharp increase in New York City. 

People who have gotten two doses of the Jynneos mpox vaccine are protected against infection and don’t need a booster at this time, according to the CDC. 

Public health experts are concerned that the launch of the summer travel season and the upcoming LGBTQ Pride festivals in cities across the country will drive greater sexual connectivity among gay and bi men and potentially hasten mpox transmission.

Christina Hutson, chief of the CDC’s Poxvirus and Rabies Branch, and other public health experts told NBC News that this is no time for complacency about mpox (formerly called monkeypox). The various factors that likely have kept the U.S. outbreak relatively in check since late 2022 — including vaccination, infection-driven immunity, and sexual behavioral change — may be tenuous.

The mpox outbreak is “poised to return under the right conditions,” said Dr. Jeffrey Klausner, an infectious disease expert at the University of Southern California. Infections rapidly tore around the globe beginning in May 2022 and made that summer a misery for many gay and bisexual men before collapsing worldwide.

Critically, the proportion of at-risk American gay and bi men who are fully vaccinated against mpox is considered inadequate to assure long-term protection for this vulnerable population.

“Vaccination is a critical way to help protect yourself and others,” Hutson said. “It’s important that people at risk for mpox exposure who have not previously recovered from mpox — including certain gay, bisexual, and other men who have sex with men — complete the two-dose Jynneos vaccination series.” 

On May 16, the CDC published an ominous report about nearly 20,000 recent cases of what is known as clade 1 of mpox that have been documented in the Democratic Republic of Congo, or DRC, since January 2023. 

Concerningly, this viral clade appears to be more transmissible and to cause higher rates of severe disease and death compared with clade 2 of mpox, which drove the recent global outbreak. Five percent of those diagnosed with clade 1 in the DRC have died, compared with just 0.2% of the 96,000 people in the global clade 2 outbreak.

To date, there have been no reports of clade 1 cases outside of the handful of African nations where mpox has been endemic for decades. In December, the CDC first alerted health care providers of the possibility that this more harmful viral clade could hit the United States.

“We’re facing a big, potentially dangerous situation,” Ira Longini, a biostatistician at the University of Florida, said of the potential for global spread of clade 1. “But we really don’t know.”

Dr. Boghuma Titanji, an assistant professor at the Emory University School of Medicine, suggested that the Jynneos vaccine will likely provide protection against clade 1. The Jynneos vaccine is approved in the U.S. for mpox regardless of clade. 

“It’s reasonable to anticipate that there would be some immune cross-protection,” she said of immunity stemming both from the vaccine and previous infection with clade 2.

A clinical trial of the Jynneos vaccine is ongoing among health care workers in the DRC. It is not expected to be completed until the end of next year.

But the vaccine has not otherwise been rolled out in the DRC, a lost opportunity to help control the nation’s outbreak and prevent clade 1 from spreading globally, Titanji said.

Dr. Placide Mbala, the head of epidemiology and the global health department at the University of Kinshasa in the DRC, said the nation has seen “a lot of interest” from global public health leaders in providing such assistance. 

“But we are still waiting for concrete action,” Mbala said.

During the clade 2 outbreak, mpox has overwhelmingly transmitted via intercourse, both oral and anal, between men. Transgender people have also been disproportionately affected. The virus has not transmitted readily through the air or surfaces, in health care settings, or through casual, nonsexual contact.

In an interview earlier this year, CDC epidemiologist Dr. Jennifer McQuiston said mpox “needs to be thought about as an STD. The good news is it’s a preventable STD.”

Multiple studies of real-world uptake of the Jynneos vaccine have suggested that receiving both doses is associated with a 66% to 89% lower infection rate and one dose is 36% to 75% effective.

In one of the new CDC reports, agency investigators analyzed demographic data and clinical characteristics concerning 271 mpox cases from the U.S. outbreak’s outset in May 2022 to May 2024 among fully vaccinated people in 27 U.S. jurisdictions that provided sufficient related data. 

According to a CDC official, the agency estimates that only 0.1% of the fully vaccinated population developed a breakthrough infection. Reported such cases amounted to 0.8% of all 32,819 mpox diagnoses nationally. Thirteen percent of mpox cases were in partially vaccinated people.

The CDC estimates that 2 million men in the U.S. are at significant risk of mpox because they engage in sex with multiple male partners or otherwise are HIV positive; people with HIV have had a high mpox diagnosis rate. Of the overall group of at-risk gay and bi men, only approximately 25% have been fully vaccinated and an additional 14% have received one Jynneos shot.

In keeping with previous studies, the CDC’s new report found that full vaccination was associated with less severe disease and a lower hospitalization rate.

All 56 mpox deaths were among unvaccinated people.

Recent research has raised concerns that the antibodies Jynneos prompts wane over time. But the CDC investigators found evidence that, at least so far, the vaccine’s actual protection against infection hasn’t waned, possibly due to what’s known as innate or cell-based immunity.

Shortly after the vaccine was first rolled out in midsummer 2022, U.S. health authorities began stretching the temporarily short supply by changing its administration from a traditional subcutaneous (under the skin) shot to an intradermal (within the skin) shot that allowed for a much lower dose.

The new CDC report found no evidence that this vaccine-application shiftcompromised vaccine effectiveness.

A separate new CDC analysis of recent U.S. mpox diagnoses found the virus is still overwhelmingly seen among gay and bi men. Just 0.4% of recent cases were in people younger than 18.

Between October and April, 1,802 probable and confirmed mpox cases were reported to the CDC by 42 jurisdictions — for an average weekly rate, which remained essentially steady, of 59 cases. By stark contrast, the nation saw 2,000 to 3,300 weekly cases at the outbreak’s peak between mid-July and late August 2022.

And yet, CDC records show that the nearly 750 mpox cases seen this year through mid-April is more than twice the figure reported during the comparable period in 2023. New York City has seen a nearly five-fold case-rate increase between these two periods, with 191 cases thus far in 2024.

As for concerns about how a U.S. outbreak of clade 1 might transpire, infectious disease experts said they could only speculate whether higher quality health care, for one, might yield a lower death rate than in the DRC. Global clade 2 deaths have largely occurred among peoplethose with compromised immune systems, mostly due to untreated HIV.

Other unknowns include how and among which groups clade 1 might tend to transmit in Western nations. The DRC outbreak has occurred both in men with multiple male sex partners and in female sex workers and their contacts. And two- thirds of the DRC’s clade 1 outbreak has been in people under age 16; only a bit over 1% of the global clade 2 outbreak was in minors.

Epidemiologists see evidence of sustained person-to-person transmission in one DRC province, where cases are primarily in adults. 

While this transmission apparently has largely been through sex, compared with clade 2 of mpox clade 1 shows signs that it can nevertheless transmit more readily absent sexual contact. However, clade 1 still seems to require close personal contact, and nonsexual transmission appears largely limited to household settings. Also, the substantial transmission in children could be driven in part, the recent CDC report suggested, by multiple spillovers from wild animals encountered by young people in rural settings.

CDC officers believe that widespread transmission of clade 1 among children in the U.S. is much less likely, owing to a lack of an animal reservoir, less- crowded living quarters, and better cleaning and hygiene.

Emory’s Titanji reported worries that the gay and bi men she cares for quickly lost interest in mpox vaccination after the outbreak stopped being a primary concern for them. During the fall of 2022, the nation’s weekly distribution rate of Jynneos shots plummeted in tandem with the mpox case rate. 

Since then, no substantial progress has been made in raising the proportion of at-risk gay and bi men who have received both Jynneos doses.

“If you’re not yet vaccinated and you meet criteria, go and get vaccinated,” Titanji said. “We can’t be complacent about the response now moving forward.”

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Neurodiversity Pride isn’t centered on LGBTQ+ people, but perhaps it should be

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Neurodiversity Pride Day will be observed internationally on June 18, 2024 as a way to celebrate people who have neurologically atypical ways of thinking, learning, and behaving, and to reduce stigma against these people.

The neurodiversity (ND) movement often uses a rainbow infinity symbol — one that’s also used by autism awareness advocates. But while neither movements are specifically centered on LGBTQ+ people, perhaps it’s time to re-think that, especially since LGBTQ+ identities have long been stigmatized as forms of mental illness and numerous studies have linked queerness with autism.

Below is a quick look at the slippery concept of neurodivergence, the origins of the neurodiversity movement, and the curious link between autism and LGBTQ+ people.

What does “neurodivergent” mean? It depends…

Neurodivergence is a slippery concept, depending on where and when it’s defined. That’s because different societies throughout history have often labeled neurological differences as mental illnesses and “disorders,” even when those differences result from genetic inheritance, neurochemical imbalances, or trauma.

The term is often applied to autism spectrum disorder (ASD), an umbrella term that covers a wide variety of symptoms that manifest differently in each individual, including difficulties in social interactions, repetitive behaviors, resistance to change, and increased or decreased sensory sensitivity. ASD often accompanies other diagnoses, including learning disabilities, attention hyperactivity deficit disorder (ADHD), and self-harm.

While some people with autism are high-functioning and live independently, others may require lifelong support. Regardless, neurodiversity proponents say that people with autism should be accommodated rather than cured; that there’s not a one-size-fits-all solution to helping them; and that their symptoms may be worsened by societal norms that force them to behave in “neurotypical” (NT) ways. 

Since the start of the autism awareness movement in the late 1980s, public understanding of neurodivergence has changed as psychology learns more about the unique ways that people perceive, process, and react to different situations. As such, the concept of neurodiversity has widened to include people with a range of psychological issues, including complex post-traumatic stress disorder, depression, anxiety, obsessive-compulsive disorder, bipolar disorder, and many others.

The neurodiversity movement’s origins & LGBTQ+ connection

Society has long struggled with how to handle people who exhibit psychological differences. While ancient societies often blamed these differences on supernatural causes, philosophers in the Middle Ages blamed them on an imbalance of mood-altering fluids (or “humors”) in the body.

Over time, people with psychological differences were criminalized and hidden from society by being thrown into prisons alongside violent offenders, religiously-run asylums, or workhouses for the poor. In all places, they were often subjected to inhuman living conditions, cruel abuse, and unproven experimental “treatments.”

The rise of psychoanalysis, psychosurgery, and psychopharmacology in the 19th and 20th centuries accompanied a mental health reform movement that sought to provide greater support for neurodivergent people in order to gradually reunite them with their families, jobs, and society at large. 

During these centuries, LGBTQ+ identities were increasingly stigmatized as forms of “sexual deviation” by mental health authorities. Even today, right-wingers claim that transgender people are mentally ill and that queerness can be “cured” by so-called conversion therapy. The resulting discrimination and stigma have resulted in higher rates of mental distress and illness among LGBTQ+ people and increased calls to treat queer people with compassion and respect.

The formal neurodiversity movement began in the late 1990s, as internet users with autism began communicating and creating supportive online forums. This movement eventually connected with the disability rights movement and sought to destigmatize autism and provide greater support for people with autism. 

In 1999, the Autism Society created the infinity symbol for autism awareness to represent the infinite potential of individuals with autism. The symbol has been appropriated by the wider neurodiversity movement and illustrated in rainbow colors, sometimes to denote a broad and varied spectrum of experiences among neurodiverse people and, other times, to acknowledge the existence of neurodiverse LGBTQ+ people in the movement.

In 2005, the group Aspies for Freedom (AFF) first celebrated Autistic Pride Day, choosing June 18 because it was the birthday of the youngest AFF member at that time. Since then, organizations have observed the day internationally, holding celebrations and meetups to raise awareness and support. There’s no official flag for Neurodiversity Pride, though numerous ones have been created by web users.

Why is autism linked to LGBTQ+ people?

Increasingly, conservative legislation seeking to ban gender-affirming care for trans youth has said that mental health professionals should evaluate minors for autism before diagnosing them with gender dysphoria, unease due to a mismatch between a person’s gender identity and the biological sex they were assigned at birth. But autism doesn’t “cause” trans identity per se, nor does trans identity cause autism — experts are still exploring the link between the two.

A 2016 study found that autistic children were seven times more likely to exhibit gender variance than their non-autistic peers. A 2019 study found that trans and nonbinary people are also more likely to be autistic or display autistic traits than those who are cisgender. In 2021, a University of Cambridge study — the largest study on autistic people to date — found that people with autism (especially girls and women) were about eight times more likely to identify as asexual and “other” sexuality than their non-autistic peers. 

“It is more common for autistic individuals to deviate from gender norms … that attempt to dictate the ways a person should act, look, and identify based on their gender,” according to the Organization for Autism Research. Alternately, some psychiatrists think that prenatal hormonal exposure may increase the likelihood of queerness and autism.

Regardless, studies show that LGBTQ+ people and people with autism both suffer from stigma and unmet healthcare needs, making the need for Neurodiversity Pride and advocacy more important now than ever.

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CDC warns of new mpox outbreak, urges vaccination

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With a severe version of mpox breaking out in the Democratic Republic of Congo, officials with the U.S. Centers for Disease Control and Prevention are warning that it could spread and that people at risk should be vaccinated as soon as possible.

High-risk populations include men who have sex with men, although anyone can contract the disease, which is largely spread by skin-to-skin contact — sexual relations, for instance, but also in crowds at outdoor festivals. Thousands of gay and bisexual men developed mpox in a 2022 outbreak. People with compromised immune systems, such as those living with HIV, are at high risk for serious cases and death.

“There are two main types of mpox: Clade I, the type that is dominant in Congo, and Clade II, a version of which caused the 2022 global outbreak,” The New York Times reports. Clade I is deadlier than Clade II, the Times notes, explaining that “a clade is a genetically and clinically distinct group of viruses.”

No Clade I cases have been documented outside of Congo yet, but a global spread is possible, as the 2022 outbreak that affected Europe and North America originated in Nigeria.

“This is a very important example of how an infection anywhere is potentially an infection everywhere, and why we need to continue to improve disease surveillance globally,” Anne Rimoin, an epidemiologist at the University of California, Los Angeles, told the Times.

Many of the cases in Congo were among sex workers, both male and female, and their clients, plus men who have sex with men, according to the CDC. The symptoms of mpox infection include fever, severe headache, back pain, a rash, and sometimes sores at the infection site.

There were about 30,000 cases of mpox in the U.S. in 2022 but only 1,700 last year, thanks to vaccines and changes in behavior, the CDC reports. However, only 23 percent of at-risk Americans have gotten both necessary doses of the Jynneos vaccine against mpox, so CDC scientists are urging all those at risk to be vaccinated. The vaccine is now available at pharmacies in the U.S., making it easier to access than previously.

A recent Government Accountability Office report found serious flaws in the federal government’s response to the 2022 outbreak. The Department of Health and Human Services’ internal communication was poor, hampering coordination of efforts to fight mpox, according to the report. Democratic U.S. Rep. Ritchie Torres of New York, a gay man, has introduced legislation to improve communication within federal agencies and messaging to at-risk populations.

“The federal government and HHS were catastrophically unprepared for the mpox outbreak,” Torres told The Advocatein April.

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Lesbian and bisexual women die earlier than straight women, decades long study finds

Lesbian and bisexual women die significantly earlier than heterosexual women, according to a new study, and it’s likely due in part to discrimination.

The role sexuality plays in overall health is a subject that’s attracted researchers for decades, resulting in a large body of evidence of how LGBTQ people experience a variety of negative outcomes, from mental health issues to chronic disease, at elevated rates. But what hadn’t been widely studied is how these outcomes actually affect mortality rates.

The paper, published last month in JAMA, reviewed decades’ worth of data from the Nurses’ Health Study II, which began in 1989 as part of a series of investigations into risk factors for major chronic diseases in women. The authors analyzed how sexuality contributed to premature death rates among the study’s cohort of more than 100,000 U.S. nurses. And what they turned up was an alarming disparity in how long lesbian and bisexual women live in comparison to their heterosexual peers. 

Compared to participants who identified as heterosexual, the analysis found, those who identified as lesbian or bisexual died 26% sooner, with lesbian women dying 20% sooner and bisexual women dying 37% sooner.

“One of the advantages of this study is that we were able to separate out bisexual and lesbian participants, because we had enough people and we followed them for long enough that we can actually look at those risks separately, which no other U.S. study has been able to do,” Sarah McKetta, the JAMA paper’s lead author and a postdoctoral fellow at Harvard Medical School, told NBC News.

Although the team expected to see disparities given the existing research on negative health outcomes, McKetta said they didn’t expect to see such stark differences in mortality rates.  

As McKetta explained, gathering information about premature death rates among LGBTQ communities has proved difficult because questions about sexual orientation weren’t systematically incorporated into U.S. studies prior to 2014. But the Nurses Health Study II was an outlier. In 1995, almost 20 years before it became commonplace, the study’s participants were given the option to self-identify as heterosexual, bisexual, or lesbian, gay or homosexual in a follow-up survey. And it was that data that McKetta and her fellow researchers used, along with records kept by the National Death Index.

“We’ve known for a really long time that there are systemic and highly reproducible health disparities for LGB people, particularly LGB women, across many outcomes,” McKetta said. “We’ve seen disparities in tobacco use and alcohol use, in mental health, in chronic disease. Basically, pretty much any outcome that we’ve looked at across multiple surveys, we see that lesbian, gay and bisexual women are at higher risk. And we also know it’s due to levels of discrimination, ranging from structural to individual. The thing is, we actually don’t really know to what extent these disparities manifest in premature mortality differences, because there’s some real data limitations.”

She added, “This was an opportunity for us to actually quantify the magnitude of that disparity.”

In addition to providing a way for the researchers to compare mortality rates, the Nurses Health Study model allowed them to draw conclusions about how specific health outcomes contributed to differences in mortality rates. Using information gathered on the women 20 years prior — which revealed a twofold prevalence of alcohol and tobacco use, as well as higher risks for breast cancer, cardiovascular disease and depression, among lesbian and bisexual participants — McKetta and her colleagues came to the conclusion that the disparities could be largely attributed to preventable causes. 

“This isn’t something that just happened; this is something that is due to chronic processes and we think is also multifactorial,” McKetta said, pointing to an extra analysis they did involving only the participants who had never smoked, which showed the same disparities in death rates. “It’s not because of one thing; it’s because of a lot of things.” 

At the heart of those factors, McKetta explained, are various layers of discrimination and isolation that lesbian and bisexual women are exposed to on a daily basis. From interactions in health care settings to workplaces and private spaces, these “toxic social exposures,” as she called them, translate into damaging behaviors and negative mental and physical health outcomes. And this is especially true for bisexual women, who experience higher rates of substance abuse and sexual victimization, in addition to having poorer physical health and mental health, than lesbian and heterosexual women.

“If this isn’t research that you typically do, it can be really easy to think that because sexuality is a spectrum, that the risk kind of goes up as people get more exclusively lesbian, more exclusively gay. But actually, the healthcare risks are much more pronounced for bisexual folks,” McKetta said. “They have these dual pressures given their identity, and they experience discrimination from both inside and outside of queer communities.”

McKetta acknowledged that the study portrays a “grim” reality for the participants, who were born between 1945 and 1964. But she’s hopeful that the findings will call attention to the many systems that contribute to poor health outcomes for LGBTQ women and people in general, so that younger generations won’t see the same kind of shortened lifespans as their predecessors. 

“One of the things that I was worried about with this study is that the takeaway would be that it kills to be gay,” she said. “It doesn’t kill to be gay. It kills to be discriminated against. And that’s the lived experience of lesbian and gay women and bisexual women who are just trying to walk through the world.”

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Gay couple files first-of-its-kind class action against NYC for IVF benefits

A gay couple filed a first-of-its-kind class action lawsuit against New York City on Thursday alleging that the city’s health insurance plan is discriminatory because it doesn’t cover in vitro fertilization, or IVF, for male couples. 

The lawsuit is the latest development in what has become a yearslong effort by the couple to get the city to change its IVF benefits, which the couple argues makes accommodations for heterosexual and lesbian couples, and for single women.

Corey Briskin and Nicholas Maggipinto said they have been talking about having children since 2014, ahead of their engagement. They planned to use a two-part process: First, they would use IVF, where an egg is combined with a sperm in a lab, and second, they would work with an agency to hire a surrogate who would have the fertilized egg implanted and would carry the baby to term. They planned to have the IVF covered by insurance and planned to pay for the surrogacy out of pocket. 

Briskin took a job as an assistant district attorney at the New York County District Attorney’s Office in Manhattan in 2017, and he learned soon after that the city’s health plan doesn’t cover IVF benefits for gay men. Briskin left that job in March 2022, but he is still covered under the city’s plan through a federal law called COBRA, which allows employees to continue to receive health care coverage from their former employer for up to three years if they pay the full premium. 

The couple filed a charge of discrimination with the Equal Employment Opportunity Commission in April 2022 and hoped that it would encourage the city to change its policy. However, that didn’t happen. 

Peter Romer-Friedman, who runs his own firm, Peter Romer-Friedman Law PLLC, based in Washington, D.C., said the city responded to the EEOC charge with a position statement arguing that it doesn’t provide IVF benefits to surrogates and, as a result, it would not provide benefits to Briskin and Maggipinto. Romer-Friedman called the city’s argument a red herring, because he said Briskin and Maggipinto have never sought any benefits for a surrogate. 

“They’re seeking fertilization of donated eggs with their sperm, and those are things that are provided to other people under the plan,” Romer-Friedman said. “So, in our view, the city offered no legitimate, legal or factual explanation for treating Corey and Nicholas differently than other couples who get IVF benefits.”

Romer-Friedman is representing the couple alongside David Lopez, who was general counsel for the EEOC from 2010-2016.

A city hall spokesperson said Mayor Eric Adams’ administration “proudly supports the rights of LGBTQ+ New Yorkers to access the health care they need.” 

“The city has been a leader in offering IVF treatments for any city employee or dependent covered by the city’s health plan who has shown proof of infertility, regardless of gender identity or sexual orientation,” the spokesperson said. “The city will review the details of the complaint.”

Romer-Friedman said that in order to bring a lawsuit under Title VII of the Civil Rights Act of 1964, a federal law that prohibits employment discrimination on the basis of race, color, religion, sex and national origin, a party is required to first file an EEOC complaint. After a six-month EEOC investigation, the party can choose to go to court. 

The couple’s lawsuit argues that the city’s exclusion of gay men from being eligible for IVF benefits violates Title VII, the equal protection and due process clauses of the 14th Amendment and New York state and New York City human rights laws.

The city categorically denies IVF benefits to gay men because it requires employees to meet its definition of infertility in order to qualify, the suit argues. The city defines infertility as the inability to conceive a child through male-female unprotected intercourse in a consecutive 12-month period or through intrauterine insemination, or IUI. Under this definition, single women and lesbian couples can qualify as infertile and receive IVF benefits if they undergo IUI and don’t become pregnant, according to the complaint.  

“But gay men, although equally incapable of conceiving a child without IVF, are always denied access to IVF under the City’s healthcare plan,” the complaint states. “By defining ‘infertility’ in this exclusionary manner, single female employees, female employees with male partners, female employees with female partners, and male employees with female partners are always potentially eligible for some IVF benefits under the City’s healthcare plan, but gay male employees—whether individually or with male partners—are never eligible for any IVF benefits.”

Through its health care plan, the suit argues, the city “denies gay men equal treatment and makes it much harder for gay men to have biological children than other employees and their partners.”

Since 2022, Briskin said, he and Maggipinto have started their journey to become parents. They have received donated embryos that are awaiting transfer to a surrogate, and they hope to have their first child within the next year. However, they are paying for all of the services out of pocket. So far, they have spent about $80,000, and they just received another $9,000 medical bill this week for prescription medications necessary for the IVF process, they said. They expect to pay about $100,000 for the IVF costs, and surrogacy can cost an additional $165,000, according to documents filed with the couple’s 2022 EEOC complaint.

Due to the costs, Briskin left the public sector and took a job at a private law firm. 

“I certainly had to make the difficult decision to leave the public sector, which I clearly felt very strongly about — I worked as a public servant for the first decade of my career,” Briskin said. “And that decision was driven in large part by our need to make sure that we can finance this ourselves.”

Briskin said they’ve mostly received support from those who have heard about their case, and that people have been “flabbergasted at the notion that we are even having to have this fight in New York City in 2024.” But the couple has had a few critics, they said, who have argued that Briskin and Maggipinto don’t need the benefits because they are both lawyers.

Maggipinto said they have been fortunate enough to be able to save money to have children, but that their fight isn’t about money.

“If this were just about the money, we would have pursued a settlement with the city and not bothered with all the frustration that this brings, but if there’s any point that I would want to make, it’s that the policy needs to change,” Maggipinto said. “I would love the city to just answer the question directly: What exactly is the holdup? Why are you denying us equal treatment? They’ve come up with nothing.”

Since the couple filed their EEOC charge, Romer-Friedman said that 10 New York City council members introduced a bill to offer IVF benefits to city employees regardless of whether they can meet the city’s definition of “infertility,” and two federal courts have held that health care plans that exclude same-sex couples, specifically lesbian couples, from IVF benefits may violate federal nondiscrimination laws, such as Title VII.

Currently, just seven states, including New York, require IVF benefits to include same-sex couples, according to a report from nonprofit news website Stateline, though these policies don’t explicitly require coverage for gay men.

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The FDA grants trans-inclusive at-home cervical screening device a priority review

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The U.S. Food and Drug Administration (FDA) has granted a priority review for a trans-inclusive cervical screening at-home test to become approved in the US, and we think it’s high time for a change.

For women, trans and non-binary people with uteruses, undergoing a regular cervical smear to prevent and detect cervical cancer can be an unpleasant experience due to the cold and down-right uncomfortable speculum used. Some gender-diverse people also experience gender-based discrimination in such appointments.

The outdated device used in pelvic appointments to separate the vaginal walls can be cold and uncomfortable. The clamp-like instrument was invented in the mid-19th century and hasn’t adapted much since its bleak origins. 

But the wait for a trans-inclusive and women’s-forward cervical screening at-home test might not be much longer, as the Teal Wand has been granted Breakthrough Device Designation status from the FDA. This means once the women-owned brand Teal Health submits its final study, it will be fast-tracked for a review.

This status is reserved for devices which the FDA believes could provide more effective diagnosis or treatment of life-threatening diseases, as well as their potential to benefit populations impacted by healthcare disparities. 

Self-collected cervical screening tests actively reduce barriers for women and LGBTQ+ people facing healthcare-based discrimination. In the UK, LGBTQ+ people are less likely to access vital screenings, with 15 per cent of lesbian and bisexual women over 25 never having had a smear test, compared to seven per cent of women over 25 in general.

The new device allows people at risk of cervical cancer (all those with a cervix who are or have been sexually active) to perform their pap smear in the comfort of their own home with less discomfort, nerves and pain, compared to in-clinic collection methods, according to clinical trial results.

The tool combines a wand designed to fit all bodies”, a dial which “moves up and down to extend and retract the sponge”, and a soft sponge which collects the cervical cells for testing.

Similar self-collection screenings for cervical cancer are already available in other countries. In Australia, the government introduced such tests in July 2022. 

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Aetna agrees to settle lawsuit over fertility coverage for LGBTQ customers

Aetna has agreed to settle a lawsuit that accused the health insurer of discriminating against LGBTQ customers in need of fertility treatment.

Under the deal announced Friday, the insurer will make coverage of artificial insemination standard for all customers nationally and work to ensure that patients have equal access to more expensive in-vitro fertilization procedures, according to the National Women’s Law Center, which represented plaintiffs in the case.

Aetna, the health insurance arm of CVS Health Corp., covers nearly 19 million people with commercial coverage, including employer-sponsored health insurance.

The insurer will set aside a $2 million fund to reimburse people who had coverage from some of its commercial insurance plans in New York and were denied reimbursement for artificial insemination, a procedure in which sperm is placed directly in a woman’s uterus.

A CVS Health spokesman said the company was pleased to resolve the case and “committed to providing quality care to all individuals regardless of their sexual orientation or gender identity.”

A federal judge still must approve the deal.

The settlement stems from a 2021 lawsuit filed in a federal court in New York. Emma Goidel said she and her spouse, Ilana Caplan, spent more than $50,000 on fertility treatments to conceive their second child after Aetna rejected several requests for coverage.

The couple had insurance through a Columbia University student health plan.

Their plan required people who cannot conceive a child naturally to first pay thousands of dollars for cycles of artificial insemination before the insurer would start covering fertility treatments.

The lawsuit noted that heterosexual couples didn’t have the same costs. They just had to attest that no pregnancy had occurred after several months of unprotected sex before they got coverage.

“You never know when you start trying to conceive and you have to do it at the doctor, how long it’s going to take and how much it’s going to cost,” Goidel said. “It was unexpected, to say the least.”

Goidel became pregnant with the couple’s second child after six cycles of artificial insemination — which each cost a few thousand dollars — and one unsuccessful, $20,000 attempt at in vitro fertilization, where an embryo is created by mixing eggs and sperm in a lab dish.

Goidel said she’s “thrilled” that Aetna changed its policy as part of the settlement, and she expects to be reimbursed.

Fertility treatment coverage has grown more common in recent years, especially among employers eager to recruit and retain workers.

The benefits consultant Mercer says 45% of employers with 500 or more workers offered IVF coverage last year. That’s up from 36% in 2021. Many place limits on the number of treatment cycles or set a lifetime maximum for the benefit.

Many insurers also cover artificial insemination as a standard benefit for all policyholders, according to Sean Tipton of the American Society for Reproductive Medicine.

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How did the Biden administration just make health care fairer for LGBTQ+ people?

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The Biden-Harris administration announced Friday that it had finalized an essential update to Section 1557 of the Affordable Care Act, significantly strengthening protections against discrimination in health care, especially for the LGBTQ+ community. This pivotal rule change reverses prior rollbacks under the Trump administration and establishes a new benchmark for inclusivity in health care access. Advocacy groups have praised the move.

What is Section 1557?

Section 1557 of the ACA is a critical nondiscrimination statute prohibiting discrimination based on race, color, national origin, sex, age, or disability in health programs or activities. It plays a vital role in ensuring equity within the U.S. health care system. The definition of “sex” under this section has been subject to changes in interpretation, expanding and contracting under various administrations.

What did the Trump-era rules change?

The Trump administration’s 2020 amendments redefined “sex discrimination” to exclude gender identity and sexual orientation, effectively removing explicit protections for transgender and nonbinary people under federal law. This interpretation allowed health care providers and insurers to legally deny services based on an individual’s gender identity, significantly impeding access to necessary medical care for the LGBTQ+ community.

What is the rule change?

The Biden administration’s update to Section 1557 restores and expands protections that had been rescinded. It reaffirms that discrimination “on the basis of sex” includes sexual orientation and gender identity. This change not only counters previous setbacks but also explicitly incorporates protections against discrimination based on sex characteristics and sex stereotyping, crucial for intersex and transgender individuals, respectively.

The rule also strengthens protections for people with disabilities and those with limited English proficiency, ensuring more inclusive health care access. It requires all health programs and activities that receive federal funding and health insurers to comply with these nondiscrimination requirements.

How does the rule affect LGBTQ+ people, especially transgender people?

This rule change is a significant advancement for the LGBTQ+ community, particularly transgender patients, who often encounter discrimination in health care settings — from denial of routine care to refusals of critical gender-affirming treatments such as hormone therapies or surgeries. The updated rule prohibits such discrimination under federal law, guaranteeing access to health care without fear of rejection due to gender identity.

Moreover, the rule mandates that services and coverage are provided nondiscriminatorily, including specific stipulations that insurance policies do not exclude care related to gender transition, addressing a prevalent barrier for transgender individuals in accessing necessary treatments.

What are advocacy groups and lawmakers saying?

Responses from LGBTQ+ advocacy groups have been overwhelmingly positive, recognizing the updated rule as a vital move toward eliminating health care discrimination.

Lambda Legal counsel and health care strategist Omar Gonzalez-Pagan noted the significance of these restored protections.

“The rule released today restores critical regulatory nondiscrimination protections for those who need them most and ensures a legally proper reading of the Affordable Care Act’s healthcare nondiscrimination law,” he said in a statement. “This marks a significant reversal of the harmful, discriminatory policies set by the previous administration.”

Human Rights Campaign President Kelley Robinson praised the update: “Today we mark a crucial step forward by the Biden-Harris administration in the fight for complete health equity for LGBTQ+ Americans. This milestone underscores years of advocacy by HRC and our partners, steadfast in refusing any form of discrimination against LGBTQ+ people.”

GLAAD president and CEO Sarah Kate Ellis commented on the rule’s immediate impact.

“This reversal of Trump-era discriminatory rules that sought to single out Americans based on who they are and make it difficult or impossible for them to access necessary medical care will have a direct, positive impact on the day-to-day lives of millions of people,” Ellis said in a statement. “Health care is a human right that should be accessible to all Americans equally without unfair and discriminatory restrictions. LGBTQ Americans are grateful for this step forward to combat discrimination in health care so no one is barred from lifesaving treatment.”

The rule change marks the 334th action of the Biden-Harris administration in support of LGBTQ+ people, according to GLAAD.

The Congressional Equality Caucus also welcomed the update, with Chair U.S. Rep. Mark Pocan, a Wisconsin Democrat, affirming the rule’s importance.

“All people deserve to access healthcare without fear of discrimination,” Pocan said. “This rule’s explicit nondiscrimination protections for our community will improve health outcomes and ensure countless LGBTQI+ people are not denied care just because of who they are. I thank President Biden and Secretary Becerra for their steadfast commitment to LGBTQI+ health equity and look forward to continuing our work together to improve access to care for all Americans, regardless of their identity.”

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Evidence around youth gender care ‘remarkably weak’, major English review says

Medical evidence underlying gender care for adolescents is “remarkably weak” and provides little clarity on long-term outcomes, according to an in-depth review of care commissioned by England’s state-funded National Health Service.

Gender care can include anything from counselling to medications related to gender issues, including drugs that can pause puberty.

The final report of the Cass Review, led by prominent pediatrician Dr. Hilary Cass and which includes research from independent academics at the University of York as well as input from families and clinicians was released on Wednesday.

The report concludes that young people with gender dysphoria — the distress of identifying as a gender different from the one assigned at birth — deserve better care but stresses that there is a lack of good evidence about how best to provide that.

The review was commissioned by the National Health Service in 2020, after the service — in line with other countries in Europe as well as the United States — saw increasing numbers of young people seeking gender care and differing opinions among experts about how best to help them.

The NHS has already announced that, in future, puberty-blocking drugs in England will only be available for young people experiencing gender distress in the context of a clinical trial. It acted after the Cass Review published interim recommendations in 2022. There is little detail yet on how this trial may work.

As part of plans to widen access to gender care and broaden the professionals involved, the NHS has also closed the previous provider of gender care for young people and replaced it with two new services in London and northwest England.

However, there is a huge backlog of cases after delays in getting services operational, and several thousand young people remain stuck in limbo on years-long waiting lists.

Prime Minister Rishi Sunak said he welcomed the “care and compassion” of the review.

“We simply do not know the long-term impacts of medical treatment or social transitioning… and we should therefore exercise extreme caution,” he said.

The Cass Review urges extreme caution around providing masculinizing or feminizing hormones before the age of 18.

But on social transition — changing names or pronouns — it concludes there is a lack of good evidence on the impact. It recommends professionals are consulted early on for pre-pubertal children, but for adolescents, “exploration is a normal process and rigid binary gender stereotypes can be unhelpful.”

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New research helps explain why lesbians report more orgasms than straight women

Research over the last decade has found that lesbians have more orgasms than straight women, but questions remained as to why. 

A new study published this month in the journal Social Psychological and Personality Science found that these differences when it comes to pleasure could be in part due to sexual scripts — or what people expect to happen during sex based on what they’ve seen in movies, television or even pornography. Cisgender women’s expectations for those sexual scripts and for orgasms can vary based on the gender of their partner, the study found. 

Past research has found that men have more orgasms than women, creating what researchers call the orgasm gap. Previous studies have also found that lesbians have orgasms at rates similar to men, which shows that there’s “nothing inherently biological” about the orgasm gap, according to Grace Wetzel, one of the study’s authors and a psychology doctoral candidate at Rutgers University. Wetzel said she wanted to look into the “sexual context” missing from that research, or the other psychological and social factors affecting differences in orgasm rates.

“We wanted to look into why that disparity between lesbian and heterosexual women exists so that we could get a better understanding of why the orgasm gap exists in general,” she said.

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Partner gender is connected to orgasm pursuit/frequency in that women expect different sexual scripts based on their partners’ gender, rather than because of their sexuality.Getty Images

Wetzel and two other researchers designed two online studies — one of heterosexual women and lesbians and another of bisexual women. The first study asked a mixed group of 476 heterosexual women and lesbians about the importance of orgasms and their expectations about climaxing during sex. It found that lesbians reported more clitoral stimulation in their sexual encounters, higher orgasm expectations, greater orgasm pursuit and having more orgasms than heterosexual women. However, orgasms were equally important to heterosexual women as they were to lesbians.

In the second study of 482 bisexual participants, the researchers asked the women similar questions about their expectations of orgasms and how strongly they would pursue them in a hypothetical sexual encounter with either a man or a woman.

That study found that bisexual women had the same orgasm pursuit and importance regardless of partner gender in the hypothetical scenario, but those partnered with women in those cases had higher expectations for clitoral stimulation and orgasms than those hypothetically partnered with men. This means that partner gender, through varying sexual scripts, is indirectly associated with greater orgasm pursuit, the study found.

The average sexual script, or what people expect to happen during sex based on TV, culture and more, between a man and a woman, according to the study, includes foreplay, then vaginal intercourse, from which the man orgasms, and then sex ends. 

“This heterosexual script prioritizes the man’s orgasm, as intercourse alone is associated with the lowest orgasm frequency for women,” the study said. Women who have sex with women are more likely to engage in nonpenetrative acts and don’t adhere as much to any sexual script based on gender, researchers added. 

“What we should take away from this research is that when women are having sex with men, in general, they’re typically not experiencing enough clitoral stimulation to facilitate an equal opportunity for orgasm,” Wetzel said, adding that the findings should encourage heterosexual couples to improve communication during sex. 

Wetzel noted that the study shouldn’t lead couples to feel pressure, because other research has shown that such pressure will make orgasms less likely and less enjoyable. Rather, couples, regardless of sexuality and gender, could “work to make their sexual encounters more pleasurable in general by including those sex acts that are most likely to result in orgasm for their partner.”

The study is limited in part by its correlational design, Wetzel said. As a result, the researchers don’t know all of the factors that affect the difference in orgasm frequency between lesbians and heterosexual women. Some of the other factors behind that difference could be that women feel more comfortable communicating with other women versus men about what they need to experience orgasm. That’s where the second study is helpful, she said, because the only variation between the hypothetical sexual encounters bisexual women were asked about was the gender of their partner. 

“That doesn’t mean there still can’t be other factors at play as well, but because of that experiment in the second study, we feel more confident saying that these sexual scripts are differing based on partner gender,” she said. 

Incia Rashid-Dawdy, a counselor with the Expansive Group, a therapy practice based in New York City and Chicago, said the study shows how people in heteronormative relationships have been socially conditioned to see orgasm through vaginal penetration as a “goal,” while people in queer relationships aren’t going into sex with the same gendered expectations.

“When we’re talking about queer relationships, lesbian relationships, we’re talking about how, in order for them to be able to understand how to make each other feel good, they need to talk about it,” she said. “This is a reminder that there’s no one way to have sex.”

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