Features

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CMS Data Highlight: Health Disparities Experienced Among Older Sexual Minorities

CMSThe Office of Minority Health at the Centers for Medicare and Medicaid Services (CMS OMH) posted online national data – for the first time ever – exploring differences in 15 health characteristics between adults 65 years of age or older (older adults) who self-identify as lesbian, gay, or bisexual (sexual minority), and older adults who identify as heterosexual or straight (sexual majority).

This data present estimates using data from two years of the National Health Interview Survey (NHIS 2013-2014) conducted by the Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS) showing statistically significant differences for several health characteristics between sexual minority and sexual majority respondents.

Key Findings:

  • Among persons aged 65 and older, 62.7% of sexual minority respondents reported that they are in excellent or very good health compared to 45.9% of sexual majority respondents.
  • Nearly 80% of older sexual minority respondents reported that they received an influenza vaccine during the past year compared to nearly 70% of older sexual majority respondents.
  • More than half (51.3%) of the older sexual minority respondents reported that they had been tested for HIV compared to only 15.8% of the older sexual majority respondents.
  • Nearly twice as many older sexual minority respondents (14.5%) had five or more alcoholic drinks in one day – at least once in the past year – compared to older sexual majority respondents (6.7%).

Data Source: 2013 and 2014 National Health Interview Survey, conducted by the Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS)

The Office of Minority Health at the Centers for Medicare and Medicaid Services is committed to supporting the departments’ goals and to advancing sexual orientation and gender minority data collection and research.

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Sugar-binding Protein Galectin-9 Found to be a New Weapon to Cure HIV

The ultimate impediment to a cure for HIV infection is the presence of latent, HIV-infected cells, which can reawaken and produce new virus when antiretroviral drug therapy is stopped.  These latent, HIV-infected cells are untouched by antiretroviral therapy and are unseen by the immune system.  Moving medicine closer to a cure for HIV, scientists at Blood Systems Research Institute (BSRI), the University of California at San Francisco (UCSF), and the University of Hawaii have discovered that the human sugar-binding protein galectin-9 potently forces latent HIV out of hiding, and poisons the virus on its way out.

Building off of their earlier studies that identified key human genes involved in maintaining the latent, hidden state of HIV-infected cells, the paper’s lead author, Dr. Mohamed Abdel-Mohsen, Scientist at BSRI and UCSF School of Medicine, and colleagues used cutting-edge technologies to demonstrate that galectin-9, a beta-galactoside-binding lectin, reactivates latent HIV and renders infected cells visible to the immune system.  This concept of therapeutically forcing latent HIV out of hiding as a curative approach is known as the “shock and kill” HIV eradication strategy.

Dr. Satish Pillai, lead researcher on the study, Associate Investigator at BSRI and Associate Director of the UCSF-Gladstone Institute of Virology & Immunology Center for AIDS Research, explains, “For nearly two decades, antiretroviral therapy has demonstrated efficacy in suppressing HIV replication, but these drugs do not completely clear viral infection or fully restore health. We need a means to draw out the virus from its hidden reservoirs within the body and allow the body’s own immune system to eliminate it.”

Beyond subjecting latent HIV-infected cells to destruction by the immune system, the team found that galectin-9 strongly increases levels of an antiviral protein called “APOBEC3G” in infected cells.  APOBEC3G is a lethal mutagen that destroys the genetic code of viruses including HIV.  This ensures that virus that comes out of hiding at the hands of galectin-9 will be sterilized on its way out of the cell, preventing any further infection.  These findings reveal that galectin-9 is a new weapon in the HIV cure arsenal, promoting eradication of the latent HIV reservoir in infected individuals on antiretroviral therapy.

The research was published in PLoS Pathogens and is an open access manuscript.

An additional revelation in the authors’ study is that galectin-9 works by manipulating sugars on the surface of HIV-infected cells to deliver the signals that force latent HIV out of hiding.  “Galectin-9 binds to certain classes of sugars on the surface of cells to start a chain reaction that forces HIV out of hiding.  There’s been very little attention paid to how the sugar coating on the surface of human cells affects the fate of the virus that lies inside.  This sugar coating may hold the key to new therapeutics that can be harnessed to cure HIV and possibly a range of other infectious diseases.” says Abdel-Mohsen.

Pillai and Abdel-Mohsen also see the potential for galectin-9 to alter the current course of treatment for HIV, which involves life-long adherence to antiretroviral therapies to prevent latent stores of the virus in the body from reactivating and infecting new cells. “Our findings make us optimistic that future HIV treatments can eliminate all traces of the virus from the body,” says Pillai. “Ultimately, we hope that galectin-9 gets us one big step closer to a cure.” says Abdel-Mohsen.

The study was funded in large part by the amfAR Institute for HIV Cure Research and by the National Institutes of Health (NIH), with additional support from the University of California and the San Francisco-Gladstone Institute of Virology & Immunology Center for AIDS Research. The findings are among the first to be generated by researchers supported by the amfAR Institute, which was announced in December 2015. The centerpiece of amfAR’s Countdown to a Cure for AIDS initiative, the Institute brings together leading HIV researchers working collaboratively to address the scientific challenges that stand in the way of a cure.

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Could Mimicking Infants’ Immune Response Produce a Faster-acting HIV Vaccine?

An HIV vaccine based on how the adult immune system responds to the virus could take a long time to build protection, say researchers, who after looking at how HIV affects infants, suggest mimicking their immune response may offer a better model.
vaccine vials and hypodermic

The researchers suggest developing HIV vaccines that mimic infant immune responses may lead to faster-acting, effective protection against the virus.

In the journal Cell, researchers led by a team from the Fred Hutchinson Cancer Research Center, Seattle, WA, describe how broadly neutralizing antibodies to HIV can arise in infants within a year after infection – much more quickly than in adults.

Even though scientists have accumulated mountains of information on HIV, the prospect of a protective vaccine remains elusive. For a vaccine to be effective, it must act relatively quickly to trigger an immune response with the right mix of antibodies to eliminate the virus.

Moreover, an effective HIV immune response also adapts to the virus during the infection, and it tweaks its initial antibody response by adding antibodies that have undergone “somatic hypermutation.”

Somatic hypermutated antibodies have enhanced ability to bind to and block the pathogen and form an essential component of a broadly neutralizing response.

In the adult immune system, this process can take years – even decades – to produce an effective, broad immune response that is capable of protection against HIV.

A vaccine that mimics the adult immune response would, therefore, take too long to provide protection.
Infant antibodies to HIV produced within a year

In their study, the team examined samples taken from infants in Nairobi born to HIV-positive mothers in the years before antiretroviral drugs were developed.

They found that the infant immune system can produce broadly neutralizing antibodies against many HIV variants within a year after infection – and with less fine-tuning than previously thought.

Senior author Dr. Julie Overbaugh leads a lab at the Fred Hutchinson Cancer Research Center that investigates mechanisms of HIV transmission and disease development. She says that in contrast to studies of HIV in adults, this study enabled them to “document a case in infants where a broadly neutralizing antibody developed in a time frame and in a way that is something that we could consider mimicking with a vaccine.”

When HIV infects a human, their body cannot control the virus – “it’s too late,” explains Dr. Overbaugh. Thus, broadly neutralizing antibodies “are really a response to the replicating virus and the evolution of the virus.”

However, to be practical, an HIV vaccine needs to trigger an effective immune response within months – not years.

The new study builds on previous findings that unexpectedly found broadly neutralizing antibodies can be generated early in life.

In that study, the team used blood samples from infants who, with their mothers, took part in a breast-feeding study in the Kenya Research Program. The samples were collected before antiretrovirals were available that can protect infants from becoming HIV-infected through breast milk.
Evidence of polyclonal response

In the new study, the team took a closer look at the antibodies in the infants’ blood. They examined the antibody response of one baby in particular – the child was HIV-negative at birth but was infected by the age of 4 months.

The researchers found the infant’s blood contained evidence of what is called a “polyclonal response.”

Dr. Overbaugh explains that all adults studied so far have produced immune responses that are dominated by a single, specific antibody. Polyclonal responses are much harder for viruses to elude and much more likely to protect against a wider range of variants.

The team also found that broadly neutralizing antibodies in the infant samples had gained their HIV-blocking abilities without exhaustive rounds of somatic hypermutation, which – in theory – shortens the time it takes to produce a broadly neutralizing response.

In another part of the study, the team found that the infant broadly neutralizing antibodies target a different site on HIV to that targeted by adult antibodies – again suggesting a different path from infection to protection.
Infants’ broadly neutralizing antibodies could lead to HIV vaccine

These results suggest broadly neutralizing antibodies from infants could lead to a fast-acting, effective HIV vaccine. However, the roadmap still needs to be charted, and many questions remain.

For example, do infant antibodies differ because of differences in the types of HIV variants they are exposed to, or because of unique features in the infant immune system?

Dr. Overbaugh suggests perhaps infants are exposed to a different spectrum of HIV variants than adults because those viruses have already been exposed to their mothers’ immune systems, so the ones that pass into breast milk are shaped by the mothers’ antibodies.

However, if it turns out that infant immune systems have a unique ability to make broadly neutralizing antibodies against HIV quickly, then perhaps vaccinating babies is the way to early protection.

The researchers are already doing further research to confirm their findings in blood samples taken from another baby whose HIV variants have led to many studies of the structure of the virus.

They are also taking a closer look at the process of HIV antibody fine-tuning, and hope to deploy any new findings into developing preclinical models of infection that may also produce fast, protective responses.

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Transgender Woman Settles in Court After Profiling Landed Her in Jail

 

A Black transgender woman who spent 8 days in jail after being falsely accused of prostitution by the hotel she was staying at has settled her lawsuit against the Iowa hotel in court, The Guardian reports. The details of the settlement have not been released due to a confidentiality agreement.

Meagan Taylor checked into the Drury Inn in West Des Moines, Iowa, last July with a friend—also a Black transgender woman—during a trip to Kansas City for a funeral. But despite the somber, and fairly typical, reason for their stay, hotel staff called police to report that the two women were “two men” engaged in prostitution after seeing that Taylor’s ID included her birth name and “male” gender marker. It’s not uncommon for transgender people’s ID not to match their gender identity or presentation due to the challenges associated with changing gender on personal identity documents.

When police arrived, they arrested Taylor for charges including not having her hormone prescription with her. She was jailed for eight days and the charges were later dropped.

“Meagan’s case garnered national attention and has been an important reminder to those in the criminal justice system and who run businesses and other public accommodations in Iowa that transgender people are explicitly protected by our civil rights laws from discriminatory treatment,” Rita Bettis, ACLU of Iowa legal director, told The Guardian. Iowa is one of just 16 states that provides such protections. “Given the attack on transgender people happening across the country, we in Iowa are proud and thankful to work in a place where transgender people are afforded dignity and protection under our state law.”

Taylor’s isn’t the first high-profile case of profiling trans women of color as prostitutes. Arizona trans activist Monica Jones was arrested in 2014 while walking down the street with friends for “manifesting prostitution.” Though she was convicted, that conviction was later vacated.

Megan Taylor has settled her lawsuit against the Iowa hotel that got her put in jail.

Megan Taylor has settled her lawsuit against the Iowa hotel that got her put in jail. Whitney Curtis/ACLU of Iowa

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Aging Gayfully – Knowing Where to Turn

 

We don’t like to think about future needs.  However, the aging journey can sometimes present us with unexpected crises.  Knowing where to turn for help before we need it can lessen our stress and optimize our success in meeting challenges as they arise.

Navigating the Maze:  Our “safety net” of benefits and services is actually more like a “crazy-quilt” of loosely stitched patches   As community needs were identified, a separate non-profit or government agency was formed to meet that specific need.  This agency provides transportation, another agency provides home-delivered meals, and yet another can help with in-home care.  Some agencies serve the entire county, others are limited to local communities.  The Senior Resource Guide for Sonoma County is composed of nearly 80 pages of service providers, each meeting a specific need and each with its own eligibility criteria!

Please obtain a copy of the 2016 Resource Guide (available at your local senior center) and become familiar with its contents (and note that for the first time there is a separate category of listings for LGBTQI resources!!!).  Keep it handy for emergencies such as if you are discharged from the hospital and urgently need home-delivered meals or transportation to your follow-up medical appointments.

Another good place to turn when you need help with a specific need is 2-1-1 provided by the Volunteer Center of Sonoma County.  Just call 2-1-1 or visit www.211sonoma.org.

If you are trying to live on a very tight budget, I encourage you to go on-line to www.benefitscheckup.org.  While you will be asked a lot of questions to determine your eligibility for various benefits, you will not be asked to enter any identifying information and you might be amazed at the many ways you can save on food, utilities, and health costs.

Resistance to Getting Help:  We tend to internalize the values of the culture we were born into.  For many of us, that means we pride ourselves on our independence and self-sufficiency.  Vanity can also keep us from acknowledging our need for help with personal care or from using assistive devices such as hearing aids, canes, walkers and wheelchairs.  Those of us who identify as LGBTQ may have yet another layer of resistance — our fear of how we might be treated by those who provide the services we need.  Fortunately, there has been much work done in Sonoma County on making sure our aging service providers are aware of our history of alienation and sensitive to our concerns.

 

Buz Hermes is co-facilitator of the Sonoma Valley LGBT Seniors Group and a former staff member of Spectrum’s Senior Outreach Program.  He is currently offering 8-week “Aging Together With Pride” workshops sponsored by Adult and Aging Services for LGBT seniors.  He can be reached at GaryDHermes@comcast.net or (707) 227-6935

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amfAR Study Observes Potential Breakthrough in Treatment of HIV

A new study funded by amfAR, The Foundation for AIDS Research conducted by researchers at the San Francisco VA Medical Center (SFVAMC) observes that pharmacological enhancement of the immune systems of HIV patients could help eliminate infected cells, providing an important step in the ongoing quest to find a lasting HIV cure.

The study, titled “Stimulating the RIG-I Pathway to Kill Cells in the Latent HIV Reservoir Following Viral Reactivation,” addresses the persistence of latent HIV reservoirs in patients who are on antiretroviral therapy. Latent HIV reservoirs are established during the earliest stage of HIV infection, and they are infected with HIV even though they are not actively producing the virus. Although antiretroviral therapy can reduce the level of HIV in the blood to an undetectable level, latent reservoirs of HIV continue to survive. When a latently infected cell is reactivated, the cell begins to produce HIV again. For this reason, antiretroviral therapy cannot cure HIV infection.

According to the study, HIV latency depends on immune system suppression, including immune system responses that detect viral pathogens and induce the destruction of infected cells. The study shows that retinoic acid can stimulate the innate immune system into eliminating HIV-infected cells. In particular, acitretin, an FDA-approved retinoic acid derivative, can increase HIV transcription in the latent HIV reservoir and allow the innate  immune system to target and destroy HIV infected cells.

“The current model of HIV treatment can help manage symptoms and increase the quality of life for patients, but it is not a cure,” says the study’s lead author Peilin Li, MD, MHS, Research Associate at SFVAMC, and an Assistant Adjunct Professor at the University of California, San Francisco School of Medicine. “HIV patients on antiretroviral medications must take them for the rest of their lives, and they often experience adverse side effects.”

“It is important to strengthen the body’s defense system against the virus. This will help the antiretroviral drugs do their job,” says Dr. Li. “We want the immune system to recognize and kill the virus. By boosting immune response, the body will be able to kill cells in the latent HIV reservoir that are still capable of producing HIV.”

Dr. Li is hopeful that the study’s findings will lead to new ways of thinking about treating HIV. “I think this can open new doors to fighting HIV. With further research, we can create clinical solutions that can boost immune system functioning and find a lasting cure for this disease. This is a patient-centered approach to HIV treatment that moves beyond treating symptoms and toward whole health.”

This study was published in Nature Medicine magazine on June 13, 2016. You can read the study at: http://go.nature.com/1ro7w9j

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JetBlue Passengers And Crew Comfort Woman Traveling To Funeral Of Grandson Slain In Orlando Massacre

One of the youngest victims in Orlando’s deadly shooting was Luis Omar Ocasio-Capo. Known as Omar to friends, he was a dancer and barista. On Tuesday, less than three days after Omar’s brutal murder, his grandmother, heartbroken and alone, boarded a flight to Orlando to attend his funeral.
Jetblue crew member Kelly Davis Karas decided that the woman, though grieving alone, could not leave the plane without knowing the world was with her. Karas passed around a piece of paper for passengers to sign so their words might ease the grandmother’s aching heart.
As Karas pushed the beverage cart down the plane’s aisle, she whispered to passengers about the paper. Halfway down the aisle, another crew member on board said more paper was needed. Instead of signing their names and moving on, passengers were writing paragraphs—long notes of compassion, grief and strength.“When we gathered them together to present them to her, we didn’t have just a sheet of paper covered in names, which is what I had envisioned. Instead, we had page after page after page after page of long messages offering condolences, peace, love and support. There were even a couple of cash donations, and more than a few tears,” Karas wrote on Facebook.

When the plane landed, the captain announced a moment of silence for Omar. And then every passenger stopped by the grandmother’s seat to personally console her. Not one complained about the delay in deplaning. The crew knew in advance of the woman’s situation because JetBlue is granting free travel to families of the victims.

omar-feat

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Disney Donates $1 Million To Orlando Victims

From Disney’s corporate blog:

Today, the Walt Disney Company is announcing a $1 million cash commitment to the OneOrlando Fund, established by Orlando Mayor Buddy Dyer to assist those affected by the tragic events in Orlando. Also, eligible donations from Disney employees will be matched dollar for dollar by Disney Employee Matching Gifts: A Program of The Walt Disney Company Foundation.

“We are heartbroken by this tragedy and hope our commitment will help those in the community affected by this senseless act,” said Bob Chapek, chairman, Walt Disney Parks and Resorts. “With 74,000 Cast Members who call Orlando home, we mourn the loss of the victims and offer our condolences to their families, friends and loved ones.”

OneOrlando Fund will provide funds and other services to individuals affected by the tragedy. The website for the new fund is www.oneorlando.org.

Walt Disney World Resort has also been working in coordination with other Central Florida agencies and leaders to provide support to those in need. In coordination with OneBlood, cast members and other employees working at Walt Disney World Resort wishing to donate blood to help victims may donate at five designated locations across the resort property.

Through an effort led by the City of Orlando and the Central Florida Hotel & Lodging Association, Walt Disney World Resort is also providing complimentary accommodations for the families and friends of the victims.

Our hearts are with everyone impacted by this horrific event.

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VA Proposes Rule Change to Lift Ban on Gender Confirmation Surgery for Transgender Veterans

The American Military Partner Association (AMPA), the nation’s largest organization of lesbian, gay, bisexual, and transgender (LGBT) military families has welcomed the news that the U.S. Department of Veterans (VA) is proposing a rule change to lift its outdated ban on gender confirmation surgery for transgender veterans.

“This is incredibly welcome news for so many transgender veterans and their families,” said AMPA President Ashley Broadway-Mack. “So many veterans rely on the VA for important medical care that they have earned serving our nation, including transgender veterans. Gender confirmation surgery is often a critically important and medically necessary treatment for transgender veterans, and lifting this ban is long overdue.”

The proposed rule change states in part, “Due to the prior limited knowledge about both gender dysphoria and effective transition-related procedures, surgical procedures in particular were not deemed to be medically necessary. However, increased understanding of both gender dysphoria and surgical techniques in this area have improved significantly, and surgical procedures are now widely accepted in the medical community as medically necessary treatment for gender dysphoria. Additionally, recent medical research shows that gender dysphoria is a serious condition that has had severe medical consequences for certain patients if transition-related surgeries and procedures are not provided. In light of these medical advances and recent research, VA would revise its regulation to remove the prohibition on medical services that are considered gender alterations. In this way, medical decisions would be made on a case-by-case basis about what procedures are medically necessary to treat gender dysphoria.”

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School Policy Says It Can Kick Out Students With Gay Parents

Trinity Academy, a private Christian high school in Wichita, Kansas, came under fire this week for its policy allowing the school to reserve the right to deny admission or expel students who have an LGBT family member or live in a household that promotes LGBT equality.

The school’s Statement of Understanding and Agreement for Parent and Student, initially made public on the blog Friendly Atheist, lays out some of the school’s foundational principles: the Bible is inerrant, families must be active members of a local church, students will refrain from alcohol, drugs, or premarital sex. It’s the final clause, however, that has garnered attention.

Given the debate and confusion in our society about marriage and human sexuality it is vital that Trinity families agree with and support the school’s traditional, Christian understanding of those issues. Therefore, when the atmosphere or conduct within a particular home is counter to the school’s understanding of a biblical lifestyle, including the practice or promotion of the LGBT (lesbian, gay, bisexual, transgender) lifestyle or alternative gender identity, the school should have the right, in its sole discretion, to deny the admission of an applicant or discontinue enrollment of a current student.

The form requires the signature of the mother, father, and student (nontraditional families need not apply it seems).

Dustin Deckard, a former Trinity student who has since come out as gay, told local news station KSN that upon learning about the policy, “the message I received loud and clear from that is that we don’t want you here.”

Trinity officials did not respond to KSN’s requests for an on-camera interview, but emailed a statement clarifying the school’s position. “Trinity Academy holds biblical views on human sexuality and gay marriage and we want prospective families to understand that,” the statement read. “We feel that this is only fair given the disagreement and discord in our society over such issues.”

The school’s response continued by refuting a very narrow example posed by critics: whether a current or prospective student had a gay sibling. “Trinity would not and has not denied admission to a student simply because they have a sibling who is gay. Neither would we necessarily deny admission to a student with same sex attraction.”

The response doesn’t address other scenarios, such parents who are gay or who merely support LGBT equality in the home. Nor does it completely rule out denying admission or expelling a student who happens to be attracted to the same sex. While Trinity, as a private school, has some latitude to set criteria for admission, the extreme nature of this particular policy surprised even Deckard.

“This is as forward as I’ve seen them take this particular agenda,” he told KSN.

Currently, there are roughly 320 students enrolled at Trinity Academy. Earlier this year, the school announced that it plans to expand its campus, adding a school for kindergarten through eighth grade by the fall of 2017. Tuition is $10,000 a year for high school students.

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