News last year that Signapore removed it’s barrier on HIV-positive travelers reminded us that if you’re HIV-positive and looking to visit or work in another country anytime soon, you had better know whether your status will be a source of trouble. In some places, stories of travelers who ended up at the emergency room after an unexpected accident and then found themselves immediately deported for being HIV-positive aren’t uncommon. Forty-five countries, territories, and regions have some legal restrictions on foreigners known to have HIV, according to a 2012 study compiled by UNAIDS.
Caribbean Paradises
Turks and Caicos (above) in the Caribbean are a sightseer’s paradise, but the islands bar HIV-positive people from working or residing there for even a short period. But if your hopes are set on escaping to the Caribbean, there are no laws on the books barring HIV-positive tourists from St. Lucia or Trinidad and Tobago, and, let’s face it, they probably have better beaches.
Headed to Zion
Surprisingly, some of the places that have restrictions on HIV-positive travelers are known for social and political acceptance of LGBT people. For example, LGBT-friendly countries including Israel, Australia, and New Zealand have laws requiring HIV testing for foreign workers, and the United States barred HIV-positive visitors until fairly recently.
Israel requires HIV testing for certain foreign workers, and the Ministry of Interior reserves the right to deny work permits to those who are HIV-positive. The law appears designed to largely to prevent people from countries with particularly high HIV rates, such as those in sub-Saharan Africa from entering the country, but it can affect anyone with HIV, including Americans.
The Bustle of Asia
A record 6 million travelers visited Taiwan (above) in 2011, yet the country is anything but friendly to those with HIV. Foreigners planning on staying in the country longer than three months can be forced to take HIV tests or other medical examinations, according to the Tainan City Health Bureau, and are not allowed to stay in the country if they test positive.
Pyramid Hunting
If you’re looking to visit pyramids, you might want to plan your vacation for Mexico or Peru, since Egypt is strict about deporting HIV-positive foreigners.
Going Down Under
In Australia restrictions come into play primarily when HIV-positive people wish to stay in the country for longer than 90 days. HIV testing is required for anyone older than 15 applying for a permanent visa. Being HIV-positive does not usually disqualify an applicant, but government officials may take the cost of the applicant’s care or public health risks into consideration.
New Zealand’s law is similar to Australia regarding the treatment of HIV-positive people: Tourists who are staying in the country less than 90 days do not have to declare their status upon arrival. However, people applying for work permits or residency must be tested for HIV and can be turned away if they are positive. Also, a New Zealand policy on accepting refugees from political persecution reserves 20 places for people with HIV.
The Rest of the Best
Most countries, territories, and regions have no HIV-specific restrictions on entry, stay, and residence these days. The United States is now included in that list (after lifting its ban on HIV-positive foreign visitors in 2012), along with such major nations as the United Kingdom, Brazil, and Japan.
For more on places where it’s OK to travel (or not) visit UNAIDS.org.
As mentioned in an earlier blog, recent studies are showing that we LGBT seniors tend to be more resilient than our non-LGBT peers. In learning to live with the stress of being a stigmatized minority we have increased our capacity for handling the difficult challenges of aging. As the saying goes, our wounds have made us stronger. That resilience may also come in handy as we prepare to face the unknowns of the recent election. What are the qualities of that resilience? Here are some of my ideas:
Humor: One of the first qualities that pops up is that we have learned not only to laugh at ourselves, but we have also perfected the art of “dark humor!” We find ways to release hurt and tension, even in sad or fearful times such as during the AIDS pandemic. Humor can help us cope with the losses and uncertainty of our aging.
Self-Awareness: We tend to be introspective. While many of us as children did not have today’s diverse terminology, we knew at a very young age that we were “different” and that led us on an early path of eagerly discovering our authentic selves and finding unique ways to express our talents … a path that many non-LGBT individuals begin much later in life when traditional cultural expectations have been fulfilled.
Self-Protection: As we were learning what made us different, we also learned how to hide those differences in order to survive an intolerant, even hostile culture. In so doing, we developed a heightened awareness of our environment, an intuitive sense of others and strategies for avoiding uncomfortable or even dangerous situations. This ability to preserve our well-being may help us be pro-active and creative in exploring options when difficult aging challenges arise.
Self-Nurturing: While many of us had to overcome unhealthy behaviors that accompanied our internalized stigma, we have also learned the importance of self-care in coping with stress. Some of us find peace and fulfillment through seeking and expressing beauty while others may nurture themselves by connecting with animals and nature or by serving others or by cultivating gratitude and a positive attitude.
Interdependence: Last but not least, we have developed a “kinship” with each other within the LGBT community. We have demonstrated the power and the value of standing together. By combining our individual strengths with our compassionate caring for each other, we will meet both the challenges of our individual aging and overcome any hurdles that may await us collectively. Now that’s resilience!!!
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 a consultant on LGBT aging and can be reached at GaryDHermes@comcast.net or (707) 227-6935.
NASTAD (National Alliance of State and Territorial AIDS Directors), has announced the launch of a new online training platform, HisHealth.org, to help doctors, nurses, and medical professionals unlearn racial biases that create barriers to good care and elevate the quality of healthcare for black gay men and black men who have sex with men.
The barriers for black gay men in search of medical care are high. Even though most medical providers want to give good care, only 1 in 3 doctors know what PrEP is — a groundbreaking HIV prevention medication; many doctors aren’t versed in providing quality care for LGBTQ people; and research indicates implicit bias has lead to subpar care for Black Americans. “His Health” gives accredited in-depth training for medical professionals alongside stories of the best care programs in the country.
“Finding a good doctor as a black gay man with HIV is incredibly difficult,” said Terrance Moore, Deputy Executive Director at NASTAD. “Research shows that implicit bias stops many doctors from providing high-quality care to black Americans. Add to that a lack of understanding about the sexual health care needs of LGBT patients — and many men I know would rather stay home. That’s why this new tool is so important — we can help doctors fight implicit bias and provide better care.”
Provides accredited and expert-led continuing education courses that count towards the credits medical professionals already need to maintain their medical licensure;
Offers portraits of innovative models of care including Project Silk, a CDC funded, Pittsburgh -based recreational safe space and sexual health center rooted in house ball culture and Connecting Resources for Urban Sexual Health, a sexual health clinic created by and for LGBTQ youth of color; and
Gives easy access to evidence-based resources to support the delivery of high quality, culturally affirming healthcare services for Black men who have sex with men.
“There is a lot of discussion right now about implicit bias and police brutality in the U.S. — but the truth is, this is a huge challenge for health care providers as well,” said Omoro Omoighe, Associate Director of Health Equity and Health Care Access at NASTAD. “We know doctors and nurses desperately wish to offer culturally affirming healthcare that is stigma free to Black LGBT patients. With the advent of His Health, they now have the tools necessary to tackle implicit bias and feel more confident in their ability to uplift the standard of care for black gay men while maintaining their licensure to practice medicine.”
The His Health platform was developed for and by Black same gender loving men and their healthcare providers in partnership with NASTAD and the Health Resources Services Administration’s HIV/AIDS Bureau (HRSA/HAB) in response to the high HIV rates amongst black men who have sex with men.
The Transgender Day of Remembrance was set aside to memorialize those who were killed due to anti-transgender hatred or prejudice. The event is held in November to honor Rita Hester, whose murder on November 28th, 1998 kicked off the “Remembering Our Dead” web project and a San Francisco candlelight vigil in 1999. Rita Hester’s murder — like most anti-transgender murder cases — has yet to be solved.
Although not every person represented during the Day of Remembrance self-identified as transgender — that is, as a transsexual, crossdresser, or otherwise gender-variant — each was a victim of violence based on bias against transgender people.
We live in times more sensitive than ever to hatred based violence, especially since the events of September 11th. Yet even now, the deaths of those based on anti-transgender hatred or prejudice are largely ignored. Over the last decade, more than one person per month has died due to transgender-based hate or prejudice, regardless of any other factors in their lives. This trend shows no sign of abating.
The Transgender Day of Remembrance serves several purposes. It raises public awareness of hate crimes against transgender people, an action that current media doesn’t perform. Day of Remembrance publicly mourns and honors the lives of our brothers and sisters who might otherwise be forgotten. Through the vigil, we express love and respect for our people in the face of national indifference and hatred. Day of Remembrance reminds non-transgender people that we are their sons, daughters, parents, friends and lovers. Day of Remembrance gives our allies a chance to step forward with us and stand in vigil, memorializing those of us who’ve died by anti-transgender violence.
J.W. da Silva (24 years old)
Cause of death: stoned to death.
Location of death: Paudalho, Brazil
Date of death: October 27th, 2016 source
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Julia Sofia (20 years old)
Cause of death: stabbed to death.
Location of death: Nazaré, Bahia, Brazil
Date of death: October 21st, 2016 source
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Yasmin Montoy (20 years old)
Cause of death: beaten to death, blunt force trauma to the head.
Location of death: São Paulo, Brazil
Date of death: October 16th, 2016 source
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unidentified woman
Cause of death: suffucation
Location of death: Sorocaba, Brazil
Date of death: October 13th, 2016 source
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W. R. Alexandre
Cause of death: beaten to death.
Location of death: Baixada Fluminense, Brazil
Date of death: October 8th, 2016 source
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unidentified woman
Cause of death: stabbed to death
Location of death: Aracaju, Sergipe, Brazil
Date of death: September 30th, 2016 source
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Rafael Silva (17 year old)
Cause of death: 17 gunshots, ran over by car.
Location of death: Porto Alegre, Rio Grande do Sul, Brazil
Date of death: September 30th, 2016 source
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Chaiene da Silva
Cause of death: multiple gunshot wounds
Location of death: Paudalho, Pernambuco, Brazil
Date of death: September 24th, 2016 source
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Larissa (31 years old)
Cause of death: shot in abdomen, thrown from car
Location of death: São Paulo, Brazil
Date of death: September 16th, 2016 source
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H.J. Silva (37 years old)
Cause of death: blunt force trauma
Location of death: Sítio do Quinto, Bahia, Brazil
Date of death: September 11th, 2016 source
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Pâmela Pereira (16 years old)
Cause of death: multiple gunshot wounds
Location of death: Conceição do Jacuípe, Bahia, Brazil
Date of death: September 9th, 2016 source
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unidentified woman (24 years old)
Cause of death: gunshot and stab wounds
Location of death: Caxias do Sul, Rio Grande do Sul, Brazil
Date of death: September 9th, 2016 source
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Taina W.P. Alencar (22 years old)
Cause of death: stab wound
Location of death: Londrina, Paraná, Brazil
Date of death: September 4th, 2016 source
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Hilda A.J. da Silva (46 years old)
Cause of death: strangled with an electrical cord
Location of death: Aliança, Pernambuco, Brazil
Date of death: September 4th, 2016 source
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Bruniele
Cause of death: multiple gunshot wounds
Location of death: São Bernardo do Campo, São Paulo, Brazil
Date of death: August 29th, 2016 source
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Erika W.P. de Arruda (30 years old)
Cause of death: gunshot wounds to neck and groin
Location of death: Cuiabá, Mato Grosso, Brazil
Date of death: August 25th, 2016 source
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Brenda
Cause of death: stabbing
Location of death: Castanhal, Pará, Brazil
Date of death: August 19th, 2016 source
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Tiffany Rodrigues (23 years old)
Cause of death: asphyxiation
Location of death: Alta Floresta, Mato Grosso, Brazil
Date of death: August 8th, 2016 source
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unidentified woman
Cause of death: stabbing
Location of death: Londrina, Paraná, Brazil
Date of death: August 1st, 2016 source
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Thiemy Oliveira (24 years old)
Cause of death: stabbing
Location of death: Maringá, Paraná, Brazil
Date of death: August 1st, 2016 source
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Adriane Bonek (43 years old)
Cause of death: unknown
Location of death: São Pedro da Aldeia, Rio de Janeiro, Brazil
Date of death: August 1st, 2016 source
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Sabrina E.S. Sales (25 years old)
Cause of death: beaten to death
Location of death: Luís Eduardo Magalhães, Bahia, Brazil
Date of death: July 25th, 2016 source
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unidentified woman
Cause of death: stabbing
Location of death: João Pessoa, Paraíba, Brazil
Date of death: July 13th, 2016 source
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Edymara M. Leão (36 years old)
Cause of death: asphyxiation
Location of death: Lago Norte, Brazil
Date of death: July 11th, 2016 source
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Nickolle Rocha (19 years old)
Cause of death: beaten to death
Location of death: Cachoeira do Sul, Rio Grande do Sul, Brazil
Date of death: July 11th, 2016 source
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Pandora Pereira (26 years old)
Cause of death: stabbed to death
Location of death: São Sebastião, São Paulo, Brazil
Date of death: July 3rd, 2016 source
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Daiane Brasil (36 years old)
Cause of death: gunshots to the neck, chest, and face.
Location of death: Uberaba, Minas Gerais, Brazil
Date of death: June 27th, 2016 source
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Julia Almeida (28 years old)
Cause of death: strangled, thrown in sugar cane field.
Location of death: Ituverava, São Paulo, Brazil
Date of death: June 25th, 2016 source
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Danielly Barby (24 years old)
Cause of death: gunshot to the neck
Location of death: Mogi das Cruzes, São Paulo, Brazil
Date of death: June 25th, 2016 source
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Sheila Santos
Cause of death: gunshot
Location of death: Calabar, Bahia, Brazil
Date of death: June 24th, 2016 source
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Lorran Lorang (19 years old)
Cause of death: asphyxiation
Location of death: Duque de Caxias, Rio de Janeiro, Brazil
Date of death: June 22nd, 2016 source
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unidentified woman
Cause of death: beaten to death with a wooden club
Location of death: Manaus, Amazonas, Brazil
Date of death: June 18th, 2016 source
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Gabriel Figueira de Lima (21 years old)
Cause of death: stabbed in the neck
Location of death: Manaus, Amazonas, Brazil
Date of death: June 16th, 2016 source
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Paula
Cause of death: beaten to death
Location of death: Goiandira, Goiás, Brazil
Date of death: June 16th, 2016 source
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Lauandersa
Cause of death: stabbed over 30 times
Location of death: Genipabu, Caucaia, Brazil
Date of death: May 16th, 2016 source
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Ana Hickmann (30 years old)
Cause of death: 2 gunshots in the neck
Location of death: Rio Branco, Acre, Brazil
Date of death: May 15th, 2016 source
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Michele de Souza (22 years old)
Cause of death: 7 gunshots to the chest, abdomen, legs and arms.
Location of death: São José do Rio Preto, São Paulo, Brazil
Date of death: May 11th, 2016 source
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Leticia Silva (22 years old)
Cause of death: multiple gunshot wounds.
Location of death: Belém, Pará, Brazil
Date of death: May 5th, 2016 source
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Alana da Silva Pessoa (22 years old)
Cause of death: gunshot wound.
Location of death: João Pessoa, Paraíba, Brazil
Date of death: May 4th, 2016 source
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Jéssica L.C. Menezes (24 years old)
Cause of death: multiple stab wounds
Location of death: Uberlândia, Minas Gerais, Brazil
Date of death: April 16th, 2016 source
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Luana Biersack (14 years old)
Cause of death: sexually assaulted, beaten, and drowned..
Location of death: Novo Itacolomi, Paraná, Brazil
Date of death: April 13th, 2016 source
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Amanda Araujo (17 years old)
Cause of death: multiple stab wounds
Location of death: Imperatriz, Maranhão, Brazil
Date of death: April 11th, 2016 source
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Bianca Abravanel (25 years old)
Cause of death: 15 gunshot wounds to the chest and face.
Location of death:Ribeirão Preto, São Paulo, Brazil
Date of death: April 11th, 2016 source
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Andinho
Cause of death: multiple gunshot wounds.
Location of death: Aracaju, Sergipe, Brazil
Date of death: March 29th, 2016 source
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Gabriela Rodrigues
Cause of death: multiple gunshot wounds.
Location of death: Aparecida de Goiânia, Goiás, Brazil
Date of death: March 28th, 2016 source
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Keyti (42 years old)
Cause of death: beaten to death.
Location of death: Imperatriz, Maranhão, Brazil
Date of death: March 27th, 2016 source
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D.S. Barros (21 years old)
Cause of death: 30 stab wounds over entire body Location of death: Belo Horizonte, Minas Gerais, Brazil
Date of death: March 23th, 2016 source
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M. Moreira (16 years old)
Cause of death: head trauma
Location of death: Sinop, Mato Grosso, Brazil
Date of death: March 20th, 2016 source
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Camilla Rios (32 years old)
Cause of death: 30 stab wounds over entire body
Location of death: Jacarepagua, Rio de Janeiro, Brazil
Date of death: March 14th, 2016 source
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unidentified woman
Cause of death: unknown, dismembered
Location of death: Brazil
Date of death: March 10th, 2016 source
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Mika P. Da Silva
Cause of death: gunshot wounds to the head and groin
Location of death:Macau, Rio Grande do Norte, Brazil
Date of death: March 7th, 2016 source
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María la del Barrio
Cause of death: unknown
Location of death: Manaus, Brazil
Date of death: March 6th, 2016 source
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V.
Cause of death: multiple stab wounds to the neck
Location of death: João Pessoa, Brazil
Date of death: March 7th, 2016 source
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unidentified woman
Cause of death: multiple gunshot wounds
Location of death: Gravatai, Rio Grande do Sul, Brazil
Date of death: February 27th, 2016 source
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Natascha (37 years old)
Cause of death: set on fire.
Location of death: Tarumã, São Paulo, Brazil
Date of death: February 24th, 2016 source
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unidentified woman
Cause of death: strangled, partially burned
Location of death: Porto Alegre, Rio Grande do Sul, Brazil
Date of death: February 19th, 2016 source
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unidentified woman
Cause of death: strangled, partially burned
Location of death: Porto Alegre, Rio Grande do Sul, Brazil
Date of death: February 19th, 2016 source
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unidentified woman
Cause of death: gunshot
Location of death: Carapicuiba, São Paulo, Brazil
Date of death: February 12th, 2016 source
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Malu (30 years old)
Cause of death: unknown
Location of death: Maracanaú, Ceará, Brazil
Date of death: March 11th, 2016 source
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Fabiane Hilario (20 years old)
Cause of death: Gunshot at point blank range to the head.
Location of death: Curitiba, Paraná, Brazil
Date of death: January 27th, 2016 source
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Dani (20 years old)
Cause of death: Gunshot to the chest
Location of death: São José do Rio Preto, São Paulo, Brazil
Date of death: January 24th, 2016 source
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Bruna Souza (23 years old)
Cause of death: multiple stab wounds
Location of death: Rio Verde, Goiás, Brazil
Date of death: January 23rd, 2016 source
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Ketelen Alves (23 years old)
Cause of death: gunshots
Location of death: Manaus, Brazil
Date of death: Jaunuay 23rd, 2016 source
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Giovana Atanazio (20 years old)
Cause of death: Thrown from a bridge, drowned
Location of death: São José dos Campos, Brazil
Date of death: January 17th, 2016 source
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unidentified woman
Cause of death: multiple gunshots
Location of death: Fortaleza, Ceará, Brazil
Date of death: January 4th, 2016 source
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Italy
Thiago Fernando Batista (30 years old)
Cause of death: unknown, body thrown in dumpster.
Location of death: Rome, Italy
Date of death: July 29th, 2016 source
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Mexico
Paulett Gonzalez (24 years old)
Cause of death: murdered, burned beyond recognition.
Location of death: Celaya, Guanajuato, Mexico
Date of death: June 2016 source
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Pakistan
Alisha (23 years old)
Cause of death: multiple gunshot wounds.
Location of death: Parda Bagh, Faqirbabad, Pakistan
Date of death: May 25th, 2016 source
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Russia
Raina Aliev (25 years old)
Cause of death: dismembered
Location of death: Dagestan
Date of death: October 2016 source
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Spain
Lorena Reyes (32 years old)
Cause of death: fall, after being stabbed
Location of death: Santa Cruz de Tenerife, Spain
Date of death: October 24th, 2016 source
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Thailand
Amphon Kongsong (28 years old)
Cause of death: strangled, body stuffed in bed frame.
Location of death: Pattaya, Thailand
Date of death: August 20th, 2016 source
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Turkey
Hande Kader (24 years old)
Cause of death: murdered, burned beyond recognition.
Location of death: Istanbul, Turkey
Date of death: August 2016 source
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USA
Monica Loera (43 years old)
Cause of death: gunshot
Location of death: Austin, Texas, USA
Date of death: January 22nd, 2016 source
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Jasmine Sierra (52 years old)
Cause of death: beaten to death
Location of death: Bakersfield, California, USA
Date of death: January 22nd, 2016 source
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Maya Young (25 years old)
Cause of death: stabbing
Location of death: Philadelphia, Pennsylvania, USA
Date of death: February 20th, 2016 source
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Kendarie/Kandicee Johnson (16 years old)
Cause of death: Gunshot
Location of death: Burlington, Iowa
Date of death: March 2nd, 2016 source
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Keyonna Blakeney (22 years old)
Cause of death: upper body trauma
Location of death: Rockville, Maryland, USA
Date of death: May 1st, 2016 source
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Tyreece “Reecey” Walker (32 years old)
Cause of death: multiple stab wounds
Location of death: Wichita, Kansas, USA
Date of death: May 1st, 2016 source
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Mercedes Successful (32 years old)
Cause of death: gunshot
Location of death: Haines City, Florida, USA
Date of death: May 15th, 2016 source
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Amos Beede (38 years old)
Cause of death: beaten to death
Location of death: Burlington, Vermont
Date of death: May 22nd, 2016 source
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Devin Diamond (22 years old)
Cause of death: blunt force trauma, set on fire
Location of death: New Orleans, Louisiana
Date of death: June 5th, 2016 source
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Deeniquia Dodds (22 years old)
Cause of death: shot
Location of death: Washington D.C., USA
Date of death: July 4th, 2016 source
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Dee Whigham (36 years old)
Cause of death: stabbed to death
Location of death: St. Martin, Mississippi, USA
Date of death: July 23rd, 2016 source
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Erykah Tijerina (36 years old)Cause of death: Stabbed 24 times
Location of death: El Paso, Texas, USA
Date of death: August 8th, 2016 source
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Rae’lynn Thomas (28 years old)
Cause of death: Shot at point blank range
Location of death: Columbus, Ohio, USA
Date of death: August 10th, 2016 source
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TT Saffore (26 years old)
Cause of death: Throat cut
Location of death: Chicago, Illinois, USA
Date of death: September 11th, 2016 source
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Crystal Edmonds (32 years old)
Cause of death: Shot in back of head
Location of death: Baltimore, Maryland, USA
Date of death: March September 16th, 2015 source
The primary, if (mostly) unspoken, purpose of voter ID laws is to keep down turnout among African-American voters who prefer Democrats. But one of the side effects of the laws is that they make it harder for trans voters too. An estimated 34,000 trans voters may find it impossible to cast a ballot this election because they can’t clear the hurdles that Republican legislatures have put in place.
According to a report from the Williams Institute at the UCLA School of Law, eight states have laws that make voting incredibly (and perhaps intentionally) difficult for trans people. At issue is the need to produce documentation, such as a birth certificate, that not only proves that they are U.S. citizens but that also reflects their gender. Of course, North Carolina, hotbed of anti-trans activity, is one of the eight offending states.
“Transgender people have unique, and sometimes insurmountable, burdens to obtaining accurate IDs for voting in states that require it,”says Williams Institute Scholar Jody Herman, the author of the study.
Changing documents so that they accurately reflect the voter’s gender is a burdensome and often costly process that requires jumping through a series of bureaucratic hoops. Needless to say, that burden falls disproportionately on transgender people of color, youth, students and people with disabilities. The National Center for Transgender Equality has a checklist for voters to help them navigate both pre- and post-Election Day challenges.
Did Republican legislators intentionally decide to craft laws that target trans voters? Probably not. But that if they did, they’d consider it a feature of the law, not a bug.
In 2017, the patents for two antiretroviral drugs for HIV that continue to be widely used will likely expire in the United States and generic alternatives at lower market prices could be introduced. Some have long awaited this occurrence, hoping for increased competition and a drive to lower prices for all HIV medications. However, it is an open question whether generic competition, at least in the short term, will actually materialize or if it does, lead to reduced prices. If savings are realized, there is also no guarantee they will be funneled back into other critical HIV services. To explore the possibilities of wider generic availability in the United States, Project Inform co-hosted a meeting with the National Association of State and Territorial AIDS Directors (NASTAD) and the Treatment Action Group (TAG) in Washington, D.C. on September 29 and 30, 2016.
The two drugs going off patent soon are efavirenz – marketed as Sustiva – and tenofovir disoproxil fumarate (TDF) – marketed as Viread. Both efavirenz and TDF are available in combination with other antiretroviral drugs as single tablet regimens (STRs), and some of the other drugs contained in those STRs will not be going off patent. This could have significant consequences, such as the need to break up prescribed regimens into multiple pills with multiple insurance copayments.
Co-sponsors invited a diverse set of stakeholders, including providers, activists, policy makers, health economists and generic manufacturers to the meeting to ensure a broad and lively discussion. The primary segments of the discussion were:
an analysis of current drug costs across multiple payers (e.g. private insurance, Medicaid, The VA, etc.);
the potential (if any) to redirect any savings to other HIV services; and,
what the positive, neutral or negative outcomes might be for people living with HIV and front-line providers when generic HIV drugs become available.
As became clear through early discussions, the drug purchasing systems in the United States are incredibly convoluted, vary significantly by payer source, and are fairly opaque to those seeking to understand or reform purchasing systems.. Appearances can be deceiving. The price actually paid by private and public payers is almost never publicly available as negotiations are protected by privacy agreements. Because of certain purchasing mechanisms , public programs such as Medicaid or public health clinics or hospitals may be paying very little and generating program income on some older brand drugs before they go off patent. This income could significantly decrease with the introduction of generics, depending on a number of factors, including how the generics were priced and whether or not supplemental rebates were negotiated.
Examination of the generic market and payer purchasing systems raised real questions about how much money could actually be saved within a system on generic versions of HIV drugs, certainly in the near future. It is unclear where savings might be possible and how much savings would be generated by the entry of generic HIV drugs into various health care settings. Generic manufacturers and some academic studies have previously stated that significant savings could be generated but a closer examination of generic competition and health care systems made it clear that more analysis is necessary. This is not to say that generic competition is inherently bad or unuseful as a bargaining chip to lower health care costs, but that the system is so complex and everchanging that it will take considerable effort to unravel the potential outcomes of different possible scenarios.
In most cases, there are no mechanisms for savings on drug costs within most health systems to accrue back to other HIV services. Some experimental comprehensive care programs in one state are being attempted, but there is no guarantee that such programs will continue or be could be adopted in other states.
Finally, there is the fear among some advocates and providers that more aggressive cost containment measures, such as the need for a provider to get prior authorization from an insurer in order to prescribe brand name or single tablet regimens drugs, could result in some people with HIV having to take less tolerable or simple regimens and an increase in the time spent by providers and their staff dealing with the ever-changing rules and policies put in place by payers.
Though the participants agreed that the hopes once expressed about the potential for generics to usher in lower drug prices for all HIV medications in the United States are perhaps not grounded in our current reality, the activists and providers who gathered on the second day were determined to identify actions that could be taken now to ensure that benefits might be achieved. In addition, it was decided to further explore what protections might be necessary for patients and their providers to ensure access to standard of care HIV treatment in all health care systems with the entry of generic HIV drugs.
These actions have been prioritized and are being refined by the co-sponsors. They will be outlined in in more detail in recommendations put forward by the co-sponsors and we will work on implementation of some of the prioritized suggestions, which include a modelling project that would help to better understand potential cost savings and/or program income loss with the entry of generic HIV drugs. Project Inform will provide updates on these important efforts as they become available.
New data just released from the 2015 National Survey on Drug Use and Health found that 39 percent of LGB adults said they had used some type of illicit drug over the past year compared to about 17 percent of straight respondents, HealthDay Newsreports.
About 15 percent of LGB adults said they’d battled substance use disorder vs. 15 percent of straight respondents. Smoking and drinking rates were higher as well — 32 percent smoking for LGB people vs. 21 percent of straight folks. For drinking, it was 64 vs. 56 percent respectively.
However LGB adults seemed to be more amenable to seeking out treatment for a substance-abuse disorder if one developed. The report found that among adults who required substance use treatment, 15.3 percent of LGB adults received it at a specialty facility over the past year, compared with 10.6 percent of straight adults, HealthDay reports.
LGB adults were more than twice as likely as straight adults to have had any kind of mental illness in the past year (37.4 percent versus 17 percent), and also had a higher rate of past year serious mental illness (13 versus 3.6 percent).
However, treatment rates were higher for LGB adults with a mental illness, the researchers said. For adults with any kind of mental illness in the past year, LGB adults were more likely to receive mental health treatment than straight adults (48.5 percent versus 42.6 percent), according to HealthDay.
About 4.3 percent of American adults are either lesbian, gay or bisexual, according to the report.
LGBT HealthLink LGBT HealthLink is a community-driven network of experts and professionals enhancing LGBT health by eliminating tobacco use, reduce cancer, and understand other health realities within our communities.
Big Bi Study Finds Mixed Results
A study of U.S. adults found that many people neither agreed nor disagreed with stereotypical statements such as “bisexuality is just a phrase” or bisexuals “are incapable of being faithful,” showing the public has yet to reject stigmatizing beliefs on bisexuality. Women felt more positive towards bisexuality than did men, and both genders felt more positive about bi women than about bi men.
Cigarette Tax Could Save Queer Lives
The CEO of LA’s LGBT Center argued that California’s proposed tobacco tax – which Californians are voting on as this Roundup is being published – could save LGBT lives… and lots of them. The author points to the fact that queer Californians smoke at more than double the rate of heterosexual Californians, and that tobacco taxes are proven to slash smoking rates.
Post-ACA, More Queer Men Are Insured
Researchers found that men who have sex with men (MSM) went from being 68% insured in 2008 to 79% insured in 2014, and credit the Affordable Care Act (ACA) as well as marriage equality, which allows same-sex spouses to join employer coverage. The biggest improvements were among younger men, the less educated, and the low-income – but those groups still had lower overall rates.
Breast Cancer and Queer Women
The Hill reported that lesbian and bisexual women face increased breast cancer risk based on lifestyle factors like smoking and weight, and may be hesitant to share their sexual orientation with their doctors, which further inhibits detection. Meanwhile, the New York Times reports that more women are choosing to forgo breast reconstruction after mastectomy, referred to as “going flat”, – a choice already preferred by many queer women, who see reconstruction as less important for their body image.
LGBT Caregivers Face Challenges
US News reports that LGBT caregivers of loved ones with chronic conditions face unique challenges, such as facing discrimination from providers when trying to care for parents, or having to help LGBT friends whose families are unsupportive.
Seniors who do not have supportive family connections are frequently referred to as “orphan seniors.” Many of us who are LGBT have never had children and we may be alienated from other family members. While there are many supportive services provided by government and non-profit agencies, they cannot fulfill all the needs that can arise when a health-related crisis occurs.
Our past efforts to create non-traditional family ties are more difficult now as our peers develop their own age-related challenges. Many of us also lost many friends during the AIDS pandemic and now we are losing friends to age-related causes. Even if we are partnered, we may be isolated as a couple and there may come a time when one of us will be alone. So whom can we call upon for practical and emotional support when a crisis happens?
First of all, I think we have to be prepared for the unexpected. We might make a list of things that need regular attention in the event we are unable to carry out those tasks. Is there a pet that would need care? Are there bills that would need to be paid? Is there a garden that would need regular watering?
Secondly, we might begin to think about who might fulfill those responsibilities. This involves some creative brainstorming as we don’t want to burden just one person. Think about neighbors, acquaintances, and connections made through shared activities such as clubs, meet-ups and walking groups.
Thirdly, we will want to make it easy for people to help us. That means getting over our attachment to independence and learning the value of interdependence. We need to feel as comfortable asking for help as well as we do offering it. We also need to make our requests clear and definite and to offer options. When someone asks “How can I help?” and we feel it is sincere, we can offer a list of concrete possibilities from something simple such as picking up an item at the store or providing a periodic phone check-in to something more involved such as a home visit or going with us to a medical appointment.
Conversely when we are called upon to support another, it is important to know our strengths and to set boundaries. For example, some us are much better at practical support than we are at emotional support. We need to contribute in ways that allow us to be both comfortable and effective.
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 a consultant on LGBT aging and can be reached at GaryDHermes@comcast.net or (707) 227-6935.
Various off putting and discriminatory terms have been used in employment interviews to indicate management disapproval of a candidate. For example, a young professional woman may be asked if her husband would allow her to take business travel with male colleagues.
Of course, there is always the pregnancy question of a professional woman and that can lead in several discriminatory directions. Are you planning to have a family? Would you want to continue to work after having a child? And so it goes.
For openly out LGBT employment seekers, discriminatory questions tend to go toward health issues, especially mental health and HIV status. Employers are, of course, not allowed to ask health questions and are required by federal and state laws to accommodate health conditions designated or defined as a disability.
Still. When it comes to openly out LGBT job seekers, especially those seeking high paid professional jobs that require high levels of responsibility, veteran employers have subtle ways of asking “Are you mentally stable?”
Variations on “Are you mentally stable?” include “Are you well adjusted?” Translation: Are you sexually stable?
Another variation: “With regard to your sexuality, are you at peace with that?” Translation: “Are you sexually confused and/or mentally stable?”
Another variation: “Your family is supportive of your sexuality and at peace with that?” Translations: “Do you come from a stable home with a stable upbringing and are you mentally stable?”
Another variation, “Are you in control of your sexuality?” Translation: “At the firm, we can’t have displays of sexuality that might disrupt the work and offend our staff.”
Another translation: “Are you mentally stable?”
Employers have a variety of subtle ways to ask these questions, whether verbally or through a set of in-house questionnaires developed by staff to discriminate against LGBT employment seekers. Since the questionnaire is company property, the LGBT jobseeker will not have access to them as proof of employment discrimination. For this reason the LGBT jobseeker should take an iPhone image of the questionnaire and insist on completing the questionnaire in private.
If the interview is all verbal, an iPhone recorder in a jacket pocket might be used to record the interview. Recorders can be activated by accident if any questions arise about the recording. The job applicant can also ask to go to bathroom to check and adjust, if necessary, the quality of the recording.
In a July 1972 Dear Abby column a writer identified as Happy Heterosexual wrote, “There is no such thing as a well-adjusted homosexual; the two terms are antonymous. Homosexuality, male female, is a form of sexual deviation which is symptomatic of personality disorder.”
I am editing Abby’s response to “Dear Happy” with, “Much of the maladjustment seen in homosexuals is due to the rejection, persecution, and guilt imposed upon them by intolerant and ignorant contemporaries.”
Abby, Abigail Van Buren whose real name was Pauline Phillips, died in 2013, was an LGBT ally and spokesperson to the masses long before anyone else. Her daughter Jeanne continues her mother’s work to change minds today.
LGBT employment discrimination continues to cause suffering in our community due to “intolerant and ignorant employers,” outdated business and personnel policies, and outright bigotry. We all have to do our part to help bring the employment and other changes we want to see to support ourselves and our families. That takes work, action and the technology we all have in our pockets.
James Patterson is a Washington DC based writer and speaker who nearly lost his job as a diplomatic post due to long political interference from U.S. Sen. Jesse Helms. Patterson’s work appears in The Washington Post, The Foreign Service Journal, TheHill.com, The Advocate.com, San Francisco Chronicle, and many others. JEPCapitolHill@gmail.com
Cause of death: Stabbed 24 times
