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‘The numbers are staggering’

14 percent of gay, bi men in D.C. have HIV: study

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Local activists and health officials this week called for new approaches in HIV prevention following a city study that shows 14 percent of tested gay and bisexual men were HIV positive and 25 percent of black gay male participants were positive.

During a March 29 town hall meeting organized by the D.C. Center for the LGBT community to discuss the study’s findings, a number of AIDS activists noted the study included a sample of just 500 male respondents and did not cover the full demographics of all men who have sex with men.

But most activists speaking at the forum said the study reveals a number of important new findings showing high-risk behavior among those sampled and should not be dismissed because it’s less than perfect.

“Because we’ve determined that it is not a truly representative sample due to methodological limitations of the research, we can’t say that 14 percent of D.C.’s gay [and men who have sex with men] population is HIV positive,” said Daniel O’Neill, chair of the D.C. Center’s HIV Prevention Working Group.

“The reality: It’s probably far worse than 14 percent, as the data is both dated and under-represents some of the most at-risk subgroups.”

Dr. Shannon Hader, director of the D.C. HIV/AIDS Administration, opened the town hall meeting with a 45-minute presentation explaining the study’s findings and comparing it to existing city data on HIV prevalence among MSM, homosexuals and injection drug users, the three key groups used by researchers to measure the AIDS epidemic.

Hader and O’Neill were among five panelists who spoke at the town hall meeting and fielded questions from about 50 people who attended. The other panelists included Jose Gutierrez, a gay Latino activist affiliated with La Clinica Del Pueblo, a D.C. clinic that provides services to people with HIV/AIDS; Ken Pettigrew, director of programs for Us Helping Us, a local AIDS advocacy group that provides services for mostly black gay men; and Calvin Gerald, an organizer with the D.C. Center’s HIV Prevention Working Group.

Hader’s presentation followed the city’s release of the study’s findings March 26 at a news conference outside the Wanda Alston House for LGBT youth in Northeast D.C.

A first-of-its-kind look into the behavior of men who have sex with men in the District of Columbia, the study’s main finding was that 14 percent of those sampled were HIV positive. The figure represents an HIV-positive rate nearly five times higher than the 3 percent HIV infection rate among all adults and teens in the city, according to separate data gathered by the HIV/AIDS Administration.

The MSM study also found that black men who have sex with men, who participated in the study, had an HIV infection rate of 25 percent, compared to an 8 percent infection rate among white MSM who participated in the study.

“The numbers are staggering, but they are changeable,” says a report accompanying the study, which was conducted for the city by George Washington University’s School of Public Health and Health Services. “We are convinced that there are no foregone conclusions to getting HIV for men who have sex with men.”

Although gay and AIDS activists attending Monday’s town hall meeting said the high HIV positive rate findings among MSM did not surprise them, some expressed surprise and puzzlement over other findings. Among them are that men under age 30 “generally had safer sex behaviors” while men over 30 “got tested less and used condoms less and had more sex partners.”

The study also found that more than 40 percent of the men participating did not use a condom at the time of their last sexual encounter and more than one-third did not know the HIV status of their last sex partner.

Another development that came as a surprise to many activists, more than half of the study’s participants reported an annual income of $50,000 or greater, an education significantly higher than a high school degree, and were believed to be “socially connected” with the LGBT community.

Hader and some of the AIDS activists attending the town hall meeting said this suggests that many gay men who should be aware of the need for greater condom use and overall less risky behaviors were nevertheless continuing to engage in risky behavior.

In a finding said to highlight a seeming paradox among black MSM, the study found that black MSM of all ages used condoms more frequently than whites. Yet the infection rate for black MSM remains high, the report says, most likely because the number of infected black MSM is significantly higher than white MSM, increasing the chance of infection even if safer sex is practiced most of the time.

“Though white men were more likely to engage in higher risk sexual behavior, more men of color were impacted by HIV,” says the report.

The report also notes that, “Contrary to some perceptions, younger men generally had safer sex behaviors, while older men got tested less and used condoms less and had more sex partners.”

The study found that about 66 percent of black MSM reported using a condom during their most recent instance of anal sex, compared to about 47 percent of white MSM.

Hader said the study was conducted using protocols established by the U.S. Centers for Disease Control & Prevention for similar studies in other cities.

She said that similar MSM studies will be conducted every three years, alternating with studies of HIV-related heterosexual sexual behavior and studies of injection drug users conducted.

“The data are the data are the data,” she said at the town hall meeting. “They’re not the whole picture or the only picture, but they’re really useful information.

“And they’re not the answers So my hope is our data is to be used to start to come up with the answers, to reinforce anything we think we’re on the right track on, to bring up new ideas.”

‘We have more work to do’

D.C. Mayor Adrian Fenty joined Hader and other officials with the Department of Health and its HIV/AIDS Administration at the news conference March 26 announcing the release of the study.

D.C. Council member David Catania (I-At Large), who chairs the D.C. City Council’s Committee on Health, also participated in the news conference. He praised Fenty and Hader for working hard during the past three years to transform what he called a highly flawed public health data gathering system into a “world class” system recognized and praised by health departments in other cities and states.

Fenty joined Hader and Dr. Pierre Vigilance, director of the D.C. Department of Health, in noting that the study’s troubling findings of high HIV infection rates among MSM were offset by what they said were highly useful new data generated by the study.

“Knowing the facts about our HIV/AIDS epidemic improves how we fight this disease,” Fenty said.

Pointing to a separate study released last week, he noted that, “we’ve already shown that we can make progress against HIV by reducing AIDS cases and deaths and increasing people getting into medical care.”

“This study shows that we have more work to do to fight HIV/AIDS among men who have sex with men,” he said.

The D.C. MSM study consisted of 500 participants who were recruited “at open air venues, gyms, bars, restaurants, and clubs where men who have sex with men tend to frequent,” says the study report. “Participants were interviewed at these venues, which were located in Wards 1, 2, 5, 6 and 8.”

The study, which was conducted in 2008, doesn’t identify the specific venues, and representatives of the GWU team that conducted the survey declined at the news conference to disclose the names of the venues.

The report acknowledges that the study did not reach all MSM and most likely under-represents some groups, including MSM who don’t identify as gay or bisexual, and younger white MSM.

It notes that of the nearly 100 white men under age 30 who participated in the study, none were found to be HIV positive.

Vigilance and Hader said that while most of the MSM participants in the study reported having been tested for HIV, 40 percent did not know they were HIV positive until they were tested at the time of the study. Among those who tested positive during the study, nearly three-quarters had seen a doctor or other health care provider at least once in the previous 12 months, but were not tested.

Vigilance and Hader noted that a D.C. public health policy established four years ago calls for all adults in the city to be tested routinely for HIV during regular doctor visits, just as they are tested for high blood pressure and diabetes.

As a result of the study’s findings, Vigilance said the health department is calling on MSM to be tested for HIV twice a year instead of the once-a-year recommendation made four years ago.

Hader also announced at the press conference that the Department of Health is launching a new MSM HIV screening project in partnership with the Whitman-Walker Clinic and the Crew Club, a gay male gym and social venue.

According to Hader, the yearlong project will screen about 500 men at the Crew Club considered to be at high risk for HIV. She said pharmaceutical company Gilead Sciences, Inc., is contributing $40,000 to the project and the Crew Club is contributing more than $5,000 along with special accommodations on its premises to conduct the screening.

She said that while the 14 percent HIV infection rate among MSM in D.C. is too high, previous MSM studies in Baltimore, Los Angeles, Miami, New York and San Francisco found a combined infection rate of 25 percent in 2005. She noted that in Baltimore, the MSM infection rate was found to be 40 percent.

‘What are we doing wrong?’

The panelists who joined Hader at the town hall meeting and members of the audience expressed differing views on whether existing HIV prevention programs in the city, including those operated by community organizations like Us Helping Us and the Whitman-Walker Clinic, have been effective in their mission.

“There is a notion to say what are we doing wrong?” said Pettigrew of Us Helping Us. “But you can also ask, ‘What are we doing right?’”

He noted that one of the key findings in the MSM study was that men under 30 years old had a lower rate of HIV infection and were engaging in less risky behavior.

Ernest Hopkins, a veteran AIDS activist involved with programs in D.C. and San Francisco, said the D.C. government has been less aggressive and less visible in its AIDS prevention messages than in the past. He and D.C. Center Executive Director David Mariner called for greater city funding for community based HIV programs, including programs organized by the Center.

AIDS activist Chris Lane, a former official with the Sexual Minority Youth Assistance League, noted that a mental health component appeared to be missing from the MSM study.

Hader said the full scientific report on the study, which is to be published soon on the Department of Health’s web site, discusses mental health-related issues and that the city would pursue these issues when its reviews its overall HIV prevention programs in the next few months.

Gerald of the Center’s HIV Prevention Working Group cautioned against placing all the responsibility of HIV prevention on the city. He expressed concern that not enough black gay men have attended meetings and planning sessions to address the issue.

“We should not just wait for the government to do something,” he said. “We should educate our own people in the black community. We can let the government go so far, but we have to take it up from there.”

The study, titled “MSM in D.C.: A Life Long Commitment to Stay HIV Free,” is available through the Department of Health’s website, www.doh.dc.gov.

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Should we vacation in homophobic countries?

Secret gay bar in St. Petersburg seemed unfathomable

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(Image by Askonsat Uanthoeng via Pexels)

ST. PETERSBURG, Russia — The tiny rainbow light projecting onto the corner baseboard of the bar and tipsy people constantly belting out Mariah Carey karaoke songs clued me in. There was something unique happening here. It wasn’t until a gentleman with glittered cheeks approached me to say how fabulous my dress was that I suddenly clocked it. I’d unknowingly ended up in a gay bar in the middle of Saint Petersburg, Russia.

A flood of overwhelming joy first took over. Before coming to Russia on vacation, I knew all too well the discrimination and fear LGBTQ Russians lived in. A gay bar in Russia, even a secret one like this, seemed unfathomable, so being where people could unapologetically be out and proud — even if it was only in the compounds of these four walls — was emotionally profound.

But within seconds, dread took over. Were we all safe? If you didn’t know what to look out for, you’d assume this was just like every other neighboring non-gay bar — it wasn’t hidden or anything. I wondered what was stopping a homophobe, if they found out, from vandalizing the bar or doing something much worse.

After all, Russia approved a legislation in 2013 prohibiting the distribution of information about LGBTQ matters and relationships to minors. The legislation, known as the “gay propaganda law,” specifies that any act or event that authorities believe promotes homosexuality to individuals under the age of 18 is a punishable felony. According to a 2018 report by the international rights organization Human Rights Watch, anti-LGBTQ violence in the country spiked after it passed. The bill perpetuates the state’s discriminatory ideology that LGBTQ individuals are a “danger” to traditional Russian family values.

A recent poll indicated that roughly one-fifth of Russians want to “eliminate” gay and lesbian individuals from society. In a poll conducted by the Russian LGBT Network — a Russian queer advocacy group — 56 percent of LGBTQ respondents said they had been subjected to psychological abuse, and disturbing reports of state-sanctioned detention and torture of gay and bisexual men in Chechnya, a semi-autonomous Russian region, have surfaced in recent years.

Considering this, it was no surprise that most of my gay friends refused to come on vacation with me to Russia. In our everyday, gay people don’t march around with a gay Pride flag so homophobic Russians would probably never be able to tell which tourists are gay. However, many LGBTQ people will never travel to Russia or any other homophobic country for one logical reason: Fear.

Unfortunately, many exotic locations abroad are dangerous territory for the LGBTQ community to be in. Physical safety isn’t guaranteed in countries like Nigeria, Iran, Brunei and Saudi Arabia where same-sex relationships are punishable by the death penalty. Not to mention the numerous transgender people who’ve been detained and refused entry to similar countries — even when it’s only been a layover! However, an alternative reason why someone may refuse to vacation in a homophobic country is having a conscience.

When you pay for accommodation, nights out and sightseeing tours, your money doesn’t just reach the hotel staff and waiters pockets — you’re also financially supporting that country’s government. Money talks so not giving homophobic countries tourism puts pressure on them. Ethically, why would anybody ever want to support a country through tourism that treats their LGBTQ community like dirt? Homophobia shouldn’t be shrugged off simply as a local “culture.”

Other LGBTQ people firmly embrace the right to go anywhere they choose, and that choosing to go gives them power. Homophobic countries still have closeted LGBTQ folks living there running underground gay spaces and groups. Is turning our back on the wonderful people and beautiful culture of a new place turning our back on their gay community too? There are countries where gay marriage is legal and trans rights are progressive, but abortion laws remain backwards. Do we boycott these countries too? And, how do we collectively define what a homophobic country is? Is legalizing gay marriage a requisite? Gay marriage is still illegal in Thailand when it is one of the most gay and trans-friendly countries in the world.

Increasingly the line of what is “right” and “wrong” erases all grey areas. Morality and activism — particularly when politics is involved — is never straightforward. The biggest surprise about Russia was how my own stereotypes I’d picked up from the media weren’t always true. Saint Petersburg in Russia is far more liberal and gay-friendly compared to rural Russia but the fact still stands that my bisexual friend and I actively chose to go to a homophobic country for pleasure. In an ideal world, anybody of any sexual orientation or gender identity would be able to vacation wherever they want but that’s sadly not reality. In the meantime, the wanderlust LGBTQ community will go on gay cruises that guarantee safe refuge or put civil rights and ideological differences aside to experience the world’s natural wonders and incredible cultures.

Ash Potter is a writer and radio host.

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Health

FDA approves injectable PrEP to reduce the risk of sexual HIV infection

Manufactured as Apretude, it will be available to at-risk adults & adolescents who weigh at least 77 pounds & have tested negative for HIV

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FDA headquarters, Silver Spring, MD (Photo Credit: U.S. government/FDA)

SILVER SPRING, Md. – The U.S. Food and Drug Administration announced Monday that the agency had approved the first injectable treatment for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV.

Manufactured under the name Apretude, it will be available to at-risk adults and adolescents who weigh at least 77 pounds and have tested negative for HIV immediately beforehand the agency said in a press release.

By granting its approval, the FDA opens up the option for patients to receive the injectable drug instead of a daily HIV prevention oral medication, such as Truvada.

“Today’s approval adds an important tool in the effort to end the HIV epidemic by providing the first option to prevent HIV that does not involve taking a daily pill,” said Debra Birnkrant, M.D., director of the Division of Antivirals in the FDA’s Center for Drug Evaluation and Research. “This injection, given every two months, will be critical to addressing the HIV epidemic in the U.S., including helping high-risk individuals and certain groups where adherence to daily medication has been a major challenge or not a realistic option.”

According to the U.S. Centers for Disease Control and Prevention, notable gains have been made in increasing PrEP use for HIV prevention in the U.S. and preliminary data show that in 2020, about 25% of the 1.2 million people for whom PrEP is recommended were prescribed it, compared to only about 3% in 2015.

However, there remains significant room for improvement. PrEP requires high levels of adherence to be effective and certain high-risk individuals and groups, such as young men who have sex with men, are less likely to adhere to daily medication.

Other interpersonal factors, such as substance use disorders, depression, poverty and efforts to conceal medication also can impact adherence. It is hoped that the availability of a long-acting injectable PrEP option will increase PrEP uptake and adherence in these groups.

The safety and efficacy of Apretude to reduce the risk of acquiring HIV were evaluated in two randomized, double-blind trials that compared Apretude to Truvada, a once daily oral medication for HIV PrEP.

Trial 1 included HIV-uninfected men and transgender women who have sex with men and have high-risk behavior for HIV infection. Trial 2 included uninfected cisgender women at risk of acquiring HIV.

Participants who took Apretude started the trial with cabotegravir (oral, 30 mg tablet) and a placebo daily for up to five weeks, followed by Apretude 600mg injection at months one and two, then every two months thereafter and a daily placebo tablet.

Participants who took Truvada started the trial taking oral Truvada and placebo daily for up to five weeks, followed by oral Truvada daily and placebo intramuscular injection at months one and two and every two months thereafter.

In Trial 2, 3,224 cisgender women received either Apretude or Truvada. The trial measured the rate of HIV infections in participants who took oral cabotegravir and injections of Apretude compared to those who took Truvada orally.

The trial showed participants who took Apretude had 90% less risk of getting infected with HIV when compared to participants who took Truvada.

Apretude includes a boxed warning to not use the drug unless a negative HIV test is confirmed. It must only be prescribed to individuals confirmed to be HIV-negative immediately prior to starting the drug and before each injection to reduce the risk of developing drug resistance.

Drug-resistant HIV variants have been identified in people with undiagnosed HIV when they use Apretude for HIV PrEeP. Individuals who become infected with HIV while receiving Apretude for PrEP must transition to a complete HIV treatment regimen.

The drug labeling also includes warnings and precautions regarding hypersensitivity reactions, hepatotoxicity (liver damage) and depressive disorders.

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Health

FDA slow in responding to calls for end to ban on MSM tissue donors

‘Scientific evidence does not support these restrictions’

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Tammy Baldwin, gay news, Washington Blade
Sen. Tammy Baldwin (D-Wis.) is a lead signer of the letter to the FDA. (Washington Blade photo by Michael Key)

As of early this week, the U.S. Food and Drug Administration had yet to respond to a Nov. 29 joint letter by 52 members of the U.S. House and U.S. Senate calling on the FDA to end its policy of restricting the donation of human tissues such as corneas, heart valves, skin, and other tissue by men who have sex with men, or MSM.

The letter is addressed to Acting FDA Commissioner Janet Woodcock and Department of Health and Human Services Secretary Xavier Becerra. The FDA is an agency within the HHS.

The letter says the FDA’s restrictions on MSM tissue donation date back to a 1994 U.S. Public Health Service “guidance” related to the possible transmission of HIV, which stated that any man “who has had sex with another man in the preceding five years” should be disqualified from tissue donation.

“We also call your attention to the broad consensus within the medical community indicating that the current scientific evidence does not support these restrictions,” the letter states. “We have welcomed the FDA’s recent steps in the right direction to address its discriminatory MSM blood donation policies and urge you to take similar actions to revise the agency’s tissue donation criteria to align with current science so as not to unfairly stigmatize gay and bisexual men.”

The letter adds, “In fact, a recent study in the medical journal JAMA Ophthalmology estimated that between 1,558 and 3,217 corneal donations are turned away annually from otherwise eligible donors who are disqualified because of their sexual orientation, an unacceptable figure given widespread shortages of transplantable corneas.”

The letter continues, saying, “FDA policy should be derived from the best available science, not historic bias and prejudice. As with blood donation, we believe that any deferral policies should be based on individualized risk assessment rather than a categorical, time-based deferral that perpetuates stigma.”

U.S. Sen. Tammy Baldwin (D-Wisc.), the nation’s only out lesbian U.S. senator, and U.S. Rep. Joe Neguse (D-Colo.) are the two lead signers of the letter. All 52 signers of the letter are Democrats.

Among the others who signed their names to the FDA letter are four of the nine openly gay or lesbian members of the U.S. House. They include Reps. David Cicilline (D-R.I.), Richie Torres (D-N.Y.), Mondaire Jones (D-N.Y.), and Mark Takano (D-Calif.). 

Also signing the letter are D.C. Congressional Del. Eleanor Holmes Norton (D-D.C.), and Rep. Jamie Raskin (D-Md.). 

In response to a Dec. 21 email inquiry from the Washington Blade, FDA Press Officer Abigail Capobianco sent the Blade a one-sentence statement saying, “The FDA will respond to the letter directly.”

The statement didn’t say to whom the FDA would respond or when it would issue its response.

https://neguse.house.gov/imo/media/doc/FINAL%20-%20Letter%20to%20FDA%20and%20HHS%20on%20Corneal%20Tissue%20Donations.pdf

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