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Local news in brief: Nov. 26

New condom campaign targets gay men, local gay couple participate in adoption day and more

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‘Rubber Revolution’ campaign targets gay men

The D.C. Department of Health launched a new condom awareness campaign last week called “Rubber Revolution,” which includes ads in gay publications urging men who have sex with men to use condoms “every time” to prevent the spread of HIV.

AIDS activists have expressed concern that the city’s existing condom distribution and awareness campaigns didn’t go far enough to attract the attention of high risk groups, including black men and women and gay men. In a statement released on Nov. 18, DOH Director Dr. Pierre Vigilance pointed to the new campaign’s more blunt and explicit messages.

“Big Enuf 4 U,” “A condom Fits Any Head,” and “Get Wrapped Up for the Moment,” are among slogans the “Rubber Revolution” condom campaign will use in its literature and on its newly launched website, HYPERLINK “http://www.rubberrevolutiondc.com/”RubberRevolutionDC.com.

“The Rubber Revolution aims to encourage sexually active people to always use condoms and engage community and business partners to support condom use,” said Mayor Adrian Fenty in a statement. “The District is proud of its aggressive approach to address this issue, and we hope to build on our success as one of the only two cities in the country with a public sector condom distribution program that has provided more than 3.5 million free condoms last year,” Fenty said.

DOH said in its statement that it developed the campaign in response to studies showing that between 40 percent and 70 percent of all D.C. adults and adolescents are not regularly using condoms

The city will continue to fund a separate condom distribution campaign organized by gay D.C. physician Terry Gerace with the involvement of the Whitman-Walker Clinic and the D.C. LGBT Community Center called “FUK!T.”

That campaign has already distributed thousands of packets containing condoms and lube to the city’s gay establishments. Volunteers assemble the packets each week, according to AIDS activist and D.C. medical student Daniel O’Neill, who is involved with the project.

“It’s a step in the right direction,” O’Neill said of the ‘Rubber Revolution’ campaign. “It can’t be as provocative as the ‘FUK!T’ campaign. But this could be helpful with certain groups.”

LOU CHIBBARO JR.

Gay couple participates in D.C. Adoption Day

A judge signed the official papers for a gay male couple to adopt a two-year-old girl they have raised since infancy on Nov. 20 during the 24th Annual Adoption Day ceremony at the D.C. Superior Court.

District residents John Coon, 43, and Josh Tuerk, 42, who have been a couple for 18 years, were among the parents of more than 20 kids whose adoptions were finalized at the ceremony. Their adopted daughter, Gabriella “Ella” Logan, who attended the event, was described by an announcer as having a “captivating and vivacious personality.”

Court officials and the D.C. Child and Family Services Agency said in a statement that the  Adoption Day event is intended to “celebrate the joy of adoption and encourage area residents to consider adopting or fostering a child” through the city’s child welfare system.

Same-sex couples have been adopting children in the city since 1994, when the D.C. Court of Appeals issued a ruling clearing the way for such adoptions. Local gay rights attorney Michelle Zavos, who specializes in gay family law, said the city’s child welfare and adoption office is fully supportive of gay adoptions. She noted that qualifications and background checks used in the adoption approval process are the same for same-sex and opposite-sex couples.

“We adopted two boys 10 years ago—Noah and Marcus. They’re both 10,” Coon told the Blade. “And Ella — we decided it was time to add a little princess to join our all-male household,” he said.

Coon, an interior decorator, and Tuerk, who owns and operates a D.C.-based pet care business, live with their children in the city’s Wesley Heights section. They recently bought a farmhouse and farm outside Charlestown, W.Va., where they plan to spend the Thanksgiving holiday.

“All the grandparents will be with us,” Coon said.

LOU CHIBBARO JR.

Anti-gay lawmaker ousted in Maryland

LGBT advocates in Maryland are celebrating the defeat of Republican State Senator Alex X. Mooney in the recent elections. Mooney conceded the contest to Ron Young a few days after most of the absentee ballots were counted. He lost by fewer than 1,000 votes and had represented the 3rd District that includes Frederick and Washington counties.

Since taking office in January 1999, Mooney, 39, was a vocal opponent of LGBT rights. He frequently denounced the LGBT community.

Mooney once said “Homosexual activists have managed to gain legal recognition as a minority, based solely on their lifestyle choices, through so-called ‘hate crimes’ and domestic partnership laws.”

Mooney had been a member of the Senate Judicial Proceedings Committee, which consistently blocked movement on marriage equality and gender identity protection bills.

In each of the three previous races for Senate, Mooney’s margin of victory declined — a trend that speaks to the changing demographics in Frederick.

But the election may have also turned on the work of Equality Maryland, SEIU and a host of volunteers. Equality Maryland’s Field Organizer Aimee Martin was in charge of GOTV (Get Out the Vote) support in Frederick County. She turned out approximately two-dozen Equality Maryland supporters to work in the Frederick area each weekend during October through the election.

According to Lisa Polyak, PAC Director for Equality Maryland, the organization provided ground support, such as literature drops, door knocking and phone banks on behalf of all the LGBT-supportive candidates, including Ron Young, Candy Greenway and Ryan Trout in the Frederick area. During the summer, Equality Maryland collected signed statements from 1,200 residents who support LGBT equality in Frederick County. In addition, the PAC contributed $3,000 to Young’s campaign.

Equality Maryland also collected signatures in support of gender identity anti-discrimination and marriage equality at two dozen polling places in Anne Arundel, Baltimore, Howard, Montgomery and Prince Georges counties on Election Day. This resulted in identification of 3,278 voters who were willing to sign their names in support of LGBT equality, including 588 new supporters in the home district of Senate President Mike Miller (District 27).

STEVE CHARING/BALTIMORE OUTLoud

Orange Crush wins football championship

Last Sunday, the D.C. Gay Flag Football League (DCGFFL) held its inaugural league championships. Orange Crush was 0-3 after the first two weeks of the season and then went undefeated for the next five weeks to make it to the championships.

The team lived up to their name and crushed Gang Green by a score of 34-20. The teams started the championship game by trading touchdowns. As Gang Green was driving to score again, Kevin Smith intercepted a pass and it was all Orange Crush for the rest of the game.

Quarterback Brian Moll was voted MVP for the Orange Crush and Brian Sparrow, utility player, was voted MVP for Gang Green.

In the consolation brackets, Rug Burn defeated Golden Wave 14-13 for 3rd place and Blue Ballers topped Hell Marys 40-14 for 5th place. Complete details can be found at HYPERLINK “http://www.dcgffl.org”dcgffl.org.

KEVIN MAJOROS


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Cases of multi-drug resistant gonorrhea ‘super strain’ multiply

CDC and WHO have once again sounded alarm about STI

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Gonorrhea bacterium (CDC/Los Angeles Blade graphic)

The Centers for Disease Control and Prevention along with the World Health Organization  are raising red flags for the second time this year as cases multiply of a “super strain” of drug-resistant gonorrhea globally, but particularly among men who have sex with men. 

This strain of gonorrhea has been previously seen in Asia-Pacific countries and in the U.K., but not in the U.S. A genetic marker common to two Massachusetts residents and previously seen in a case in Nevada, retained sensitivity to at least one class of antibiotics. Overall, these cases are an important reminder that strains of gonorrhea in the U.S. are becoming less responsive to a limited arsenal of antibiotics.

Gonorrhea is a STI with most people affected between ages 15-49 years. Antimicrobial resistance in gonorrhea has increased rapidly in recent years and has reduced the options for treatment.

Last February, cases of XDR, or “extensively drug resistant,” gonorrhea, are on the rise in the U.S., the CDC said.

Gonococcal infections have critical implications to reproductive, maternal and newborn health including:

  • a five-fold increase of HIV transmission
  • infertility, with its cultural and social implications
  • inflammation, leading to acute and chronic lower abdominal pain in women
  • ectopic pregnancy and maternal death
  • first trimester abortion
  • severe neonatal eye infections that may lead to blindness.

This past January, Fortune reported the U.S. is experiencing “a rising epidemic of sexually transmitted disease,” Dr. Georges Benjamin, executive director of the American Public Health Association, said with some experts referring to the issue as a “hidden epidemic.” 

Cases of gonorrhea — an STI that often shows no signs, but can lead to genital discharge, burning during urination, sores, and rashes, among other symptoms — rose by 131 percent nationally between 2009 and 2021, according to public health officials. While rates of STI transmission in the U.S. fell during the early months of the pandemic, they surged later in the year, with cases of gonorrhea and syphilis eventually surpassing 2019 levels, according to the CDC.

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EXCLUSIVE: Meet the director of Johns Hopkins Center for Transgender Health

Dr. Fan Liang on politicizing healthcare, fear among patients

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Fan Liang (Photo courtesy of Fan Liang)

The topic of gender affirming healthcare has never attracted more attention or scrutiny, presenting challenges for both patients and providers, including Dr. Fan Liang, medical director of the Johns Hopkins Center for Transgender and Gender Expansive Health and assistant professor of plastic and reconstructive surgery.

Speaking with the Washington Blade by phone last week, Liang shared her perspective on a variety of topics, including her concerns about the ways in which media organizations and others have shaped the discourse about gender affirming care.

Too often, she said, the public is provided incomplete or inaccurate information, framed with politically charged and polarizing language rather than balanced and nuanced reporting for the benefit of audiences who might have little to no familiarity with the topics at hand.

“This is an evolving field that requires input from many different types of specialists,” Liang noted, so one issue comes when providers “start to comment outside of their scope of practice, or extrapolate into everybody’s experience.”

A more intractable and difficult problem, Liang said, is presented by the fact that, “issues with transgender health have really taken center stage with regard to national politics, and as a result of that, the narrative has really been reduced to an unsophisticated representation of what’s going on.”

“I think that is dangerous for patients and for the community that these patients live in and have to work in and survive in because it paints a picture that is really inaccurate,” she said.

Conservative state legislatures across the country have introduced a record number of anti-LGBTQ bills this year, passing dozens, including a slew of anti-trans healthcare restrictions. The Human Rights Campaign reports 35.1 percent of transgender youth now live in states that have passed bans on gender affirming care, many of which carry criminal penalties for providers.

A big part of the Center’s work, Liang told the Blade, involves working closely with trans patients and organizations like Trans Maryland and the Trans Rights Advocacy Coalition “to make sure that the community’s voices are being heard, so that we’re able to represent those interests here.”

She described “a generalized sense of anxiety and fear,” concerns that she said are “pervasive throughout the community,” over “access to surgery and to overall gender healthcare.”

“I get a lot of questions about that,” she said.

While Liang has not yet worked with any patients who traveled to the Center because gender affirming care was banned in the states where they reside, she said, “I do anticipate that will happen in the relatively near future.”

Challenges for clinicians

The political climate “really interferes in physician autonomy and basically using our training and discretion to provide the best therapies that we can,” based on research and evidence-based guidelines from medical organizations on best practices standards of care, Liang said.

“I earnestly believe that people who go into medicine try to do right by their patients and try to provide exceptional care whenever they can,” she said. “When I speak to other providers who are engaged in trans care, the reason they entered the field was because they saw patients that were suffering and had no other providers to go to and they were filling a need that desperately needed to be filled.”

“It is unfortunate that their motives are being misinterpreted, because it is causing significant emotional harm to these providers who are being targeted,” Liang said, noting “there is so much vitriol from the anti-trans side of things,” including “this narrative out there that physicians are providing trans care because of financial reasons or because of some sort of politically motivated, I don’t know, conspiracy.”

The political climate, along with the realities of practicing in this speciality, may threaten to stem the pipeline of new providers whose practice would otherwise include gender affirming care, said Liang, who serves on the interview board for incoming residents who are looking to specialize in plastic surgery.

Many, perhaps even most, she said, are eager to explore transgender care, often because, particularly among young trainees, they are friends with trans and non-binary people. “I don’t know how much of that interest persists as they move through the training pipeline, because — especially if they are at an institution that does provide trans care — they do see a lot of the struggles that physicians encounter in being able to offer these services.”

Liang noted the “significant hurdles from an insurance standpoint” and the “significant prerequisites in order to access surgery,” which require “a tremendous amount of back-end coordination and optimization of the logistics for surgical readiness.”

“And then,” she said, “they see a lot of the backlash in the media against trans providers, and I think that that does discourage residents who otherwise would be interested in the field because physicians, by and large, are a pretty conservative bunch. And having them start their practice where they’re sort of stepping into a political minefield is not ideal.”

Speaking up can be beneficial but risky

“Some physicians feel like they can make the most amount of impact by being advocates for the patient population on a national stage or being more vocal about how anti-trans legislation has been impacting their patients,” Liang said.

“My goal, as the director for the Center for Transgender Health here at Hopkins is really to normalize this care to allow for the open conversation and discussion amongst providers to create a safe space for people to feel comfortable providing this care,” she said.

Destigmatizing gender affirming care and connecting clinicians who practice in this space will help these providers understand they are not “functioning in isolation” and instead are part of “a national effort and a nationally concerted effort toward delivering state-of-the-art health care,” Liang said.

“It’s important,” she said, to “bring the generalized healthcare community to the table in offering these services and have a frank discussion when it comes to education, research and teaching.”

Other providers, however, “do not feel comfortable putting themselves into that place of vulnerability,” Liang said, “and I don’t fault them for it because I personally know people who’ve received death threats and who have been targeted because of what they say to the media,” in many cases because their comments were reported incorrectly or out of context.

In July, Liang participated in an emergency trans rights roundtable on Capitol Hill with representatives from advocacy groups like the Southern Poverty Law Center and the Transgender Law Center, as well as members of Congress including U.S. Reps. Mark Takano (D-Calif.), Barbara Lee (D-Calif.), and Sara Jacobs (D-Calif.).

She told the Blade it was “a really wonderful experience” to “hear the heartfelt stories” of the panelists advocating on behalf of themselves, their friends, and their families, earning the attention of members of Congress.

“I do think advocacy is important,” Liang told the Blade. “I try to make time for it when I can,” she said, “but I have to balance that with all of my other clinical obligations.”

Finding compassion and lowering the temperature

On Aug. 1, The Baltimore Banner reported that the director of the Mayor’s Office of LGBTQ Affairs in Baltimore filed a discrimination complaint with the city’s Office of Equity and Civil Rights against the Hopkins Center for Transgender and Gender Expansive Health. (The story was also published by the Washington Blade, which has a media partnership with the Banner.)

Asked for comment, Liang said “it was an upsetting article to read,” adding, “I was upset that there wasn’t more due diligence done to investigate a little bit further” because instead the article presents “just this one person’s account of things.”

She noted there is “not much I can say from a physician standpoint because everything is contained within HIPAA,” the federal Health Insurance Portability and Accountability Act, which prohibits providers from even acknowledging which patients they may or may not have worked with.

The Banner article underscores the importance of journalists’ obligations to “make sure there is due diligence to confirm sources and make sure things are accurate,” Liang said, including, of course, when covering complicated and politically fraught subjects like gender affirming care.

“On the one hand, it’s really wonderful that there’s a fair amount of press being dedicated to trans issues around the country,” Liang said, but what is “frustrating for me is these conversations always seem to be so loaded and politically charged, and there doesn’t seem to be much space for people to ask earnest and honest questions” without taking heat from either side.

There is “compassion to be offered for patients who are struggling to receive basic health care” as well as for “people who are struggling to understand how this issue is evolving,” those for whom the matter is “uncharted territory” and therefore likely to “cause consternation and fear,” she said.

“Most of the time, the way to overcome” this is to cultivate “relationships with people who do identify as transgender or non-binary” on the grassroots level, she said, while leaving room “for people to ask earnest and honest questions.”

Removing the artificial “us-versus-them” paradigm provides “opportunity for more compassionate interactions,” Liang said.

At the same time, she conceded, amid the heightened polarization and escalation of an anti-trans backlash over the last few years, efforts to fight sensationalization with compassion and understanding have often fallen short, presenting hurdles that have long plagued other areas of science and medicine like abortions and vaccines.

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CDC official discusses new STI prevention tool

Dr. Leandro Mena spoke with the Blade on Thursday

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Dr. Leandro Mena, director of the Centers for Disease Control and Prevention's Division of STD Prevention (Screen shot/YouTube)

The Centers for Disease Control and Prevention is expected to soon issue draft guidelines for the use of doxycycline to help prevent the spread of gonorrhea, chlamydia and syphilis in transgender women and gay and bisexual men who have sex with men.

Doctor Leandro Mena, director of the public health agency’s Division of STD Prevention, talked to the Washington Blade by phone on Thursday about the post-exposure prophylactic intervention — DoxyPEP for short — which he characterized as “the first important innovation that we have had in the field of STIs in almost three decades.”

Studies show a 200 mg dose of the widely available antimicrobial antibiotic, if taken within 72 hours after sex, has shown tremendous efficacy in reducing the risk of transmitting these three diseases, he said.

For now, research is limited to certain LGBTQ populations for whom “we know that network prevalence, the prevalence of STIs in the sexual network of this group, is sufficiently high that the benefits outweigh the potential risks,” Mena said, while “other strategies like the use of condoms, you know, are not really that feasible.”

Research on DoxyPEP conducted and published over the past couple of years has been game-changing, he said, “because it’s an antimicrobial that’s already approved, we know it’s very low-cost, and I think we have the evidence of its effectiveness.”

“Since the development of nucleic acid amplification test — which allows [providers to] diagnose gonorrhea and chlamydia by amplifying nucleic acids, by doing PCR, that really revolutionized access to STI testing — we really haven’t had much,” Mena said.

The CDC expects to work quickly on DoxyPEP, but a few hurdles must be cleared first.

“We have engaged with the communities, right, that are poised to benefit the most from this intervention,” Mena said. “And where we are is that we are finishing our guidance, we anticipate that it will be out for public comment close to the end of this fall, and shortly after we will be able to have the final guidance.”

“Guidelines like these that have important public health consequences goes all the way up to the highest levels of clearance in the CDC,” he added.

“While we know that that benefits are significant, there are some unknowns about the potential risks of taking antimicrobials to prevent infections, as they may perhaps have other effects [like] inducing resistance” in STIs and other types of bacteria, Mena said.

“Those are some of the unknowns that we’re trying to currently understand better, as we try to balance risk and benefits of the use of doxycycline as post exposure prophylaxis,” he said.

Another challenge for the CDC as it develops the guidelines, Mena said: They must be as relevant for folks in San Francisco as for people in Montgomery, Ala., and (the) Navajo Nation, based on each place’s “local epidemiology, local context and population.”

Additionally, the agency warns, doxycycline can carry side effects — namely, “phototoxicity, gastrointestinal symptoms, and more rarely esophageal ulceration.”

So, the CDC is working diligently, Mena said, to “better understand the potential risk that its use – its regular use, in this way, may present to the individual and potentially at the population level.”

Mena called DoxyPEP an “amazing tool,” noting the need for new ways to combat the increase in rates of STIs that has persisted for nearly a decade.

“In 2021, we had more than 2.5 million cases of syphilis, gonorrhea and chlamydia reported, and the reasons we’re seeing these increases, it’s really, you know, multifactorial,” he said. “There are subpopulations that are disproportionately affected — among these, racial-ethnic minorities, young people, men who have sex with men.”

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