At least seven D.C.-based LGBT or LGBT-friendly organizations sprang into action on Tuesday to help members of the LGBT community and people with HIV choose a health insurance plan under the controversial U.S. Affordable Care Act that’s better known as “Obamacare.”
Similar to reports surfacing from across the country, officials from the local groups said some of their clients encountered computer glitches on the website for D.C. Health Link, the city’s online health insurance marketplace or “exchange” on its first day of operations on Tuesday.
But all of the officials contacted by the Blade said they were optimistic that the exchange program in D.C. and those in neighboring Maryland and Virginia would soon be operating smoothly and would be an important resource for LGBT people looking for health insurance.
“I’m excited about it,” said Ron Simmons, executive director of the D.C.-based Us Helping Us, an HIV services organization that reaches out to black gay men.
“We have so many clients who don’t have health insurance,” Simmons said. “If you are HIV positive you need a certain type of insurance, and we are ready to help people choose the best policy suited for their needs.”
Us Helping Us is one of five D.C.-based organizations that received a grant from the D.C. Health Benefit Exchange Authority to recruit members of the LGBT community to sign up for insurance under the Obamacare program. The grant calls on the five groups — as well as another 30 organizations that received grants to work with other constituencies — to help their clients navigate the complicated process of choosing the best possible insurance plan.
The other organizations that received grants to work with the LGBT community on the Obamacare program are Whitman-Walker Health, D.C. Care Consortium, Damien Ministries and Health HIV.
Health HIV, a new national AIDS advocacy organization located in the Dupont Circle area, applied for its grant in partnership with the D.C. Center for the LGBT Community and Westminster Presbyterian Church’s START program. The START program provides HIV/AIDS-related services with a special outreach to people with substance abuse problems.
“This is an important opportunity to engage our communities in a conversation about healthcare and for us all to better understand the changes that are taking place in the healthcare system,” said David Mariner, executive director of the D.C. Center.
“Our goal is to help 300 individuals enroll in a healthcare plan and to make the process as simple as possible for them,” Mariner said.
Simmons of Us Helping Us said his group has a goal of helping to enroll 1,000 people on a health insurance plan through the D.C. Health Link system during the nine-month-long grant period.
“We will have town hall meetings,” said Simmons. “We will go to the clubs. Our purpose is to help people enroll in the plan best for them.”
Under the Affordable Care Act’s various provisions, Tuesday, Oct. 1, became the first day that the health insurance exchanges opened for business, enabling people to review dozens of options for insurance plans. Consumers may sign up for a plan between now and next March during the program’s first annual open enrollment period. Insurance policies won’t go into effect until Jan. 1.
In order to receive a policy that begins Jan. 1, people must sign up and pay their first monthly premium by Dec. 15, government officials in charge of the program said. People may still sign up between Dec. 15 and March 31, with their policy taking effect at the first day of the following month. After the March 31 deadline, enrollment in the program will be closed until October 2014.
Experts monitoring the system have said the cost of premiums and additional payments such as deductibles and co-payments for doctor visits and prescription drugs vary widely with the different options available. But those familiar with the program say the costs so far appear to be significantly lower than health insurance available in the past in the private market.
Carl Schmid, deputy director of the AIDS Institute, a national AIDS advocacy organization, noted that low-income people may now enroll in Medicaid in the states that have agreed to expand their Medicaid programs under a non-mandatory provision of the Affordable Care Act. D.C. and Maryland opted to become part of the expanded Medicaid program while Virginia declined to do so.
Schmid points out that prior to the Affordable Care Act’s Medicaid provision, which took effect last year, low-income people with HIV who didn’t have private health insurance were not eligible for Medicaid unless they were medically disabled with an AIDS diagnosis.
“So now people with HIV who don’t have full-blown AIDS qualify for Medicaid,” Schmid said. “Our goal, of course, is to keep these people healthy.”
Schmid and others familiar with the Obamacare program note that in Virginia and other states that chose not to participate in the expanded Medicaid program, people with incomes below a certain federally defined level are eligible for federal subsidies to help pay for their insurance premiums and co-pays.
Erin Loubier, director of public benefits and senior managing attorney for Whitman-Walker Health, said people with HIV and LGBT people whose income levels may not make them eligible for the subsidies will benefit from another provision of the healthcare law already in effect.
“Anyone living with HIV or another chronic health condition will be able to get insurance,” she said, noting that prior to the Obamacare law insurance companies routinely rejected people with a pre-existing condition.
She said the generally lower prices for premiums through the exchanges will also benefit those who aren’t eligible for subsidies.
Under its grant from the D.C. Health Benefit Exchange Authority, Whitman-Walker will provide its clients as well as non-clients the services of trained “navigators” or “assisters” to help people choose the best insurance policy through D.C. Health Link. According to Loubier, Whitman-Walker will also provide training for people to become navigators and, similar to Us Helping Us, will reach out into the community to recruit people to sign up for insurance under the Obamacare program.
“The role of these assisters is critical,” she said. “Even computer savvy people may not be able to navigate the system by themselves.”
Guy Westin, executive director of D.C. Care Consortium, which provides services to people with HIV, said his group is providing navigator services to individuals as well as non-profit community organizations about the enrollment process for Obamacare.
D.C. gay businessman David Franco, owner of the clothing store chain Universal Gear and the real estate development company Level Two, said he was pleased to discover that prices announced so far by insurance companies offering employer health plans for small businesses are lower than previously available plans.
“I was able to see in a matter of 15 minutes with a couple of clicks on my keyboard what my rate would be and compare that to an equivalent plan and see the savings that are offered by different insurance companies,” Franco said.
“So the fact that you’ve got this open, free market has really created this price competition, and it’s going to drop the overall cost for the plan for all of my employees,” he said.
Franco was among several D.C.-area advocates who spoke at a news conference at the National Press Club on Tuesday called by D.C. Health Link and the healthcare consumers’ group Families USA to draw attention to what they consider the strong advantages of the Obamacare program.
Similar to Americans across the country, local LGBT advocates working on the Obamacare program say some LGBT people will likely be surprised and put off when they realize they will be subjected to a $95 tax penalty from the IRS in 2014 if they don’t have insurance and fail to buy a policy under the new program. The penalty for not having insurance in 2015 goes up to $700.
Federal officials in charge of Obamacare point out that people who already have insurance either through their employer or on the private market and people already on Medicaid or Medicare will not be required to do anything under the new program. Their insurance status will remain as it is, officials said.
Following is a list of the seven D.C.- based organizations known to be providing services to the help the LGBT community and people with HIV access the Obamacare program, including the process of singing up for an insurance plan. Officials with the groups say it’s preferable to call first for an appointment but walk-ins are accommodated when possible.
1701 14th St., N.W.
Us Helping Us
3636 Georgia Ave., N.W.
D.C. Care Consortium
7059 Blaire Road, N.W., Suite
2000 S St., N.W.
2200 Rhode Island Ave., N.E.
D.C. Center for the LGBT Community
1318 U St., N.W.
START Program at Westminster Presbyterian Church
400 I St., S.W.
Should we vacation in homophobic countries?
Secret gay bar in St. Petersburg seemed unfathomable
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.
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
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.
FDA slow in responding to calls for end to ban on MSM tissue donors
‘Scientific evidence does not support these restrictions’
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.
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