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Study weighs use of HIV drug ‘before-after’ sex

Study weighs use of HIV drug ‘before-after’ sex

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Michael Weinstein, gay news, Washington Blade, PrEP, Truvada
Michael Weinstein, gay news, Washington Blade, PrEP, Truvada

Michael Weinstein, president of the AIDS Healthcare Foundation, said condom use is the best way for gay men to protect their sexual health. (Washington Blade file photo by Michael Key)

A study evaluating the effectiveness of limiting the dose of the pre-exposure HIV prophylaxis drug Truvada to between two and 24 hours before sex and for two days after sex showed that gay and bisexual men who followed this regimen reduced their risk of HIV infection by an average of 86 percent.

The findings of this and a separate study also yielding an 86 percent risk reduction rate for HIV by taking Truvada as a pre-exposure prophylaxis or PrEP on a daily basis were presented on Tuesday before the Conference on Retroviruses and Opportunistic Infections in Seattle.

“These findings together provide additional evidence of the power of PrEP to reduce the risk of HIV infection,” the U.S. Centers for Disease Control and Prevention said in a statement.

CDC officials expressed caution, however, that the first-of-its-kind study by researchers in France of a ‘before-and-after-sex” regimen of Truvada might be most effective for men who have frequent sexual encounters with multiple partners. Participants in the study, which was conducted in France and Canada, had a median of 10 sex acts per month and eight partners every two months, according to the CDC analysis.

With that many instances of sexual encounters, those participating in the study were taking PrEP on an average of three to four times per week, suggesting that a buildup of Truvada in their bodies gave them a level of protection closer to those taking PrEP on a daily basis.

“CDC cautions that researchers do not yet know if this regimen will work among MSM who have sex less frequently and would therefore be taking PrEP less often,” the CDC analysis says. “CDC continues to recommend daily dosing of PrEP and urges people at substantial risk for HIV infection and their health care providers to continue to follow current CDC guidelines.”

Those guidelines along with recommendations by other health experts call for MSM and others to continue to use condoms when engaging in sex, in part, because PrEP does not protect against other sexually transmitted diseases, including hepatitis.

The second study analyzed by the CDC consisted of gay and “other men who have sex with men” who were clients at sexual health clinics in England.

“Participants incorporated PrEP into existing risk reduction strategies, which included condom use,” says a write-up by organizers of the study, who have named the study PROUD. “There was no difference in the number of men diagnosed with other sexually transmitted infections between those on PrEP and those not on PrEP,” the write-up says.

That finding is considered significant because critics of PrEP have expressed concern that men taking PrEP would no longer be motivated to use condoms, placing them at risk of other sexually transmitted diseases.

A third study presented at the Seattle conference, which was conducted by CDC researchers and published in the Journal of the American Medical Association, used statistical modeling to show how the rate of new HIV infections would change if more people with HIV became virally suppressed through treatment.

“More than 90 percent of new HIV infections in the United States could be averted by diagnosing people living with HIV and ensuring they receive prompt, ongoing treatment,” a CDC statement says the study shows.

The statement says the study for the first time developed estimates of the number of HIV transmissions caused by people in different stages of care, including those who are unaware they are infected, those who are retained in care, and those who have their virus under control through treatment.

“By quantifying where HIV transmissions occur at each state of care, we can identify when and for whom prevention and treatment efforts will have the most impact,” said Jonathan Mermin, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

“We could prevent the vast majority of new infections tomorrow by improving the health of people living with HIV today,” he said.

“People who were successfully keeping the virus under control through treatment were 94 percent less likely than those who do not know they are infected to transmit their virus,” a CDC statement says the study shows. “However, previous national estimates have indicated that just 30 percent of people with HIV have reached this critical step in care.”

Michael Weinstein, president of the AIDS Healthcare Foundation, which has opposed the widespread use of PrEP, said his organization was reviewing the latest data from the new studies. He said the data he has seen so far show that the French study was limited to the most sexually active gay men.

“This is a small subset of the total gay male population and a far cry from the 500,000 men that the CDC recommended take the drug,” Weinstein said. He cited a recent study in San Francisco that found a 45 percent decrease in condom use among PrEP patients.

“Based on the currently available data consistent condom use is the best way for gay men to protect their sexual health,” he said.

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Health

Biden outlines plan to renew fight against HIV/AIDS ahead of World AIDS Day

More than 38 million people around the world live with HIV

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White House on World AIDS Day 2021 (Washington Blade photo by Michael Key)

President Joe Biden detailed how his administration plans to improve the lives and health outcomes for people living with HIV/AIDS while strengthening treatment and prevention efforts at home and abroad in a statement published Wednesday on the eve of World AIDS Day.

Proposed healthcare reforms on the domestic agenda included improving access to lifesaving treatments, broadening the use of preexposure prophylaxis (PrEP) to reduce the rate of new infections, and strengthening efforts to reduce stigma associated with the disease. Biden noted his request for $850 million from Congress to fund these initiatives.  

Policy wise, he highlighted the administration’s pressure on the Armed Forces to sunset rules prohibiting deployments and commissions for servicemembers with HIV, and on state legislatures to repeal HIV criminalization statutes used to prosecute people for exposing others to HIV.

Internationally, the president said, “My administration has also pledged up to $6 billion to the Seventh Replenishment of the Global Fund to Fight AIDS, Tuberculosis, and Malaria — an initiative that has saved an estimated 50 million lives to date.” He called on other countries to match the pledge “so we can together deliver on the promise of health and well-being for millions around the world.”

“World AIDS Day presents an opportunity to renew America’s commitments to fighting the disease,” Biden said, while also acknowledging the tremendous progress in science, medicine, public health, and other arenas that have made the prospect of an end to AIDS and the worldwide transmission of HIV achievable. “At the same time, while these advancements have saved so many lives, they also exposed longstanding racial and gender-based disparities in access to prevention and care.”

“For the more than 38 million people around the world now living with HIV — especially members of the LGBTQI+ community, communities of color, women, and girls — a diagnosis is still life-altering,” Biden said. “We can do better.”

“As we today honor the 700,000 Americans and 40 million lives lost worldwide to AIDS-related illnesses over the years, we have new hope in our hearts,” the president’s statement concludes. “We finally have the scientific understanding, treatments, and tools to build an AIDS-free future where everyone — no matter who they are, where they come from, or whom they love — can get the care and respect they deserve.”

The full statement is available here.

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Nonbinary Department of Energy official replaced after felony theft charges

Sam Brinton allegedly stole suitcase at Minneapolis airport

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Sam Brinton, gay news, Washington Blade
Sam Brinton

The Department of Energy replaced a nonbinary senior official who had served as the agency’s deputy assistant secretary for spent fuel and waste disposition after they were charged with a felony over an incident at Minneapolis-St. Paul International Airport on Sept. 16.

Sam Brinton, whose departure from the Energy Department was confirmed by a spokesperson to the New York Post, did not immediately respond to the Washington Blade’s request for comment via Facebook Messenger.

Brinton, who has dual degrees from MIT and years of experience in nuclear waste management and climate change work, is also an LGBTQ activist who made history this year with their appointment as the first openly gender-fluid person to serve in a senior government post.

A 2018 column in the Los Angeles Times argued there was a cultural shift afoot towards greater acceptance of transgender and gender fluid people — using, as an introductory anecdote, Brinton’s appearance at the Academy Awards. According to the author, Brinton spoke passionately about their suicide prevention work for the Trevor Project and was embraced by Hollywood icons like Jane Fonda.

They also encountered some hateful backlash from anti-LGBTQ figures on the right, which was renewed on Monday with the news about Brinton’s dismissal pursuant to the felony charges filed against them, which conservative-leaning outlets were among the first to report.

Extreme right-wing Congresswoman Marjorie Taylor Greene (R-Ga.) published an offensive tweet yesterday targeting Brinton and their nonbinary identity:

According to reporting in the New York Post, during an initial conversation with police, Brinton allegedly denied that they had stolen another passenger’s suitcase. Subsequently, Brinton told investigators they accidentally grabbed the wrong bag at the luggage carousel by mistake out of exhaustion.

Court filings indicate that Brinton, upon realizing they had mistakenly taken someone else’s bag, emptied its contents into dresser drawers in their hotel room, anxious about the prospect of facing accusations of property theft.

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No one would have expected me to attempt suicide

Successful career, busy social life hid reality of depression

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Rev. David Lett shares the story of his suicide attempt and urges readers to seek help if they are in crisis.

Editor’s note: The Blade has covered several suicides in our community in recent months. Sadly, the holidays are a time of increased anxiety, isolation, and depression for many. The following is a first-person account of surviving suicide along with resources and information on where to get help if you are in crisis. There is an abundance of resources addressing the unique needs of the LGBTQ community. If you have a personal story you’d like to share with Blade readers about overcoming suicidal ideation, depression, addiction, or isolation, please email us at [email protected].

In late winter 2015 it would have seemed that I had everything going for me — a successful drag career (hosting at Town Friday and Saturday nights), and an extremely busy priesthood that consumed my time, especially with preparation for the upcoming holidays. My family life contained the usual stressors. I have plenty of friends, acquaintances, and a handful of very close friends, and dare I say a few fans.  

Looking from the outside, my life seemed normal (normal for me). No one would have ever expected me to consider suicide. More and more, depression continually rolled over me like a tidal wave and I found myself with no purpose or defense. I had experienced depression before, but never to this magnitude. It became unbearable; a feeling of worthlessness and sheer sadness with anxiety that consumed me. My days were filled with pain and my nights with unrelenting insomnia, one right after the other.  

Being a person of faith required that I make peace with my decision and my creator. I believed that a God who so loves me would not want me to suffer under such a crushing weight of depression. The Lord is a God of mercy, and how could a merciful God show anything but mercy? I realized that suicide was my best option, despite the many resources available to me, such as The National Suicide Prevention hotline (1-800-273-8255), the various suicide prevention organizations (The Trevor Project, A.F.S.P., Outreach by the DC Center), and now the newly established 988 number. 

I availed myself of none. I reached out to no one. I believed no one would understand my situation. I was embarrassed that I could not handle my own life and therefore concluded that taking my own life would cause little fuss.  

So, on Dec. 6, 2015, I Googled “What are the least painful ways to kill yourself?” No. 2 in the search was “shoot yourself in the heart.” The page promised it would be quick and painless. So, I devised a plan, the first thing I needed to do was pick a day. I picked Dec. 11, 2015. I made a list of all the other things I needed or wanted to get accomplished before the day. Chores as simple as getting my hair cut and setting out the clothes I wanted to be buried in. I decided on a last meal. A very simple shrimp salad from Cameron’s on 16th Street. The writing of 12 individual handwritten letters (which were to serve as my suicide notes). I wrote a special letter to the boys who were going to take care of my everything, my French Bulldog Christian, He would stay with me until the end, and then he would be someone else’s love.

If anything, during this period my depression and hopelessness had grown even deeper.  It was a bitter cold day on the 11th of December. At 2:55 p.m., I took a 38-caliber revolver, placed it over my heart and pulled the trigger. The loud noise and smell are what I remember first. It was so loud my ears were ringing and the smell of gunpowder filled the area I was standing in (not a pleasant odor). It is nothing like we see in the movies or on television. First and foremost what I found shocking to me was that I did not fall down, but instead I was walking around for 8-10 minutes before the bullet had done enough damage causing me to lie down and eventually pass out.  

I thought I must have done it wrong. After all, why was I still upright and moving around? Then the pain started to set in. Oh, the pain! The greatest pain I have ever felt in my life.  I would later reflect that it was the pain that caused me to eventually pass out, that is how severe it was. I passed out before the ambulance arrived. I was lucky enough to have a friend call for emergency services. Once I arrived at MedStar I underwent a 21-hour surgery. The bullet missed my heart by three centimeters; further proof that Americans are awful at the metric system. I was put in a medically induced coma for 10 days.  I would later have three additional surgeries to correct various issues. The bullet nicked a rib and traveled downward. I spent a month and three weeks in the hospital. The surgeons removed a portion of my liver, and completely removed my gallbladder, spleen, a portion of my lower intestine and appendix. Likewise, they repaired some major damage done to my stomach.

Waking up with my wrists bound and a breathing tube down my throat was horrific (I would rather have died). At first, I was angry that I had not succeeded. I could not believe where I found myself — it was not supposed to be like this! Once the breathing tube was removed my recovery began and, with it, a whole new story. During recovery I had to avail myself of counseling and was diagnosed with severe depression and acute anxiety. I was started on numerous medications and therapy.  

Throughout all of this, I was fortunate enough to have many visitors from the community — friends, family, and some folks I had only known from interacting socially at the club. Perhaps one of the more profound lessons I learned through this process is that my death would have caused pain for so may people.

I keep up with my counseling and medications to minimize suicidal thoughts. To someone who is suicidal and it seems like it is the only option out, you are wrong. It requires courage to reach out. Depression is worn inwards and it can weigh a ton at times. But no one has to go through this alone. There are plenty of groups that specialize in helping those who are suicidal especially in OUR LGBT community. 

CRISIS RESOURCES

988. The new 988 suicide and crisis lifeline is available 24 hours/day and offers telephone and online chat.

The Trevor Project: 866-488-7386. The Trevor Project is the leading national organization providing crisis intervention and suicide prevention services to LGBTQ young people ages 13-24.

National Suicide Prevention Lifeline: 800-273-8255 (online chat available).The National Suicide Prevention Lifeline is a national network of local crisis centers that provides free and confidential support to people in suicidal crisis 24/7. 

Crisis Text Line: Text START to 741-741, a free, 24/7 support for those in crisis. 

The Gay, Lesbian, Bisexual and Transgender National Hotline: 888-843-4564. Provides telephone, online private one-to-one chat and email peer-support, as well as information and local resources across the United States.

Trans Lifeline: 877-565-8860. Trans Lifeline is a trans-led organization that connects trans people to the community, support, and resources 

The True Colors United, 212-461-4401. The True Colors Fund works to end homelessness among LGBTQ youth.

Self Abuse Finally Ends (S.A.F.E). Addresses individuals coping with non-suicidal self-injury, including locally based information, support and therapy referrals.

U.S. National Domestic Violence Hotline: 800-799-7233. Operating around the clock, seven days a week, confidential and free, the National Domestic Violence Hotline provides lifesaving tools and immediate support to enable victims to find safety and live lives free of abuse.

Rape Abuse and Incest National Network (RAINN): 800-656-HOPE/800-810-7440 (TTY). The nation’s largest organization fighting sexual violence, RAINN also carries out programs to prevent sexual violence, help victims and ensure that rapists are brought to justice.

SMYAL, smyal.org. D.C.-based organization advocating for LGBTQ youth.

D.C. Department of Mental Health Access Helpline, 888-7WE-HELP.

Wanda Alston Foundation (202-733-3643) in D.C. provides transitional living and support services to homeless and at-risk LGBTQ youth ages 18-24. 

(This list was compiled by PFLAG and Blade staff )

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