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Military: high number of trans youth seeking care

Health system reports dramatically higher numbers

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LGBT youth, gay news, Washington Blade
trans children, transgender teen depression, LGBT youth, gay news, Washington Blade
(Photo by Glynnis Jones; courtesy Bigstock)

LONDON — The number of transgender children and adolescents receiving care in the U.S. military health system rose substantially from 2010-2017, a new study reported on by Reuters shows.

During that time, the number of children of active or retired military personnel seeking gender-affirming care more than quadrupled, researchers found.

Until September 2016, gender-affirming care was not covered for the 1.7 million youth who may be eligible for military health service care based on their parents’ current or prior service, Reuters reports. At that point, the Department of Defense enacted a policy allowing children of service members to receive full coverage for nonsurgical transgender and gender-diverse care, researchers note in JAMA Pediatrics.

The number of children seeking transgender and gender-diverse care in the military health system rose from 135 in all 12 months of 2010 to 528 in just the first four months of 2017, according to Dr. David A. Klein of the Uniformed Services University in Bethesda, Maryland and colleagues, Reuters reports. 

Overall during the study period, 2,533 youngsters sought this kind of care. Roughly two-thirds had female as their first recorded gender. Half of the youngsters were under age 17 when they had their first gender-associated appointment, Reuters reports. 

“Approximately 500 children presented to care during early puberty between the ages of 10 and 14,” Klein told Reuters Health in an email. He added, “Because the sex characteristics associated with puberty can be particularly troublesome for transgender and gender-diverse adolescents, clinicians caring for such children should promptly refer these children to healthcare professionals who are familiar with gender development for consideration of fully reversible treatment to suppress puberty. This treatment provides time to determine the most appropriate next steps, which may include additional gender-affirming therapy.”

In 2010, military doctors wrote 24 new prescriptions for gender-affirming hormones, compared to 332 in just the first four months of 2017.

Co-author Dr. Elizabeth Hisle-Gorman, also at the Uniformed Services University, told Reuters Health by email, “This study shows that transgender care, which was only officially available to military dependents in 2016, is used and needed. Meeting the healthcare commitment to our military families includes providing appropriate quality transgender care to military dependent children.”

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Monkeypox

Monkeypox vaccination effort shifts towards maintaining demand

‘Thousands of shots’ administered at gay events across country

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White House National Monkeypox Response Deputy Coordinator Dr. Demetre Daskalakis (YouTube screenshot)

As ensuring adequate supply and distribution of the monkeypox virus vaccine becomes “less of an issue,” efforts have shifted toward maintaining demand, Dr. Demetre Daskalakis, White House national monkeypox response deputy coordinator, said on Sept. 7. 

This will mean, “making sure that people know that a effective and safe vaccine is available for those that could benefit,” he said, during a press briefing that also featured National Response Coordinator Dr. Bob Fenton and White House Press Secretary Karine Jean-Pierre. 

The officials said they were pleased with the impact of their targeted allocations of vaccine doses to events with large numbers of gay and bisexual men who have sex with men, populations considered high risk for MPV infection. 

“Thousands of shots were administered” at Southern Decadence in New Orleans, Black Pride in Atlanta and Oakland Pride in the San Francisco Bay Area, Fenton said. These efforts “were, frankly, wildly successful,” Daskalakis said. 

During a Q&A with reporters that followed the briefing, Daskalakis addressed questions about the racial disparities that have begun to emerge with respect to infection and vaccination rates. 

According to the Kaiser Family Foundation, “Black people have received 22 percent vaccines, while they account for 36 percent of cases. In contrast, White people have received 63 percent of vaccinations but account for 42 percent of cases.”

Daskalakis explained the events that were targeted this summer were a major part of addressing the disproportionately higher rates of infection and lower rates of vaccination among people of color. 

“It’s not about just the vaccine allocation,” he said. “It’s about that intense community engagement that happens on the ground because, ultimately, public health is a local event.”

From the beginning of the outbreak, those engaged in the federal response were in touch with community organizations, Daskalakis said: “Giving the tools that people need to be able to sort of reach health goals is what we’ve been doing. And the support of organizations that serve Black and brown people have been pivotal in really turning the tide in what I think you’re going to see, the new vaccine numbers emerging over the next few weeks.”

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Health

Percentage of gay D.C. monkeypox cases rises slightly

Latest data show category of ‘unknown’ sexual orientation at 41.9%

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The latest weekly release of monkeypox case numbers by the D.C. Department of Health shows there were a total cumulative number of 431 monkeypox cases in the District as of Wednesday, Aug. 31, an increase of 26 cases since 405 cases reported one week earlier.

This week’s DOH data for the category of cases based on an individual’s sexual orientation show there were a total of 14 cases (3.2%) listed as straight/heterosexual, up from 11 cases (2.7%) from the previous week;  212 (49%) gay, up from 172 (42.5%) from last week; 24 (5.6%) bisexual, up from 18 (4.4% last week; and 179 (41.5%) in a category listed as “unknown” for the person’s sexual orientation, which was up from 172 (42.5%) from the previous week.

Officials at DOH, which is also known as D.C. Health, have said since the start of the monkeypox outbreak earlier this year that the overwhelming majority of cases in D.C., similar to across the nation, have been among gay, bisexual, and other men who have sex with men.

One DOH official speaking at a monkeypox town hall event last month placed the number of D.C. cases among all men who have sex with men at more than 90 percent. Officials have said the lower percentage of “gay” cases and the rise in the “unknown” category reported over the past two weeks is most likely due to a change in the data gathering policy.

In an effort to lessen the stigma associated with monkeypox infections, officials have said they do not want to appear as if they are applying undue pressure on people to disclose their sexual orientation when they apply for a monkeypox vaccination or seek a monkeypox test or treatment.

For the category of “lesbian” and “other,” the DOH this week included an asterisk instead of a number and a percentage.

“To help protect confidentiality, small numbers (between 0 and 4 are shown by an asterisk,” DOH states as an explanation for not including a number for the “lesbian” and “other” categories.

In last week’s data release, DOH said there were 0 recorded monkeypox cases for lesbians and one case in the “other” category.

In its category of “gender identity,” the DOH data released on Wednesday show that as of this week, out of the total cumulative cases of 431,423 (98.1%) were male. An asterisk is shown instead of a number for the categories of female; female-to-male transgender; male-to-female transgender; and gender nonconforming.

 A full breakdown of the latest monkeypox case number for all categories, including race/ethnicity, age group, and residential ward can be accessed at the D.C. Health website.

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Biden health officials defend approach to monkeypox as cases grow

Contradictory information emerges on vaccine administration

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Biden officials defended their approach to monkeypox as contradictory emerges among health experts.

Top health officials in the Biden administration defended their approach Thursday to the monkeypox outbreak as cases continue to grow and contradictory information has emerged on appropriate vaccine administration.

Members of the White House monkeypox task force, in response to a question from the Washington Blade in a conference call with reporters, held fast to their new guidance on the JYNNEOS vaccine, which seeks to change the method of administration of the shot in an effort to expand use of the existing supply by fivefold — despite objections and even threats to cancel the supply from the vaccine manufacturer, according to a report this week in the Washington Post.

Meanwhile, cases of monkeypox in the United States are escalating — and beginning to extend outside the community of men who have sex with men — as the total number of confirmed cases has reached 13,517.

Bob Fenton, the White House monkeypox response coordinator, was first to respond to the Blade’s question on how the public can trust guidance from health officials amid the contradictory information by asserting “anytime that you have change, you’re going to have the need to update and educate the community on those changes.”

“The day…the FDA made that decision, we need signaled a week that this was being undertaken by FDA there already were a number of jurisdictions that started the training in anticipation of that decision,” Fenton said. “And that day, there were jurisdictions actually delivering intradermal shots that day [to] fivefold the number of shots and did that to areas of high risk and did that to areas that made equity a factor in those decisions where they vaccinated. So it is happening; it is being successful.”

The context of the Biden administration’s change in guidance last week — which shifts from injection through the subcutaneous route (delivery of the vaccine under the fat layer underneath the skin) to the intradermal route (delivery of the vaccine into the layer of skin just underneath the top layer) — is an announcement from localities, including the D.C. government, shifting from two doses to one dose to make up for limited supply. Biden officials discouraged the one-dose approach, pointing to data suggesting it was not effective in protecting against monkeypox.

In essence, contradictory information is coming from health experts on monkeypox on all levels localities offer on the vaccine, which in turn is criticized by the federal government as ineffective in favor of different approaches, which is in turn criticized by the vaccine manufacturer as untested and inappropriate.

Rochelle Walensky, director of the Centers of Disease Control & Prevention, responded to previously articulated concerns about the one-dose approach from localities by saying the Biden administration is working “really hand in glove in really fluid communication through this outbreak.”

“As I articulated we don’t yet know how well this vaccine will work in this outbreak,” Walensky said. “And as those data are evolving, as we had some resource constraints early on with the vaccine, we were working close with health departments so that they could maximize their coverage. We’ve met with them to talk about what data might be available for one dose, which are really limited [and] concerning in terms of how well it would work. And so when the strategy for intradermal dosing, which we anticipate will work just as well as subcutaneous dosing, we again met closely with the health departments…so that we could provide the data to them.”

Defense of changes in guidance in vaccine administration ended up overshadowing the announcements top officials were seeking to make, such as making an additional 1.8 million doses available for ordering starting Monday, a pilot program setting aside 50,000 doses for jurisdictions hosting large LGBTQ events, such as Black Pride in Atlanta and Southern Decadence in New Orleans; and making available next week 50,000 patient courses of TPOXX monkeypox treatment.

Dawn O’Connell, assistant secretary for preparedness and response at the Department of Health & Human Services, said when asked by CNN about expanding the supply the administration may look elsewhere aside from the JYNNEOS vaccine manufacturer, Bavarian Nordic in Denmark, calling the company a “small manufacturer.”

“They currently have one active line and in the Copenhagen area that we’re relying on for 2.5 million doses to be filled and finished, but when we ordered that second 2.5 million to be built and finished, we made it a requirement that they work with a domestic U.S. contract manufacturing organization and we continue to partner with Bavarian Nordic as they solidify that relationship,” O’Connell said. “We are also helping them in other ways consider manufacturing capacity increases, potentially working with a larger pharmaceutical company.”

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