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Monkeypox being spread through sex, not brief skin-to-skin contact: experts

Health experts weigh declaring virus an STD

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Health experts are now emphasizing monkeypox is being spread through sex, not brief skin-to-skin contact.

Amid fears monkeypox would spread at an increased rate at the end of summer as gay men gather in close quarters for dance parties and other celebrations, health experts are starting to emphasize that the current outbreak isn’t spreading through minimal skin-to-skin contact, such as brushing up against a fellow shirtless dance partner, but rather through sexual activity and overwhelmingly among men who have sex with men.

With reported cases of monkeypox in the United States this week reaching 15,505, according to data from the Centers for Disease Control, a number of health experts who spoke to the Blade talked about outright declaring monkeypox a sexually transmitted disease as part of this messaging — although they acknowledge such a label would have pros and cons.

Juan Carlos Loubriel, senior director of community health at the D.C.-based Whitman-Walker Health, was among the health experts making the distinction between the negligible risks of transmitting monkeypox through brief skin-to-skin contact as opposed to sexual activity.

“I’ll say that we need to provide the real facts to our community that indicates right now that the majority of the cases are sexually transmitted, right?” Loubriel said. “So transmission is not occurring by casual touch, right? That’s what we know as of today … So the majority of the cases [are] by prolonged skin-to-skin contact, and during sex there is a lot of skin-to-skin contact.”

As health experts at large are beginning to make a distinction in how the disease is transmitted, the Biden administration has also taken up messaging that downplays the risk of monkeypox transmission through minimal skin-to-skin contact.

Demetre Daskalakis, who is the face of the LGBTQ outreach for the Biden administration as deputy coordinator of the White House monkeypox task force, made colorful remarks Friday during a conference call with reporters downplaying the risk of contracting monkeypox through brief contact, quoting a senior policy adviser at the CDC who has studied LGBTQ health issues.

“I think I’m going to quote my friend Robbie Goldstein that sex involves friction, and friction seems to be how this happens,” Daskalakis said. “So, I think, that from the perspective of events, the real risk at an event is low. Of course, you have to gauge that risk based on what you’re doing, so if there’s a lot of clothes out dancing and friction, that could be a mechanism of transmission, but just brushing by someone, I’ve said this many times before, just brushing by someone is probably low or no risk.”

Asked by the Blade during the call about any consideration on declaring monkeypox a sexually transmitted disease, Daskalakis said it’s “really important that the decision around monkeypox and whether it’s designated happen thoughtfully from the perspective of other implications.”

“What’s really important from the perspective of our communication on the ground is that our harm reduction and safer sex guidance really does mention the importance of sexual transmission or the associated transmission of the virus, and also provides guidance necessary, like reminding people that condoms may have a role — not necessarily the full role — in preventing monkeypox, but also reminds folks that skin-to-skin contact in the context of sex can be really a part of how transmission occurs,” he said.

The messaging is consistent with new studies finding cases of monkeypox are overwhelmingly the result of sexual activity. According to a recent report by NBC News, an increasing amount of scientific evidence — such three studies published in peer-reviewed journals, as well as reports from national, regional, and global health authorities — has indicated “experts may have framed monkeypox’s typical transmission route precisely backward.”

“[A]n expanding cadre of experts has come to believe that sex between men itself — both anal as well as oral intercourse — is likely the main driver of global monkeypox transmission,” the NBC News report says. “The skin contact that comes with sex, these experts say, is probably much less of a risk factor.”

With evidence the monkeypox outbreak is overwhelmingly being transmitted through sexual activity and risks from skin-to-skin contact virtually non-existent, experts say discussion on whether or not to label the virus as a sexually transmitted disease are ongoing and controversial.

On one hand, designating monkeypox as a sexually transmitted disease would give the public a clearer idea about the way it’s being transmitted to allay concerns and enable the public to take appropriate precautions. On the other hand, as seen during the height of HIV/AIDS crisis, an emphasis on monkeypox being transmitted among men who have sex with men may have the effect of stigmatizing the community (and the sexual activity) as being responsible for the outbreak.

Loubriel said the issue of whether or not monkeypox should be messaged more as a sexually transmitted disease is “a very good question and also a very big debate around public health, even within the public health sector.”

“The only reason we cannot say it is just sexually transmitted is because we know as a fact that it can be spread by other various avenues like touching clothing, bedding with an infected person or towels being used by someone with monkeypox, potentially contact with respiratory secretions,” Loubriel added. “So that is why it’s probably not been named as a sexually transmitted infection.”

Joseph Lee, a professor of health education at East Carolina University who studies health inequities among LGBTQ people, said there’s “real tension” in finding the right messaging, which he said would strike a balance between being factual while not being stigmatic of the marginalized community affected by monkeypox.

“We see when we have messaging that goes to the general public…that messaging about how a particular group is doing worse triggers negative stereotypes and makes people feel less at risk than they are,” Lee said. “And really importantly, it makes the group at the worst end of that problem feel sometimes like they’re feeling fatalistic or they can’t do anything to protect themselves. You almost feel like you have to give up and you’re just going to get it anyway because the messaging is so clear, how much it’s impacting your community.”

Lee, however, praised communications on monkeypox from the Centers for Disease Control & Prevention, saying the agency has “very useful guidance about promoting equity in monkeypox communication that I actually really like.”

Key points in the guidance, Lee said, is messaging that monkeypox can affect anyone, while going through some of the ways the virus is being transmitted and ways the public can protect itself. The guidance, Lee said, follows the right strategy of articulating a message to the general public, then adding more specific messages about protection against the disease and risk to the communities most vulnerable.

“That’s sort of their big picture strategy that I think is actually the right strategy,” Lee concluded. “How well everyone’s implementing it across the country in our messy, somewhat broken public health system is another question.”

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U.S. Supreme Court

US Supreme Court rules Idaho to enforce gender care ban

House Bill 71 signed in 2023

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U.S. Supreme Court (Washington Blade photo by Michael Key)

BY MIA MALDONADO | The U.S. Supreme Court has allowed Idaho to enforce House Bill 71, a law banning Idaho youth from receiving gender-affirming care medications and surgeries.

In an opinion issued Monday, the U.S. Supreme Court granted the state of Idaho’s request to stay the preliminary injunction, which blocked the law from taking effect. This means the preliminary injunction now only applies to the plaintiffs involved in Poe v. Labrador — a lawsuit brought on by the families of two transgender teens in Idaho who seek gender-affirming care. 

Monday’s Supreme Court decision enforces the gender-affirming care ban for all other trans youth in Idaho as the lawsuit remains ongoing in the Ninth Circuit Court of Appeals.

Idaho Attorney General Raúl Labrador
Idaho Attorney General Raúl Labrador gives a speech at the Idaho GOP election night watch party at the Grove Hotel in Boise, Idaho, on Nov. 8, 2022. (Otto Kitsinger for Idaho Capital Sun)

The American Civil Liberties Union and the ACLU of Idaho, both of whom represent the plaintiffs, said in a press release Monday that the ruling “does not touch upon the constitutionality” of HB 71. The groups called Monday’s ruling an “awful result” for trans Idaho youth and their families.

“Today’s ruling allows the state to shut down the care that thousands of families rely on while sowing further confusion and disruption,” the organizations said in the press release. “Nonetheless, today’s result only leaves us all the more determined to defeat this law in the courts entirely, making Idaho a safer state to raise every family.”

Idaho Attorney General Raúl Labrador in a press release said the state has a duty to protect and support all children, and that he is proud of the state’s legal stance. 

“Those suffering from gender dysphoria deserve love, support and medical care rooted in biological reality,” Labrador said. “Denying the basic truth that boys and girls are biologically different hurts our kids. No one has the right to harm children, and I’m grateful that we, as the state, have the power — and duty — to protect them.”

Recap of Idaho’s HB 71, and what led to SCOTUS opinion

Monday’s Supreme Court decision traces back to when HB 71 was signed into law in April 2023.

The law makes it a felony punishable for up to 10 years for doctors to provide surgeries, puberty-blockers and hormones to trans people under the age of 18. However, gender-affirming surgeries are not and were not performed among Idaho adults or youth before the bill was signed into law, the Idaho Capital Sun previously reported

One month after it was signed into law, the families of two trans teens sued the state in a lawsuit alleging the bill violates the 14th Amendment’s guarantee of equal protection under the law.

In late December, just days before the law was set to take effect in the new year, U.S. District Judge B. Lynn Winmill blocked the law from taking effect under a preliminary injunction. In his decision, he said he found the families likely to succeed in their challenge.

The state of Idaho responded by appealing the district court’s preliminary injunction decision to the Ninth Circuit, to which the Ninth Circuit denied. The state of Idaho argued the court should at least enforce the ban for everyone except for the plaintiffs. 

After the Ninth Circuit’s denial, the Idaho Attorney General’s Office in February sent an emergency motion to the U.S. Supreme Court, the Idaho Press reported. Monday’s U.S. Supreme Court decision agrees with the state’s request to enforce its ban on trans health care for minors, except for the two plaintiffs.

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Mia Maldonado

Mia Maldonado joined the Idaho Capital Sun after working as a breaking news reporter at the Idaho Statesman covering stories related to crime, education, growth and politics. She previously interned at the Idaho Capital Sun through the Voces Internship of Idaho, an equity-driven program for young Latinos to work in Idaho news. Born and raised in Coeur d’Alene, Mia moved to the Treasure Valley for college where she graduated from the College of Idaho with a bachelor’s degree in Spanish and international political economy.

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The preceding piece was previously published by the Idaho Capital Sun and is republished with permission.

The Idaho Capital Sun is the Gem State’s newest nonprofit news organization delivering accountability journalism on state politics, health care, tax policy, the environment and more.

We’re part of States Newsroom, the nation’s largest state-focused nonprofit news organization.

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Kansas

Kansas governor vetoes ban on health care for transgender youth

Republican lawmakers have vowed to override veto

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Democratic Gov. Laura Kelly vetoed two abortion bills and a measure criminalizing transgender health care for minors. House and Senate Republican leaders responded with promises to seek veto overrides when the full Legislature returned to Topeka on April 26. (Photo by Sherman Smith/Kansas Reflector)

BY TIM CARPENTER | Gov. Laura Kelly flexed a veto pen to reject bills Friday prohibiting gender identity health care for transgender youth, introducing a vague crime of coercing someone to have an abortion and implementing a broader survey of women seeking abortion that was certain to trigger veto override attempts in the Republican-led House and Senate.

The decisions by the Democratic governor to use her authority to reject these health and abortion rights bills didn’t come as a surprise given her previous opposition to lawmakers intervening in personal decisions that she believed ought to remain the domain of families and physicians.

Kelly said Senate Bill 233, which would ban gender-affirming care for trans minors in Kansas, was an unwarranted attack on a small number of Kansans under 18. She said the bill was based on a politically distorted belief the Legislature knew better than parents how to raise their children.

She said it was neither a conservative nor Kansas value to block medical professionals from performing surgery or prescribing puberty blockers for their patients. She said stripping doctors of their licenses for serving health interests of patients was wrong. Under the bill, offending physicians could be face lawsuits and their professional liability insurance couldn’t be relied on to defend themselves in court.

“To be clear, this legislation tramples parental rights,” Kelly said. “The last place that I would want to be as a politician is between a parent and a child who needed medical care of any kind. And, yet, that is exactly what this legislation does.”

Senate President Ty Masterson (R-Andover) and House Speaker Dan Hawkins (R-Wichita) responded to the governor by denouncing the vetoes and pledging to seek overrides when legislators returned to the Capitol on April 26. The trans bill was passed 27-13 in the Senate and 82-39 in the House, suggesting both chambers were in striking distance of a two-thirds majority necessary to thwart the governor.

“The governor has made it clear yet again that the radical left controls her veto pen,” Masterson said. “This devotion to extremism will not stand, and we look forward to overriding her vetoes when we return in two weeks.”

Cathryn Oakley, senior director of the Human Rights Campaign, said the ban on crucial, medically necessary health care for trans youth was discriminatory, designed to spread dangerous misinformation and timed to rile up anti-LGBTQ activists.

“Every credible medical organization — representing over 1.3 million doctors in the United States — calls for age-appropriate, gender-affirming care for transgender and nonbinary people,” Oakley said. “This is why majorities of Americans oppose criminalizing or banning gender-affirming care.”

Abortion coercion

Kelly also vetoed House Bill 2436 that would create the felony crime of engaging in physical, financial or documentary coercion to compel a girl or woman to end a pregnancy despite an expressed desire to carry the fetus to term. It was approved 27-11 in the Senate and 82-37 in the House, again potentially on the cusp of achieving a veto override.

The legislation would establish sentences of one year in jail and $5,000 fine for those guilty of abortion coercion. The fine could be elevated to $10,000 if the adult applying the pressure was the fetuses’ father and the pregnant female was under 18. If the coercion was accompanied by crimes of stalking, domestic battery, kidnapping or about 20 other offenses the prison sentence could be elevated to 25 years behind bars.

Kelly said no one should be forced to undergo a medical procedure against their will. She said threatening violence against another individual was already a crime in Kansas.

“Additionally, I am concerned with the vague language in this bill and its potential to intrude upon private, often difficult, conversations between a person and their family, friends and health care providers,” the governor said. “This overly broad language risks criminalizing Kansans who are being confided in by their loved ones or simply sharing their expertise as a health care provider.”

Hawkins, the House Republican leader, said coercion was wrong regardless of the circumstances and Kelly’s veto of the bill was a step too far to the left.

“It’s a sad day for Kansas when the governor’s uncompromising support for abortion won’t even allow her to advocate for trafficking and abuse victims who are coerced into the procedure,” Hawkins said.

Emily Wales, president and CEO of Planned Parenthood Great Plains Votes, said HB 2436 sought to equate abortion with crime, perpetuate false narratives and erode a fundamental constitutional right to bodily autonomy. The bill did nothing to protect Kansas from reproductive coercion, including forced pregnancy or tampering with birth control.

“Planned Parenthood Great Plains Votes trusts patients and stands firmly against any legislation that seeks to undermine reproductive rights or limit access to essential health care services,” Wales said.

Danielle Underwood, spokeswoman for Kansas for Life, said “Coercion Kelly” demonstrated with this veto a lack of compassion for women pushed into an abortion.

The abortion survey

The House and Senate approved a bill requiring more than a dozen questions be added to surveys of women attempting to terminate a pregnancy in Kansas. Colorful debate in the House included consideration of public health benefits of requiring interviews of men about reasons they sought a vasectomy birth control procedure or why individuals turned to health professionals for treatment of erectile dysfunction.

House Bill 2749 adopted 81-39 in the House and 27-13 in the Senate would require the Kansas Department of Health and Environment to produce twice-a-year reports on responses to the expanded abortion survey. The state of Kansas cannot require women to answer questions on the survey.

Kelly said in her veto message the bill was “invasive and unnecessary” and legislators should have taken into account rejection in August 2022 of a proposed amendment to the Kansas Constitution that would have set the stage for legislation further limiting or ending access to abortion.

“There is no valid medical reason to force a woman to disclose to the Legislature if they have been a victim of abuse, rape or incest prior to obtaining an abortion,” Kelly said. “There is also no valid reason to force a woman to disclose to the Legislature why she is seeking an abortion. I refuse to sign legislation that goes against the will of the majority of Kansans who spoke loudly on Aug. 2, 2022. Kansans don’t want politicians involved in their private medical decisions.”

Wales, of Planned Parenthood Great Plains Votes, said the bill would have compelled health care providers to “interrogate patients seeking abortion care” and to engage in violations of patient privacy while inflicting undue emotional distress.

Hawkins, the Republican House speaker, said the record numbers of Kansas abortions — the increase has been driven by bans or restrictions imposed in other states — was sufficient to warrant scrutiny of KDHE reporting on abortion. He also said the governor had no business suppressing reporting on abortion and criticized her for tapping into “irrational fears of offending the for-profit pro-abortion lobby.”

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Tim Carpenter

Tim Carpenter has reported on Kansas for 35 years. He covered the Capitol for 16 years at the Topeka Capital-Journal and previously worked for the Lawrence Journal-World and United Press International.

The preceding story was previously published by the Kansas Reflector and is republished with permission.

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The Kansas Reflector is a nonprofit news operation providing in-depth reporting, diverse opinions and daily coverage of state government and politics. This public service is free to readers and other news outlets. We are part of States Newsroom: the nation’s largest state-focused nonprofit news organization, with reporting from every capital.

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Colorado

Five transgender, nonbinary ICE detainees allege mistreatment at Colo. detention center

Advocacy groups filed complaint with federal officials on April 9

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(Photo courtesy of GEO Group)

Five transgender and nonbinary people who are in U.S. Immigration and Customs Enforcement custody at a privately-run detention center in Colorado say they continue to suffer mistreatment.

The Rocky Mountain Immigrant Advocacy Network, the National Immigration Project and the American Immigration Council on April 9 filed a complaint with the Department of Homeland Security’s Offices for Civil Rights and Civil Liberties, Immigration Detention Ombudsman and Inspector General and ICE’s Office of Professional Responsibility on behalf of the detainees at the Aurora Contract Detention Facility near Denver.

Charlotte, one of the five complainants, says she spends up to 23 hours a day in her room. 

She says in the complaint that a psychiatrist has prescribed her medications for anxiety and depression, but “is in the dark about her actual diagnoses because they were not explained to her.” Myriah and Elsa allege they do not have regular access to hormones and other related health care.

Omar, who identifies as trans and nonbinary, in the complaint alleges they would “start hormone replacement therapy if they could be assured that they would not be placed in solitary confinement.” Other detainees in the complaint allege staff have also threatened to place them in isolation.

“They have been told repeatedly that, if they started therapy, they would be placed in ‘protective custody’ (solitary confinement) because the Aurora facility has no nonbinary or men’s transgender housing unit,” reads the complaint. “This is so, despite other trans men having been detained in Aurora in the past, so Omar is very likely receiving misinformation that is preventing them from accessing the treatment they require.”

Omar further alleges staffers told them upon their arrival that “they had to have a ‘boy part’ (meaning a penis) to be assigned to” the housing unit in which other trans people live. Other complainants say staff have also subjected them to degrading comments and other mistreatment because of their gender identity. 

“Victoria, Charlotte and Myriah are all apprehensive about a specific female guard who is assigned to the housing unit for transgender women at Aurora,” reads the complaint. “Victoria has experienced this guard peering at her through the glass on the door of her form. Charlotte, Myriah and the other women in her dorm experienced the same guard making fun of them after they complained that she had confiscated all of their personal hygiene products, like their toothbrushes and toothpaste, and replaced them with menstrual pads and tampons, which she knows they do not need.”

“She said something to them like, ‘If you were real women, you would need these things,'” reads the complaint. “The same guard told them that they had to ask her for their personal hygiene products when they wanted to use them, stripping them of their most basic agency.”

Victoria, who has been in ICE custody for more than two years, also says she does not have regular access to hormones. Victoria further claims poor food, lack of access to exercise and stress and anxiety because of her prolonged detention has caused has made her health deteriorate.

The GEO Group, a Florida-based company, operates the Aurora Contract Detention Facility.

Advocates for years have complained about the conditions for trans and nonbinary people in ICE custody and have demanded the agency release all of them.

Roxsana Hernández, a trans Honduran woman with HIV, on May 25, 2018, died in ICE custody in New Mexico. Her family in 2020 sued the federal government and the five private companies who were responsible for her care.

Johana “Joa” Medina Leon, a trans Salvadoran woman, on June 1, 2019, passed away at a Texas hospital four days after her release from ICE custody. Kelly González Aguilar, a trans Honduran woman, had been in ICE custody for more than two years until her release from the Aurora Contract Detention Center on July 14, 2020.

ICE spokesperson Steve Kotecki on Friday told the Blade there were 10 “self-identified transgender detainees” at the Aurora Contract Detention Center on April 11. The facility’s “transgendered units” can accommodate up to 87 trans detainees. 

A 2015 memorandum then-ICE Executive Associate Director of Enforcement and Removal Operations Thomas Homan signed requires personnel to allow trans detainees to identify themselves based on their gender identity on data forms. The directive, among other things, also contains guidelines for a “respectful, safe and secure environment” for trans detainees and requires detention facilities to provide them with access to hormone therapy and other trans-specific health care.

“U.S. Immigration and Customs Enforcement (ICE) is committed to ensuring that all those in its custody reside in safe, secure and humane environments,” said Kotecki. “ICE regularly reviews each case involving self-identified transgender noncitizens and determines on a case-by-case basis whether detention is warranted.”

The complaint, however, states this memo does not go far enough to protect trans and nonbinary detainees.

“ICE’s 2015 guidance has some significant flaws,” it reads. “It fails to provide meaningful remedies for policy violations. It does not acknowledge the challenges that nonbinary people face when imprisoned by ICE and the lack of such guidance explains why the needs of nonbinary people are largely misunderstood and unmet.”

“Further, the language used to describe people who are TNB is not inclusive and does not reflect terminology adopted by the community it is meant to describe,” adds the complaint. “Although this list is not exhaustive, it addresses some of the primary concerns voiced by the complaints.”

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