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New CDC data shows HIV infections dropped, but mostly among whites

Socioeconomic factor into disproportionate rates

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Data published Tuesday by the Centers for Disease Control and Prevention shows a significant decline in new HIV infections, but suggests the impact of prevention efforts was far less substantial for Black and Latino populations.

From 2017-2021, as rates of HIV testing, treatment and the use of pre-exposure prophylaxis (PrEP) medication rose, new cases dropped by 12 percent overall and by as much as 34 percent among gay and bisexual males aged 13-24.

The numbers show a “move in the right direction,” CDC Director Rochelle Walensky said in a press release.

However, when broken down by race, the CDC found new infections were down by 27 percent and 36 percent, respectively, among Black and Latino populations, compared with 45 percent of whites.

Similarly, by 2021 about one third of those who are considered eligible were taking PrEP for HIV prevention, but the CDC noted this number includes “relatively few Black people or Hispanic/Latino people” despite the significant increase in prescriptions up from just 13 percent in 2017.

“Longstanding factors, such as systemic inequities, social and economic marginalization and residential segregation,” Walensky noted, continue to act as barriers “between highly effective HIV treatment and prevention and people who could benefit from them.”

She added, “Efforts must be accelerated and strengthened for progress to reach all groups faster and equitably.”

Robyn Neblett Fanfair, acting director of the CDC’s Division of HIV Prevention, said that “At least three people in the U.S. get HIV every hour — at a time when we have more effective prevention and treatment options than ever before.”

“These tools must reach deep into communities and be delivered faster to expand progress from some groups to all groups,” she said.

The HIV+Hepatitis Policy Institute issued a press release following the CDC’s announcement of the new data, noting both the encouraging progress and need for improvement.

“It appears that our investments in HIV prevention are providing some positive results, but the persistent high number of new diagnoses and the low usage of PrEP among the communities most impacted by HIV point to the need for increased resources, particularly for a national PrEP program,” said the group’s executive director, Carl Schmid.

President Joe Biden’s FY24 budget requested $237 million for a national PrEP program along with $850 million to support the U.S. Department of Health and Human Services’ “Ending the HIV Epidemic in the U.S.” initiative.

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Officials eye mpox prevention, vaccination initiatives for this summer’s LGBTQ events

New cluster of cases reported in Chicago

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Drs. Robert Fenton and Demetre Daskalakis, coordinator and deputy coordinator for the White House national mpox response, during a briefing in August 2022 (Official White House Photo by Cameron Smith)

Federal health agencies, in coordination with their state and local counterparts and community partners, are exploring opportunities to offer mpox prevention initiatives and vaccinations at LGBTQ events this summer, Dr. Demetre Daskalakis said on Thursday.

Daskalakis, the deputy coordinator for the White House’s national mpox response, described these deliberations in response to a question from the Washington Blade during a media telebriefing on mpox that was hosted by the Centers for Disease Control and Prevention.

The CDC on Monday issued a Health Alert Network Health Update on the potential risk for new mpox cases.

Since the peak of about 460 cases per day in August 2022, new cases have steadily declined, but following the cluster recently reported in the Chicago area, the update warns, “spring and summer season in 2023 could lead to a resurgence of mpox as people gather for festivals and other events.”

“We have the vaccine, and we have organizations that are willing to do it,” Daskalakis said during Thursday’s call, adding that resources are available and can be deployed flexibly because they are built into existing “HIV and STI funding to allow for this work.”

And the Mpox Crisis Response Cooperative Agreement, Daskalakis said, “provides even more resources locally for such efforts.”

Daskalakis and CDC Mpox Response Incident Manager Dr. Christopher R. Braden also briefed reporters on findings from new studies on the efficacy of the JYNNEOS vaccine for the prevention of mpox.

That data, per the CDC’s Morbidity and Mortality Weekly Report, reveals that “Among gay, bisexual, and other MSM and transgender adults aged 18-49 years, two doses of the JYNNEOS vaccine were 86 percent effective against mpox, indicating substantial protection against mpox.”

Additionally, “All routes of vaccine administration provided similar protection.”

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FDA finalizes new blood donation guidelines

‘A significant milestone for the agency and the LGBTQI+ community’

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Photo Credit: American Red Cross

The U.S. Food and Drug Administration on Thursday finalized new guidelines for blood donation that will use a uniform individualized risk assessment questionnaire for respondents regardless of their sexual orientation, sex, or gender.

The move, which brings U.S. policy in line with procedures used in countries like Canada and the United Kingdom, marks a significant departure from longstanding bans targeting gay and bisexual men who have sex with men that were gradually eased over the decades since the AIDS epidemic.

“The implementation of these recommendations will represent a significant milestone for the agency and the LGBTQI+ community,” said Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, in a press release issued by the agency.

“The FDA is committed to working closely with the blood collection industry to help ensure timely implementation of the new recommendations and we will continue to monitor the safety of the blood supply once this individual risk-based approach is in place.”

Under the new guidelines, prospective donors who have had a new sexual partner, or more than one sexual partner in the past three months, and anal sex in the past three months, would be ineligible.

So would those who are “taking medications to treat or prevent HIV infection (e.g., antiretroviral therapy (ART), pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP),” because these drugs can delay the detection of HIV.

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Incoming AMA president: ‘We simply will not stand’ for anti-trans healthcare restrictions

Org will use ‘every avenue available’ to push back

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Incoming American Medical Association Jesse Ehrenfeld at the AMA's Washington, D.C. office. (Washington Blade photo by Michael Key)

Doctor Jesse Ehrenfeld sat down with the Washington Blade on Tuesday, weeks ahead of the start of his tenure as the American Medical Association’s first openly gay president and amid an onslaught of legislative attacks targeting trans Americans’ access to healthcare.

“We see the attack on reproductive care, reproductive access, and transgender healthcare as a continuum of government overreach into patient-physician decision making,” Ehrenfeld said.

“We simply will not stand for the government coming in to interfere with the doctor-patient relationship,” such as by passing these laws that “outlaw what we know to be appropriate, evidence-based clinical guidelines-based care,” he said.

An anesthesiologist who served as the Joseph A. Johnson Jr. Distinguished Leadership Professor of anesthesiology, surgery, biomedical informatics & health policy at Vanderbilt University’s School of Medicine, much of Ehrenfeld’s professional background has been focused on matters of healthcare access, particularly for LGBTQ patients.

Ehrenfeld directs a $560 million philanthropic organization, Advancing a Healthier Wisconsin Endowment, while also serving as a consultant for the World Health Organization’s Digital Health Technical Advisory Group. He was special adviser to former U.S. Surgeon General Jerome Adams, who served during the Trump administration.

For his research on “understanding how can we use technology to work better for LGBTQ people,” in 2018 Ehrenfeld became the inaugural recipient of the NIH’s Sexual and Gender Minority Research Investigator Award.

He and his team did much of the work for that project at Vanderbilt’s Program for LGBTQ Health, which he co-founded and led for several years “before I took on my current clinical role in Wisconsin.”

“At the end of the day,” Ehrenfeld said, “we’re really about improving access to health care for LGBTQ people, which is a lot of the work that I have been involved in at the AMA and is a core piece of what we’re trying to do nationally through our policy activities.”

In testimony before the U.S. House Armed Services Committee in 2019, Ehrenfeld told lawmakers: “I would like to state unequivocally that there is no medically valid reason—including a diagnosis of gender dysphoria—to exclude transgender individuals from military service.”

Last year, far-right anti-trans pundit Matt Walsh targeted Vanderbilt’s Transgender Health Clinic on his podcast, leading conservative lawmakers in Tennessee to call for investigations of the institution based on information the university claims was “misrepresented” or taken out of context.

“It’s deeply personal for me,” Ehrenfeld said. “Almost everybody that I helped recruit and hire at Vanderbilt, their personal information was shared online. Their names were on TV. And that has had a chilling effect [both] there and in many places across the country, as there have been attempts to intimidate and threaten practitioners who are providing what we know is evidence based appropriate care.”

A big moment for Ehrenfeld and the AMA

Ehrenfeld will be inaugurated as AMA president on June 13, midway through Pride month. It will be an exciting time, he said. “The AMA will have our first contingent walking in the Chicago Pride Parade…so, my husband and the family and the kids will all be there with a bunch of AMA colleagues celebrating at the end of June.”

“It’s an exciting moment for the organization, but I think also for the community for a bunch of reasons,” Ehrenfeld said. “One is, you know, to be an out person in a very visible role, I think sends a message to patients in the community as well as LGBTQ physicians and other healthcare workers, that their needs are being heard in a way that hasn’t always happened,” notwithstanding “challenges that are happening in many places on the legislative level.”

On a personal level, he said, “growing up, I didn’t have a lot of LGBTQ role models in college and medical school who I saw as defining a career pathway for me.” This meant “I would often question, ‘would I have a role? Was there a place for me as an out person in medicine, in leadership, doing policy work, trying to make the community healthier and improve access to health care?'”

Ehrenfeld said his leadership of the AMA marks an “important moment” in the organization’s history, demonstrating what is now possible for LGBTQ people who historically were denied these types of opportunities.

Jesse Ehrenfeld (Washington Blade photo by Michael Key)

Anti-trans laws worsen systemic issues in healthcare

“The AMA opposes any policy “that creates a barrier between a patient and their doctor making a decision that’s in the patient’s best interests,” Ehrenfeld said, which includes “efforts to ban care for transgender people” at the state and federal level. “We stand for the science, the evidence, [and] the clinical guidelines that we know lead to better outcomes for patients.”

Even beyond healthcare restrictions that are passed legislatively, “we have a lot of backseat drivers trying to tell doctors what to do,” Ehrenfeld said, like “insurance companies who put up barriers around prior authorization for getting approval for care and services.”

“Those things are real and they cause people to give up trying to get the care they need,” he said.

Six states have passed laws criminalizing certain healthcare interventions for the treatment of gender dysphoria, which carry the specter of felony charges for healthcare providers. These, Ehrenfeld said, are the most “heartbreaking” for him personally.

Survey data says one in five physicians is experiencing signs of burnout, with an increase beginning with the COVID-19 pandemic, Ehrenfeld said. “That burnout is only exacerbated when you find yourself practicing in a place where a law is passed that tells you how to practice or [tells you] that you can’t practice.”

“That causes moral injury to a physician who finds an untenable choice: provide the care that they know is in the patient’s best interests, or break the law and [potentially] go to jail,” Ehrenfeld said. “And that stress is real. There’s not a week that goes by that I don’t hear from a colleague who says I can’t take it anymore.”

Beyond impacts felt by individual healthcare workers, “we’ve seen a drop in the number of physicians who are applying for training positions in states where care is being restricted,” he said. “When, suddenly, you don’t have specialists and internists and primary care providers working in a state, that impacts care for everybody.”

Anti-trans legislative restrictions on healthcare are increasingly targeting adults, too. Florida’s S.B. 254, which would allow the state to take children away from parents who facilitate their access to best-practices treatments for gender dysphoria, would also bar all Floridians from accessing gender affirming care via telehealth, or that which is administered by nurse practitioners and physicians’ assistants.

“Telehealth is particularly important for a lot of LGBTQ people because of access distance challenges and the need to seek care in places that often is not immediately local,” Ehrenfeld said.

“There’s this cascading effect of, unfortunately reducing access to care that’s very concerning to me and to the AMA,” he said.

When laws proscribe healthcare interventions that “we know to be appropriate,” Ehrenfeld said, “we use every avenue available” – from pressuring the National Governors Association to filing lawsuits and amicus briefs in coordination with other stakeholders as well as “work on the policy side at the federal level and with our state partners.”

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