Health
D.C. Dept. of Health reaches out to ‘all communities’
New gay interim director has worked on AIDS, substance abuse issues
‘My vision is that every one of us at some time is out in the community doing service work that really shows we are out there for the community,’ said Dr. Saul Levin. (Blade photo by Michael Key)
Dr. Saul Levin, the newly appointed interim director of the D.C. Department of Health, says his mission during his expected one-year tenure as head of the department is to educate the city’s diverse communities, including the LGBT community, about the wide range of services DOH offers to keep people healthy.
“One of the things I would like to put on the table is each and every one of us working here essentially comes from the community,” he told the Blade in an interview in his office. “My vision is that every one of us at some time is out in the community doing service work that really shows we are out there for the community.”
D.C. Mayor Vincent Gray on July 17 announced he had appointed Levin, a psychiatrist and senior deputy director of the DOH, as interim director, making him the first known out gay person to serve as head of a city department of that size.
A DOH spokesperson said the department has about 800 employees and a budget of about $268 million.
Gray said Levin would fill in for DOH Director Dr. Mohammad Akhter, who the mayor said is taking an unpaid leave of absence to become head of the executive board of the city’s newly created Health Benefit Exchange Authority, which is part of the Obama administration’s health insurance reform program.
In his role as senior deputy director of the DOH, Levin was in charge of the department’s Addiction Prevention and Recovery Administration, which operates the city’s programs to combat drug and alcohol abuse. He is expected to return to that post if Akhter resumes his role as DOH director.
A native of South Africa, Levin received his medical degree at a leading medical school in Johannesburg before completing his residency in psychiatry at the University of California’s Davis Medical Center.
Levin then joined the staff of the U.S. Department of Health and Human Services and later became coordinator of a special program within the department’s Substance Abuse and Mental Health Services Administration. The program integrated primary care, substance abuse, mental health and HIV/AIDS as part of an effort to improve treatment and care for people with both medical and substance abuse problems.
From there Levin returned to school, receiving a master’s degree in public administration from Harvard University’s Kennedy School of Government in 1994. Upon completion of his studies he started a health care consulting company for which he served as president for the next 10 years.
He said around 2004 he accepted an offer to become president and CEO of Medical Education for South African Blacks, a U.S.-based anti-apartheid educational trust that had provided scholarships to South African blacks prior to the end of country’s apartheid government in 1994.
Levin said leaders of the organization continued its work in the years following the apartheid system to ensure that black candidates would have the opportunity to enter jobs in the medical profession before improved educational institutions had been established in the country.
“It educated one-third of all black doctors up until six years ago,” he said. “It gave out 11,000 grants. It was truly about how someone can make a difference.”
Prior to coming to the D.C. DOH, earlier this year Levin served as vice president of the American Medical Association for Science, Medicine, and Public Health.
Levin said his involvement in AIDS-related work and the gay community began in the early 1980s during his medical school years in South Africa, when he helped to open the country’s first hospice for people dying of what was then known as “wasting disease.”
“You would just have these people who would waste away,” he said. “Their immune system would just go to pieces. So I got very involved in that way.”
Noting that he came out as gay in South Africa, Levin added, “In some ways today when you look at South Africa they have a huge problem both in the African community as well as in the white gay community” concerning AIDS. “Had they begun to see the early warning signs they could have really maybe have begun to do something a little differently to address the problem.”
Levin said the DOH’s HIV/AIDS, Hepatitis, Sexually Transmitted Disease and Tuberculosis Administration (HAHSTA) is redoubling its HIV prevention efforts directed toward black men in D.C., both gay and straight, who have the highest infection rate among all the groups at risk for HIV.
He noted that HAHSTA is headed by Dr. Greg Pappas, a gay physician with extensive experience in AIDS-related medicine and public health.
“I would say this,” Levin said in discussing the city’s programs to combat AIDS for all at-risk groups, including the gay men. “We would go anywhere and everywhere to try to get education and services to those who need it. Treatment is prevention. Prevention is treatment.”
His background in substance abuse issues and mental health has made him especially aware of substance abuse issues affecting the LGBT community, Levin said.
“I used to have a research project when I had my company, and NIH wanted me to try to get to the guys in the gym, the gay gyms,” he said. “They were exercise fanatics and the next thing I would see was photos of them out at all these parties where crystal meth and ecstasy – you name it – was used.
“And I would try to say why is it that you have so divorced yourself from your healthy bodies? You spend a lot of your life in the gym and yet you are still doing this to yourself,” he said. “Addiction is just like diabetes, hypertension or HIV. It’s a chronic relapsing treatable disease.”
Levin added that DOH offers a “full choice” treatment program for people with substance abuse problems that he highly recommends.
“Any LGBT person can come to our assistance center at 51 N St.,” he said. “It’s at the corner of First Street and N streets in Northeast. You go in there – anyone can walk in. You will be evaluated. And we will then say this is the level of care you will need,” Levin said.
“If you don’t have insurance, we will pay for it. And you will choose the program you go to.”
When told of how the recent suicide of a popular D.C. gay bartender shocked friends and co-workers, who perceived the bartender as happy and upbeat, Levin said suicide is a “difficult” issue to address.
“Someone who is clearly getting to the point of that kind of depression needs help,” he said. “Your friends can help you. Your friends and your support system and your co-workers – when you see someone becoming more depressed, not being as energetic, withdrawing from the usual things they love to do – you’ve got to address the issue,” he said.
“You know your family,” he said. “You know your partners…People do give signs when they’re thinking of suicide. You should address it.”
Monkeypox
US contributes more than $90 million to fight mpox outbreak in Africa
WHO and Africa CDC has declared a public health emergency
The U.S. has contributed more than $90 million to the fight against the mpox outbreak in Africa.
The U.S. Agency for International Development on Tuesday in a press release announced “up to an additional” $35 million “in emergency health assistance to bolster response efforts for the clade I mpox outbreak in Central and Eastern Africa, pending congressional notification.” The press release notes the Biden-Harris administration previously pledged more than $55 million to fight the outbreak in Congo and other African countries.
“The additional assistance announced today will enable USAID to continue working closely with affected countries, as well as regional and global health partners, to expand support and reduce the impact of this outbreak as it continues to evolve,” it reads. “USAID support includes assistance with surveillance, diagnostics, risk communication and community engagement, infection prevention and control, case management, and vaccination planning and coordination.”
The World Health Organization and the Africa Centers for Disease Control and Prevention last week declared the outbreak a public health emergency.
The Washington Blade last week reported there are more than 17,000 suspected mpox cases across in Congo, Uganda, Kenya, Rwanda, and other African countries. The outbreak has claimed more than 500 lives, mostly in Congo.
Health
Mpox outbreak in Africa declared global health emergency
ONE: 10 million vaccine doses needed on the continent
Medical facilities that provide treatment to gay and bisexual men in some East African countries are already collaborating with them to prevent the spread of a new wave of mpox cases after the World Health Organization on Wednesday declared a global health emergency.
The collaboration, both in Uganda and Kenya, comes amid WHO’s latest report released on Aug. 12, which reveals that nine out of every 10 reported mpox cases are men with sex as the most common cause of infection.
The global mpox outbreak report — based on data that national authorities collected between January 2022 and June of this year — notes 87,189 of the 90,410 reported cases were men. Ninety-six percent of whom were infected through sex.
Sexual contact as the leading mode of transmission accounted for 19,102 of 22,802 cases, followed by non-sexual person-to-person contact. Genital rash was the most common symptom, followed by fever and systemic rash.
The WHO report states the pattern of mpox virus transmission has persisted over the last six months, with 97 percent of new cases reporting sexual contact through oral, vaginal, or anal sex with infected people.
“Sexual transmission has been recorded in the Democratic Republic of Congo among sex workers and men who have sex with men,” the report reads. “Among cases exposed through sexual contact in the Democratic Republic of the Congo, some individuals present only with genital lesions, rather than the more typical extensive rash associated with the virus.”
The growing mpox cases, which are now more than 2,800 reported cases in at least 13 African countries that include Kenya, Uganda, Rwanda, and prompted the Africa Centers for Disease Control and Prevention this week to declare the disease a public health emergency for resource mobilization on the continent to tackle it.
“Africa has long been on the frontlines in the fight against infectious diseases, often with limited resources,” said Africa CDC Director General Jean Kaseya. “The battle against Mpox demands a global response. We need your support, expertise, and solidarity. The world cannot afford to turn a blind eye to this crisis.”
The disease has so far claimed more than 500 lives, mostly in Congo, even as the Africa CDC notes suspected mpox cases across the continent have surged past 17,000, compared to 7,146 cases in 2022 and 14,957 cases last year.
“This is just the tip of the iceberg when we consider the many weaknesses in surveillance, laboratory testing, and contact tracing,” Kaseya said.
WHO, led by Director General Tedros Adhanom Ghebreyesus, also followed the Africa CDC’s move by declaring the mpox outbreak a public health emergency of international concern.
The latest WHO report reveals that men, including those who identify as gay and bisexual, constitute most mpox cases in Kenya and Uganda. The two countries have recorded their first cases, and has put queer rights organizations and health care centers that treat the LGBTQ community on high alert.
The Uganda Minority Shelters Consortium, for example, confirmed to the Washington Blade that the collaboration with health service providers to prevent the spread of mpox among gay and bisexual men is “nascent and uneven.”
“While some community-led health service providers such as Ark Wellness Clinic, Children of the Sun Clinic, Ice Breakers Uganda Clinic, and Happy Family Youth Clinic, have demonstrated commendable efforts, widespread collaboration on mpox prevention remains a significant gap,” UMSC Coordinator John Grace stated. “This is particularly evident when compared to the response to the previous Red Eyes outbreak within the LGBT community.”
Grace noted that as of Wednesday, there were no known queer-friendly health service providers to offer mpox vaccinations to men who have sex with men. He called for health care centers to provide inclusive services and a more coordinated approach.
Although Grace pointed out the fear of discrimination — and particularly Uganda’s Anti-Homosexuality Act — remains a big barrier to mpox prevention through testing, vaccination, and treatment among queer people, he confirmed no mpox cases have been reported among the LGBTQ community.
Uganda so far has reported two mpox cases — refugees who had travelled from Congo.
“We are for the most part encouraging safer sex practices even after potential future vaccinations are conducted as it can also be spread through bodily fluids like saliva and sweat,” Grace said.
Grace also noted that raising awareness about mpox among the queer community and seeking treatment when infected remains a challenge due to the historical and ongoing homophobic stigma and that more comprehensive and reliable advocacy is needed. He said Grindr and other digital platforms have been crucial in raising awareness.
The declarations of mpox as a global health emergency have already attracted demand for global leaders to support African countries to swiftly obtain the necessary vaccines and diagnostics.
“History shows we must act quickly and decisively when a public health emergency strikes. The current Mpox outbreak in Africa is one such emergency,” said ONE Global Health Senior Policy Director Jenny Ottenhoff.
ONE is a global, nonpartisan organization that advocates for the investments needed to create economic opportunities and healthier lives in Africa.
Ottenhoff warned failure to support the African countries with medical supplies needed to tackle mpox would leave the continent defenseless against the virus.
To ensure that African countries are adequately supported, ONE wants governments and pharmaceutical companies to urgently increase the provision of mpox vaccines so that the most affected African countries have affordable access to them. It also notes 10 million vaccine doses are currently needed to control the mpox outbreak in Africa, yet the continent has only 200,000 doses.
The Blade has reached out to Ishtar MSM, a community-based healthcare center in Nairobi, Kenya, that offers to service to gay and bisexual men, about their response to the mpox outbreak.
Health
White House urged to expand PrEP coverage for injectable form
HIV/AIDS service organizations made call on Wednesday
A coalition of 63 organizations dedicated to ending HIV called on the Biden-Harris administration on Wednesday to require insurers to cover long-acting pre-exposure prophylaxis (PrEP) without cost-sharing.
In a letter to Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services, the groups emphasized the need for broad and equitable access to PrEP free of insurance barriers.
Long-acting PrEP is an injectable form of PrEP that’s effective over a long period of time. The FDA approved Apretude (cabotegravir extended-release injectable suspension) as the first and only long-acting injectable PrEP in late 2021. It’s intended for adults and adolescents weighing at least 77 lbs. who are at risk for HIV through sex.
The U.S. Preventive Services Task Force updated its recommendation for PrEP on Aug. 22, 2023, to include new medications such as the first long-acting PrEP drug. The coalition wants CMS to issue guidance requiring insurers to cover all forms of PrEP, including current and future FDA-approved drugs.
“Long-acting PrEP can be the answer to low PrEP uptake, particularly in communities not using PrEP today,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “The Biden administration has an opportunity to ensure that people with private insurance can access PrEP now and into the future, free of any cost-sharing, with properly worded guidance to insurers.”
Currently, only 36 percent of those who could benefit from PrEP are using it. Significant disparities exist among racial and ethnic groups. Black people constitute 39 percent of new HIV diagnoses but only 14 percent of PrEP users, while Latinos represent 31 percent of new diagnoses but only 18 percent of PrEP users. In contrast, white people represent 24 percent of HIV diagnoses but 64 percent of PrEP users.
The groups also want CMS to prohibit insurers from employing prior authorization for PrEP, citing it as a significant barrier to access. Several states, including New York and California, already prohibit prior authorization for PrEP.
Modeling conducted for HIV+Hep, based on clinical trials of a once every 2-month injection, suggests that 87 percent more HIV cases would be averted compared to daily oral PrEP, with $4.25 billion in averted healthcare costs over 10 years.
Despite guidance issued to insurers in July 2021, PrEP users continue to report being charged cost-sharing for both the drug and ancillary services. A recent review of claims data found that 36 percent of PrEP users were charged for their drugs, and even 31 percent of those using generic PrEP faced cost-sharing.
The coalition’s letter follows a more detailed communication sent by HIV+Hepatitis Policy Institute to the Biden administration on July 2.
Signatories to the community letter include Advocates for Youth, AIDS United, Equality California, Fenway Health, Human Rights Campaign, and the National Coalition of STD Directors, among others.
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