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Cruel court decision makes it harder to prevent AIDS

Disease gets a boost from federal judge in Texas

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Just as the disease was on a glide path to extinction thanks to new drugs, HIV/AIDS got a boost from a federal court in Texas.

On Sept. 7, U.S. District Judge Reed O’Connor ruled that the government can’t require an employer-sponsored health care plan to cover a therapy that prevents the spread of a disease that has already killed more than 700,000 Americans. The decision in Braidwood Management Inc. v. Becerra is not just poorly argued; it is flat-out cruel.

Perhaps the best feature of the Affordable Care Act (ACA) of 2010, nicknamed Obamacare, was a requirement that insurance offer coverage of specified preventive care procedures and therapies, such as colon cancer screening and influenza immunizations.

In June 2019, the U.S. Preventive Services Task Force, an advisory panel of experts, issued a “Grade A” recommendation for pre-exposure prophylaxis, or PrEP, a medicine that is 99% effective in preventing HIV transmission during sex. The first PrEP drug, Truvada, had been approved seven years earlier by the Food & Drug Administration. On Jan. 1, 2021, the federal government required plans to cover PrEP with no copay, coinsurance, or deductible.

Even before the mandate, the Centers for Disease Control and Prevention (CDC) credited PrEP with helping reduce new HIV infections in the U.S. by 8% between 2015 and 2019 “after a period of general stability.” The CDC now calls PrEP “a key prevention strategy for ending the HIV epidemic in the U.S.,” a goal for 2030 set by both the Trump and Biden administrations.

The way to end AIDS once and for all is to get PrEP to those who need it most. Researchers are developing intravaginal rings, implants, antibodies, and long-lasting injectables. Although PrEP use has risen by a factor of eight in just five years, three-quarters of those most at risk are not using the therapy.

The success of the lawsuit by a group of self-described Christian business owners and employees will make access even more difficult. The plaintiffs argued that the preventive care mandate for PrEP violated their constitutional right to religious freedom. In the complaint, Dr. Steven Hotze said that he was unwilling to pay for a health plan covering PrEP “because these drugs facilitate or encourage homosexual behavior, which is contrary to [his] sincere religious beliefs.”

Hotze, whose vitamin company ran afoul of the FDA for COVID-19 claims, was indicted in April on aggravated assault charges involving a bizarre search for ballots after the 2020 election.

In the PrEP case, Hotze’s objection went beyond gay sex. He complained that providing coverage of the drugs facilitates and encourages “sexual activity outside of marriage between one man and one woman” as well as illegal drug use.

Judge O’Connor agreed. He went even further, ruling that members of the Preventive Services Task Force were “unconstitutionally appointed.”

In a previous case, O’Connor had ruled that the entire ACA was unconstitutional, but the Supreme Court reversed that decision last year. The current ruling draws on the Religious Freedom Restoration Act (RFRA) of 1993, which was enacted by Congress after the Supreme Court ruled in Employment Division v. Smith that the protection of the free exercise of religion in the First Amendment does not entitle anyone to a religion-based exception from a general law.

In recent years, writes Michael Dorf of the Cornell University Law School, “conservative Christians have increasingly relied on [RFRA] to obtain exceptions from laws involving insurance coverage for contraception and abortion.”

For example, in Burwell v. Hobby Lobby, a 2014 case, the Supreme Court held that a company owned by religious Christians could be excused from an obligation to pay for health insurance that covered “forms of contraception that the owners regarded as tantamount to abortion.”

But the ruling in the Braidwood case is far more sweeping. The Hobby Lobby plaintiffs considered abortion itself immoral. In this case, it’s not PrEP that Braidwood considers immoral; it’s certain kinds of sexual activities. By substantially lowering the risk of contracting HIV/AIDS, this twisted logic goes, PrEP is a facilitator of what Hotze considers immoral. And by offering insurance that covers PrEP, Braidwood says it becomes complicit.

There is a serious cost to this attenuated argument. By decreasing access to PrEP, people will needlessly become ill and, in some cases, die. The economy will also be burdened with the cost of treating a disease that can be prevented.

Modern science has developed therapies that are ending the spread of a dangerous, mortal virus. Easing access to these medicines is clearly a legitimate function of government — undoubtedly, a compelling interest. What can be more selfish and foolish than to erect needless obstacles for those who want to protect themselves and people around them?

James K. Glassman, a former Under Secretary of State in the George W. Bush administration, is an adviser to health care companies and non-profits.

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Successful open relationships take effort

We have options as couples but they all require work

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Jake Stewart

(Editor’s note: This is the second of a two-part feature on open relationships. Click here for last week’s installment.)

Open relationships are often ridiculed as the easy way out of commitment. After speaking with Scott and Kelsey, however, it’s clear they’re anything but easy. 

Kelsey reflected on the ups and downs of being open in the past. “Younger me definitely needed it,” Kelsey said. “At the same time, drama came with it as well.”

While Scott and their partner have been together for nine years, it took four before they decided to open their relationship. “It came from the desire for the two of us to meet boys together,” said Scott. “Then we had some really terrible threesomes.” 

Drama. Bad threesomes. Yikes – these aren’t exactly selling points for being open. But their experiences underscore something important: open relationships, like all relationships, are actually quite hard. Couples considering openness shouldn’t trick themselves into thinking it will make things easier. In reality, they take a lot of work. 

For Scott, those really terrible threesomes led them to opening up further, but with established boundaries. “We came up with ground rules. Use protection. No spending the night at somebody’s house, etc.”  

Since Scott and their partner are happy in their relationship, these rules seem to work even if they’ve shifted over time. “Being in an open relationship comes down to being really good at communicating with your partner,” they added. “It’s about communicating and checking in to see where your partner is.”

Open relationships should be for the right reasons 

As open relationships began taking off, observers were skeptical for good reason. “In the past, people were just cheating,” said Kelsey. Another comment from Scott echoed this. “I’ve seen open relationships and it felt like one partner was being taken advantage of by the other.” 

It turns out there is a fine line between sexual exploration and free passes. While some open relationships walk that line well, others – not so much.  

In all fairness, now more than ever it’s difficult to remain monogamous, and one culprit is the rise of accessible hookup culture via social media. Apps like Tinder, Grindr, and dare I say Instagram are facilitating secret sexual connections never seen before. They ushered in a new era of cheating into relationships, alongside a bit of excessive stalking as well. 

So, to avoid an atmosphere of mistrust and pain, a natural evolution for couples is to change the rules altogether. Cheating can’t be cheating if it’s allowed, right?

However, once it is allowed, I wondered why these people don’t cut the strings altogether and be single. In response, Chad made an interesting point: people aren’t just afraid of being cheated on – they’re afraid of the appearance of being single as well. We live in flashy times where our online image means everything. The dream is not necessarily having a partner, but showing the world you have a partner. Without that, you otherwise appear lonely. 

So, do open relationships ease the pain of cheating and perceived loneliness? As a proud lone wolf I’m not the best person to assess, but based on my observations I can say this: being open works for some couples, but by no means is it a fast pass to being happy. Understanding why you want one is just as important as discovering how to make one work. 

With all this said, the undeniable risk – and perhaps downside – of a monogamous coupling is the higher chance of cheating outright. Unfortunately, that’s something Chad knows all too well. 

Preferring monogamy is still OK

Chad had dated someone for two years before they married for five. Then, just over a year into the pandemic, his husband informed him he was dating someone else. They separated a few days later. 

For Chad this was painful, as it is for anyone, gay or straight, who’s gone through something similar. But when I asked him if this experience shaped his outlook on what he’s looking for, his response came as a bit of a surprise: 

“It has not changed my view for or against open relationships,” he said. “I learned a lot in my marriage. It takes a lot of love, trust, and communication, which at times can feel like work. It also takes two; one can’t carry the relationship. I want to date someone who wants to be in a relationship with me.” 

My heart swells hearing that, for even after experiencing the deepest kind of hurt, Chad searches for his one and only. Why? Because for him, the love he’s looking for is worth the wait. It’s a beautiful sentiment that makes so-called hopeless romanticism the raddest feeling in the world sometimes. 

More importantly, Chad doesn’t let fear alter his view on love, and to me that’s the most important lesson of this article. Love always comes with risks, and lowering your standards to reduce them never really pans out, does it? The best we can do is to be ourselves. 

By the way, this is a lesson I should also apply. My main hesitation toward an open relationship is that I’m a jealous bitch, and I fear that jealousy will never go away. Yet this can be hard to admit when everyone around you is propping up a culture where open is supreme and jealousy is immature. 

When I brought this up to Kelsey, she pushed back with a simple question: “Do you think jealousy is a bad thing?” 

This caught me off guard. “I’m not sure,” I replied. “Do you?” 

“Jealousy is a natural, human emotion,” she said. “It’s what you do with it that matters.” 

So, maybe my goal is not to suppress my jealousy but rather be upfront about it. If it’s part of me, I should own it, then ideally find someone who loves me regardless.  

Changing your mind is OK, too

In gay man speak, I was a top for my first seven years before I embraced bottoming. For some, they’d be shocked to hear it. Yet maybe no one should be surprised, for as we all know sexuality is fluid, and this applies to more than just your orientation. Your sexual preferences can shift over time, too, and this will inevitably affect your relationships. 

This was the case for Scott and their partner. “When we first started dating, we did not want to be open,” they mentioned, “but as our relationship grew, we decided to reevaluate that.” Meanwhile, Kelsey went the opposite direction – she was open back in the day but chooses to be closed now. 

Even Chad remains open to being open. “I’m not opposed to an open relationship, but I feel like it would take more work. I just don’t see myself starting a relationship open. The first few years there is a lot of learning about each other.” 

In a world of shifting preferences, the best we can do is reflect on what we want and be honest about it. Life is a process of discovering who we are, and damn is it messy. So, perhaps I should cut some slack to the couple trying things out. And perhaps they can cut me slack for not understanding their rules. 

For the couples: remember, a solid relationship is not only about meeting the needs of your partner, because your needs matter, too. The best relationships, open or closed, strive to find that balance. 

For those still searching: remember that love is more than just that thing, that connection, that spark. In fact, love is so complex that the “spark” is just one of many factors, alongside timing and how you want to be loved, that come together and form an imprint as unique and special as the person you want to be with.

In this sense, open and closed relationships aren’t diametrically opposed but rather complimentary, a sort of yin and yang where both become better because the other option exists. Today, we have options as couples, and that’s significantly better than abiding by rules because we assume that’s how it must be.

And that feels right. Because regardless of whether you’re more a Chad or a Scott, the truth is: I feel lucky to have both.  

(Writer’s note: A big thank you you to Chad, Scott, and Kelsey for allowing me to share their stories.)

Jake Stewart is a D.C.-based writer and barback.

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Fact: The next president will be Biden or Trump

One candidate is clearly better for the future of the world

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(Washington Blade file photos by Michael Key)

Like it or not, the next president will be either Joe Biden or Donald Trump. In our system, third-party candidates are simply spoilers, they don’t win. The last time a third-party candidate won was 1856. It has been 36 years since a third-party candidate even got more than 5% of the vote. So, it’s time to face reality and choose; for your future, do you want Biden or Trump? 

I was prompted to write this column because I see the media interviewing young people about who they want as their president. I have great respect for the young people of today. In many ways, they are smarter than my generation was. But it’s clear, some don’t fully understand the presidential election process. I hear many complain about Biden, and then follow that up and say they will never vote for Trump. Some then say they will vote for a third-party candidate. They need to understand their third-party candidate will not win, but their vote could help elect Trump. I hate to say it, but in 2024, voting for a third-party candidate is the equivalent to flushing your ballot down the toilet. 

I am an unabashed Biden supporter. I see the great things he has done, including: getting us through the fallout from the pandemic, passing an infrastructure bill, forgiving billions in student loans, ensuring our economy is the best in the world with more than 13 million jobs created, and increasing wages. He supports unions, being the first president to walk a picket line with the UAW. His administration is working to deal with climate change. He is fighting for a woman’s right to control her own body and healthcare, and supports full equality for the LGBTQ community. In this dangerous world he has kept our troops out of war.

Then there is Trump. To be clear; I see him as a racist, sexist, misogynistic, homophobic, pig. OK, so maybe I don’t have strong feelings about him. Trump has been found liable for sexual assault and has been indicted on 91 counts. He proudly claims credit for having taken away control of their body and healthcare from women, when the justices he appointed ended Roe v. Wade. He supports states making decisions on abortion, and we see what recently happened in Arizona. He is a climate change denier and is opposed to wind and solar power. He wants to give more tax deductions to the rich and to corporations, while opposing any increase in the minimum wage. He opposes equality for the LGBTQ community, refusing to endorse the Equality Act. He opposes student debt relief.

You may see these candidates differently, and that is OK. But if you like one more than the other, fear one more than the other, or just aren’t enamored by either, you must still make a choice and vote for one of them. Staying home is abrogating your civic responsibility, and especially if you would never vote for Trump, understand your staying home helps him. 

Young voters, like all voters, should take the time to do the research on both candidates. Then match what you find as close as possible to what you want to see as your future. If you want student loan relief, equality for the LGBTQ community, women having control of their body and healthcare, equal pay for women, efforts to ameliorate the impact of climate change, then clearly Trump is not your candidate. 

I hear some young people say they won’t vote for Biden because of his positions on the Israel/Hamas war. I, too, have called for Israel to recalibrate how they fight this war. But I ask you to look again at Trump’s history of attachment to Netanyahu, even going so far as relocating the U.S. embassy to Jerusalem. If you want a chance for the Palestinian people to live in peace and prosperity, for Israel to remove their settlements from the West Bank, your chance of having that happen is clearly better with Biden than Trump. Don’t let your emotions today, cloud the reality of the future.

Yes, Biden is old, but so is Trump. He apparently can’t even stay awake at his own trial having nodded off two days in a row.  So, since one of them will be president, with no third-party candidate having a chance, I urge you to look at them again, in a realistic way. Then make your choice. I think you may come to the same conclusion I have. Though not perfect, and no one is, Biden is the better candidate for your future, and for the future of the world. 

Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist. He writes regularly for the Blade.

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Don’t avoid drug education on 4/20 day

Cannabis culture continues to grow in the District

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In 2023, the law was signed to expand the District’s medical cannabis program. It also made permanent provisions allowing residents ages 21 and older to self-certify as medical cannabis patients. Overall, cannabis is fully legal in D.C. for medical and recreational use, and 4/20 Day is widely celebrated. 

Medical cannabis, for example, has a long history with the LGBTQ community, and they have often been one of the oldest supporters of marijuana and some of the most enthusiastic consumers. Cannabis use also has a long history of easing the pain of the LGBTQ community as relief from HIV symptoms and as a method of coping with rejection from society. 

The cannabis culture continues to grow in the District, and as a result, so does the influence on younger people, even youth within the LGBTQ community. Drug education can play an important role and should not be avoided during 4/20 Day. Parents and educators can use drug education to help their kids understand the risks involved with using marijuana at a young age. 

According to DC Health Matters, marijuana use among high school students has been on the decline in the District since 2017. In 2021, it was estimated that around 20% of high school students use marijuana, a drop from 33% in 2017. Nationally, in 2020, approximately 41.3% of sexual minority adults 18 and older reported past-year marijuana use, compared to 18.7% of the overall adult population.

When parents and educators engage with their kids about marijuana, consider keeping the conversations age appropriate. Speaking with a five-year-old is much different than speaking with a teenager. Use language and examples a child or teen would understand. 

The goal is to educate them about the risks and dangers of using cannabis at a young age and what to avoid, such as edibles. 

Most important, put yourself in your kid’s shoes. This can be especially important for teenagers as they face different social pressures and situations at school, with peer groups, or through social media. Make a point of understanding what they are up against. 

When speaking to them about cannabis, stay calm and relaxed, stay positive, don’t lecture, and be clear and concise about boundaries without using scare tactics or threats. 

Yet, it’s OK to set rules, guidelines, and expectations; create rules together as a family or class. Parents and educators can be clear about the consequences without lecturing but clearly stating what is expected regarding cannabis use. 

Moreover, choose informal times to have conversations about cannabis and do not make a big thing about it. Yet, continue talking to them as they age, and let them know you are always there for them.     

Finally, speak to them about peer pressure and talk with them about having an exit plan when they are offered marijuana. Peer pressure is powerful among youth, and having a plan to avoid drug use helps children and students make better choices. Ultimately, it is about assisting them in making good choices as they age. 

Members of the LGBTQ community often enter treatment with more severe substance use disorders. Preventative measures involving drug education are effective in helping youth make good choices and learn about the risks.

Marcel Gemme is the founder of SUPE and has been helping people struggling with substance use for over 20 years. His work focuses on a threefold approach: education, prevention, and rehabilitation.

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