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AMA strengthens gender affirming care policies

Organization’s openly gay president sworn in on Tuesday

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American Medical Association President Dr. Jesse Ehrenfeld (center left) (Photo courtesy AMA)

The American Medical Association on Monday voted to strengthen its policies governing access to gender affirming care for transgender and gender diverse individuals.

The group committed to opposing the criminalization of patients for seeking gender affirming care, and of families and healthcare providers for facilitating access to or administering that care.

Additionally, the AMA pledged to work with federal and state legislators and regulators to oppose policies criminalizing these guideline-directed healthcare interventions and to educate the Federation of State Medical Boards on their importance.

The resolution was introduced by the Endocrine Society, which issued a press release Monday celebrating the move: “As political attacks on gender-affirming care escalate, it is the responsibility of the medical community to speak out in support of evidence-based care.”

“Medical decisions should be made by patients, their relatives and health care providers, not politicians,” the Endocrine Society wrote.

The resolution was cosponsored by the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Urological Association, the American Society for Reproductive Medicine, the American College of Physicians, the American Association of Clinical Endocrinology, GLMA: Health Professionals Advancing LGBTQ+ Equality and the AMAā€™s Medical Student Section.

The Endocrine Society explained the legislative bans on gender affirming care ā€” passed in states in which 30 percent of the nationā€™s trans and gender-diverse youth now live ā€” are misguided.

“Pediatric gender-affirming care is designed to take a conservative approach,” the group wrote.

“When young children experience feelings that their gender identity does not match the sex recorded at birth, the first course of action is to support the child in exploring their gender identity and to provide mental health support, as needed.”

“Medical intervention is reserved for older adolescents and adults, with treatment plans tailored to the individual and designed to maximize the time teenagers and their families have to make decisions about their transitions.

“Major medical organizations also agree on waiting until an individual has turned 18 or reached the age of majority in their country to undergo gender-affirming genital surgery.”

Additionally, the Endocrine Society noted research that shows gender affirming care can be lifesaving.

“A 2020 study analyzed survey data from 89 transgender adults who had access to puberty-delaying medication while adolescents and data from more than 3,400 transgender adults who did not. The study found that those who received puberty-delaying hormone treatment had lower likelihood of lifetime suicidal ideation than those who wanted puberty-delaying treatment but did not receive it, even after adjusting for demographic variables and level of family support.”

“Approximately nine in 10 transgender adults who wanted puberty-delaying treatment, but did not receive it, reported lifetime suicidal ideation.”

AMA inaugurates first gay president

Jesse Ehrenfeld, the AMA’s first openly gay president, was inaugurated during the 2023 Annual Meeting of House of Delegates on Tuesday.

An anesthesiologist who formerly served as the Joseph A. Johnson Jr. Distinguished Leadership Professor of anesthesiology, surgery, biomedical informatics and health policy at Vanderbilt Universityā€™s School of Medicine; Ehrenfeld spoke to the Washington Blade for an exclusive interview last month.

During his inaugural speech on Tuesday, Ehrenfeld relayed a personal story about how his now 4-year-old son, born early and severely underweight, needed a blood transfusion. “At this moment,” he said, “watching my son cling to life, I was struck by the painful reality that, even though I was a physician and now, a father ā€¦ neither I, nor my husband, could donate blood ā€” simply because we are gay.”

“Just recently, the FDA, thanks in large part to a decade of advocacy by our AMA and others, rescinded some of these discriminatory practices, making it possible for my husband and I to give someone elseā€™s child a much-needed blood transfusion,” Ehrenfeld said. “This kind of advocacy is why I am so proud to lead our AMA at this moment.”

“Today there is an unconscionable effort to interfere in medicine,” Ehrenfeld said. “An assault on patient and physician autonomy. Legislative over-reach. Attacks on maternal health ā€¦ on LGBTQ patients.”

“We have a duty to push back against legislative interference in the practice of medicine that is leading to the criminalization of care.”

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MISTR announces itā€™s now prescribing DoxyPE

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MISTR, the telemedicine provider that offers free online PrEP and long-term HIV care in all 50 states, D.C., and Puerto Rico, announced it is now prescribing Doxycycline Post-Exposure Prophylaxis (DoxyPEP), an antibiotic that reduces bacterial STIs, including gonorrhea, chlamydia, and syphilis. Patients can now use MISTRā€™s telehealth platform to receive DoxyPEP online for free, according to a release from the company.

With this launch, MISTR plans to offer patients access to post-exposure care, in addition to its existing preventive and long-term HIV treatment options, which include PrEP and antiretroviral therapy (ART). This comes at a time when the rate of STIs continue to rise. In 2022, more than 2.5 million cases of syphilis, gonorrhea, and chlamydia were reported in the U.S; of that population, gay and bisexual men are disproportionately affected, the company reported.

ā€œDespite an ongoing STI epidemic affecting the LGBTQ+ community, there are few resources available for this underserved, vulnerable community to get the preventative medication they need,ā€ said Tristan Schukraft, CEO and founder of MISTR. ā€œIā€™m proud that MISTR is democratizing access to PrEP, HIV care, and now DoxyPEP.ā€

An NIH-funded study published by the New England Journal of Medicine in April 2023 found that doxycycline as post-exposure prophylaxis, now known as DoxyPEP, reduced syphilis by 87%, chlamydia by 88%, and gonorrhea by 55% in individuals taking HIV PrEP, and reduced syphilis by 77%, chlamydia by 74% and gonorrhea by 57% in people living with HIV. 

MISTR is a telemedicine platform offering free online access to pre-exposure prophylaxis (PrEP) and long-term HIV care Visit mistr.com for more information.

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UNAIDS to commemorate Zero Discrimination Dayā€™s 10th anniversary

UN agency urges global action to protect human rights

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A UNAIDS anti-discrimination exhibit at Tocumen International Airport in Panama in 2018. (Washington Blade photo by Michael K. Lavers)

As the world marks the 10th anniversary of Zero Discrimination Day; UNAIDS is sounding the alarm on the increasing threats to human rights, calling for renewed efforts to protect the rights of all individuals as a fundamental step towards ensuring health for everyone.

Established by UNAIDS a decade ago, Zero Discrimination Day aims to promote equality and fairness regardless of gender, age, sexuality, ethnicity or HIV status. The progress achieved over the past years is now in jeopardy, however, due to rising attacks on the rights of women, LGBTQ people and other marginalized communities.

UNAIDS Executive Director Winnie Byanyima emphasized the critical link between protecting human rights and safeguarding public health. 

“The attacks on rights are a threat to freedom and democracy and are harmful to health,ā€ she said in a press release. ā€œStigma and discrimination obstruct HIV prevention, testing, treatment and care and hold back progress towards ending AIDS by 2030. It is only by protecting everyoneā€™s rights that we can protect everyoneā€™s health.”

Despite challenges, there has been notable progress. 

At the onset of the AIDS pandemic more than 40 years ago, two-thirds of countries criminalized consensual same-sex sexual relations. They are now decriminalized in two-thirds of countries. An additional 38 countries around the world have pledged to end HIV-related stigma and discrimination, contributing to positive changes that include 50 million more girls attending school compared to 2015.

To sustain and enhance these advancements; UNAIDS urges global support for womenā€™s rights movements, LGBTQ rights, racial justice, economic justice, climate justice and peace initiatives. By standing with communities advocating for their rights, the U.N. aims to reinforce the collective effort towards a more inclusive and equitable world.

Zero Discrimination Day is observed on March 1.

Events and activities that will take place around the world throughout the month will serve as reminders of the essential lesson and call to action: Protecting everyoneā€™s health is synonymous with protecting everyoneā€™s rights.

“Through upholding rights for all, we will be able to achieve the Sustainable Development Goals and secure a safer, fairer, kinder and happier world ā€” for everyone,” said Byanyima.

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New CDC report finds transgender women at higher risk for HIV

More than 1,600 people in seven cities surveyed

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The Centers for Disease Control and Prevention in Atlanta (Photo courtesy of the CDC)

The Centers for Disease Control and Prevention issued a new study report this week that revealed that restricted by employment and housing discrimination and lack of access to needed gender-affirming healthcare for transgender women increasing the risk of contracting HIV. 

Researchers reviewed data from a 2019-2020 survey, theĀ National HIV Behavioral Surveillance Among Transgender Women, which found that the demographics of HIV/AIDS have been disproportionally high, especially among Black and Latina trans women, who had experienced employment and housing discrimination coupled with lack of access to gender-affirming healthcare.

The Jan. 25Ā Morbidity and Mortality Weekly Report was based on data studies of more than 1,600 trans women in seven major urban locales. Participants from Atlanta, Los Angeles, New Orleans, New York, Philadelphia, San Francisco and Seattle were chosen by referrals from people and community-based organizations who knew or were part of the local population of trans women.

The studyā€™s researchers noted: ā€œEmployment discrimination occurs at the overlapping nexus of poverty, homelessness, incarceration, health insurance, disability, food insecurity and survival sex work. These issues are interconnected.ā€

The study stated that trans womenā€™s inability to access quality healthcare, including gender-affirming treatment or access to PrEP, and can expose them to potential incarceration as many turn to ā€œsurvival sex workā€ and violence, which increases the risk of contracting HIV. 

The studyā€™s authorā€™s pointed out: ā€œWhen economically marginalized transgender women are refused employment, this refusal cyclically contributes to economic hardships. This analysis ā€¦demonstrates the importance of transgender women working and living with dignity and without fear of unfair treatment.ā€

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