Tag Archives: men who have sex with men

Come Out For Health: National LGBT Health Awareness Week

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The 10th Annual National LGBT Health Awareness Week is March 26–30, 2012

March 26–30, 2012 is National LGBT Health Awareness Week, highlighting the disparities in access to culturally competent care and positive health outcomes between lesbian, gay, bisexual, and transgender (LGBT) people and their heterosexual counterparts. The health of the LGBT community has long been at the heart of Fenway’s mission; and while we have seen great progress, we still have a long journey to true health equity.

LGBT people have unique health and wellness needs and continue to be impacted by health disparities. For instance:

Compared to other men, MSM are at increased risk of major depression during adolescence and adulthood, bipolar disorder; and generalized anxiety.

  • Lesbian women are more likely than straight or bisexual women to be overweight and obese, increasing their risk for cardiovascular disease.
  • In 2009, men who have sex with men (MSM) accounted for an estimated 2% of the U.S. population but accounted for 64% of new HIV infections.
  • In one survey, 41% of transgender respondents had attempted suicide.
  • LGBT young people represent an alarmingly high proportion of homeless youths across the U.S.—an estimated 20–40%.
  • Many LGBT people turn to substance abuse to cope with increased stress. An estimated 20–30% of gay and transgender people abuse substances, compared to about 9% of the general population.

However, there have been many recent advances in the field of LGBT health. A year ago, the Institute of Medicine (IOM) issued a historic report on LGBT health that highlights a number of issues, including:

  • LGBT youth have an elevated risk for attempted suicide and depression.
  • LGBT adults lack access to providers who are knowledgeable about LGBT health needs and fear of discrimination in health care settings.
  • LGBT elders are more likely to rely on friends and others as caregivers than biological family members, at least in part because they are less likely to have children.
  • Research has not been conducted evenly across sexual and gender minority populations, with more research focusing on gays and lesbians than on bisexual and transgender people.
  • Research has not adequately examined subpopulations, particularly racial and ethnic groups.

LGBT elders have higher rates of disability, depression, and loneliness compared to heterosexuals of similar ages.

The report also includes recommendations to better understand and address the unique health needs of LGBT Americans.

The U.S. Department  of Health and Human services details a number of accomplishments in the area of LGBT health, including better data collection on LGBT populations and a multi-year HRSA grant to The Fenway Institute to create a national LGBT health technical assistance and training center for community health centers.

Still, our work is far from over. This year’s National LGBT Health Awareness Week focuses on four core principles:

Consumer Empowerment
Lesbian, gay, bisexual, and transgender individuals need to be educated about their health and empowered to discuss sexual orientation and gender identity with their providers. If you don’t feel comfortable with your current provider, there are resources to help you find LGBT-affirming care, including the Gay & Lesbian Medical Association provider directory.

Culturally Competent Services
Health care providers need more information and resources to help them better serve the LGBT community. To that end, The Fenway Institute has  released policy briefs on Why and How to gather sexual orientation and gender identity data in a clinical setting. The Fenway Institute has also launched a website for the National LGBT Health Education Center, which will provide educational programming and consultation for health care organizations with the goal of eliminating health disparities among lesbian, gay, bisexual, and transgender people.

More than 20% of transgender survey respondents reported having to teach their doctor about transgender care.

We must also continue to work toward better access to these services for LGBT individuals and support policies that make this possible. Lesbian, gay, and bisexual Americans are roughly twice as likely to be uninsured as the general population—partly due to unequal legal recognition of their relationships and employment discrimination, including insufficient protection against being fired for sexual orientation or gender identity. If all employers offered domestic-partner benefits, the uninsured rates for same-sex and different-sex unmarried couples would decrease by as much as 43%.

Inclusive Policymaking
Congressional briefings are scheduled during LGBT Health Awareness but you can always advocate for more inclusive policies by contacting your local, state, and national representatives. 

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Policy Focus: PrEP Could Be A “Game Changer” in Fight Against HIV

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Analysis examines biomedical prevention technology to be reviewed by U.S. Food and Drug Administration by June 15, 2012

Pre-exposure chemoprophylaxis (PrEP)—taking antiretroviral medications to prevent HIV transmission—could be a “game changer” for HIV prevention. PrEP has demonstrated partial efficacy with men who have sex with men (MSM), transgender women, and heterosexuals in several recent studies. Recent modeling of PrEP implementation coupled with scaled up treatment predicts that PrEP could significantly reduce HIV incidence and prevalence. And if PrEP is accompanied by sustained care, behavioral interventions, and safety monitoring, PrEP need not lead to increased sexual risk behavior or drug resistance.

The latest Policy Focus from The Fenway Insitute summarizes the state of PrEP and microbicides research as of January 2012, looks at willingness to use PrEP among various populations, addresses concerns about PrEP that could present obstacles to implementation, offers strategies for effective implementation, and examines policy issues related to cost and how to make PrEP accessible to those most vulnerable to HIV.

The Fenway Institute’s analysis found that the most effective prevention interventions will be those that combine behavioral interventions, structural interventions, and emerging biomedical technologies, such as PrEP and microbicides. The analysis concludes with recommendations for implementation of PrEP, including:

  • If the U.S. Food and Drug Administration (FDA), which is considering approving FTC-TDF for use as PrEP, feels that research on PrEP’s efficacy among heterosexuals is inconclusive, it should consider approving PrEP for MSM now separately and consider heterosexuals, IDUs and other populations in the near future as the science advances;
  • The World Health Organization (WHO) should issue guidance on PrEP that takes into account the promising results of the iPrEx study, Partners PrEP, and the Botswana CDC study;
  • Following the release of the Bangkok injection drug user (IDU) trial results, if appropriate the U.S. Centers for Disease Control and Prevention, the U.S. Public Health Service, and the WHO should issue guidance for PrEP with IDUs.;
  • States should provide access to PrEP as a critical prevention service and prescription medication under the Essential Health Benefits provision of the Affordable Care Act;
  • State Medicaid programs should also cover PrEP as a cost-saving measure that will improve public health and ultimately save money in health care costs;
  • Provision of PrEP to MSM and transgender women should occur in a broader context of ensuring clinically competent health care to gay, lesbian, bisexual and transgender people.
You can read or download the full PDF document below or on The Fenway Institute’s website.

You can also read past Policy Focuses on asking about sexual orientation and gender identity in clinical settings. 

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HIV and MSM Abroad: The Fenway Institute’s Work in Malawi

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malawifigure5

In December of 2011, staff from The Fenway Institute collaborated with Johns Hopkins School of Public Health and the Centre for the Development for People to train Health Care Workers and Peer Educators in Malawi on working with MSM and preventing HIV in this vulnerable population. Fenway Health’s Medical Director of Behavioral Health, Kevin Kapila, shares his experience.

When I first learned about the possibility of conducting trainings for medical providers in Malawi, like many Americans I did not know much about this landlocked country in southeast Africa. I knew, like most gay men, that Madonna had adopted a child from Malawi, and was also aware of the gay couple that was sentenced to 14 years hard labor for having an engagement ceremony.

I did some research and found out that Malawi faces a lot of challenges—it is the second poorest country in the world, 11% of its population is infected with HIV, and over 50,000 people a year in Malawi die from HIV/AIDS. Malawi is also known as the “warm heart of Africa,” because of the kindness of its people, which from our experience there is most definitely true.

A view from the car on trip from Lilongwe to Blantyre

The Fenway Institute was invited to take part in trainings in Malawi that took place in early December of 2011. The trainings focused on educating health care workers and peer educators to meet the needs of men who have sex with men (MSM) and help prevent HIV in this vulnerable population. As one of Fenway Health’s medical providers, I was honored to be part of these trainings that will hopefully create positive change for Malawi’s MSM. The trainings were done in collaboration with Johns Hopkins School of Public Health and The Centre for the Development of People (this is a human rights organization focused on the needs of the LGBT community in Malawi.) The trip was funded by a grant from AmFAR. The team from Fenway included Rodney VanDerwarker, MPH (Administrative Director of The Fenway Institute); Marcy Gelman NP,MPH (Associate Director for Clinical Research); and Kevin Kapila, MD (Medical Director of Behavioral Health and primary care provider.)

Preparation for these trainings started months in advance, with multiple conference calls with Johns Hopkins and our colleagues in Malawi. We were able to put together a two-day training program for health care providers and a one-day training for peer educators. There were many challenges that had to be overcome, including the lack of resources and many negative perceptions about men who have sex with men.

The team meets in Lilongwe after two long days of travel

We left Boston and after almost two days of travel landed in Lilongwe, the capital of Malawi. We met Stefan Baral from Johns Hopkins and Gift Trapence from CEDEP and began the five-hour drive from Lilongwe to Blantyre. This was not an easy drive on this two-lane highway that was populated by cars, bikes, pedestrians and goats. The trip did allow us to appreciate the beauty of the country and connect with each other and discuss the upcoming trainings.

The first day of the trainings was attended by over 20 representatives from different health service providers in Malawi. Stefan Baral presented on human rights and epidemiology. Rodney VanDerwarker talked about the Fenway Health model of care. Marcy Gelman gave a presentation on how to take a sexual history from MSM, which was followed by role-playing exercises. Marcy had a difficult challenge, as this was is the first time many of the providers had been exposed to some of this information in a culture where gay and bisexual men are not accepted. We were prepared for the possibility this would not go over well, but Marcy’s extensive preparation in regards to the cultural issues, well thought out presentation, and stellar execution of the material went over very well. There was active participation from the audience and the first day ended well.

Marcy and Rodney preparing on Day One.

Marcy started the second day of training with continued education on identifying, screening, and treating the different sexually transmitted infection that commonly occur in MSM. I was the presenter for the second half of the morning and the afternoon sessions, and started with going over the use of condoms and lubricants, which are in short supply in Malawi. 

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