The Effects Of HIV On The Body

Once the human immunodeficiency virus (HIV) enters your body, it launches a direct attack on your immune system. It gradually weakens your natural defenses against disease and infection and can affect every part of your body. Find out how here.

world-aids-day-300x300The human immunodeficiency virus (HIV) seeks and destroys CD4+ cells, a type of T lymphocyte (T cell). T cells are critical to the immune system. They’re responsible for warding off diseases and most infections, including viral infections.
HIV targets the type of cells that would normally fight off an invader like HIV. As the virus replicates, it damages or destroys the infected CD4+ cell and produces more virus to infect more CD4+ cells. Without treatment, this cycle continues in most infected people until the immune system is badly compromised, leaving them open to many serious infections and illnesses. Many of the illnesses that people compromised immune systems get are rare in people with functioning immune systems.
How quickly the virus progresses varies from person to person. Factors like your age, overall health, and how quickly you’re diagnosed and treated can make a difference.
Acquired immunodeficiency syndrome (AIDS) is the final stage of HIV. At this stage, the immune system is severely weakened, and the risk of contracting opportunistic infections is much greater. Not everyone with HIV will go on to develop AIDS.
Importantly, many of the effects described here are related to the failure of the immune system in progressing HIV and AIDS. Many of these effects are preventable with early antiretroviral treatment, which can preserve the immune system. However, for anyone without access to effective antiretroviral treatment, these effects remain possible.
Immune System
Your immune system prevents your body from acquiring the diseases and infections that come your way. White blood cells defend you against viruses, bacteria, and other organisms that can make you sick.
When HIV enters the body, it goes straight for the CD4+ T cells that are a lynchpin for the operation of the entire immune system. As the virus infects and kills more of these T cells, your immune system grows weaker, and you become more susceptible to illness.
Early on, symptoms may be mild enough to be dismissed. Within a few months of becoming infected, most people experience a flu-like sickness that lasts a few weeks. Symptoms may include:
fever
chills
night sweats
diarrhea
headache
muscle aches
joint pain
sore throat
rash
swollen lymph glands
mouth or genital ulcers
The first stage of HIV is called the acute infection stage. The virus reproduces rapidly at this stage. You may not have much in the way of serious symptoms, but there are usually large quantities of virus in your blood. Many people are unaware of their HIV status at this point, but the risk of transmission during the acute infection stage is very high. Acute infection may cause flu-like symptoms, including decreased appetite, headache, night sweats, and others.
The next stage is called the clinical latent infection state. On average, it lasts 8 to 10 years. In some cases, it lasts much longer than that. You may or may not have symptoms during this stage.
As the virus advances, CD4 count decreases more drastically. This can lead to symptoms like:
fatigue
shortness of breath
cough
fever
swollen lymph nodes
weight loss
diarrhea
If HIV infection advances to AIDS, the body becomes prone to opportunistic infections. People with advanced HIV/AIDS are at increased risk of a number of infections, including a herpes virus called cytomegalovirus. It can cause problems with your eyes, lungs, and digestive tract.
Kaposi’s sarcoma, another possible infection, is a cancer of the blood vessel walls. It’s rare among the general population, but common in people who are HIV-positive. Symptoms include red or dark purple lesions on the mouth and skin. It can also cause problems in the lungs, digestive tract, and other internal organs.

HIV/AIDS also puts you at higher risk of developing lymphomas. An early sign of lymphoma is swollen lymph nodes.

Respiratory and Cardiovascular Systems
HIV increases the risk of colds, influenza, and pneumonias. According to the American Lung Association, HIV/AIDS can lead to opportunistic lung diseases. Without preventive treatment, people with advanced HIV are susceptible to tuberculosis, pneumonia, and a disease called pneumocystis carinii pneumonia (PCP). PCP causes trouble breathing, cough, and fever.

HIV raises the risk of pulmonary arterial hypertension (PAH). PAH s a type of high blood pressure in the arteries that supply the lungs. It puts added strain on the heart.
If you have HIV and have become immunocompromised (have a low T cell count), you’re susceptible to tuberculosis (TB), a leading cause of death in people who have AIDS. TB is an airborne bacterium that affects the lungs. Symptoms include chest pain and a bad cough that may contain blood or phlegm. Symptoms can linger for months.
Digestive System
A common HIV-related infection is called candidiasis. Symptoms include inflammation of and a white film on the tongue. It can also cause inflammation of the esophagus, which can make it difficult to eat. Another viral infection that affects the mouth is oral hairy leukoplakia, which causes white lesions on the tongue.
Salmonella infection is spread through contaminated food or water and causes diarrhea, abdominal pain, and vomiting. Anyone can get it, but if you have HIV, you’re at higher risk of serious complications from this infection.
Consuming contaminated food or water can also result in a parasitic intestinal infection called cryptosporidiosis. It affects the bile ducts and intestines. It can be particularly severe and cause chronic diarrhea in people who have AIDS. Cryptosporidiosis infection can occur in people with effective immune systems, but it can become a chronic problem in people with CD4 levels under 200.
HIV-associated nephropathy (HIVAN) is when the filters in your kidneys become inflamed, making it harder to remove waste products from your bloodstream.
Problems with your digestive tract can decrease your appetite and make it difficult to eat properly. Weight loss is a common side effect of HIV.

Central Nervous System
There are significant neurological complications of AIDS. Even though HIV doesn’t generally directly infect nerve cells, it does infect the cells that support and surround nerves in the brain and throughout the body.
All of the mechanisms of HIV-associated neurologic damage aren’t completely understood, but it’s likely that infection of these support cells contribute to nerve injury. Advanced HIV infection can damage nerves (neuropathy). Small holes in the conducting sheaths of peripheral nerve fibers (vacuolar myelopathy) can cause pain, weakness, and difficulty walking.
HIV/AIDS can cause HIV-associated dementia or AIDS dementia complex, two conditions that seriously affect cognitive function.
Toxoplasma encephalitis is another possible complication of advanced HIV. People with AIDS are at increased risk of inflammation of the brain and spinal cord due to this parasite found commonly in cat feces. Symptoms include confusion, headaches, and seizures.
Some common complications of AIDS include memory impairment, anxiety, and depression. In very advanced cases, hallucinations and frank psychosis can occur. Some people experience headaches, balance issues, and vision problems.

Skin
One of the more obvious signs of HIV/AIDS can be seen on the skin. A weakened immune response leaves you more vulnerable to viruses like herpes. Herpes can cause you to develop sores around your mouth or genitals.
People with HIV are at increased risk of shingles, which is caused by herpes zoster, the virus that gives you chickenpox. Symptoms of shingles include a painful rash, often with blisters.
A viral skin infection called molluscum contagiosum involves an outbreak of bumps on the skin. Another condition is called prurigo nodularis. It causes crusted lumps on the skin, as well as severe itching.

- See more at: http://www.healthline.com/health/hiv-aids/effects-on-body#sthash.IOtHxYfO.dpuf

Dare We Hope?

My sermon to the UUFB today:

There are a lot of words we use every day,
that we don’t really pause to consider.
“Hope” is one of those words.

What do you think of when you hear the word “Hope”?

For most of us, “hope” will conjure up images of fantastical satisfaction and happiness- or maybe the iconic images of a certain presidential campaign.

Maybe almost trite images.

And yet, there’s an allure to the word “Hope”

In that presidential campaign, the opponents made fun of the word, made light of it- and I would submit- that may be why they lost.
They underestimate the human gift of optimism.
And I do think it’s a gift.

It’s very easy to look around and see the evidence of malignancy and evil around us- and far away from us- thanks to the miracle of instantaneous global communication. It’s not hard to find stories of death and destruction, exploitation and pain, suffering and greed, disease and addiction.

It’s not hard at all.
In fact, it’s so easy that our society suffers from all sorts of ills because of it- depression being ubiquitous in this day and age.

I think hope and optimism have a bad rap. It’s easy to make fun of the word “hope”. Realists say that it’s fantasy.

I think it’s completely and perfectly human.

Take Winter. It’s no accident that the early Christians of the Northern Hemisphere chose the solstice for the celebration of the Savior’s birth.

The Advent wreath, the greenery, the Christmas tree- none of them originated with Christianity. Some maintain that Germanic tribes placed candles in a sacred circle of greens to symbolize hope in the return of the sun and the promise of Spring. We know Scandinavian people placed candles on a wheel to honor the cycle of the seasons. We know that midwinter- again in the Northern Hemisphere- is around December 21- when days are at their shortest and night is at its longest.

I can imagine that for primitive people whose lives depended on the return of warmth it was good to remind themselves that winter won’t last forever. And I can imagine that it was very hard centuries ago- without antibiotics and polar fleece and refrigerators and Costco- in a harsh climate when those who were weak would often die- I can imagine that some would find it hard to believe that the winter would ever end- especially during the time that night became longer and longer and colder and colder.

But those who knew- those who had lived through the winters before- they were the strength of those who weren’t so sure.
They held out hope.

They knew that in the midst of the longest night- it was important to tell stories of the approaching spring. To hold out hope- to remember optimism when it was at its most elusive.

As always, our lives our shaped by those who have gone before us.

Hope is in our genes- if we care to think about it.

The basic instinct of survival is a mechanism of hope, isn’t it?

Even the limbic system that shuts down our reason in the face of danger and makes us flee, fight or freeze to enable our survival- even that is a sign of hope. It’s in our biology.

That’s probably why the pessimists never win in the long term. Hope isn’t just a trite term for people who can’t handle reality. It’s an attitude for living.

I like to tell my clients that the only difference between excitement and fear is the projected outcome.

The energy is the same- it’s just the projected outcome that’s different. And that projected outcome starts with us.

In our minds, in our hearts, in the way we choose to interpret the world around us. Excitement and curiosity- or fear and dread? It’s our choice- at least more than we think.

One of my favorite stories is this one:

Two boys who were twins, one an incurable optimist, one a pessimist.
The parents were worried about the extremes of behavior and attitude and finally took the boys in to see a psychologist.

The psychologist observed them a while and then said that they could be easily helped. He felt they just needed to adjust to the world by encountering things that would counteract their strong tendencies of optimism and pessimism.

He said that they had a room filled with all the toys a boy could want. They would put the pessimist in that room and allow him to enjoy life.

They also had another room that they filled with horse manure. They put the optimist in that room. They observed both boys through one way mirrors.

The pessimist continued to be a pessimist, stating that he had no one to play with.

They went to look in on the optimist, and were astounded to find him digging through the manure.

The psychologist ran into the room and asked “What on earth are you doing?”

The boy replied “With all this manure, there HAS to be a pony in here somewhere!”

I love that story.

But I know that sometimes i’m not looking though the manure for the pony. Sometimes I’m just sitting in the manure, disgusted. Because, well, you know, it’s manure.

That’s when I forget myself. It’s when I forget my biology.

It’s when I forget that the energy I feel in my body is often harnessed by the projected outcome I hold.

So, yeah, I can sit in the manure, or I can haul the manure back to the garden where it’ll do some good.

My choice.

Our ancestors have chosen to celebrate the return of the light for millennia- it’s why the early Christians chose the bleak midwinter- to link the returning light to the birth of Jesus. Smart, eh?

They’ve chosen to believe that the dawn follows the darkness, that life will continue.

And so do we.

I’m betting that it’s why you’re here today.

And I’m also betting that you’re interested in learning to become skillful at living life with hope.

I believe that the first step in living a more skillful life
is to become more aware of living an UNskilled life.
And by that, I mean living by habit-
not with awareness, not with wonder, not with hope-
but by automatic pilot- habit. By numbing perhaps- or lying to ourselves.

It’s ultimately unsatisfying.
Habits are things we do without thinking. That’s very unskillful.

Skill means bringing awareness and creativity, attention and intention into our endeavors.

I think it’s only by paying close attention that we live skillfully in this world.
And by paying attention to the possibilities is the way we live hopefully in this world.

During his days as president, Thomas Jefferson and a group of companions were traveling across the country on horseback.

They came to a river which had left its banks because of a recent downpour.

The swollen river had washed the bridge away.

Each rider was forced to ford the river on horseback, fighting for his life against the rapid currents.

The very real possibility of death threatened each rider, which caused a traveler who was not part of their group to step aside and watch.

After several had plunged in and made it to the other side, the stranger asked President Jefferson if he would ferry him across the river.

The president agreed without hesitation.

The man climbed on, and shortly thereafter the two of them made it safely to the other side.

As the stranger slid off the back of the saddle onto dry ground, one in the group asked him, “Tell me, why did you select the president to ask this favor of?”

The man was shocked, admitting he had no idea it was the president who had helped him.

“All I know,” he said, “Is that as I thought of asking the question, on some of your faces was written the answer ‘No,’ and on some of them was the answer ‘Yes.’

His was a ‘Yes’ face.”
(C. Swindoll, The Grace Awakening, Word, 1990, p. 6.)

That, my friends, is the face of hope.

So, dare we hope?

If biology and the human spiritual history of millennia have anything to say about it, we dare not.

HIV Cures Come At A Price

Also published on Bilerico.com

Today, amfAR grantee Dr. Timothy Henrich announced two HIV-positive patients who have undetectable levels of HIV after undergoing stem-cell transplants at the 7th annual International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur, Malaysia.

Money

Money (Photo credit: 401(K) 2013)

We’ve had some excellent news about the curing of HIV-infected people in the past year. But it comes at a price.

It’s important to note that the individuals involved received intensive care and went through extreme discomfort in order to eradicate the virus from their bodies. It’s not something that we’ll be able to replicate for the general population anytime soon.

And I think we need to remember that people are still dying of HIV-related causes every day- thousands of people. And new infections aren’t really slowing down- even in the First World where there is convenient access to safe sex supplies. There’s still a disconnect. There’s still ignorance and apathy out there.

It’s still good news however.

From amFAR:

The patients had been on long-term antiretroviral therapy for HIV when they developed lymphoma. To treat the cancer, the patients underwent reduced intensity chemotherapy followed by stem-cell transplants. Since the transplants, Dr. Henrich has been unable to find any evidence of HIV infection.

Dr. Henrich was awarded a grant through the amfAR Research Consortium on HIV Eradication (ARCHE) after presenting preliminary findings on these patients at the International AIDS Conference last July. With support from amfAR, he conducted a clinical study in which his research team withdrew the patients’ antiretroviral therapy and performed several sophisticated assays looking for signs of viral rebound in blood and other tissues. One patient has been off treatment with no detectable virus for approximately 15 weeks, and the second patient for seven weeks, with similar results. However, it is too soon to draw any definitive long-term conclusions.

It is also unclear how long viral rebound might take in a patient whose viral reservoirs have been dramatically depleted, but not eradicated. According to amfAR/ARCHE grantee Dr.Robert Siciliano of Johns Hopkins University, it may take over a year. Previously a patient in a study by the National Institutes of Health had gone 50 days after treatment withdrawal without viral rebound. Dr. Henrich’s patients are at or beyond this threshold, and more definitive answers will emerge as these patients continue to be closely monitored.

“These findings clearly provide important new information that might well alter the current thinking about HIV and gene therapy,” said amfAR CEO Kevin Robert Frost. “While stem-cell transplantation is not a viable option for people with HIV on a broad scale because of its costs and complexity, these new cases could lead us to new approaches to treating, and ultimately even eradicating, HIV.”

The first person to be cured of HIV, Timothy Brown (“the Berlin patient”), also underwent a stem-cell transplant to treat his leukemia. These new cases differ significantly, however, in that the stem-cell donors lacked the genetic mutation (CCR5 delta32) that renders a person virtually resistant to HIV infection. Nor did Dr. Henrich’s patients undergo the intensive chemotherapy or total body irradiation that preceded Timothy Brown’s stem-cell transplant.

“Dr. Henrich is charting new territory in HIV eradication research,” said amfAR Vice President and Director of Research Dr. Rowena Johnston. “Whatever the outcome, we will have learned more about what it will take to cure HIV. We believe amfAR’s continued investments in HIV cure-based research are beginning to show real results and will ultimately lead us to a cure in our lifetime.”

I still can’t help but think we’ve not done our best in response to this epidemic- especially in the last decade. I wonder if, as a community, we settled for simply not dying as a substitute for true health.

If so, what does that say about our self-esteem, self-care and community spirit? Have we lost interest in each other beyond the obvious?

That’s a heavy price to pay.

“Unacceptable Levels” Tonight at The Emerson

Women’s Voices for the Earth is proud to host the Montana premier of “Unacceptable Levels,” on Wednesday, June 26th at the Emerson Theater in Bozeman. Doors open at 7:00pm; Program begins at 7:30pm. Admission is free.

Evening Details.

This evening screening will host families, educators, small business owners, and community leaders alike in premiering one of the most innovative and exposing documentaries ever made on the role of chemicals in our modern-­‐day lives. Following the film will be a short panel discussion, in which WVE is honored to host the filmmaker, Ed Brown (Los Angeles); WVE Executive Director, Erin Switalski (Missoula); Richard Eidlin, of the American Sustainability Business Council (Denver); and business and individual community representatives from Bozeman.

About the Film.

Unacceptable Levels is an innovative documentary that opens a dialog about the effects of chemicals in everyday products on the environment and on our bodies. The film dissects the lack of regulatory oversight of industrial chemicals in consumer goods — from cosmetics to household cleaning products to industrial farming — and inspires consumers to push for changes that protect us all.

Shot and edited almost entirely by independent filmmaker, Ed Brown, it is the result of three years of arduous travel and research. “I made this movie because I couldn’t ignore the effects of chemicals on my family. I had to find out more,” said Ed Brown. The interplay of facts and personal history is central to the success of Unacceptable Levels as a film and an educational tool, combining the weight of expert interviewees with the universality of family.

Unacceptable Levels comes at a time when growing awareness of chemicals on human and environmental health has met a stronger call for safer products and regulatory legislative efforts. Montana is a leader in this movement, with two of our own senators co-­‐sponsoring the Safe Chemicals Act: a bill reintroduced to the Senate this spring to patch gaping regulatory holes in the only existing chemical legislation, Toxic Substances Control Act (TSCA).

About Women’s Voices for the Earth.

Based in Missoula, Montana, Women’s Voices for the Earth (WVE) is a national organization that works to eliminate toxic chemicals that harm women’s health by changing consumer behaviors, corporate practices and government policies. WVE is proud to call Montana home, where recently we secured co-­‐ sponsorship from our two Senators – Tester and Baucus – for the Safe Chemicals Act that passed it through the Senate Sub-­‐Committee last year, effectively taking the first step to amend toxic substances legislation in over 50 years.

 

“Where Would I Begin?” Reflections on the Historic filing of the Crawford Case

The historic litigation in the case of M.C. has profound significance for many in the intersex community. Advocates for Informed Choice (AIC) is publishing a series of personal responses to the M.C. litigation. The first in this series is by longtime intersex activist and former AIC staff member Jim Ambrose (formerly Jim Bruce). This piece originally appeared on AIC’s blog, June 5, 2013.

“M.C. will spend the rest of his life paying for his caretakers’ actions.” – Erica K. Landau, Huffington Post

Where would I begin? I asked myself that question every other hour after AIC asked me to submit my reaction to the filing of the Crawford case. Hell, I’m asking it right now. I worked for AIC from 2009 to February, 2013 so I knew this case was coming for a while. That said I had a feeling it wouldn’t get filed, that it’d slip away or rather be taken away. I wasn’t alone in feeling that simply filing the lawsuit, just filing it, would be monumental. Looking back it was kind of like when an 8 year-old thinks Christmas is an oasis (7 months away!), too far off to comprehend day-to-day and so the kid resigns himself to childhood drudgery. Because, come on, nothing exists that far in the future least of all everything you ever wanted.

But, on the morning of May 14, 2013 The Southern Poverty Law Center (SPLC) and Advocates for Informed Choice issued a press release detailing how a group of professional adults irreparably harmed a child in South Carolina. I gazed at my laptop as a press conference took place right in front of some giant brick courthouse. Attorneys representing a child called M.C. stood in a semi-circle behind a podium, and there was Anne! Anne, who will argue breathlessly that ‘They Might Be Giants’ was the greatest band of the 20thcentury, was right there on the Primetime Live at 5 Eyewitness News! Ever-measured Anne gently explained what she knows she can prove: That what happened to M.C. was unnecessary, arrogant and brutal.

You see, for me, the most difficult aspect of intersex advocacy is making this complex issue understood by any audience. Intersex stuff is nothing but sprawl. It gets everywhere: sex, genitals, going to the bathroom, hormones, clothing, fitting in, not fitting in, showering, sports, inclusion/exclusion, sex again, interpersonal connection, how we all sleep at night, self-determination, the opportunities we give ourselves and take from others and contentment. You know, the basics. These items are hardly approachable because most educated folks often fail to even understand the difference between sex and gender. So tell me how a kid is to know what a numerator is if they struggle to count to 10?

So, then two of the bravest people I may ever know did something most intersex advocates (myself included) thought could never happen. They stood in front of cameras, on record, in their son’s hometown and demanded justice. Pam and Mark Crawford denounced the needless removal of their son’s genitals and reproductive organs as “a careless and reckless action,” and that the State of South Carolina “disfigured (M.C.) because they could not accept him for who he was.” When I glanced down to watch the seconds peel away on the web clip I noticed my hands and knees were trembling. No. I was shaking all over. That’s when I realized Pam bears a passing resemblance to my own mother. My mother has that red hair, those sturdy-yet-stylish eyeglasses, and a voice that tells a careful listener suffering is something you do alone.

The thing is M.C. and I (along with many intersex people) share a similar childhood narrative. We both endured early years of ghastly cosmetic genital surgery, the loss of our reproductive organs and silence. But, M.C. was adopted by the Crawford family. I never saw the inside of an orphanage. M.C. has a sense of self and of his safety. My sense of self was gray, disoriented. I did not feel safe. M.C. has a voice that he uses. I had a voice too, but if I’d shared that voice with my parents I would have told them I was lost. M.C. used his voice to inform his family that he is a boy.

Pam projected her voice. I can hear it as I type: “The adults involved are sending him the message that your body is not acceptable and has to change in order for you to be loved.” I know how true those words are. I, and many intersex advocates, have articulated versions of them to those in power for the past 20 years. But, hey, why should highly-educated clinicians listen to a handful of surgical ingrates? History tells us that appeals for mercy through testimonials of truth and suffering have never been enough to effect institutional change. Those words from a proud and committed mother of an intersex kiddo in front of most of the world are not an appeal for mercy. They are a shot across the bow.

Pam’s unshakeable words found a spot in me I thought I’d grieved out. Out and away. I’d say it was unbearable save for the fact that I knew thousands of other intersex people were witnessing the Crawfords’ demonstration of love and belief in their son. I shared May 14, 2013 with many people, especially the ones no longer with us. And, frankly that experience reminds me how alone I was for so long, how alive I am now and, finally that resilience brings liberation to those residing on the right side of history.

Jim Ambrose is a worker bee at The Interface Project. #justice4mc

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Drug-Resistant Gonorrhea: New Facts

"WARNING - VENEREAL DISEASES" - NARA...

“WARNING – VENEREAL DISEASES” – NARA – 516044 (Photo credit: Wikipedia)

From The National Association of STD Directors (NASTAD) comes a new fact sheet, which begins with this:

For several decades, the Centers for Disease Control and Prevention (CDC) has closely monitored gonorrhea and its potential to become resistant to available antibiotics. Gonorrhea is one of the most commonly reported communicable diseases in the United States. In 2011, there were 321,849 reported cases and another 400,000 estimated unreported cases. If left untreated, the illness can cause infertility in both women and men, dangerous pregnancy complications and can be passed on to newborns, possibly causing blindness or pneumonia. Gonorrhea can also facilitate HIV transmission.

The CDC now reports that gonorrhea has become resistant to all but one of the antibiotics recommended to treat it, and resistance to the remaining antibiotic is increasing. If no new antibiotics become available, gonorrhea has the potential to become a serious epidemic. However, by increasing public health infrastructure investment and encouraging pharmaceutical companies to create new antibiotics, we can prevent a public health emergency.

Read the full fact sheet here: ncsd.astho_antibiotic_sheet

Banning Same-sex Marriage Has Psychological Toll

Fascinating stuff from Shankar Vadantam at NPR:

As the country awaits two important Supreme Court decisions involving state laws on same-sex marriage, a small but consistent body of research suggests that laws that ban gay marriage — or approve it — can affect the mental health of gay, lesbian and bisexual Americans. When several states passed laws to prohibit same-sex marriage, for example, the mental health of gay residents seemed to suffer, while stress-related disorders dropped in at least one state after gay marriage was legalized.

Here’s the research trail:

Beginning around 2004, several states banned gay marriage. Just before that series of bans, the National Institutes of Health happened to conduct a massive survey of 43,093 Americans. The questions elicited detailed information about respondents’ mental health. (To validate what people reported about themselves, psychiatrists also interviewed samples of the people in the survey, and their medical diagnoses closely matched the findings of the survey.)

Soon after the wave of state bans on gay marriage, in 2004 and 2005, the NIMH conducted a second round of interviews, managing to reach 34,653 of the original respondents. (That’s a high rate compared with most polls and surveys.)

Mark Hatzenbuehler, a psychologist at Columbia University who studies the health effects of social policies, analyzed the data gathered before and after the bans to determine how the mental health of people who identified themselves as gay, lesbian or bisexual had changed in those states.

Hatzenbuehler and his colleagues Katie McLaughlin, Katherine Keyes and Deborah Hasin published their analysis in 2010 in the American Journal of Public Health.

“Lesbian, gay and bisexual individuals who lived in the states that banned same-sex marriage experienced a significant increase in psychiatric disorders,” Hatzenbuehler says.

“There was a 37 percent increase in mood disorders,” he says, “a 42 percent increase in alcohol-use disorders, and — I think really strikingly — a 248 percent increase in generalized anxiety disorders.”

To put those numbers in perspective, although Hatzenbuehler did find more than a doubling in the rate of anxiety disorders in states that eventually banned gay marriage, in absolute numbers he found that anxiety disorders went from being reported among 2.7 percent to 9.4 percent of gay, lesbian and bisexual people.

The million-dollar question is whether the laws, and the debates around them, were responsible for the change in mental health. To help answer that question, Hatzenbuehler and his colleagues looked at comparable groups and experiences.

“We showed the psychiatric disorders did not increase in lesbian, gay and bisexual populations in states that didn’t debate and vote on same-sex marriages,” Hatzenbuehler says. “There were also no increases — or much smaller increases — among heterosexuals living in the states that passed same-sex marriage bans.”

Hatzenbuehler has also found, in a study conducted in Massachusetts, that gay men experienced fewer stress-related disorders after that state permitted gay marriage.

In a study tracking the health of 1,211 gay men in Massachusetts, Hatzenbuehler found that the men visited doctors less often and had lower health treatment costs after Massachusetts legalized same-sex marriage. When the researchers examined the diagnostic codes doctors were giving the men, they saw a decrease in disorders that have been linked to stress, such as hypertension, depression and adjustment disorders.

Hatzenbuehler says he thinks stress associated with gay-marriage debates was the “X factor.” He says the quantitative data is backed by what gays, lesbians and bisexuals told the surveyors. “They reported multiple stressors during that period,” Hatzenbuehler says. “They reported seeing negative media portrayals, anti-gay graffiti. They talked about experiencing a loss of safety and really feeling like these amendments and these policies were really treating them as second-class citizens.”

Today, about three-dozen states ban gay marriage and about a dozen have passed laws thatapprove it. Some states have laws that permit civil unions but ban gay marriage.

It’s unclear how or whether the upcoming Supreme Court decisions involving the constitutionality of same-sex marriage will affect the mental and physical health of gays and lesbians nationally.

It’s likely that many gay, lesbian and bisexual people would see an upholding of same-sex marriage bans as an example of prejudice. But it’s also possible the debate around the Supreme Court decisions could have different effects on gays than a local debate involving friends and neighbors.

Hatzenbuehler says his larger point is really that policymakers, judicial leaders and ordinary citizens need to remember that social policies are also health policies.