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.

 

Bisexual Men and Women Less Likely Than Gay Men, Lesbians to Disclose Sexual Orientation

English: Illustration of the double moon symbo...

English: Illustration of the double moon symbol used by bisexuals who wish to avoid the use of triangles. This example is in the colours of the Bisexual Pride flag. (Photo credit: Wikipedia)

New research shows that bisexual men and women are less likely than gay men and lesbians to disclose their sexual orientation to healthcare providers.  The study, which examined nondisclosure of sexual orientation among lesbians, gay men and bisexual men and women, found that concealment of sexual orientation from healthcare providers was related to poor psychological wellbeing.

“This study adds to a growing literature that shows that a one-size-fits-all approach to understanding the health of sexual minorities ignores differences among subpopulations within this community,” said Laura Durso Ph.D., Williams Institute Public Policy Fellow.

Nondisclosure was higher among bisexual men of whom 39% did not disclose to any medical provider and bisexual women of whom 33% did not disclose to any medical provider.  Disclosure was much more prevalent among gay men and lesbians among whom only 13% and 10%, respectively, did not disclose their sexual orientation to any medical provider.  Among lesbians, greater nondisclosure was found among racial/ethnic minorities, women with lower educational level, and women with children. Among both gay and bisexual men, greater nondisclosure was found among younger men and men who were born outside the U.S.

The study, entitled “Patterns and Predictors of Disclosure of Sexual Orientation to Healthcare Providers among Lesbians, Gay Men, and Bisexuals,” was funded by the National Institute of Mental Health and is published in Sexuality Research and Social Policy.

Full study: click here.

Study: Access to HIV Services for Gay Men Worldwide Stunted By Homophobia

Global study finds homophobia, comfort with service provider, and community engagement make significant impact on access to condoms, lubricant, HIV testing, and HIV treatment

A large-scale study of gay men and other men who have sex with men (MSM), conducted by the Global Forum on MSM & HIV (MSMGF), indicates that only one third of MSM can easily access condoms, lubricant, HIV testing, and HIV treatment. Combining a multi-lingual online survey and focus group discussions, the study suggests that structural barriers like homophobia play a significant role in blocking access to HIV services for MSM, while greater comfort with service providers and community engagement are associated with higher levels of service access.

The MSMGF’s study aimed to identify barriers and facilitators that affect access to HIV services for MSM. The online survey conducted this summer included 5779 men from 165 countries.  In addition, the MSMGF collaborated with African Men for Sexual Health and Rights (AMSHeR) to conduct focus group discussions with a total of 71 MSM across five cities in South Africa, Kenya, and Nigeria.

Of men who participated in the online survey, only 35% reported that condoms were easily accessible, 21% reported easy access to lubricant, 36% reported easy access to HIV testing, and 42% reported easy access to HIV treatment. Levels of access differed across low-, lower-middle-, upper-middle- and high-income countries, with reduced access to services more commonly reported in lower-income countries.

Percent of MSM reporting that condoms, lubricant, HIV testing, and HIV treatment
are easily accessible
(organized by country income level using World Bank country income classifications)

“Such poor levels of access at the global level are unacceptable,” said Dr. George Ayala, Executive Director of the MSMGF. “The differences in access by country income level are especially important to note as the Global Fund moves into a new funding model where countries are grouped into bands by income level. Even in upper-middle-income countries, MSM still have extremely low access to services. Without targeted funding to MSM and other key populations, the new funding model may continue to deteriorate levels of access for the groups most affected by HIV.”

The MSMGF research team also conducted analyses to identify barriers (factors associated with lower access) and facilitators (factors associated with higher access) that impact the ability of MSM to obtain condoms, lubricant, HIV testing, and HIV treatment.

Adjusting for country income, greater access to condoms, lubricants and HIV testing were associated with less homophobia, greater comfort with health providers, and more community engagement. Among participants living with HIV, higher access to HIV treatment was associated with less homophobia and greater comfort with service providers.  Greater access to lubricants and greater access to HIV testing were also associated with less outness (the degree to which others know of one’s sexual orientation) and fewer negative consequences as a result of being out, respectively.

“As we collectively forge ahead into the new territory of treatment-based prevention, it is clear that many of the old challenges remain,” said Noah Metheny, Director of Policy at the MSMGF. “Addressing structural barriers remains essential to realizing the potential of HIV interventions for MSM, and it becomes more important with each new prevention and treatment option that is made available. Investments in the development of new interventions must be accompanied by efforts to increase access.”

The quantitative data from the online survey was supplemented with qualitative data from focus group discussions, helping to place barriers and facilitators in the broader context of the sexual health and lived experiences of MSM. Focus group discussion participants identified barriers and facilitators that were highly consistent with those found in the online survey, and many participants explained the ways that structural barriers at the policy, cultural, and institutional levels cascade down through the community and individual levels to block access to services for MSM.

Focus group discussion participants described how structural barriers like stigma, discrimination, and criminalization force MSM to hide their sexual behavior from health care providers, employers, landlords, teachers, and family members in order to protect themselves and maintain a minimum livelihood. The inability of MSM to reveal their sexual behavior to health care providers was linked to misdiagnosis, delayed diagnosis, and delayed treatment, leading to poor health prognosis and higher risk of transmitting HIV and other sexually transmitted infections to partners.

Conversely, focus group discussion participants explained that the negative consequences of structural barriers were moderated by the existence of safe spaces to meet other MSM, safe spaces to receive services, access to competent mental health care, and access to comprehensive health care. Participants described MSM-led community based organizations as safe spaces where they could celebrate their true selves, receive respectful and knowledgeable health care, and in some cases receive mental health services.

“The study’s findings underscore the urgent need to improve access to essential HIV services for gay men and other MSM worldwide,” said Dr. Ayala. “Interventions must both disrupt the negative effects of barriers and bolster the protective effects of facilitators. Study participants clearly indicated that community engagement and community-based organizations are central to moderating barriers and facilitating service access. Successfully addressing HIV among MSM will require a real effort to address structural barriers, and the findings from this study suggest that investing in MSM-led community-based organizations may be the best way to do that.”

Agreed. MSM-led community-based organizations must continue to work tirelessly to eliminate fear, shame, stigma and ignorance. They are all still very much with us.

And they’re killing us.

Related articles

Cognitive Training Beneficial For People With HIV

From Science Daily:

As more effective antiretroviral therapy has evolved over the past 30 years, HIV/AIDS has shifted from an acute to a chronic condition. But as patients live longer, research indicates that they are experiencing cognitive impairments at a higher rate than people without the disease.

A new study by researchers at the University of Alabama at Birmingham, published online Oct. 15, 2012 in the Journal of the Association of Nurses in AIDS Care, shows that cognitive training exercises can help — improving mental processing speed and the ability to complete daily tasks in middle-age and older adults with HIV.

“Today, more than 25 percent of people living with HIV in the United States are older than 50,” says the study’s lead author, David Vance, Ph.D., associate professor in the UAB School of Nursing, associate director of the UAB Center for Nursing Research and scientist in the UAB Edward R. Roybal Center for Research on Applied Gerontology. “Thirty to 60 percent of adults living with HIV experience cognitive problems at some point in the illness, a condition known as ‘HIV-associated neurocognitive disorders.’ It’s imperative for people with HIV and their treatment teams be proactive in addressing cognitive problems as they emerge, because without treatment these issues — which mimic premature aging — can lead to difficulties in working and living independently.”

 Full story here.

Participate! Study about LGB persons In the Workplace

Received today:

My name is Paul Battle, I am a doctoral student at Oakland University working on my dissertation.   I am currently compiling research on the work experiences of lesbian, gay and bisexual individuals.  I hope that learning more about the work experiences of lesbian, gay and bisexual individuals will help improve work experiences and counseling education.

Participants should be over the age of 18 and currently be employed.  To participate in the study please click on this link: http://www.surveymonkey.com/s/Workplaceidentity

FDA Approves new HIV Treatment

English: Logo of the .

The FDA approved “the Quad”- a four-medication-in-one-pill treatment for controlling HIV. Two of the medications comprising Stribild, tenofovir and emtricitabine, have been previously combined and sold under the brand name Truvada (itself approved a few weeks ago as a preventative or prophylactic for HIV, see related articles below).

Two of the medications are new, and – as a condition of approval- will require greater testing in women and children, as well as studying possibilities and occasions of resistance.

This is good news.

Simplifying regimens is a helpful strategy in helping keep HIV-infected persons faithful to their medication schedules, a key in effectively treating HIV. Cost is yet to be determined- and most HIV regimens cost in excess of $18,000.00 a year (mine cost $24k).

Still no picnic- but good news for those who need a simpler med schedule.