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We already had the pill debate

Fight over PrEP mirrors 1960s concerns over birth control

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Truvada, Gilead, gay news, Washington Blade
Truvada, Gilead, gay news, Washington Blade

(Photo courtesy of Gilead)

When PrEP (taking the drug Truvada or another drug to prevent — rather than treat — HIV infection) first became a subject of discussion I was inclined against the idea. But, having listened, read and considered, I’ve changed my mind. Not only does it seem like an acceptable alternative for certain men, it can be a definitive plus for the community as a whole.

One of the keys to my change of heart was the realization that the debate about PrEP very much mirrors the 1960s debate about the birth control pill — something that happened in my lifetime. And once one makes that connection, the arguments against using PrEP for prevention make no more sense than did the arguments about another “pill” several generations ago.

One argument against PrEP is that it does not protect against other sexually transmitted diseases, including highly dangerous hepatitis C. But the same argument could be used against the birth control pill. It offers no protection against STIs (including HIV). That has never been deemed a reason to prevent or discouraging people from using it.

Another argument against PrEP is that anti-HIV drugs have known side effects. But so does the pill. Moreover, when the pill was first approved the side effects were far more severe than with the formulations used today. Some women died from the side effects (strokes, for example) and others faced increased risks of certain cancers and increased blood pressure. Importantly, however, women were allowed to decide for themselves whether the physical and mental risks of an unplanned pregnancy outweighed the risks of the pill. So long as the side effects and risks of PrEP drugs are properly explained there is no reason not to allow individuals the same ability to weight the risks.

Another argument against PrEP is that the touted theoretical effectiveness is not as high as the actual “usage” effectiveness. But there are counter arguments to that contention.

Condoms also only work when used consistently and properly. In fact, the difference between the real world effectiveness of condoms and oral contraceptives in preventing pregnancy is almost entirely due to the differences in adherence and proper usage. In laboratory conditions they both work almost perfectly. Unfortunately, the real world is not a laboratory and condom adherence is not perfect.

In addition, the pill itself only works when taken properly and consistently. It isn’t possible to pop a birth control pill now and then to avoid pregnancy. Public education about that is fact has ensured that women actually do take the pill faithfully, whether or not sexual relations are on the menu for any given day. There is no reason why similar public education could not work with gay men — perhaps using the birth control pill as an illustrative example.

Potential inconsistent adherence does present an issue not present with the birth control pill. Inconsistent adherence to any microbe suppressing drug (whether antibiotics or HIV treatments) increases the risk of inadvertently culturing a resistant strain of the microbe. There is a legitimate fear that inconsistent PrEP adherence could provide a breeding ground for drug resistant strains of HIV.

The “resistance” argument should give us pause. Thousands of people take Truvada and even more depend on other once-a-day formulations that are essentially Truvada with the addition of other drugs. Widespread resistance to the drugs in Truvada (itself a combination of two drugs) would wreak havoc on HIV-positive patients.

But ultimately, the worries about drug resistance should not trump the benefits (both to individuals and the public health) of PrEP. Hundreds of thousands of people already take Truvada or similar formulations as treatment. Widespread resistance has not occurred, despite what must be some cases of inconsistent adherence.

Opposition to PrEP sounds a lot like religious opposition to the pill in the 1960s.  Michael Weinstein of the AIDS Healthcare Foundation fumes that PrEP is a “party drug.” That sounds an awful lot like the dire warnings of preachers that women on the pill would become wanton and promiscuous.

If condoms were the perfect answer to HIV transmission we would not have an HIV epidemic in this country. Clearly, the wondrous theoretical effectiveness of condoms in preventing HIV doesn’t hold up in the real world. People take risks or make mistakes.

We’ve already had the conversation about a pill to prevent an unwanted outcome of sexual intimacy. There is no need to re-invent the wheel.

 

Ray Warren is the legal counsel for a local government in Northern Virginia. He and his partner live in Arlington.

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Opinions

A confused Biden and a deranged Trump

Sad state of affairs after first presidential debate

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Former President Donald Trump and President Joe Biden debate on CNN on Jun 27, 2024. (Screen captures via CNN)

Joe Biden was clearly ready with some facts for this debate, the sad part is he couldn’t articulate them. He sounded raspy, and lost track of what he was saying in the first few minutes of the debate. He did get better as the debate progressed but came off sounding and looking like an old man. For those of us hoping he would sound like he did at the State of the Union, or the speech he gave on anti-Semitism, it was a huge disappointment. 

So, where his campaign goes from here is anyone’s guess. Behind the scenes some Democrats are calling for him to step down as the candidate. But that is much more difficult than it seems at this time. And then, will there be a fight for who the candidate will be. Will it automatically be Kamala Harris, or will it be someone else?  So many unanswered questions over the next couple of weeks.

The only positive take-away for Democrats from the debate was how deranged Donald Trump sounded. He refused to deal with any issue, refused to say he would accept the results of this election, refused to acknowledge climate change, or Jan. 6, and kept saying how the states should control the issue of abortion, and women’s health. Every one of these things should be frightening to so many people. It is clear if Trump is elected, we will have a dictator in the White House, who believes Hitler did good things. His election is scary for women, young people, Black Americans, and the LGBTQ community. If states control issues related to any of these groups, they are screwed. 

One of the very few good lines Biden got across was when he said 40 high-level Trump appointees, members of the Cabinet, and his vice president, have refused to endorse him as they know him best. People need to take their word for how bad he will be should he be reelected. Trump kept talking nonsense and it was hard to keep up with the lies. The moderators didn’t call him on any of it, but CNN has said before the debate they wouldn’t. But then Biden missed so many chances to call him on the garbage he was spouting. I kept hoping he would turn to him and say clearly, “You can’t believe all the BS you are spouting. You sound like a deranged six-year-old and someone who would take our country down the tubes.”

Now I accept the fact Biden speaks more slowly and softly. Though after the debate they said he had a cold. He could have said that at the beginning of the debate, if it was true, and explained his voice to the audience. And while we know he has a stutter, it seemed so much worse during the debate than it normally does. Was it nerves, maybe, but difficult nonetheless for him, and for those listening. We must have compassion for anyone with any kind of a disability. Then one had to ask, was he over-prepared for this debate? Was he so scripted he didn’t dare say anything off script. When he did, they got into this thing about golf handicaps and both sounded so childish. 

Biden did manage to talk about the things he has done, and the successes of his first administration. There have been many. First bringing the country successfully out of the pandemic. He spoke about unemployment being the lowest it has been in decades, and the more than 15 million jobs created since he took office. He was honest about inflation and the fact that not all the economic successes the country is having are trickling down to every American. He understands that rents are high, and grocery bills are still too high. He made clear he wants to raise taxes on the rich and Trump wants to lower them. He had a plan to ensure Social Security would stay solvent, Trump had nothing as usual. 

Finally, I was surprised that in his two-minute closing, Biden didn’t go back to the issues of abortion, climate change, and saving democracy. Did his debate prep team tell him not to? If so, they were wrong. Whether it remains Joe Biden on the ticket, or is someone else, I am 1,000% committed to do everything I can to see Democrats are elected across the board. It is clear to me, and should be to all decent people, electing Donald Trump and his MAGA Republicans, will be the end of our country as we know it today. 

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

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Opinions

As fewer anti-LGBTQ bills pass, the fight gets harder

A growing indifference to suffering that is baked into the legal system

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(Photo by Proxima Studio/Bigstock)

In recent years, advocates have faced an unprecedented avalanche of anti-LGBTQ legislation each spring. In 2024, however, the onslaught seems to have faltered somewhat. While hundreds of anti-LGBTQ bills were once again introduced, as many state legislative sessions draw to a close, fewer bills have been enacted into law.

While that may seem like cause for celebration, it’s also cause for concern.

To be sure, the slowdown in anti-LGBTQ legislation is welcome. Beginning in 2020, legislation targeting transgender rights in particular had sailed through state legislatures, with the number and scope of hostile bills increasing each year. Unlike earlier years when one or two prominent anti-LGBTQ bills triggered a national pushback that often chastened lawmakers, hundreds of bills have been introduced during legislative sessions in the last four years, often with little debate or scrutiny, and dozens of them zealously passed into law.

Those bills do real damage when they are enacted, cutting LGBTQ people off from material benefits like health care and domestic violence sheltersrecognition by the state, and equal participation in public life. Even when they fail to become law, they have devastating effects on the mental health of LGBTQ people, throwing their lives into disarray and sapping valuable time and energy from LGBTQ communities. This especially affects children, with more than 90 percent of LGBTQ young people in a recent Trevor Project survey reporting that politics had negatively affected their personal well-being.

But the recent slowdown, far from being a positive signal, may well reflect a growing indifference to the suffering of LGBTQ people that is now baked into the political and legal system. Opponents of LGBTQ rights have normalized hostile rhetoric and enacted draconian laws that seemed unthinkable just a couple of years ago, and even ardent supporters of equality find themselves unsure how they might reverse state laws that unapologetically strip away LGBTQ rights.

If anything, it has become apparent that the damage that has been done since 2020 will most likely reverberate for a generation, and the past year shows that restoring and advancing LGBTQ rights will be a painstaking endeavor.

And one sobering reason for the slowing pace of anti-LGBTQ legislation is that, at this point, many conservative states have already stripped away important rights, particularly for transgender children. As of 2024, half of the states in the U.S. prohibit transgender girls from playing school sports, and half have banned or criminalized at least some forms of medically indicated healthcare.

Put differently, lawmakers aren’t targeting some rights this year because they’ve already eviscerated them.

Yet even as the pace of legislation slows, critical rights continue to be stripped away. According to the ACLU, more than 30 anti-LGBTQ bills have been enacted in 2024 — fewer than the 84 enacted in 2023, but still far too many. Among them, Utah and Mississippi restricted transgender people from accessing bathrooms and locker rooms in public schools and other government buildings.

Lawmakers in Ohio overrode the governor’s veto to ban transgender children from receiving gender-affirming care or playing sports consistent with their gender identity. South Carolina and Wyoming similarly enacted blanket bans preventing transgender children from accessing gender-affirming care.

Many of the bills that have been introduced this year sought to expand existing anti-LGBTQ legislation in new ways. Alabama, for example, successfully expanded its bathroom ban from K-12 schools to colleges and universities. Even those that didn’t pass are in many cases likely to be reintroduced after the 2024 election, particularly if anti-LGBTQ lawmakers increase their showing in state legislatures or if governors who are supportive of LGBTQ rights are no longer positioned to veto hostile legislation.

In many states with anti-LGBTQ legislation, administrative and regulatory agencies are being used to curtail LGBTQ rights even further. Florida offers an instructive example. Even after years of anti-LGBTQ legislation, the Florida Department of Highway Safety and Motor Vehicles took things a step further within its mandate, and decided in 2024 that transgender people could no longer update the gender marker on their driver’s licenses. This echoes recent regulatory crackdowns elsewhere in the United States, from the Texas Department of Family and Protective Services investigating parental support for transgender children as child abuse to school boards across the country stripping away lifesaving resources in schools.

And while many believed that courts would provide a bulwark against discriminatory legislation and regulations, in part because of strong Supreme Court precedent to suggest that anti-transgender discrimination is a form of sex discrimination, that has not consistently been the case. Trial courts have largely found in favor of transgender litigants, criticizing the insufficient justification and discriminatory purpose of anti-transgender laws, but some appellate courts have nevertheless allowed the laws to take effect.

Perhaps most alarming, there are advocates and lawmakers who, if in a position to do so, are eager to carry out an even harsher attack on LGBTQ rights. Project 2025, which a group of conservative organizations has drafted as a roadmap for a second Trump administration, promises an even more draconian attack on LGBTQ rights. This would include rolling back existing nondiscrimination protections for LGBTQ people, reinstating the transgender military ban, and codifying state restrictions on transgender rights at the federal level, in addition to limiting recognition of same-sex relationships.

The anti-LGBTQ backlash may be waning in certain respects — but in other ways, it has only just begun. As we celebrate Pride, LGBTQ people and their allies should be mindful of the need to support those communities whose rights are being eroded, invest in transgender rights organizing, demand that lawmakers prioritize LGBTQ rights, and fight for the independent institutions and protections for basic freedoms that are essential to hold power to account.

Ryan Thoreson is a specialist on LGBTQ rights at Human Rights Watch and teaches at the University of Cincinnati College of Law.

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Commentary

LGBTQ people deserve freedom, a sense of home, and belonging

Latoya Nugent found refuge in Canada after fleeing Jamaica

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Latoya Nugent, center, at the March for LGBTQ+ Rights in Toronto on May 16, 2024. (Photo courtesy of Rainbow Railroad)

Seven years ago, my fight for queer liberation in notoriously homophobic Jamaica culminated in a violent and brutal unlawful arrest and detention. This was the peak of decades of persecution due to my sexual orientation and work as a queer human rights defender and activist. It completely broke me and silenced me. I suffered severe emotional trauma, from which I am still recovering years later. 

Following that life-threatening arrest, I became a shell of who I once was. I cut off communication with my community for several years, unable to face my fear of the police and the hostility of the world around me. 

In 2022, I was one of the 9,591 at-risk LGBTQI+ people who reached out to Rainbow Railroad for help. Through the organization’s Emergency Travel Support (ETS) program, which relocates at-risk LGBTQI+ people and helps them make asylum claims in countries like the U.S., I resettled in Canada where I’ve been living safely with dignity and pride. 

This Pride Month, I’m reflecting on what it means to be safe. Who has access to safety and why others are excluded from it. What is our collective role and responsibility in expanding safety for our queer and trans communities, especially those in the over 60 countries that criminalize LGBTQI+ people? 

Safety means different things to different people depending on our experiences and journeys. For me, it’s the difference between suffering and thriving, feeling worthless and worthy, and feeling hopeless and hopeful. It is the difference between displacement and belonging. 

Rainbow Railroad recently released a report that examines the state of global LGBTQI+ persecution, drawing on data from 15,352 help requests spanning 100+ countries. This report is significant for several reasons, chief among them is the reality that no other organization or government captures the breadth and depth of data on LGBTQI+ forced displacement, perpetuating the invisibility of queer individuals in humanitarian responses. The report is an important contribution to the discourse on the intersection of queer identity, LGBTQI+ persecution, forced displacement, and humanitarian protection systems. 

Of all the data and insights uncovered in the report, I was most struck by one statistic — 91 percent of at-risk LGBTQI+ individuals relocated through the ETS program reported an improved sense of personal safety. This statistic is particularly personal to me because ETS was the only relocation option accessible to me in 2022 when I reached out to Rainbow Railroad for help. 

I am in that 91 percent because I am now thriving. I feel worthy. I am hopeful about life. And I belong. 

Today, among the 120 million forcibly displaced people around the world, queer and trans individuals face compounded complications from homophobia and transphobia while trying to access protection and safety. And while the anti-gender movement continues to swell in some states, I firmly believe that the U.S. remains a global leader in refugee resettlement — which is why the U.S. government must uphold its international obligations and reverse its recent executive order that imposes severe restrictions on the right to seek asylum. 

Queer and trans individuals deserve freedom, a sense of home, and belonging — realities that flourish only when rooted in the bedrock of safety. 

There is a lot more work to be done. It’s challenging. It’s complex. It’s costly. But I have experienced firsthand what the transformative impact of Rainbow Railroad’s work has on someone’s life — that ability to lift people out of danger into safety is something worth celebrating this Pride. 

Latoya Nugent is the head of engagement for Rainbow Railroad.

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