Unfortunately, in the last two weeks I have received a lot of sad news from my family.  My grandmother just learned during treatment she was having for a broken hip that she has pancreatic cancer. My grandfather has been waiting to die since the death of his twin brother and a few strokes. Two of my grand aunts have cancer: one just found out and the other just decided to stop her chemo treatments.  My uncle learned he may have cancer when he brought my grand aunt to the hospital and the doctor advised him to check himself in – he was completely yellow! 

My sister said “A whole generation of our family might be gone before 2010.” 

I know I’m not the only one that is dealing with gravely ill family members but I know how lucky I am that I will be heading home soon.  In an effort to keep the conversation light, I told my sister “I’ll have to thank them for getting sick now that I only have a month to go – I’ll get to see them before they go.” 

Admittedly, that was a bit morbid. It’s depressing to think about, but I am not permitted to go on emergency leave for anyone outside an immediate family member. Even if my grandmother passed before I get home, since she didn’t raise me, I am not allowed to leave to attend the funeral. 

My sister has been the harbinger of bad news. My mother would rather keep these things from me since “I have enough to worry about.”  But I am glad my sister tells me, even though learning such sad news is distracting. I have been able to discuss my thoughts and feelings with a few of my buddies here. They have been pretty supportive, but when I think about it I get kind of numb. Too much too fast, maybe. 

Reading this over as I write it, I know I should discuss the situation of gays and lesbians and how gay and lesbian soldiers with a sick or dying partnerare stuck pulling at their hair. They might have one or more confidants, as I do with my roommate, since I felt safe enough with him to come out a while back. Or they may have to go at it alone.
 
Maybe they’re not even out to their families, or worse, their families shunned them after they came out. Maybe they don’t have someone like my sister to bring them the news of tragedy.

A husband or wife is considered immediate family and you can get emergency leave to tend to them. Grandparents and aunts do not fall under this umbrella. Obviously, my gay partner is left out also.

The way things stand now and the way I feel at this moment, I am actually angry at the idea I wouldn’t be able to see my partner if he were sick. I know I would start slow and pick up speed, from sane to reckless, doing everything in my power to land myself at my partner’s bedside – hopefully avoiding ending up in jail.

I have a very close family and I can’t get home to see them. My sister is going to see my aunts soon; my grandmother, recuperating from hip surgery, isn’t seeing anyone yet. I will have to continue to hear from a third-party news of what is happening. I plan on calling my mother tonight to let her fill me in on any holes left by my sister.

In the meantime, I wait. To go home. To hear news.

The regulations, instituted in the last days of the Bush administration, strengthened job protections for doctors and nurses who refuse to provide a medical service over religious beliefs.

Human rights groups say the regulations could impair LGBT patients’ access to care services if interpreted to permit providers to choose patients based upon sexual orientation, gender identity or family structure.

The regulations also threaten women’s access to comprehensive health care by permitting pharmacists to refuse to dispense contraception even when doing so significantly burdens the patient’s access, or to refuse to participate in an emergency abortion even when the woman’s health is at risk.

The regulations, which were rushed through days before Bush left office, override many state laws protecting patients’ access to medical services.

“These ill-conceived regulations sacrifice patients’ right to medical care,” said Human Rights Campaign President Joe Solmonese. ” A patient’s access to health care services should not depend on their sexual orientation or gender identity.”

The Bush administration rule was quickly challenged in federal court by several states and medical organizations. As a candidate, President Barack Obama criticized the regulation and campaign aides promised that if elected, he would review it.

Late last week the White House released a statement saying that Obama supports a “carefully crafted” conscience clause – not Bush’s version.

The administration early this week will publish notice of its intentions, opening a 30-day comment period for advocates on both sides, medical groups and the public.

Andrea Markowski said she and her partner Ginette were stunned when the Winnipeg doctor told them during a “meet-and-greet” appointment she was uncomfortable accepting them as patients and had never treated “people like you” before.

The doctor said she only treated “husbands and wives,” said Markowski, who is legally married to her partner of 18 years.

“It was like a kick in the stomach,” said Markowski, who just moved to the city from the Northwest Territories. “It was definitely a traumatic and unexpected experience … She is a doctor who is paid with public funds.

“I have a really hard time understanding how her religion affects her ability to care for me as a human being.”

The couple has lodged a complaint with the province’s human rights commission and the Manitoba College of Physicians and Surgeons.

The Charter of Rights and Freedoms ensures no one can be denied health care on the grounds of sexual orientation, Markowski pointed out. The bodies regulating doctors in Canada must therefore take more responsibility to ensure foreign-trained physicians are ready to practise here, she added.

“We’ve stumbled upon a pretty serious problem and we want to make sure that it gets fixed. In some ways you feel a bit like a prisoner. There are so few doctors, it’s hard to see one, but they still are accountable to provide good service,” Markowski said.

“The College of Physicians and Surgeons in Manitoba and other places in Canada has to broaden the way that it assesses the skills -  particularly of foreign doctors who may be coming from places where beliefs and norms are quite different – to make sure that they really are able to practise the physical, mental and emotional care of patients.”

Dr. Kamelia Elias did not return phone calls seeking comment. But she told the Winnipeg Free Press that she has no experience treating gays and lesbians who have “sexual problems” and “a lot of diseases and infections.”

“I said it’s better to find someone who has experience and will take this type of patients,” she told the newspaper.

Gay-rights organizations are calling for better programs specifically aimed at nipping prejudice in the bud.

The registrar of Manitoba’s physicians college said foreign-trained doctors do undergo an orientation before they can practise in the province. Bill Pope said doctors coming from other countries suffer from culture shock when they come to Canada. Some of them have never done a pelvic exam on a woman or put on a plastic cast, he said.

“How much of a change do you think it would be if you or I were put down somewhere in a Muslim Arabic country or Uzbekistan? It would be a shock,” Pope said. “We would hope that we would be forewarned about areas where we could potentially create problems without our knowing it.”

The province’s college has recently extended its orientation for foreign-trained doctors from one week to a month, he said. There is also some discussion of holding a session with the Manitoba Human Rights Commission so doctors get a briefing of the expectations of them under the charter.

The head of Canada’s gay-rights organization said transgendered people are sometimes denied health care. But Helen Kennedy with EGALE said this is the first instance she’s heard of involving a lesbian.

As the number of foreign-trained doctors in Canada increases, it’s incumbent upon colleges and the country’s Immigration Department to ensure they accept gay, lesbian and transgendered patients, she said.

“This is really sad. It really shows a bigger problem with people who are medically trained coming to Canada from other cultures. There is nothing in place to assist them to make the adjustment and to get the training that they need when they come here.”

Still others say all doctors would benefit from a better understanding of gay and lesbian health issues.

“All physicians need to get more training on this,” said Gens Hellquist, executive director of the Canadian Rainbow Health Coalition. “What little they get tends to be focused on HIV and AIDS, which is only one of the range of health issues.”

(New York City) New Yorkers who binge drink tend to have many more sex partners, putting themselves at an increased risk for sexually transmitted diseases compared with those who drink less or don’t drink at all, according to a new Health Department.

The report – Alcohol Use and Risky Sex in New York City – shows that teenagers who drink are also more likely to engage in risky sexual behaviors, including having multiple sex partners.

Drinking may also be responsible for more sexual transmission of HIV than drug use because it is much more common, particularly among high-risk men who have sex with men.

The report found that about 15 percent of adults - some 883,000 - report binge drinking, defined as five or more drinks on one occasion, at least once a month.

The new study, based on the Health Department’s 2007 Community Health Survey, found that binge drinkers are 50 percent more likely than non-binge drinkers - and three times more likely than non-drinkers - to report having two to four sexual partners in the past year.

Both drinkers and non-drinkers reported high rates of sex without a condom.

“Heavy drinkers are more likely to have multiple partners - increasing their risk of HIV, other STDs, and unplanned pregnancy,” said Dr. Thomas R. Frieden, New York City Health Commissioner.

“Many New Yorkers recognize that drinking increases the risk of injuries and auto accidents, but they may not recognize these other risks. Reducing the amount that people drink can help prevent HIV and other STDs. With rates of syphilis rising, as well as HIV among young MSM, it is important to look at how drinking may be contributing to the problem.”

Men who have sex with men (MSM) are at particularly high risk of binge drinking and its negative consequences the report found.

One in four MSM say they binge drink, compared to one in seven adults city-wide. And MSM who binge drink are twice as likely as non-drinking MSM to report having five or more sex partners in the past year.

In addition to the Community Health Survey, the new report draws on local data from the National HIV Behavioral Surveillance project, which is based on interviews with MSM in gay bars and other venues. While not representative of MSM on the whole, the interviews shed additional light on a subset of this population the Health Department said.

Within this group, 27 percent of the men who had casual partners said they were under the influence of alcohol during their last sexual encounter, and 12 percent were under the influence of alcohol and drugs.

Among men who reported having 20 or more sexual partners in the past year, almost half were under the influence of alcohol the last time they had sex. Drinking also reduced the chances – from 86 percent to 65 percent – that a man having receptive anal intercourse - the highest risk act – would be protected by a condom.

The report, Improving Lesbian, Gay, Bisexual and Transgender Access to Healthcare at New York City Health and Hospitals Corporation Facilities, was released by Public Advocate Betsy Gotbaum.

It specifically details the barriers LGBT New Yorkers confront in obtaining health care from New York City Health and Hospitals Corporation (HHC).

The report found that both were in sensitive to LGBT medical needs, that there often was homophobia and hostility from providers, and as a result many LGBT people in the city are not accessing basic healthcare services. 

“All New Yorkers deserve equal access to public healthcare services, period. And every New Yorker should expect the quality of care to be the same no matter the sexual orientation or gender identity of the patient.,” Gotbaum said.

The report found an assessment of staff training conducted by HHC last year at the Public Advocate’s request shows great variation from facility to facility.

Of the seven HHC networks, three – North Brooklyn, Queens, South Manhattan – indicated that sensitivity to LGBT patients is not explicitly covered in their staff training. The Central Brooklyn network provides staff sensitivity training regarding different sexual practices but no training specific to LGBT individuals. The Generations and Northern Manhattan network only requires Behavioral Health staff to complete LGBT sensitivity training.

The Public Advocate worked with LGBT organizations to identify the most widely shared concerns and formulate recommendations.

Among those consulted were: Broadway Cares/Equity Fights AIDS; Bronx Community Pride Center; Callen-Lorde Community Health Center; Empire State Pride Agenda; Gay Men’s Health Crisis; National LGBT Cancer Network; The Lesbian, Gay, Bisexual & Transgender Community Center; Transgender Legal Defense & Education Fund, Inc.; and Services and Advocacy for GLBT Elders (SAGE).

“This report points out areas of concern that LGBT organizations and I have regarding healthcare for gay and transgender New Yorkers. I have shared these concerns with HHC, as well as recommendations for addressing them, and I expect HHC to take the necessary steps to help LGBT New Yorkers receive quality care,” said Gotbaum.

The report and Gotbaum’s action won plaudits from LGBT health groups.

“The current report is thorough, fair and accurately reflects our community voices and concerns. The National LGBT Cancer Network will do whatever is needed to help these recommendations be implemented,” said Liz Margolies, Founder and Executive Director of the National LGBT Cancer Network.

Ray Carannante, Gender Identity Project Coordinator and Associate Director of Center CARE said, “We know firsthand of the numerous barriers to care that LGBT communities face when seeking services at every level, from the waiting room to the emergency room.”

“Taking steps to ensure the ongoing education and skill development of providers within the Health and Hospitals Corporation will greatly impact the quality of life of all LGBT New Yorkers,” said Carannante.

The Office of the Public Advocate has recommended HHC require in-house LGBT sensitivity training for all HHC employees, that it designate an LGBT liaison in each HHC facility, establish, display, and enforce a zero-tolerance discrimination policy and establish a review process to monitor progress.

Gotbaum also recommended that the Department of Health and Mental Hygiene increase research on LGBT health issues to accurately assess the quality of healthcare services provided to LGBT individuals and to help medical providers address the needs of LGBT patients.

Health concerns common among gay and male bisexual patients include HIV/AIDS, depression, hepatitis, colon cancer, substance abuse, eating disorders, and HPV infection.

Health concerns common among lesbian and female bisexual individuals include breast and some gynecological cancers, obesity, heart disease, and osteoporosis.

For transgender individuals, the most pressing health concerns include HIV/AIDS and other STDs, substance abuse, depression and suicide. Transgender people also commonly face no insurance coverage for trans-health services or care that does not address transgender considerations like hormone therapy.

The law approved by voters in November allows patients with cancer, HIV, AIDS, glaucoma and other diseases to use marijuana to relieve their symptoms on a doctor’s recommendation.

Qualifying patients can register with the state and receive ID cards allowing them to legally acquire, possess, grow, transport and use a limited amount – no more than 2.5 ounces and 12 plants – of marijuana. They also can designate a primary caregiver to receive similar protection.

But those cards won’t be issued until the Department of Community Health introduces guidelines addressing how applications will be handled, what fees will be charged and other issues. The rules must be finalized by April 4.

Until then, anyone possessing marijuana – even patients who could later qualify for the program – can be arrested and prosecuted, though the law allows patients to use a medical-justification defense at trial.

“We have this void where this takes effect now, but there are no rules, regulations or guidance for the people who want to use it or the people who enforce the laws,” said Jim Valentine, chief of police in Lowell and first vice president of the Michigan Association of Chiefs of Police.

Officers in Lowell will arrest marijuana users even if they claim to be patients awaiting cards, Valentine said. He said he’ll let the prosecutor decide whether to pursue charges.

A medical-marijuana program nearly identical to Michigan’s was implemented without major incident in Rhode Island in 2006, said Charles Alexandre, who oversees the program as chief of health professions regulation in Rhode Island’s Department of Health. That state also had a period where the law went into effect before the regulations were in place, and patients simply had to wait until the rules were in order.

“It’s been very quiet,” Alexandre said.

Michigan is the 13th state to allow medicinal use of marijuana, though the state’s law doesn’t address how patients can obtain it. It’s illegal to sell marijuana, even to registered patients. That’s also the case in several other states.

Police in Michigan say they want guidance on the issue, and some experts said the Legislature may have to intervene if that or any other aspect of the program becomes a problem.

Missouri health authorities say preliminary October test results for St. Louis County show two new cases of HIV among people 24 and under.

It isn’t clear whether those cases are even connected to Normandy High School, where students were tested voluntarily in late October. An infected person told county health officials that as many as 50 teens might have been exposed to the virus that causes AIDS.

The county plans a second round of HIV testing in January. Antibodies to the virus can take three to six months to appear. A final assessment isn’t expected for at least six months.

Adam Isaiah Green, Assistant Professor of Sociology at U of T, interviewed dozens of gay men in Toronto to determine what qualities made some men more sexually desirable than others, and what the consequences of being undesirable might be on mental and physical health.

The study appears in the December issue of the Journal of Health and Social Behavior.

“I found that young, white, middle-class men are considered much more sexually desirable than men who are racial minorities, over 40 and poor,” Green said.

“I also learned that for gay men, being considered sexually undesirable can have serious health consequences ranging from psychological issues to risky sexual behavior.”

The study – among the first to examine the link between sex and mental health – found that undesirable gay men face stigmatization, avoidance and outright rejection, which can lead to depression, anxiety and alcohol abuse.

It also highlighted cases in which undesirable gay men will forego safe-sex discussion and, in some cases, condom use, in the context of sex with a more attractive partner.

“We tend to devalue sexual life as something that is extracurricular and frivolous, but this research shows a significant link between sexual desirability and health,” said Green.

“Men with low levels of ‘erotic capital’ are systematically marginalized, which can take a real toll both physically and psychologically.”

It is an intriguing solution to end the AIDS epidemic. But it is based on assumptions rather than data, and is riddled with logistical problems. The research was published online Tuesday in the medical journal, The Lancet.

“It’s quite a startling result,” said Charlie Gilks, an AIDS treatment expert at the World Health Organization and one of the paper’s authors. “In a relatively short amount of time, we could potentially knock the epidemic on its head.”

Gilks and colleagues used data from South Africa and Malawi. In their model, people were voluntarily tested each year and immediately given drugs if they tested positive for HIV, regardless of whether they were sick.

Within 10 years, HIV infections dropped by 95 percent. Other initiatives like safe sex education and male circumcision were also used.

The strategy would cut the estimated number of AIDS deaths between 2008 and 2050 by about half, from about 8.7 million to 3.9 million, leaving only sporadic HIV cases.

Experts think the strategy’s cost would peak at about $3.4 billion a year, though expenses would fall after an initial investment.

“This is certainly beyond the bounds of the current infrastructure for many countries, but that is not a reason not to think big,” said Myron Cohen, of the University of North Carolina, who has done similar research. He was not involved in the WHO study.

Only 3 million people are currently on AIDS drugs. Nearly 7 million people are still awaiting treatment, and about 3 million more people were infected last year. Worldwide, WHO guesses that about 33 million people have HIV.

Increasing access to testing and drugs would stretch already weak health systems in Africa, which has most of the world’s HIV cases.

“This is not like giving someone a Tylenol,” said Jennifer Kates, director of HIV policy for the Kaiser Family Foundation in Washington, DC. Once people start AIDS drugs, they must continue indefinitely. “The idea should be explored, but it’s a huge leap,” Kates said.

Handing out AIDS drugs to everyone who tests positive could also worsen drug resistance.

In addition, doctors don’t know if it’s safe to take AIDS drugs for decades; the oldest drug combinations have only been around for about a dozen years.

Other experts questioned whether the strategy might infringe on patient’s rights. Once people test positive for HIV, they would be advised to start treatment, even if they weren’t sick.

That would benefit the community, but not necessarily the patients themselves. AIDS drugs come with side effects including vomiting, liver failure, and heart attacks.

WHO emphasized that the study findings do not signal a policy change. “This is only a theoretical exercise,” said Dr. Kevin De Cock, director of WHO’s HIV/AIDS department. He said WHO would hold a meeting next year to study the idea more closely.

Vadim Pokrovsky says Russia must spend the funds more wisely by focusing on prevention as well as treatment in order to slow the spread of HIV.

He says he fears the global economic crisis could threaten future funding.

Pokrovsky says Russia has registered a total of 471,000 people as HIV-infected, including more than 50,000 who have died of AIDS-related causes. He told reporters Friday that the actual number of people with HIV was likely higher than 1 million.

The government says it budgeted 10.7 billion rubles ($445 million) for the cause last year – at least 50 times more than in 2005.