Sunday, January 5, 2014

Pope Francis Calls For Church To Provide New Understanding When Dealing With Children Of Gay And Divorced Parents, Organizers Of Orange County Tet Parade Vote To Include LGBT Participants, Student Group Successfully Pushes For Vote On Transgender Bathrooms At University Of Houston Campus, Gay Men Resisting HIV Preventative Medication Truvada, Relapse Of “Cured” HIV Patients Fails To Discourage Scientists

In Rome, Pope Francis has called for a rethink in the way the Catholic Church deals with the children of gay couples and divorced parents, warning against "administering a vaccine against faith." Francis said in a speech to the Catholic Union of Superiors General in November, extracts of which were published on Italian media websites on Saturday, that, "On an educational level, gay unions raise challenges for us today which for us are sometimes difficult to understand. The number of children in schools whose parents have separated is very high." He added that family make-ups were also changing. "I remember a case in which a sad little girl confessed to her teacher: 'my mother's girlfriend doesn't love me'," he was quoted as saying. The pontiff said educational leaders should ask themselves "how can we proclaim Christ to a generation that is changing?" He added: "We must be careful not to administer a vaccine against faith to them." Though the Church has often been in conflict with the lesbian, gay, bisexual and transgender community over its opposition to same sex marriage and to homosexuality, Francis has drawn praise for attempts to be inclusive.In July he reached out to gays, declaring that "if someone is gay and seeks the Lord with good will, who am I to judge?" And in December, the Advocate magazine -- dedicated to the gay and lesbian community -- chose the head of the Catholic Church as the "single most influential person of 2013 on the lives of LGBT people." The reform-minded pontiff has also called an extraordinary assembly of the Synod of Bishops next year to discuss the Church's position with regard to the family, which is expected to address among other issues the problem of divorcees remarrying and children of divorced parents.

In California, organizers of the upcoming Tet Parade have voted to allow gay and lesbian participants to march in the annual event. The decision is the latest chapter in a months-long saga pitting members of a gay, lesbian, bisexual, and transsexual group called Viet Rainbow Orange County against members of the Vietnamese American Federation of Southern California, the community group that organizes the annual procession along Bolsa Avenue in the heart of Little Saigon. Federation members cast ballots Saturday afternoon during a two-hour meeting at the Vietnamese Cultural Center in Garden Grove. In the end, 51 members voted to include gay and lesbian participants, while 36 voted against. Ten members cast “abstain” ballots, according to federation members and Westminster officials. “We’re not surprised by the vote, because we always knew that inclusion and equality triumphs over ignorance and prejudice,” said Hieu Nguyen, co-founder of the LGBT group, Viet ROC. Gay and lesbian participants were barred from marching in the Tet Parade last year, the first year it was organized by the federation. City officials funded the event for 18 years, but pulled back last year because of budget cuts. The Tet Parade celebrates the Lunar New Year and is scheduled this year for February 1. The City Council in December reluctantly approved a permit for the federation to host the parade again, despite pleas from the LGBT group and their supporters to block the procession if they weren’t allowed to participate. But city leaders can’t mandate who participates in a privately organized parade, which is constitutionally protected under First Amendment free-speech rights, said City Attorney Richard Jones. Federation members said the LGBT lifestyle was not yet accepted in their community, and it was their constitutionally-protected right to exclude the group. Westminster Mayor Tri Ta and Councilman Sergio Contreras attended the meeting Saturday and were allowed to cast ballots. Ta and Contreras said they voted in favor of allowing LGBT participants to march. “We’ve asked for unity and we wanted to see everyone participate in the parade,” Ta said. “This is a celebration of the new year. Everyone should celebrate together.” City leaders advocated for the two sides to reach an agreement on inclusion. Ta and Contreras sat down with group members in December in an attempt to reach a deal. “The city is extremely pleased with the results,” Contreras said. “It’s what we wanted - inclusion for all.” Nguyen said LGBT participants will march in the parade carrying rainbow flags and the Viet ROC banner. “We want to have our message of family, love, unity, respect and community be out there,” Nguyen said. Neil Nguyen, federation president, did not immediately respond to a phone message seeking comment. Federation member Jason Doan, who cast an “abstain” ballot, said the vote should strengthen ties between the two groups, rather than divide. “There was a lot of harsh talk,” said Doan, a Westminster resident. “(LGBT participants) should be allowed to be part of the mainstream and not be ashamed of who they are. This will be a step forward for the community as a whole.”

In Texas, when a transgender person is still in the transition process, using a public restroom can be uncomfortable or even unsafe, depending upon the mindset of others. At the University of Houston-Downtown, a student leader says that potential for discomfort could ease if administrators accept a proposal about to be embraced by the Student Government Association. That proposal calls for the university to select two existing restrooms in each main building and designate them as "gender-neutral," meaning they would be open to anyone, said Kristopher Sharp, Student Government Association vice president. Meanwhile, university administrators say they have been working quietly for months to address the issue by building new, single-room restrooms that can be locked, similar to "family" restrooms in airports. The first such private restroom is scheduled to open at the end of February in an area that is still under construction on the north end of campus, said John Hudson, director of the university's new Center for Student Diversity, Equity and Inclusion. "Others we hope would come on line later in the year," Hudson said. The administration's plan calls for a total of five private restrooms - one in each main building, one near the auditorium and one at the sports center, he said. The student proposal, which is scheduled for a vote January 10, has the advantage of being cheaper and quicker, since it requires only a new sign (and possibly instructions) on the door, Sharp said. The proposal has the backing of all seven senators, said Sharp, who put forward the idea but is not eligible to vote for it because he's an officer. "It is very rare that we all come together," he said. Converting one men's restroom and one women's restroom in each of three buildings would make a total of six gender-neutral facilities out of more than 60 restrooms on campus, Sharp said. "There will be many other restrooms that people can use," he said. "There is some misconception that we're changing them all." Sharp, 24, a senior majoring in social work, said he had heard that the new construction would include a family restroom but was unaware it was scheduled to be ready next month. "This is the first I've heard about it," said Sharp, who is also president of Safe Zone, the campus organization representing lesbian, gay, bisexual, transgender and queer students. Providing restrooms that everyone feels comfortable using is actually a health issue, Sharp said. Some students have refrained from using the restroom at all on campus, he said, rather than face someone telling them to get out. A male-to-female transgender student who is living as a woman was twice confronted in the women's restroom and stopped using the campus facility, Sharp said. She has heard of other transgender people in similar situations who developed urinary tract infections and is worried it could happen to her, he said. To its credit, Sharp said, the university is reviewing everything that can be done to help students feel accepted. "We as an entire institution have been analyzing what we can do to make students feel safe," he said.

Many health experts hoped that the medication — Truvada, a combination of two antiviral drugs that has been used to treat HIV since 2004 — would be exuberantly embraced by HIV-negative gay men. Instead, Truvada has been slow to catch on as an HIV preventive in the 18 months since the strategy’s approval by the Food and Drug Administration. In some quarters, the idea that healthy gay men should take a medication to prevent infection — an approach called pre-exposure prophylaxis, or PrEP — has met with hostility or indifference. “It’s gotten tons of attention at HIV meetings as a new tool for prevention, and I consider it an important option for the right person,” said Dr. Lisa Capaldini, a primary care doctor here who treats many gay men. “And yet there’s been very little interest among my patients. There’s a fascinating disconnect.” For 30 years, public health officials have aggressively promoted condom use during every sexual encounter as the only effective method, apart from abstinence, for preventing HIV transmission. Still, 50,000 new infections are occurring annually in the United States; sexual transmission between men accounts for more than half of them, and a disproportionate number among African-Americans and other minorities. Many experts hailed Truvada as an opportunity to reduce new infections among high-risk groups like young gay men, people in relationships with HIV-positive partners, and prostitutes. The FDA called for prescriptions to be accompanied by counseling, frequent HIV testing, and continued promotion of safer sex, although research suggests that daily use of the pill alone confers close to full protection. For many gay men, and for some public health officials, the new option has brought both hope and confusion. “We’ve had several decades of the recommendation to use condoms,” said Dr. Kenneth H. Mayer, a professor of medicine at Harvard University and the medical research director at Fenway Health, a community center in Boston with many lesbian and gay patients. “Now we’re saying, ‘Here’s a pill that might protect you if you don’t use condoms.’ So it’s flying in the face of community norms.” Certainly, fewer people have tried PrEP than many experts had anticipated. According to an analysis by Gilead Sciences, which makes the drug, data from more than half of retail pharmacies nationwide indicated that 1,774 people filled prescriptions for Truvada for HIV prevention from January 2011 (it could be prescribed off-label before the FDA approval) through March 2013. The numbers did not include the thousands already receiving the drug as research participants. Almost half of the prescriptions were for women, a surprise to those who expected gay men to be the early adopters. Dr. Deborah Cohan, an obstetrician and gynecologist at the University of California, San Francisco, has prescribed it to several women with HIV-positive partners, including one seeking to get pregnant. “It’s beautiful that we have this intervention that works for women who need it,” Dr. Cohan said. So why haven’t more gay men signed up? Some men have reported receiving negative reactions from their health care providers when they brought it up. Use of the drug as a preventive can be stigmatizing among gay men as well: the term “Truvada whore” has been bandied about on some social networks. And many simply may not know much about the strategy. Gilead has not launched a public campaign to market Truvada for prevention, but has instead sponsored activities by other organizations. Fenway Health, for example, has received Gilead funding for some PrEP-related education and research. Potential side effects like kidney damage and a loss of bone density, although rare, are also a concern. And Truvada is expensive: more than $1,000 a month. So far, private and public insurers, including state Medicaid programs, have generally covered the drug for prevention. (Gilead also provides it to some patients who cannot afford it.) But a generational shift in attitudes toward HIV among gay men may also be playing a role, some experts say. With advances in treatment, many younger men who did not experience the worst years of the epidemic are less fearful of the consequences of infection. Moreover, current medications can lower viral levels in HIV-positive people to the point where the risk of transmission is negligible, further reducing the perceived need for PrEP among HIV-negative partners. Damon Jacobs, a New York psychotherapist, began taking Truvada following the breakup of a long-term relationship. “I found that I was no longer as consistent with condom use as I had been in earlier days, and that scared me greatly,” said Mr. Jacobs, 42, who maintains a Facebook page promoting PrEP. He said that he has not missed a dose in two years; he also acknowledged that he was now much less likely to use condoms. That sort of acknowledgment makes some health care experts nervous, despite Truvada’s efficacy when used daily. The AIDS Healthcare Foundation, a major HIV services provider based in Los Angeles, lobbied against FDA approval of Truvada for HIV prevention, arguing that men taking the medication would be likelier to pursue riskier sexual practices. Certainly, “condom fatigue” among gay men is real. The proportion who reported unprotected anal sex in the previous year rose to 57-percent in 2011 from 48-percent in 2005, according to the Centers for Disease Control and Prevention. But a recent study found that men in a large clinical trial who believed they were taking Truvada rather than placebo did not increase their risky behavior. For his part, Mr. Rubio, the San Francisco coordinator, said he remained “adamant” about using condoms. “For me, this is a whole other layer of protection,” he said. Adherence to the drug regimen is another thorny issue. The major trial that confirmed Truvada as an effective HIV preventive among men who have sex with men, also found that many participants did not take the pill every day, leaving them more vulnerable to infection. Michael Weinstein, president of the AIDS Healthcare Foundation, warned that drug adherence will continue to be a problem, likely leading to more infections and the emergence of drug-resistant HIV strains. “If you don’t take the medication every day and you don’t use condoms, and you’re highly sexually active, you’re going to get infected,” Mr. Weinstein said. Advocates for PrEP argue, without substantial evidence to date, that people now taking and starting Truvada for prevention may be more likely to follow instructions because they know that it works, unlike participants in the early clinical trials. In any event, the protocol for pre-exposure prophylaxis is itself likely to undergo significant changes as findings emerge from current and upcoming research into other formulations of Truvada such as gels or injectables, less frequent dosing regimens, and the use of other medications altogether. “People are not lining up, but I’m not pessimistic,” said Dr. Mayer of Fenway Health. “It’s going to take time. It’s really early days.”

Scientists seeking a cure for AIDS say they have been inspired, not crushed, by a major setback in which two HIV positive patients believed to have been cured found the virus re-invading their bodies once more. True, the news hit hard last month that the so-called "Boston patients" - two men who received bone marrow transplants that appeared to rid them completely of the AIDS-causing virus - had relapsed and gone back onto antiretroviral treatment. But experts say the disappointment could lay the basis for important leaps forward in the search for a cure. "It's a setback for the patients, of course, but an advance for the field because the field has now gained a lot more knowledge," said Steven Deeks, a professor and HIV expert at the University of California, San Francisco. He and other experts say the primary practical message is that current tests designed to detect even very low levels of HIV present in the body are simply not sensitive enough. As well as having the human immunodeficiency virus (HIV), the Boston patients both also had a type of blood cancer called lymphoma, for which they were treated using bone marrow transplants - one man in 2008 and the other in 2010. They continued taking the antiretroviral AIDS drugs, but eight months after each patient's transplant, doctors found they could not detect any sign of HIV in their blood. In the early part of 2013, both patients decided to stop taking their AIDS drugs and both appeared to remain HIV-free - prompting their doctors, Timothy Henrich and Daniel Kuritzkes from Boston's Brigham and Women's Hospital, to announce at a conference in July that they may have been cured. Yet in December came news that one of the men had begun to show signs of an HIV rebound by August, while the second patient had a relapse in November. Henrich said the virus' comeback underlined how ingenious HIV can be in finding hiding places in the body to evade attack efforts by the immune system and by drug treatment. "Through this research we have discovered the HIV reservoir is deeper and more persistent than previously known and that our current standards of probing for HIV may not be sufficient," he said, adding that both patients were "currently in good health" and back on antiretroviral therapy. Barely a decade ago, few HIV scientists would have dared put the words HIV and cure in the same sentence. Yet some intriguing and inspiring cases in recent years mean many now believe it is just a question of time before a cure is found. First was the now famous case of Timothy Ray Brown, the so-called "Berlin patient," whose HIV was eradicated by a complex treatment for leukaemia in 2007 involving the destruction of his immune system and a stem cell transplant from a donor with a rare genetic mutation that resists HIV infection. Such an elaborate, expensive and life-threatening procedure could never be used as a broad-spectrum approach for the world's 34 million HIV patients. But the results in Brown focussed scientific attention on a genetic mutation known as 'CCR5 delta 32' as a target for possible gene therapy treatment. Then last March, French scientists who followed 14 HIV-positive people known as the "Visconti patients", who were treated very swiftly with HIV drugs but then stopped treatment, said that even after seven years off therapy, they were still showing no signs of the virus rebounding. That announcement came only weeks after news of the "functional cure" of an HIV-positive baby in Mississippi who received antiretroviral treatment for 18 months from the day she was born. By the time she was two this appeared to have stopped the virus replicating and spreading. A "functional cure" is when HIV is reduced to such low levels that it is kept at bay even without treatment, though the virus can still be detected in the body. Sharon Lewin, an HIV expert at Monash University in Australia, said all these developments, as well as the setback suffered by the Boston patients, inspired scientists to investigate many different approaches in the search for a cure. "We've learnt many things here - and one of the most important is that a tiny, tiny amount of virus can get the whole thing going again," she told Reuters. "It's a clear message that we need better ways to pick up the virus." Scientists are now more convinced than ever that a two-pronged approach which aims to firmly suppress the virus while bolstering the immune system provides the best way forward. "We need to attack in two ways - reduce the virus to very low levels and also to boost the immune response. We can't do one without the other," said Lewin. "So we still have to think of other creative ways to control HIV. And it's still early days... before we can say which approach is likely to be the winner."

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