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The genderless and infinite soul

Tamsin Wu writes about how the concept of reincarnation can be crucial in understanding and accepting the natural existence of LGBTQ in our lives.

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Souls pertain to the immortal force that drives the human being. Being immortal and immaterial, it never perishes, but rather gets to be incarnated time after time. Reincarnations are used to explain away the amazing talents of child prodigies, the unexplainable connection between soulmates, as well as the countless events and karma we experience. The concept of reincarnation can be crucial in understanding and accepting the natural existence of LGBTQ in our lives.

In a nutshell, reincarnation is about infinite souls going through different existential forms and lives. Souls live through this world again and again in order to fulfill spiritual contracts, learn further and face karma. A lot of our current experiences depend on the good and bad deeds we’ve made in our lifetimes before. In enlightenment, souls would be able to go to higher consciousness and realms away from the world we know of today.

While some philosophies or spiritual beliefs – such as those found in Buddhism, Hinduism and Plato’s philosophy – talk about the rebirth and ascension of the soul throughout many lives before and after, other more popular religions discredit it. Some people are closed off from reincarnation thinking it’s too much of a foreign idea in our conventional belief system for it to be real. This is unsurprisingly so considering the widespread indoctrination of mainstream Christian religion on people since the time they were born. They wouldn’t be able to grasp the concept of reincarnation without the fear of punishment for compromising their devotedness in the typical Biblical interpretations they’re accustomed to. However, in these modern days, more Christians or Catholics are showing an open-mindedness to spiritual activities and beliefs that have been considered unholy by tradition. Besides psychic reading and feng shui, the belief in reincarnation is one of them.

Religious talks aside, it is refreshing to know that psychology and science is progressing in their studies of the possibility of reincarnation. From pro-LGBTQ arguments that gay people are just born that way to interesting explanations about how homosexuality exists naturally in the animal kingdom, perhaps we can put reincarnation into the mix.

In order to blow away the cancerous notion that LGBTQ is something abnormal, demonic or out of the ordinary, we have to comprehend nonheterosexuality from a standpoint higher than the limiting characteristics of anatomy our souls are moving in.

There are two things that need to be clarified in understanding LGBTQ – sexual orientation and sexual identity. Lesbian, gay, bisexual, straight belong to sexual orientation. For many years, most societies have been heteronormative – a romantic relationship should only be between a guy and girl. Homosexuality has been feared, derided and punished. In some parts of the globe, this is still the dangerous scenario. But, as the world works, there’s always a Yang (good) to the Yin (bad). Gradually, marriage equality has been sprouting in some countries and LGBTQ is being celebrated. Humanity is starting to understand that as long as something comes out of love, there is no evil when two people of the same gender enter into a relationship. There is no harm done when a person wants to express him/herself in a way that deviates from the social constructs of masculinity and femininity. In actuality, humans fall in one or more spectrum within the Kinsey Scale in their lifetime. Eventually, they find the point that rings true to them, which brings them a step closer to fulfillment. This sexuality scale is useful to understand attraction between humans because it goes beyond the binary concept of gender, which is not inherent in souls. It shows that people cannot be labeled as only either-or, black-and-white.

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Sexual identity, as the name implies, refers to which gender a person sees oneself as. Sexual identity doesn’t immediately determine sexual orientation, which is same as the fact that biological gender doesn’t determine sexual orientation.

This brings us to the topic of transgender. Why do transgendered people identify as a certain gender that’s the opposite of the biological gender they have been born with? Doesn’t this show that the soul does have a gender? Aside from the explanation of the complexity of gender development, we can also attribute this to the reincarnation concept. As has been said, souls have gone through different lifetimes, and none of us know what stories and experiences other people’s souls have gone through (unless you’re a legit past life reader, or you have remnants of past life memories in your brain which have been testified by some). Those past lifetimes may have left some deeply felt characteristics in some people’s current human existence that had them to believe that they must be a certain gender. Past experiences and karma comes into the picture. Whatever it is, we should not judge them because it is part of their own journey. The best that we can do to understand is to see pass the material and physical essence. We should not allow our consciousness to get stuck in this dimension of materialism. Otherwise, we will always follow a limited way of thinking that bars us from embracing the beautiful infiniteness and grandness of our existence in this universe.

All of us face different joys and struggles in our lives that pave the path towards growth, strength and wisdom. For the LGBTQ community, the struggle of simply being comfortable in our own skin can already be seen as a political stance and challenging towards the status quo, even though we’re just being our authentic selves. But what is the “self’? The self is the so-called “ego” that has been painted layers upon layers of physical characteristics, social engineering and labeling, consumerist inclinations, media and political propaganda. Peel away all those thick layers and we are just left with this profound life force called the soul, with energies derived from multiples lives. Hence, the soul’s ego is molded and re-molded depending on such layers presently dealt with by the soul. Contrary to what a lot of people have been thinking their whole lives, the soul is not defined by the body. It doesn’t have a ghostly, feather-light appearance of our physical body which has been portrayed countless times on the screen. The soul is without the imposing characteristics and behavior of a human gender. The soul is unisex, devoid of such human concept. That is why regardless of race, class, religion, gender, sexual expression and orientation, we are all the same at the core of our existence. This is a universal truth that holds all of us together. It is only with layers of physical limitations, lies, fabricated truths and distorted facts that we have been differentiated and pitted against each other, as well as blinded from the true nature of our being.

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To elucidate further the difference between the soul and ego, let me share with you a recent past life reading I’ve had with my girlfriend at a The Third Eye Wellness party. The past life reader gave me a feeling of certainty that her readings were true because of the things she said about my girlfriend and I even before I’ve divulged any information to her. Anyway, on to the past life…

I honestly couldn’t remember anymore if she asked us to pick cards when she was reading a part of our past (love)life. I can only remember the details she saw. According to her reading, I was a thin, frail-looking man and my girlfriend was the woman. I was a man of wealth who held a silent dignity and substance. The woman’s face looked a lot like my girlfriend’s face, and she was someone who loved to socialize and who wore big dresses. We both mutually loved each other, albeit discreetly, since she was already married to an off-putting man with a moustache. Although they didn’t have a happy marriage, she stayed poised and positive in her life. On the other hand, the past life reader told me that she could see a plump woman with a high-pitched voice, but she couldn’t tell if that was my wife or my mother. That plump woman was dominating me in that toxic relationship as I chose to keep mum whenever she scolds. However, there were times that she showed loving ways towards me. The past life reader added that the man whom my girlfriend was married to is a male relative of hers in this lifetime. It is someone whom she dislikes very much. (We know who that is..)

The past life reader told us that we never did anything unfaithful. We just loved each other without harming anyone else. After that lifetime, she said that perhaps our souls made a contract to be women in this lifetime (and, might I add, in a country wherein LGBTQ rights are still being largely fought for) to keep in tune with the kind of discreet relationship we had before.

However, as the past life reader also said, the lifetime she described to us isn’t necessarily the previous lifetime. There were probably a few lifetimes in-between that and this current lifetime. What is important, anyhow, is the learning and growth we’ve gained, and to continue to gain.

The read was indeed interesting and just goes to show how our egos change from one lifetime to another. However, there are some things that stay the same wherever lifetime your soul goes to. Parts of your personality and relationships repeat, albeit in different situations, from one lifetime to another.

As we go through life, the soul needs to be nurtured despite the obstacles put forth in our earthly existence. Pure intentions of love, compassion, helping and learning add positivity to the soul and the environment. Hate, ignorance and violence, on the other hand, add negativity. Therefore, attacking someone based on sexual orientation and gender is obviously wrong, and would definitely reap bad karma. This is done from a consciousness of ill and uninformed thoughts. Ultimately, the goal is to rid the soul, and on a grander scale, this world, of such impurities.

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In the words of Scarlet Johannson’s character Lucy, “We never really die”. Our bodies or selves gradually morph into death, but our souls surpass it. Souls will go from one lifetime to the next, and perhaps beyond this planet we call Earth. This isn’t a new radical way of existential thinking. Old centuries have recognized that there are higher spiritual planes and dimensions than our human mind can reach. It is only with the constant pursuit of noble values, such as wisdom and love, will we transcend this lowly, materialistic existence we’ve been held to. All souls – young and old – go through this worldly life to grow and break free from negativity and oppression. Eventually, we can all attain the spiritual height that sends us back to our source, or to God, as others would say.

In the meantime, let us enjoy discovering what learning the universe has to offer us, as well as what purposes our situations and relationships want us to fulfill.

A sure-footed wanderer. A shy, but strong personality. Hot-headed but cool. A critic of this propaganda-filled, often brainwashed society. A lover of nature, creativity and intellectual pursuits. Femme in all the right places. Breaking down stereotypical perspectives and narrow-mindedness. A writer with a pen name and no face. I'm a private person, but not closeted. Stay true!

Health & Wellness

Gender identity conversion efforts associated with adverse mental health outcomes

Reported exposure to conversion efforts before the age of 10 also was associated with greater lifetime odds of suicide attempts.

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Gender identity conversion efforts to try to change a person’s gender identity to match their sex assigned at birth were associated with increased likelihood of adverse mental health outcomes, including suicide attempts.

This is according to a study helmed by Jack L. Turban, M.D., M.H.S., of the Massachusetts General Hospital, Boston.

The study, tiled “Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults”, and which appeared in JAMA Psychiatry, involved nearly 28,000 transgender adults from across the US. This observational study is based on the results of a survey distributed through community outreach to transgender adults in all 50 states, the District of Columbia, some territories and overseas U.S. military bases.

Of 27,715 transgender adults who responded, 19,741 (71.3%) reported having spoken to a secular or religious professional about their gender identity and of these 3,869 (19.6%) reported exposure to gender identity conversion efforts.

That exposure was associated with severe psychological distress during the previous month and prior suicide attempts during their lifetime compared with transgender adults who reported talking about their gender identity with a professional but weren’t exposed to conversion efforts.

Reported exposure to conversion efforts before the age of 10 also was associated with greater lifetime odds of suicide attempts.

Limitations of the study include its inability to determine causation; it didn’t capture conversion efforts by others such as family members; and it’s possible that some adults with worse mental health might have sought conversion therapy.

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The study findings support that gender identity conversion efforts should be avoided in children and adults. Professional organizations, including the American Psychiatric Association, have called conversion therapy for gender identity unethical and ineffective, and some countries have already outlawed the practice.

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Pregnant trans men at risk for depression and lack of care, Rutgers study finds

Older transgender men who become pregnant need better mental health care than female counterparts.

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Transgender men who become pregnant are at increased risk for depression and difficulty getting medical care due to a lack of knowledge among health care providers, a Rutgers study reports.

The study, published in the journal Maturitas, examined health care research on transgender men who become pregnant at or after age 35 to determine their medical and mental health needs.

“Despite the increased visibility of transgender people — there are about 1.4 million who have transitioned in the United States — medical providers are largely unprepared to care for them and most have had limited educational opportunities,” said lead author Justin Brandt, an assistant clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at Rutgers Robert Wood Johnson Medical School.

Transgender men who have transitioned hormonally and are taking testosterone but retain their female reproductive organs have the potential to become pregnant. Since the U.S. medical system has been tracking these patients as female, no data exists on how many transgender men give birth each year, but Brandt said the number is likely higher than people realize. While some plan to become pregnant, the research suggests that unintended pregnancies occur in up to 30 percent of transgender men.

According to the U.S. Transgender Survey, nearly 40 percent of its 28,000 respondents reported attempting suicide — nearly nine times the national average. That risk can be increased in transgender men with the unwanted physical changes resulting from pregnancy, according to Brandt. “The process of transitioning is long and arduous, and pregnancy, which is regarded as a feminine condition, forces these men to almost fully transition back to their sex assigned at birth, which can worsen gender dysphoria,” he said.

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Surveys used to screen pregnant and postpartum females for depression are not designed to assess the impact of pregnancy on gender dysphoria in transgender men.

The study also found that nearly 25 percent of transgender people reported negative health care experiences in the last year. This correlates with the finding that about 44 percent of pregnant transgender men seek medical care outside of traditional care with an obstetrician. Rather, they may seek out non-physician providers, such as nurse midwives, with 17 percent delivering outside of hospitals — a higher rate than with women.

Although data is limited on how transgender men give birth, the review found that 64 percent had vaginal births and 25 percent requested cesarean delivery.

The report also noted that transgender men who requested cesarean deliveries reported feeling uncomfortable with their genitalia being exposed for long periods of time while those who went through labor reported that the process of giving birth vaginally overcame any negative feelings that they had with the female gender that they had been assigned at birth.

“Although Rutgers physicians have not yet had a pregnant transgender male patient, our healthcare professionals are trained and ready,” Brandt said.

The researchers also found that about 51 percent of transgender men breast or chest fed their infants even if they had breast surgery.

Brandt recommended that transgender men planning to conceive should visit their doctor before becoming pregnant to address routine issues, such as folic acid supplementation and screening for genetic disorders, and to be counseled on the risks of advanced-age pregnancy, such as infertility, miscarriage, gestational diabetes and pre-term delivery. Transgender men also likely will need to update health screenings that could have lapsed during transition, such as pap smears and, when indicated for those who have not had chest surgery, mammograms.

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After delivery, Brandt said doctors should address long-acting and reversible methods of contraception if the individual is at risk for unplanned pregnancy. “Transgender men who intend to restart testosterone after delivery may decide to defer contraception since they perceive that their male hormone therapy induces a state of infertility, which is not always the case,” he said.

Co-authors included Amy Patel, Ian Marshall and Gloria A. Bachmann at Rutgers Robert Wood Johnson Medical School.

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Health & Wellness

Little link found on popper use and dependency; no correlation with mental health or psychological stress

A survey of more than 800 men aged 18 to 35 found little evidence of typical dependency characteristics, including health, social, legal and financial problems, and no correlation between popper use and mental health or psychological stress.

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Young gay and bisexual men are frequent users of alkyl nitrites, or poppers, but few show signs of addiction, risky consumption habits or other psychosocial problems. This is according to ‘Harmless? A hierarchical analysis of poppers use among young gay and bisexual men’, by Dr Daniel Demant and Dr Oscar Oviedo-Trespalacios, and published in Drug and Alcohol Review.

A survey of more than 800 men aged 18 to 35 found little evidence of typical dependency characteristics, including health, social, legal and financial problems, and no correlation between popper use and mental health or psychological stress.

The study is particularly noteworthy considering some efforts to control popper use and distribution – e.g. in Australia. Dr. Daniel Demant, public health researcher at the University of Technology Sydney (UTS), who conducted the study, said that the decision by Australia’s Therapeutic Goods Administration (TGA) to step back from prohibiting poppers is commendable. The TGA, instead, elected to classify them as a Schedule 3 drug, available over the counter in pharmacies from February 2020.

An interim decision by the TGA in 2018 recommended poppers be classed as a prohibited substance, in the same category as methamphetamine and heroin, which would have made “overnight criminals” of the estimated 100,000 plus Australian users.

“What we see with this research is that poppers are a very commonly used drug in the LGBT community, both recently and over their lifetime,” Demant said. “Most of the users are already oppressed or marginalized based on their social identity as gay or bisexual men. This creates a question as to whether there would have been a discriminatory element in banning a substance with such a low risk profile.”

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Demant added that banning a substance that is used by so many people would create a “new class of criminals, basically overnight.”

Currently, poppers are available on prescription from pharmacies, but they are more commonly bought illicitly, in sex-on-premises venues and LGBT bars. A vial containing 25-30mL of the clear, strong-smelling fluid, possibly labelled as “VHS tape cleaner”, “leather cleaner” or “room deodorizer”, sells for up to $50 (or equivalent in countries like the Philippines), despite costing a couple of cents to manufacture.

The new TGA decision to regulate poppers rather than banning them hopefully paves the way for some measure of quality control as well as the removal of the “extreme profit margin” that exists now, Demant said.

Demant said that with poppers becoming a pharmacy-only medicine, safety standards would have to be met and pharmacy staff could provide guidance in cases where poppers might react badly with users’ other medications, particularly Viagra.

“We could stop pretending that poppers are sold for anything other than getting people high. And once we do offer it in pharmacies, we would have something made to the highest standards for people to use,” Demant ended.

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LGBT people more likely to develop dementia, according to study

More than 14% of sexual and gender minorities (SGM) reported subjective cognitive decline, significantly higher (p<0.0001) than the 10% rate among cisgender heterosexual participants.

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More than 14% of sexual and gender minorities (SGM) reported subjective cognitive decline, significantly higher (p<0.0001) than the 10% rate among cisgender heterosexual participants. Even after adjusting for factors such as income, age and race, SGM participants were 29% more likely to report subjective cognitive decline (SCD).

This is according to a study presented at the Alzheimer’s Association International Conference (AAIC) 2019 in Los Angeles in the US. The study noted that to date, few studies have investigated the symptoms and disease progression of Alzheimer’s and other dementias in the LGBT community. And so to examine these associations, Jason Flatt, PhD, MPH, assistant professor at the Institute for Health & Aging at the University of California, San Francisco, and colleagues analyzed data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), a large phone-based survey led by the Centers for Disease Control and Prevention.

The study analyzed data from 44,403 adults aged 45 and older across nine states in the US (Georgia, Hawaii, Illinois, Minnesota, Nevada, Ohio, Virginia, West Virginia and Wisconsin) that participated in the 2015 BRFSS optional modules on the Healthy Brain Initiative, which included subjective cognitive decline and Sexual Orientation and Gender Identity. Roughly three percent of participants (1,253) identified as a sexual or gender minority (SGM). Subjective cognitive decline was defined as self-reported confusion or memory problems that have been getting worse over the past year.

The study – as noted – found higher rates of subjective cognitive decline among LGBT people compared to their cisgender heterosexual counterparts.

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“Given that one in seven adults who identified as a sexual or gender minority reported subjective cognitive decline, it is critical that more opportunities exist for people in these communities to receive regular evaluation for cognitive impairment and Alzheimer’s disease,” Flatt said. “There is also a need for greater education on Alzheimer’s risk, signs and symptoms, and training of health care providers to ensure inclusive and welcoming care for LGBTQ+ populations.”

Flatt added that “while we do not yet know for certain why sexual or gender minority individuals had higher subjective cognitive decline, we believe it may be due to higher rates of depression, inability to work, high stress, and a lack of regular access to healthcare.”

According to Flatt, less than half of SGM adults with SCD in the study talked to their health care provider about it. SGM adults with SCD were also more likely to report that they had to give up day-to-day activities (39% vs. 29%, p=0.003) and needed help with household tasks (44% vs. 35%, p=0.01) than cisgender heterosexual participants. Both groups were similar in terms of talking to their health care provider about their SCD.

LGBT people living with dementia and their caregivers often have difficulty accessing information and support services, which can be especially challenging when memory loss and dementia enter the equation.
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To advance research into Alzheimer’s in the LGBT community, Karen Fredriksen-Goldsen, PhD, professor and director of Healthy Generations Hartford Center of Excellence at the University of Washington, created the “Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA)” study. A multisite study in Seattle, San Francisco and Los Angeles, this is the first federally-funded study on dementia intervention specifically designed for LGBT older adults with dementia and their caregivers.

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The researchers had previously identified unique risk factors of LGBT older adults living with dementia through the first longitudinal study of this population (Aging with Pride: National Health, Aging, and Sexuality/Gender Study). Using longitudinal data with three time points (2014, 2015 and 2016), modifiable factors predicting physical functioning and quality of life (QOL) among LGBT older adults with dementia (n=646) were identified.

LGBT older adults living with dementia were significantly more likely to live alone (nearly 60%), not be partnered or married (65%), not have children (72%), and not have a caregiver (59%), when compared to older non-LGBT adults living with dementia. Previous experiences of discrimination and victimization (b=-0.19, p<.001) were negatively associated with QOL among LGBT older adults living with dementia. Socializing with friends or family (b=1.11, p<.05) was positively associated with QOL, and physical activity (b = 0.26, p<.001) were associated with better physical functioning.

Also as reported at AAIC 2019, “Aging with Pride: IDEA” includes a tailored approach in which trained coaches identify and modify challenging behaviors that are adversely affecting older adults living with dementia and their caregivers, either of whom are LGBT. The coaches delivered an individualized program of exercise, and behavioral and coping strategies designed to improve physical function, independence and QOL.

The exercise intervention is a low-impact physical exercise program including nine one-hour sessions over six weeks designed to improve physical functioning and maintain independence. The behavior and coping strategies include: techniques for working with LGBT-specific trauma, identity management and disclosure of their LGBT identities to providers and others, plus support engagement in the LGBT community and dementia services. Testing of the intervention is now underway and will be delivered to 225 pairs of LGBT older adults living with dementia and their caregivers.

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“Given their lifetime experiences of victimization, discrimination and bias, many LGBT older adults forgo seeking needed medical care,” said Fredriksen-Goldsen. “LGBT people living with dementia and their caregivers often have difficulty accessing information and support services, which can be especially challenging when memory loss and dementia enter the equation.”

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Psychotherapy should be first-line treatment for depression in young people, trial finds

If antidepressants have a role, they have more of a role in people at the older end of the age range. The take-home message from the study is that the first-line treatment for young people with depression should be psychotherapy.

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Young people seeking support for depression should be offered psychotherapy as the first line of treatment, a clinical trial by researchers at Orygen, the National Centre of Excellence in Youth Mental Health, has found.

Associate Professor Christopher Davey, head of mood disorder research at Orygen, said the clinical trial results emphasised the importance of a multi-faceted approach to treating depression in young people.

“The results suggest that we should really be focusing on providing good quality psychotherapy, such as cognitive behavioural therapy, to young people and keeping medication as the second line of treatment,” Associate Professor Davey said.

Psychotherapy refers to a range of psychological therapies provided by a counsellor, psychologist or psychiatrist. Cognitive behavioural therapy is the most common psychotherapy for treating depression in young people.

The randomized, double blind, placebo-controlled clinical trial involved 153 young people aged 15-25 who had been diagnosed with depression and were being treated at youth mental health services in north-west Melbourne. All trial participants received cognitive behavior therapy for 12 weeks coupled with either the common antidepressant fluoxetine or a placebo medication.

The trial results have been published in The Lancet Psychiatry.

Associate Professor Davey said at the end of treatment there were no significant differences in symptom improvement between the two groups, suggesting that the addition of fluoxetine did not affect the participants’ mental health outcomes.

However, this does not suggest that antidepressants should not be used in treating depression.

“Antidepressants can be very useful for some people,” Associate Professor Davey said. “Anyone considering the role of antidepressants in their treatment should discuss this with their doctor or clinician.

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“Our study found some evidence to suggest that if antidepressants have a role, they have more of a role in people at the older end of our age range. The take-home message from the study is that the first-line treatment for young people with depression should be psychotherapy.”

This is of particular interest to members of the LGBTQIA community because 41% of non-binary people said they harmed themselves in the last year compared to 20% of LGBT women and 12% of GBT men. One in six LGBT people (16%) said they drank alcohol almost every day over the last year.


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Health & Wellness

In Europe, syphilis notifications up by 70% since 2010

Syphilis diagnoses were consistently higher among men, with rates doubling from 6.1 per 100,000 in 2010 to 12.1 in 2017. Between 2007 and 2017, close to two-thirds (62%) were reported among men who have sex with men. Heterosexual men contributed 23% of cases and women 15%.

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The number of syphilis cases has been consistently going up across Europe since 2010, mostly affecting men who have sex with men living in urban areas. In 2017, notification rates reached an all-time high in the EU/EEA countries with more than 33 000 reported cases. An in-depth ECDC study describes the factors behind this increase and outlines the evidence-based options for public health control of syphilis, including case finding and management as well as educational activities.

Overall, more than 260 000 confirmed syphilis cases were reported from 30 EU/EEA countries between 2007 and 2017. While annual notifications decreased slightly between 2007 and 2010 (from almost 20 000 to a low of some 19 000 cases), they continuously rose to more than 33 000 cases in 2017. An all-time high since the start of ECDC surveillance recording.

This trend results from notification data of the 23 countries with comprehensive surveillance systems reporting consistently between 2007 and 2017. The rate dropped to a low of 4.2 per 100 000 persons in 2010, before reaching an EU/EEA peak of 7.1 per 100 000 population in 2017 – an increase of 70% compared with the notification rate in 2010. This means that for the first time since the early 2000s, the EU/EEA countries report more syphilis than HIV cases.

Striking country variations in Europe

Between 2010 and 2017, 15 countries reported an increase in the notification rate of more than 15%. However, this varied greatly among countries with rates more than doubling in five countries: Iceland (876%), Ireland (224%), the United Kingdom (153%), Germany (144%) and Malta (123%). On the other hand, Estonia and Romania reported a drop of 50% or more over the same period.

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During this period, syphilis diagnoses were consistently higher among men, with rates doubling from 6.1 per 100 000 in 2010 to 12.1 in 2017. Between 2007 and 2017, close to two-thirds (62%, 94 015 of the 152 233 cases where sexual orientation was known) were reported among men who have sex with men. Heterosexual men contributed 23% of cases and women 15%. The proportion of cases diagnosed among men who have sex with men ranged from below 20% in Latvia, Lithuania and Romania to more than 80% in France, Germany, Ireland, the Netherlands, Sweden and the United Kingdom.

The ECDC study looked at more than 60 studies reporting on rising syphilis trends in high-income countries since the early 2000s.

“There is a clear relationship between sexual risk behaviour and the risk of syphilis and other sexually transmitted diseases”, states Andrew Amato-Gauci, Head of the ECDC programme on HIV, STI and viral hepatitis. “The increases in syphilis infections that we see across Europe, as well as other countries around the world, are a result of several factors such as people having sex without condoms and multiple sexual partners combined with a reduced fear of acquiring HIV”, Amato continues. “To reverse this trend, we need to encourage people to use condoms consistently with new and casual partners. Regular tests for syphilis and other sexually transmitted infections should also be part of the parcel, especially if there has been a risk of infection.”

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In addition, response measures should be informed by sound epidemiological data and targeted towards affected population groups taking into account the main determinants of transmission.

The response to syphilis outbreaks or programmatic control should include a combination of:

  • case finding, including screening of at-risk groups, partner notification and surveillance activities,
  • case management with appropriate treatment following diagnosis,
  • educational activities directed at the general population, those at-risk of syphilis infection, and at healthcare providers.

Decrease among women and congenital syphilis

Congenital syphilis rates in the EU/EEA have been decreasing since 2005. During this time, rates of syphilis among women have decreased consistently in the EU/EEA, particularly in eastern Europe. This contributed to the reduction of the risk of mother-to-child transmission of syphilis in Europe that is in contrast to increasing congenital syphilis rates in many other parts of the western world. Despite this, underreporting of congenital syphilis is likely in several Member States of the EU/EEA and there is some concern regarding increasing syphilis rates among women in some western EU/EEA countries. Effective national antenatal screening programmes together with interventions to control syphilis transmission among heterosexual populations are key in order to sustain the low rates of congenital syphilis.

The diagnosis and treatment of syphilis are both accessible and cost effective. Left untreated, syphilis infection can lead to severe complications and also facilitates transmission of HIV infection. Untreated syphilis during pregnancy can severely compromise pregnancy outcomes, leading to foetal loss, stillbirth or congenital syphilis in the newborn.

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