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Publication highlights realities of access to HIV drugs

The policy brief examines challenges to accessing affordable HIV treatment for people living with HIV and key populations, provides recommendations for increasing access in middle-income countries.

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MSMGF

A number of global HIV networks released a joint policy brief entitled Access Challenges for HIV Treatment Among People Living with HIV and Key Populations in the Middle-Income Countries. The policy brief articulates how prevailing economic and trade interests compromise access to life-saving generic drugs, resulting in a devastating impact on communities of people living with HIV and key populations, including men who have sex with men (MSM), transgender people, sex workers and people who inject drugs.

The policy brief is the product of a collaboration between Global Network of People Living with HIV (GNP+), the Global Forum on MSM & HIV (MSMGF), the International Network of People Who Use Drugs (INPUD), the Global Network of Sex Work Project (NSWP), and the International Treatment Preparedness Coalition (ITPC). Each partner organization focuses on access to medicines as a priority for their respective constituencies.

The policy brief documents how access to a sustainable supply of newer, simpler, less toxic, and more potent antiretroviral medicines (ARVs) in middle income countries (MICs) is in jeopardy due to a constellation of factors, including pricing and patents, intellectual property regimes, the broader regulatory environment, and a lack of government investment in science and technology. All of these issues are further complicated by additional structural barriers that significantly impede access to essential HIV prevention and treatment services for key populations, including laws that criminalise the behavior of key populations and people living with HIV.

“We call on the governments of MICs to further tighten their patent laws, regulate all pharmaceutical companies, reject from the outset any provisions in all trade agreements that undermine access to medicines, and fully exploit TRIPS flexibilities to facilitate a sustainable supply of high quality generic medicines,” said Raoul Fransen, international coordinator/CEO (ad interim) of GNP+. “Access to high-quality, fixed-dose combination, first line ARV regimens and a greater range of possible second and third line regimens are essential to the health and well-being of people living with HIV.”

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Based on current epidemiological trends, the vast majority of people living with HIV will be from MICs by the year 2020. Currently, less than one-third of those who need treatment have access to life-saving drugs in MICs, and these countries face an additional crisis of escalating costs for HIV medicines due to high country-level burdens of HIV.

“Governments in MICs are not always well prepared to address the challenges to public health posed by current trade rules, especially when so many countries are already paying exorbitant prices for most antiretroviral medicines” said Othman Mellouk, the regional advocacy coordinator for ITPC North Africa and co-chair of the MSMGF. “With respect to key populations, a country’s ability to pay is not always commensurate with its willingness to pay. In nearly every country around the world, key populations bear the greatest disease burden. Yet these populations continue to face high drug costs, severe stigma and discrimination, and gender and economic inequality, all of which limit their access to treatment, prevention, care and support services.”

Despite these barriers, the policy brief provides numerous examples that demonstrate how key populations have mobilized successfully and used the human rights framework effectively to secure access to treatment for HIV, hepatitis C, and other medicines for non-communicable diseases. However, extremely limited funding and political support for key populations could undermine this success.

“We have less than 1,000 days to realize the UNAIDS political commitment of ensuring that 15 million people living with HIV have access to treatment by 2015,” said Dr. George Ayala, executive director of the MSMGF. “The treatment gap has widened since the revision of the WHO’s recommendation to initiate ART at CD4 counts below 500 cells/mm^3. This policy brief is the latest call for improved access to and scale-up of treatment.”

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Dr. Ayala adds: “People living with HIV, including MSM, transgender people, sex workers, and people who inject drugs stand united at this critical juncture in the global AIDS response. Governments and pharmaceutical companies worldwide should expect reinvigorated community mobilization and stepped-up advocacy from our networks in the days ahead. Closing the treatment gap successfully requires an unwavering and vocal constituency-led response.”

NEWSMAKERS

Intersex community holds first summit in Phl

In an effort to gather members of the intersex community in the Philippines, thereby discussing issues that are very specific to them and then bringing the same to the fore, Intersex Philippines (IP) organized its very first summit in the country.

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All photos courtesy of Jeff Cagandahan/Intersex Philippines

Making the “I” visible.

In an effort to gather members of the intersex community in the Philippines, thereby discussing issues that are very specific to them and then bringing the same to the fore, Intersex Philippines (IP) organized its very first summit in the country.

According to Jeff Balahadia Cagandahan, who helms IP, exactly because intersex people remain largely invisible, there’s a need to gather “so that they will not feel alone.”

IP – of course – started as an online support group, and this is the first actual physical gathering; and for Cagandahan, “it (has) a different impact when you meet in person.”

For the gathering, IP started at the basics – e.g. while there were lessons on Intersex 101 “because some of them don’t know anything about intersex, basta ang alam lng nila e kakaiba sila (they just knew they’re ‘different’)”; there were also lessons on self-acceptance because “we want them to accept themselves (as intersex people) first because mahirap manghingi ng pagtanggap sa iba kung sarili mismo namin e hirap kaming tanggapin (we can’t make others accept us if we, ourselves, have issues with accepting ourselves).”

As FYI: intersex is NOT identity; it is a medical condition/biological variation. As stated by the UN Office of the High Commissioner for Human Rights: ” Being intersex relates to biological sex characteristics, and is distinct from a person’s sexual orientation or gender identity. An intersex person may be straight, gay, lesbian, bisexual or asexual, and may identify as female, male, both or neither.”

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Added the (now-defunct) Intersex Society of North America, “intersex is a general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male.

To stress, from UN Office of the High Commissioner for Human Rights: “Intersex people are born with sex characteristics (including genitals, gonads and chromosome patterns) that do not fit typical binary notions of male or female bodies. Intersex is an umbrella term used to describe a wide range of natural bodily variations. In some cases, intersex traits are visible at birth while in others, they are not apparent until puberty. Some chromosomal intersex variations may not be physically apparent at all.”

According to experts, between 0.05% and 1.7% of the population is born with intersex traits – the upper estimate is similar to the number of red haired people (similarly stated by the Intersex Campaign for Equality).

Incidentally, Cagandahan – who is now part of Intersex Asia, an Asia-wide support group/network/organization for intersex people – was granted by the Supreme Court (SC) to change his gender marker because of his medical condition.

On December 11, 2003, Cagandahan filed a Petition for Correction of Entries in Birth Certificate before the Regional Trial Court (RTC), Branch 33 of Siniloan, Laguna. Specifically, Cagandahan asked to change his name and his sex (from female to male). Cagandahan claimed that he developed male characteristics while growing up because of a condition called Congenital Adrenal Hyperplasia (CAH).

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The case reached SC, which sided with Cagandahan.

In its 2008 decision, the highest court stated:

“Ultimately, we are of the view that where the person is biologically or naturally intersex the determining factor in his gender classification would be what the individual, like respondent, having reached the age of majority, with good reason thinks of his/her sex. Respondent here thinks of himself as a male and considering that his body produces high levels of male hormones (androgen) there is preponderant biological support for considering him as being male. Sexual development in cases of intersex persons makes the gender classification at birth inconclusive. It is at maturity that the gender of such persons, like respondent, is fixed…

…Respondent is the one who has to live with his intersex anatomy.To him belongs the human right to the pursuit of happiness and of health. Thus, to him should belong the primordial choice of what courses of action to take along the path of his sexual development and maturation. In the absence of evidence that respondent is an incompetent and in the absence of evidence to show that classifying respondent as a male will harm other members of society who are equally entitled to protection under the law, the Court affirms as valid and justified the respondents position and his personal judgment of being a male.”

This decision was written by Associate Justice Leonardo A. Quisumbing; with Conchita Carpio Morales, Dante O. Tinga, Presbitero J. Velasco Jr. and Arturo D. Brion concurring.

Now, Cagandahan wants intersex people – Filipinos, in particular – to know that “God did not make mistakes in creating us. We are God’s masterpiece. Wala kang dapat ikahiya sa pagiging intersex (You have nothing to be ashamed of for being intersex).”

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Cagandahan eventually co-formed IP to support those like him; and he keeps stressing that “hindi tayo rare; marami tayo. Ito na rin siguro ung panahon para magsalita tayo (We are not rare; there are many of us. It is time for us to speak out).” For him, “naniniwala ako na kapag mas maraming nagsasalita, mas magiging madali ang hinihingi nating pagbabago (If more people like us speak, it will be easier to get the changes we want to happen).”

For intersex people, or those who want to know more about intersex condition/s and Intersex Philippines, visit Jeff Balahadia Cagandahan’s FB account; email jeffcagandahan@yahoo.com, or contact 09155159819.

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LIFESTYLE & CULTURE

Homophobia and transphobia still a problem in sport

One third of those active in sport conceal their sexual orientation or gender identity within the context of their sporting activities. More than a third of those questioned were unable to name a single organization or individual they could contact in the event of a negative experience or incidence.

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The overwhelming majority of people perceive homophobia and transphobia to be a problem in sport; with homophobic and transphobic language remaining widespread, especially in team sports. 

This is according to analysis coming out of Europe, where a Europe-wide project was done to develop strategies and training measures in the field of sport in order to counter discrimination and violence related to sexual orientation or gender identity. In the first study, an online survey was used in which more than 5,500 LGBTI from all 28 EU states were asked about their experiences in sport. In the second study, representatives of 15 sports associations, sports federations and umbrella organizations from the five project countries were interviewed about their strategies for combating homo-/transphobic discrimination in sport.

As stated, the overwhelming majority of respondents notes homophobia and transphobia to be a problem in sport. Homophobic and transphobic language was also noted to be widespread, especially in team sports. As a result, one third of those active in sport conceal their sexual orientation or gender identity within the context of their sporting activities. More than a third of those questioned were unable to name a single organization or individual they could contact in the event of a negative experience or incidence.

“Discrimination against LGBTI is a problem facing society as a whole,” says Professor Ilse Hartmann-Tews, Director of Studies at the German Sports University, “which is why each one of us should feel responsible for creating a culture of respect.”

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In the area of organized sport, the study recommends an open and proactive attitude towards questions of sexual and gender diversity on the part of all men and women active at every level of clubs, associations and sports federations. This is because, the ideal is for participation in sport at all levels to be made easier for lesbians, gays, bisexuals, transgender persons and intersexual people.

Homophobic and transphobic language was also noted to be widespread, especially in team sports.
PHOTO FROM PEXELS.COM

The collaboration of five European project countries lasted three years and will end on 31 December. Results were presented and discussed at various levels, including the final conference of OUTSPORT held in Budapest, an international conference on the situation of LGBTI in sport in Barcelona, the sports committee of the NRW state parliament in Düsseldorf and the Federal Network Conference of Queer Sports Clubs (BuNT) in Hamburg.

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NEWSMAKERS

Women reporting greater identity uncertainty are more at risk for hazardous drinking

Mostly lesbian and bisexual women reported the most depression, anxiety, and physical health symptoms; mostly lesbian women reported the highest levels of hazardous drinking. Among those who reported drinking, mostly lesbian women drank the most frequently and reported the most alcohol-related consequences. Mostly lesbian women reported the most identity uncertainty.

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Fact: In research, “mostly lesbian” women are typically grouped with “exclusively lesbian” women, although they are sometimes grouped with “bisexual women”. A study is now saying that this grouping is problematic since it doesn’t fully show the experience of mostly lesbian women – e.g. that they are at higher risk for hazardous drinking.

In “Health Disparities Among Exclusively Lesbian, Mostly Lesbian, and Bisexual Young Women“, written by Robin J. LewisSarah J. EhlkeAlexander T. ShappieAbby L. Braitman and Kristin E. Heron and published in LGBT Health, it was noted that health disparities have been identified between groups of diverse young sexual minority women (SMW) and heterosexual women. “This approach may generate sufficient group sizes for statistical analyses but obscures important differences. Moreover, some young women may not identify as ‘lesbian’ or ‘bisexual’ but somewhere in between.”

And so, to best understand varying experiences, researchers saw it best to examine health and sexual minority identity-specific outcomes among three groups of SMW — i.e. women who identify as “exclusively lesbian,” “mostly lesbian,” and “bisexual.”

For this study, participants were 990 young (18–30 years old) SMW (exclusively lesbian: n = 305, mostly lesbian: n = 133, bisexual: n = 552) who completed an online survey, including information about mental and physical health symptoms, hazardous drinking, and identity uncertainty. Those who reported alcohol use in the past 30 days responded to questions about their alcohol use and alcohol-related negative consequences.

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The study found that, controlling for demographic differences, “health outcomes varied significantly by identity. Mostly lesbian and bisexual women reported the most depression, anxiety, and physical health symptoms; mostly lesbian women reported the highest levels of hazardous drinking. Among those who reported drinking, mostly lesbian women drank the most frequently and reported the most alcohol-related consequences. Mostly lesbian women reported the most identity uncertainty.”

The researchers stressed that “describing and classifying SMW is a complex endeavor, and collapsing across identities may mask important differences among these subgroups.”

Although the common conceptualization of sexual identity includes mostly lesbian women under the bi+ umbrella, there may be important factors that lead women to adopt this sexual identity that sets them apart from their bisexual peers. This research “suggests that women who identify as mostly lesbian may be unique from their exclusively lesbian and bisexual peers by reporting greater identity uncertainty and more hazardous drinking. Moreover, if trying to subsume them within lesbian or bisexual identities, they fall into different patterns for different outcomes.”

The researchers are recommending further research to be done to improve understanding of the development of nonmonosexual identities, and researchers should be mindful that operationalization of sexual identity may affect outcomes.

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NEWSMAKERS

Income inequality fuels status anxiety and sexualization, research shows

As economic inequality continues to grow, researchers say so too will women’s preoccupation with their physical appearance, and the mental health issues that tie in with this.

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Women’s appearance enhancement is driven partly by status anxiety and income inequality, according to new research.

Researchers at the universities of Melbourne and New South Wales have examined the relationship between income inequality, status anxiety and sexualisation of women.

Using a role-playing experiment, more than 300 people from 38 countries participated in a hypothetical society online where each version matched one of the many economies of the world today.

Participants were asked to indicate how anxious they were about social status in their respective society and then chose an outfit to wear for their first night out. Options ranged from least to most revealing.

Researchers found that women assigned to economically unequal societies chose more revealing, sexy outfits for their first night, and they did so because they were anxious about their social status.

By making women worry about social climbing, research shows that economically unequal societies incentivized women to use their attractiveness to get ahead.

University of Melbourne gender relations expert Khandis Blake said results show that for some women, being the fairest of them all can be a smart strategy to climb the social and economic hierarchy.

“Although we might like to pretend in today’s environment that beauty doesn’t matter anymore, research and our day-to-day experiences say otherwise,” Blake said. “Our results favor a view of women as strategic agents, using the tools available to them to climb the social hierarchy in specific socio-economic environments. When we see women in these outfits, pouting into their phone cameras or preening over their appearance, we might think it’s just narcissism. But things are more complex. It’s really about women responding to incentives in their environment, given the state of their economy.”

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As economic inequality continues to grow, researchers say so too will women’s preoccupation with their physical appearance, and the mental health issues that tie in with this.

“Beauty is one way women can out-do others and try to maximize their lot in life, but it’s important to remember that beauty has a shelf-life and obsessing over your appearance comes with other risks and challenges,” Blake added.

It is worth noting that LGBTQIA people are just as affected by economic disparity.

LGBTQI people are more likely than their peers to live in poverty, according to a report from the LGBTQ Poverty Collaborative, which shows how indicators of economic disparity including food insecurity, housing instability, low-wage earning potential and unemployment and under-employment are all heightened for LGBTQI communities.

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NEWSMAKERS

Empathy for perpetrators helps explain victim blaming in sexual harassment

It is widely assumed that a lack of empathy for female victims explains why people blame them, but a study found that empathy for the male sexual harasser was a more consistent explanation of variability in victim blame.

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Men’s empathy for other men who sexually harass women may help explain why they are more likely to blame victims, new research suggests.

The paper, published in the journal Psychology of Women Quarterly, is entitled: “Why women are blamed for being sexually harassed: The effects of empathy for female victims and male perpetrators.”

The research, based on two studies, compared people’s reactions after reading about an incident of sexual harassment.

In the first study, men and women showed equal levels of empathy for the female victim – but men’s greater empathy for the male perpetrator explained why they were more likely than women to blame the victim.

The second study was an experiment where people were asked to focus on the man’s or the woman’s point of view before reading the same information. Both men and women who focused on the male perpetrator’s point of view showed greater empathy for him and blamed the female victim more.

The researchers, from the universities of Exeter, Queensland and Bath, say their findings highlight a dark side to empathy.

“Despite movements such as #MeToo, women still fear negative consequences of making a sexual harassment complaint,” said Dr. Renata Bongiorno, of the University of Exeter, who led the research. “Many women encounter victim-blaming attitudes when they do, especially from men. In our research, victim blaming wasn’t high overall – but consistent with past research it was higher in men than in women on average.”

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It is widely assumed that a lack of empathy for female victims explains why people blame them, “but we actually found that empathy for the male sexual harasser was a more consistent explanation of variability in victim blame,” Bongiorno added. “Media reports of sexual harassment – especially involving male perpetrators – often focus on their point of view and the potential damage to their lives for being outed as a sexual harasser.”

The findings point to the damaging consequences of that focus for female victims.

“To improve responding, everyone but especially men, should be mindful that their empathy for a male sexual harasser can increase their likelihood of blaming women for being sexually harassed,” Bongiorno said. “And victim blame continues to make it very difficult for women who are sexually harassed to come forward and get a fair hearing when they do.”

This is also an issue in the LGBTQIA community.

In June, for instance, a study found that around seven out of 10 LGBT workers experienced at least one type of sexual harassment at work and almost one in eight LGBT women reported being seriously sexually assaulted or raped at work. But this is a hidden problem with two thirds of those who were harassed not reporting it.

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NEWSMAKERS

Race-based discrimination, stereotypes still ubiquitous in online communities and mobile apps

The degree to which racial and ethnic minorities perceive race-based partner selection as racist often gets overshadowed by “personal preference” narratives.

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Race-based discrimination and stereotypes are ubiquitous in the online communities and mobile apps that gay and bisexual men use to search for sexual and romantic partners, research indicates.

But because racialized sexual discrimination – also called sexual racism – is a relatively new area of study, researchers currently don’t have a tool for measuring its impact on the well-being of men of color who use these websites, according to University of Illinois social work professor Ryan Wade.

Wade and Gary W. Harper, a professor of health behavior and health education at the University of Michigan, have developed a scale to help researchers better understand how the psychological well-being of ethnic minorities is affected by RSD experiences.

Wade presented their latest research on the topic at the annual meeting of the American Public Health Association in Philadelphia on Nov. 6. He and Harper are the co-authors of a new study, a comprehensive review of prior research on RSD that was published recently in the American Journal of Community Psychology.

Wade and Harper found that RSD emerges in a variety of forms and contexts in these online communities and, less often, when men meet potential partners in person. These include prominent statements in users’ online profiles that express inclusionary or exclusionary racial preferences for potential partners.

The researchers note that these race-based preferences – usually expressed by the white majority seeking to exclude people of color – are a common part of the narrative within these online spaces.

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However, the degree to which racial and ethnic minorities perceive race-based partner selection as racist gets overshadowed by these personal preference narratives, Wade said.

Whiteness is the hallmark of desirability for some participants in these networks, and some researchers have called race-based partner selection “the new face of racism in online sexual and dating networks of gay/bisexual men,” according to Wade and Harper’s study.

RSD also emerges in statements that reject, erotically objectify or denigrate men of color and perpetuate stereotypes about their perceived sexual prowess, sexual roles or physical attributes.

Wade and Harper hypothesize that exposure to these experiences may foment feelings of shame, humiliation and inferiority, negatively impacting the self-esteem and overall psychological health of racial and ethnic minorities.

“We ran a series of focus groups to talk about this phenomenon, to determine the different domains it includes and to identify RSD-related experiences that could be measured,” Wade said.

Using information gathered from focus group participants, Wade and Harper developed a scale of RSD that categorized men’s experiences into four domains – exclusion, rejection, degradation and erotic objectification.

The scale consists of 60 items that assess a broad scope of unique RSD experiences across all four of the hypothesized domains, accounting for the effect and frequency of these experiences and the perpetrator’s race.

“RSD perpetrated by in-group members – people of their same race – came up as a major point in our focus group discussions,” Wade said. “Participants discussed how being discriminated against by people of their own racial or ethnic group hurt in a unique way, so we wanted to account for that too when developing the scale.”

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The overall impact of any given RSD experience is measured by multiplying the frequency and effect scores for each domain, Wade said.

To test the scale, Wade and Harper launched a project called ProfileD, in which they recruited young gay and bisexual black men ages 18-29 through social media to participate in an online survey about their RSD experiences.

Data from more than 2,000 participants who consented to be in that project were used in preliminary analyses of the scale.

Discrimination among apps users is not exactly new.

In October 2019, for instance, a study found that Grindr, the most popular dating app for gay, bisexual, two-spirit and queer men, had a negative effect on men’s body image, especially when it came to weight. The study also found that apart from weight stigma, body dissatisfaction stemmed from sexual objectification and appearance comparison.

Three out of four gay men are reported to have used Grindr.

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