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Empty hospital beds in a poorly lit room
Empty Hospital Beds
Pixabay, 2016

In an effort to remain accountable to communities who have been negatively impacted by past and present medical injustices, the staff at Himmelfarb Library is committed to the work of maintaining an anti-discriminatory practice. We will uplift and highlight diverse stories throughout the year, and not shy away from difficult conversations necessary for health sciences education. To help fulfill this mission, today's blog post highlights transgender healthcare equity.

Author notes 

The topics presented in this article may be difficult and/or retraumatizing for some readers. Subject matter includes medical neglect, transphobic harassment, usage of slurs, medical misdiagnosis, death of a Black transgender women by medical neglect, and cancer. 

While some of the sources cited in this article are from over a decade ago and may use outdated terminology and may misgender the individuals discussed in them, this article was written by a transgender member of Himmelfarb staff, who has used appropriate language in the article itself.

August 7th, 1995. Washington, DC. 

A 24 year old woman named Tyra Hunter was critically wounded in a car accident when another driver ran a stop sign (Bowles, 1995). Once first responders came on the scene and assessed the situation, instead of treating her properly, they mocked and degraded her (Remembering Our Dead, 2019). When she was finally brought to the emergency room at DC General Hospital, she was given a paralytic and slowly bled out (Fox, 1998). The delay in treatment and degrading comments took place because she was a black transgender woman.

Tyra Hunter’s case is, perhaps, one of the more extreme instances of medical transphobia and healthcare inequity. That said, Tyra Hunter is one of many transgender people who have been victimized by anti-transgender prejudice – both personal and systemic – in healthcare. 

From avoidance of medical care due to fear, to biased diagnoses from prejudiced professionals, to even the blatant transphobia that first responders directed at Tyra Hunter, transgender people – particularly for Black transgender women – frequently lack access to quality healthcare. In this post, we will review the most common ways prejudice and cultural incompetency impact transgender patients, and we will consider ways medical professionals can provide equitable healthcare to transgender individuals.

Medical transphobia can take many forms, and not all of them are as blatant as what Tyra Hunter experienced on the day of her death in 1995. Even microaggressions, when experienced over long periods of time, can cause transgender patients to avoid or delay seeking treatment. A study by Seelman et al. in the journal Transgender Health found that among transgender participants, “those reporting a noninclusive PCP or who delayed needed medical care because of fear of discrimination were less likely to have had a routine checkup in the past 2 years” (Seelman et al., 2017, p. 25). This is supported by a study by Jaffee et al., which found that “1 in 3 transgender respondents delayed needed medical care for an illness or injury due to discrimination” (Jaffee et al., 2016, p. 1012), and that “the odds of delaying needed care was approximately 4 times greater for those who reported having to teach their provider about transgender people” (Jaffee et al., 2016, p. 1012).

This fear of medical discrimination is by no means irrational. A study by Rodriguez et al. analyzing data from the National Transgender Discrimination Survey which included over 6000 participants, found that “more than one-third of transgender participants reporting having experienced discrimination in health-care settings” (Rodriguez et al., 2017, p. 980), wherein discrimination was defined as, “physical abuse, verbal harassment, and/or denied equal treatment” (Rodriguez et al., 2017, p. 975). Of note here is that this number parallels Jaffee et al.’s reported 1 in 3 transgender respondents delaying treatment.

Transgender patients’ lack of trust is also attributed to “Transgender Broken Arm Syndrome,” which occurs when healthcare providers attribute unrelated medical issues to a patient’s transgender identity or transition-related care. The colloquial term comes from the scenario where a transgender patient might go into the doctor for a broken arm, but the healthcare provider questions to the patient about their gender instead. Jennifer Kelley describes this kind of scenario with a patient named Cam in the article, Stigma and Human Rights: Transgender Discrimination and Its Influence on Patient Health. Cam wanted to see the doctor about a chronic issue unrelated to her transness, and perhaps discuss hormone replacement therapy, but the provider instead questioned her about her identity, gave her a pamphlet on HIV, and told her to find a specialist (Kelley, 2021). 

Another example of a transgender patient who was not able to access appropriate quality healthcare occured when Jay Kallio, a transgender man in his 50s living in New York, was discovered to have an aggressive form of breast cancer (Buxton, 2015). After receiving a mammogram and a biopsy, Kallio did not hear from his physician for many weeks. When he finally heard about his diagnosis, it was from the medical professional who performed the biopsy, who was shocked to hear that Kallio’s physician, a surgeon at a major New York hospital, had not informed him of the swiftly-worsening cancer. Kallio struggled to get in contact with this physician, and when he did, the surgeon began the conversation by stating that he wanted to send Kallio to a psychiatrist for his identity. Eventually, Kallio was thankfully able to transfer his case to another surgeon, and even beat the cancer in 2008, though he later succumbed to lung cancer in 2016. (Jay Kallio, n.d.) Ultimately, Kallio’s case is one that serves as a reminder of the very real potential consequences for medical transphobia.

There are, however, some of the most wretched instances of transphobia that involve harassment and blatant cruelty, such as what happened to Tyra Hunter. Another such case is that of Robert Eads, a transgender man who was taken to the emergency room in Georgia in 1996 after passing out. When he was diagnosed with ovarian cancer, he was refused treatment by more than a dozen medical practitioners. By the time he was accepted by the hospital of the Medical College of Georgia in 1997, the cancer had metastasized, and no treatment would have been able to save his life (Ravishankar, 2013). He died in 1999, and his story is told in the 2001 documentary, Southern Comfort, named after a popular transgender gathering that he spoke at after his prognosis (“Robert Eads”, 2007). His case is more similar to that of Jay Kallio than Tyra Hunter’s, but Eads’ slow and painful death was the result of medical transphobia in action.

Even the late transgender activist and author of the well-revered Stone Butch Blues, Leslie Feinberg (who used the neopronouns ze/hir), has discussed the transphobia ze faced after seeking treatment. In zir 2001 work, “Trans Health Crisis: For Us It’s Life or Death”, ze detailed how hospital staff gathered around zir, calling Feinberg “it” and “martian”. Feinberg chose to leave the hospital in question without being treated, and thankfully the illness ze had was not life-threatening, as it had been for Tyra Hunter and Robert Eads (Feinberg, 2001).

Knowing what we do about medical transphobia, how can healthcare professionals enact change within the healthcare system, ensure that transgender patients are treated equitably and ethically, and rebuild trust with the transgender community? 

Leslie Feinberg urges in zir aforementioned work that decisions related to transgender patients involve transgender and gender variant people of all kinds. Ze made recommendations large and small, some of which have been implemented already. One of the simplest, which has been picked up by quite a few healthcare professionals, is to “refer to patients by their first and last names, not Mr. or Ms., sir or ma'am.” Another is a call for institutional standards (Feinberg, 2001), such as the Standards of Care developed by the World Professional Association for Transgender Health (WPATH). This comprehensive document acts as a guideline for health care professionals “to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment.” (Standards of Care, 2012, p. 1)

Medical education has also been shown to have significant gaps in coverage of transgender healthcare. Fung et al. performed a qualitative review of Toronto medical residents’ knowledge and confidence in transgender care in 2016. The results indicated that residents had limited exposure to formal training in transgender medicine, as well as few mentors within their specializations who had enough knowledge to confidently educate or advise on such topics (Fung et al., 2020). If you’d like to learn more about the gaps in transgender health education, Korpaisarn et al.’s Gaps in transgender medical education among healthcare providers reviews a number of studies on the subject and follows with a section on effective interventions, including the use of WPATH’s Global Education Initiative (GEI), which offers training and certification courses on transgender healthcare (Kopaisarn et al., 2018).

Healthcare professionals should stay up to date on legislative matters. Our previous article for Transgender Day of Visibility discussed this at length and included a number of resources for education and for action. If you would like to learn more about the legal side of transgender health, that piece would be a good starting point. Likewise, if you would like to learn more about some terminology related to transgender individuals in a healthcare setting or about how to build rapport with transgender patients or otherwise equitably treat transgender patients, Klein et al.’s Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know, is another useful resource.

Unfortunately, transphobia may persist in society and healthcare. It is unfortunately not enough to educate ourselves alone on matters of inequity and bias; the best way to support transgender patients is to speak out against transphobia when you see it. There will be times when speaking out is difficult, but when those moments happen, please remember that if even a single person had taken action, Tyra Hunter may have survived.

References

Bowles, S. (1995, December 10) A Death Robbed of Dignity Mobilizes a Community, Washington Post. https://www.washingtonpost.com/archive/local/1995/12/10/a-death-robbed-of-dignity-mobilizes-a-community/2ca40566-9d67-47a2-80f2-e5756b2753a6/ 

Buxton, R. (2015, June 15) This Trans Man's Breast Cancer Nightmare Exemplifies The Problem With Transgender Health Care, HuffPost. https://www.huffpost.com/entry/transgender-health-care_n_7587506

Feinberg, L. (2001)  Trans health crisis: For us it's life or death, American Journal of Public Health, 91(6), p. 897-900. https://doi.org/10.2105/AJPH.91.6.897

Fox, S. D. (1998, December 12) Damages Awarded after Transsexual Woman's Death. Polare. Internet Archive. https://web.archive.org/web/20140324052938/http://www.gendercentre.org.au/resources/polare-archive/archived-articles/damages-awarded-after-transsexual-womans-death.htm

Fung, R., Gallibois, C., Coutin, A., & Wright, S. (2020) Learning by chance: Investigating gaps in transgender care education amongst family medicine, endocrinology, psychiatry and urology residents, Canadian Medical Education Journal, 11(4), p. e19-e28. https://doi.org/10.36834/cmej.53009

Jaffee, K. D., Shires, D. A., & Stroumsa, D. (2016) Discrimination and delayed health care among transgender women and men, Medical Care, 54(11), p. 1010-1016. https://doi.org/10.1097/MLR.0000000000000583

Jay Kallio. (n.d.) Compassion and Choices. https://compassionandchoices.org/stories/jay-kallio/

Kelley, J. (2021) Stigma and Human Rights: Transgender Discrimination and Its Influence on Patient Health, Professional Case Management. 26(6), p. 298-303. https://doi.org/10.1097/NCM.0000000000000506

Klein, D. A., Paradise, S. L., & Goodwin, E. T. (2018) Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know, American Family Physician, 98(11), p. 645-653.

Korpaisarn, S., Safer, J. D., & Tangpricha, V. (2020) Gaps in transgender medical education among healthcare providers: A major barrier to care for transgender persons, Reviews in endocrine & metabolic disorders, 19(3), p. e271-275. https://doi.org/10.1007/s11154-018-9452-5

Main Page. (n.d.) Global Education Institute. WPATH. https://www.wpath.org/gei

National Center for Transgender Equality. (2007, January 16) Robert Eads, National Center for Transgender Equality. https://transequality.org/blog/robert-eads

Ravishankar, M. (2013, January 18) The Story About Robert Eads, The Journal of Global Health. https://archive.ph/20130914005716/http://www.ghjournal.org/jgh-online/the-story-about-robert-eads/

Rodriguez, A., Agardh, A., & Asamoah, B. O. (2017) Self-Reported Discrimination in Health-Care Settings Based on Recognizability as Transgender: A Cross-Sectional Study Among Transgender U.S. Citizens, Archives of Sexual Behavior, 47(4), p. 973-985. https://doi.org/10.1007/s10508-017-1028-z

Seelman, K. L., Colón-Diaz, M. J. P., LeCroix, R. H., Xavier-Brier, M, & Kattari, L. (2017) Transgender Noninclusive Healthcare and Delaying Care Because of Fear: Connections to General Health and Mental Health Among Transgender Adults, Transgender Health, 2(1), p. 17-28. https://doi.org/10.1089/trgh.2016.0024

Transgender Day of Rememberance. (2019, February 17) Remembering Our Dead: Tyra Hunter, https://tdor.translivesmatter.info/reports/1995/08/08/tyra-hunter_washington-dc-usa_04a01786

World Professional Association for Transgender Health. (2012) Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. 7th ed. https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English.pdf

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In an effort to remain accountable to communities who have been negatively impacted by past and present medical injustices, the staff at Himmelfarb Library is committed to the work of maintaining an anti-discriminatory practice. We will uplift and highlight diverse stories throughout the year, and not shy away from difficult conversations necessary for health sciences education. To help fulfill this mission, today's blog post highlights transgender healthcare equity.

Visibility. What does it mean to you? Does it mean being seen or acknowledged? If something or someone is visible are they not only ‘seen’, but also understood? When someone is seen, is it the individual that is seen or is it a label ascribed to them that is seen? A fuller understanding of what it means to be transgender and the issues transgender people face within the current healthcare climate is the first step in changing the system towards a more equitable healthcare system for transgender people.

On March 31, 2022, International Transgender Day of Visibility, the United States is set to to break its all-time record for the introduction of anti-transgender legislation. While anti-transgender legislation covers a vast array of human activities – from using the restroom to participating in sports – the impact this kind of legislation has or may have on healthcare is not something to be ignored. Around the United States, transgender people, their families, and their healthcare providers are at risk of severe punishment for trans-affirming care. 

In Texas, transgender rights came into the spotlight recently when Gov. Greg Abbott instructed health-related agencies in the State of Texas to treat gender-affirming care provided to transgender minors as “child abuse” and that anyone could and should report transgender individuals, their families, and their healthcare providers under that definition (Ghorayshi, 2022; Goodman, 2022). Despite having no legally binding authority and being temporarily blocked by Judge Amy Clark Meachum, this order has already forced many families to face investigations that threaten to separate them from their transgender children. (Klibanoff & Dey, 2022)

In Idaho, HB675 seeks to group a variety of medical procedures under the definition of “genital mutilation” and was introduced in late February. Should this bill pass, medical service providers who administer medications or procedures in order “to change or affirm the child's perception of the child's sex if that perception is inconsistent with the child's biological sex, shall be guilty of a felony” (H.B. 675, 2022). This excludes procedures such as circumcision and controversial and often medically unnecessary surgeries performed on intersex children (Ejiogu, 2020), but includes the use of puberty blockers (also known as GnRHas) to delay puberty until a child comes of age and has the ability to consent to hormone replacement therapy if they so choose. A healthcare provider convicted of a felony under this proposed legislation would “be imprisoned in the state prison for a term of not more than life” (H.B. 675, 2022). This bill passed the House, but the Idaho Senate Majority Caucus released a statement against HB675, so it is unlikely that it will become law (Russell, 2022).

In Louisiana, bill HB570 functions similarly to Idaho’s HB675, with a few slight changes. Rather than a felony charge, healthcare providers would “be subject to discipline by the licensing entity with jurisdiction over the physician, mental health provider, or other medical healthcare professional” (H.B. 570, 2022). Healthcare providers might also be liable for compensation should the patient file a claim, or should their parents do so in the patient’s stead. In addition, HB570 includes sections that would restrict usage of public funds that might be used for gender affirming care (H.B. 570, 2022). This bill is currently awaiting review by the Louisiana House Committee on Health and Welfare.

In Tennessee, bill HB2835 is similarly structured. This bill includes restrictions regarding public fund usage, but medical service providers would be “subject to revocation of licensure and other appropriate discipline by the medical professional's licensing authority. The medical professional will be subject to a civil penalty of up to $1,000 per occurrence” (H.B. 2835, 2022). HB2835 also includes provisions that would require any individuals employed by the state to “immediately notify, in writing, each of the minor's parents, guardians, or custodians” of a minor’s transgender identity upon learning of it (H.B. 2835, 2022). The bill does not include any exceptions regarding this requirement should there be reason to believe that the parents, guardians, or custodians would react to the news violently. TN HB2835 was moved to the Tennessee House Health Committee for review on March 22, but was taken off notice and is unlikely to continue through any future voting procedures. (H.B. 2835, 2022)

These are only a few of the many parallel legislations raised in the last few months that have framed transgender-related care as abuse and mutilation. New Hampshire, Arizona, and Wisconsin have seen similar legislative proposals. That said, regardless of whether or not this kind of proposed legislation is passed, they raise a startling concern: how can healthcare providers care for their transgender patients should state laws subject those involved to harsh punishments? 

The truth is that visibility alone does not protect transgender individuals who would be impacted by such legislation. Healthcare providers can update their knowledge regarding legislation that targets gender affirming care. Freedomforallamericans.org features up to date information on all current anti-transgender bills, many of which are healthcare related. The Transgender Law Center’s National Equality map tracks legislation that impacts LGBTQIA+ individuals and includes healthcare as one of the major legislative categories. 

Healthcare providers can access resources to update their knowledge and to support high-quality care for transgender individuals via multiple resources available in Himmelfarb Library’s collections including:

The Whitman Walker clinic has a Cultural Competency toolkit that focuses on practices you can provide to all LGBTQIA+ patients. Other helpful associations include:

  • The DC Center for the LGBTQ Community aims “to promote health equity in our local LGBTQ Community'' with programs such as free at-home STI & HIV testing kits, the binder donation project, trauma-informed mental health support groups, and more. 
  • The DC Trans Coalition “is a volunteer, grassroots, community-based organization dedicated to fighting for human rights, dignity, and liberation for transgender, transsexual, and gender-diverse (hereafter: trans) people in the District of Columbia.” (“About DCTC”) The DC Trans Coalition has a transgender healthcare resource list, as well as a guide to educate transgender DC residents on their rights.
  • The Fenway Institute has a sub-organization known as The National LGBTQIA+ Health Education Center, which focuses on producing seminars and guides to educate health service providers. These resources cover gender-affirming surgeries, HIV and PrEP, research and data collection, and more.

Nationally, transgender individuals can find healthcare-related support through a variety of organizations. Healthcare providers can share the following resources with their transgender patients in order to improve patient education, particularly since generalized healthcare is often not suitable for transgender individuals:

  • The National Center for Transgender Equality (NCTE) aims “to change policies and society to increase understanding and acceptance of transgender people,” by way of legal support, news involving transgender rights, and guides for a variety of transgender-related topics”. (“About Us”, transequality.org) The topics of those transgender-specific guides include general healthcare, COVID-19, and health coverage. NCTE also has a page dedicated to mutual aid and emergency funds in the event that a transgender individual needs legal support when facing discrimination in a variety of spheres of life, including healthcare. 
  • In addition to legal support in defense of transgender individuals facing discrimination, Lambda Legal, which boasts “the oldest and largest national legal organization whose mission is to achieve full recognition of the civil rights of lesbians, gay men, bisexuals, transgender people and everyone living with HIV” (“About Us”, Lambda Legal) has a downloadable Transgender Rights Toolkit to support transgender individuals facing any number of discriminatory matters, including health care discrimination. Lambda Legal also has a LGBT rights by state tool to help find information about local legislation, including healthcare-related legislation.
  • The Transgender Law Center (TLC), a trans-led advocacy organization, hosts a page of health resources. This includes a guide for transgender patients on how to negotiate for more inclusive coverage, as well as a guide that explains nondiscrimination rights under the Affordable Care Act (ACA).
  • The Transgender Legal Defense and Education Fund, which offers legal services and public policy education, also manages the Trans Health Project. This program includes insurance tutorials, statements from major medical organizations in recognition of the medical necessity of treatments for gender dysphoria, literature reviews to support appeals that require proof of medical necessity, and more.
  • Anti-transgender discrimination can also be reported through the American Civil Liberties Union (ACLU), which has a page dedicated to transgender health. This page regularly updates with press releases and news analyses.

Visibility is important, and at Himmelfarb we believe that it is a human right to be acknowledged for who you are. While transgender healthcare has come a long way, there are still ways that we can improve our care and protect our patients, particularly those who live in states with anti-transgender legislation on the rise. We hope that the resources in this piece will help medical professionals, transgender patients, and allies to take action and defend transgender people so that they can be visible. 

References

“About DCTC.” DC Trans Coalition. https://dctranscoalition.wordpress.com/about-dctc/. Accessed March 30, 2022.

“About Us.” Lambda Legal. https://www.lambdalegal.org/about-us. Accessed March 30, 2022.

“About Us.” National Center for Transgender Equality. https://transequality.org/about. Accessed March 30, 2022.

Ejiogu, N. I. (2020). Conscientious Objection, Intersex Surgeries, and a Call for Perioperative Justice. Anesthesia and analgesia. Vol. 131 (5), 1626-1628. http://doi.org/10.1213/ANE.0000000000004946

Feinberg, L. (2013). Transgender liberation: A movement whose time has come (pp. 221-236). Routledge.

Ferrando, C. A. (2020). Comprehensive care of the transgender patient. Elsevier.

Forcier, M., Van Schalkwyk, G., & Turban, J. L. (2020). Pediatric gender identity : gender-affirming care for transgender & gender diverse youth. Springer.

Ghorayshi, A. (2022, February 23). Texas Governor Pushes to Investigate Medical Treatments for Trans Youth as ‘Child Abuse’. New York Times. https://www.nytimes.com/2022/02/23/science/texas-abbott-transgender-child-abuse.html

Goodman, J. D. (2022, March 11). How Medical Care for Transgender Youth Became ‘Child Abuse’ in Texas. New York Times. https://www.nytimes.com/2022/03/11/us/texas-transgender-youth-medical-care-abuse.html

Hardacker, C., Ducheny, K., & Houlberg, M. (2019). Transgender and Gender Nonconforming Health and Aging. Springer.

H.B. 570, House of Representatives, 2022 Reg. Sess. 397. (Louisiana 2022). https://www.legis.la.gov/legis/ViewDocument.aspx?d=1256678

H.B. 675, House of Representatives, 2022 2nd Reg. Sess. (Idaho 2022). https://legislature.idaho.gov/sessioninfo/billbookmark/?yr=2022&bn=H0675

H.B. 2835, House of Representatives, 2022 Health Subcommittee. (Tennessee 2022). https://wapp.capitol.tn.gov/apps/Billinfo/default.aspx?BillNumber=HB2835&ga=112

Keuroghlian, A. S., Potter, J., & Reisner, S. L. (2022). Transgender and gender diverse health care : the Fenway guide. McGraw Hill.

Klibanoff, E., & Dey, S. (2022, March 11). Judge temporarily blocks Texas investigations into families of trans kids. Texas Tribune. https://www.texastribune.org/2022/03/11/transgender-texas-court-hearing/

LGBTQ+ : support and care. Part 3, Caring for transgender children (2021). American Academy of Pediatrics.

Russell, B. (2022, March 15). Senate GOP releases statement on its opposition to HB 675 on trans youth care. Idaho Press. https://www.idahopress.com/eyeonboise/senate-gop-releases-statement-on-its-opposition-to-hb-675-on-trans-youth-care/article_5c5305d4-9854-568f-b27a-76865a04b75c.html

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In the early 1980s there were official reports of once healthy, young, gay men falling severely ill and dying from an unknown illness. The first five reported cases included men ranging in age from 29 to 36, all displaying various symptoms and eventually developing pneumonia. In the summer of 1981, the CDC established a task force to study this new debilitating condition and since then researchers have worked diligently to understand and find treatment options. The condition and the virus that causes this illness were eventually named Acquired Immunodeficiency Syndrome (AIDS) and the Human Immunodeficiency Virus (HIV) respectively. Since its initial discovery, the spread of HIV has been classified as an pandemic and has impacted millions of people around the world. UNAIDS estimates that 79.3 million people have been infected with HIV since the beginning of the pandemic and as of 2020, approximately 37.7 million people currently live with HIV.  While there is no vaccine available to prevent HIV, over the decades researchers have discovered treatment options to help individuals manage their symptoms. Through ongoing research and clinical trials, HIV/AIDS researchers have several promising leads that could potentially help with the creation of a safe and effective vaccine that will contribute to the end of this decades long pandemic.

Researchers at the National Institute of Allergy and Infectious Diseases (NIAID) are actively studying HIV and how it interacts with people’s immune systems by conducting research and clinical trials. Using a two step, complementary approach towards vaccine development, researchers not only learn new information about the virus, but they also hope to use their findings to develop a vaccine that can be distributed to the general public. Under the empirical approach, researchers rely on observation and experimentation to move different vaccine candidates into the human trial stages. With the theoretical approach, researchers seek to better understand the virus, how it impacts the human immune system and how a vaccine can bolster the immune response when a person is exposed to HIV. These two approaches allow researchers to quickly move vaccine candidates through the different stages of clinical trials.

Infographic depicting information on the history of HIV vaccine research.
Credit: National Institute of Allergy and Infectious Diseases

One of the most significant HIV vaccine clinical trials in recent years was the RV144 Trial in Thailand. This study enrolled over 16,000 volunteers and took place over the course of several years, with researchers reporting their findings in 2009. This trial showed that the vaccine candidates offered some protection against HIV in humans, which was the first time researchers discovered a vaccine could potentially protect people from the virus. The RV144 findings are still being analyzed for how the vaccine combination used in the trial helps our immune responses and other studies hope to build off the modest success of the RV144 trial. In the late 2010s, two other important clinical trials began and their data may offer a glimmer of hope for vaccine development. Launched in 2017 by the National Institutes of Health and other research partners, the HVTN 705/HPX2008 or Imbokodo study enrolled HIV-negative women in sub-Saharan Africa and used a vaccine regime “based on ‘mosaic’ immunogens–vaccine components designed to induce immune responses against a wide variety of global HIV strains.” (“NIH and Partners Launch HIV Vaccine Efficacy Study”) A complementary study called HPX3002/HVTN 706 or Mosiaco used a similar vaccine regime and took place across several countries including the United States, Brazil, and Poland. The Mosiaco study volunteers were made up of HIV-negative men and transgender people from the ages of 18 to 60. The results from the Imbokodo and Mosiaco studies were released in 2020 and 2021 respectively, though it may take years before researchers have a full understanding of the impact of these two clinical trials. In more recent news, NIAID scientists published an article in Nature Medicine that highlighted promising results of an HIV vaccine candidate based on the mRNA program used to develop vaccines for COVID-19. The researchers found that the vaccine showed promise in mice and non-human primates. According to Dr. Paolo Lusso, who led the team of researchers, "We are now refining our vaccine protocol to improve the quality and quantity of the VLPs (virus-like particles) produced. This may further increase vaccine efficacy and thus lower the number of prime and boost inoculations needed to produce a robust immune response. If confirmed safe and effective, we plan to conduct a Phase 1 trial of this vaccine platform in healthy adult volunteers..." ("Experimental mRNA HIV vaccine safe, shows promise in animals") It is difficult to predict when a vaccine will be available to the general public. But the results from clinical trials like the RV144 trial offer hope that one day researchers will create a safe vaccine and bring an end to this decades long pandemic.

 Our understanding of HIV and AIDS continues to evolve. Treatment options are improving allowing individuals with HIV to live comfortably. And every day researchers work to develop a vaccine that will provide significant protection for individuals who may be exposed to the virus. This post is a short overview of the history and current state of HIV vaccine research. If you’re interested in learning more about the history of HIV vaccine development, please visit the NIAID’s website dedicated to HIV/AIDS research and be sure to read through their ‘History of HIV Vaccine Research’ timeline which includes brief information about other previous clinical trials not discussed in this article.  Or click the links embedded in this article to learn more about the specific clinical trials and their results.

References:

“Experimental MRNA HIV Vaccine Safe, Shows Promise in Animals.” National Institutes of Health (NIH), 9 Dec. 2021, www.nih.gov/news-events/news-releases/experimental-mrna-hiv-vaccine-safe-shows-promise-animals.

“Global HIV and AIDS Statistics-Fact Sheet.” UNAIDS, www.unaids.org/en/resources/fact-sheet. Accessed 20 Dec. 2021.

“History of HIV Vaccine Research.” NIH: National Institute of Allergy and Infectious Diseases, 22 Oct. 2018, www.niaid.nih.gov/diseases-conditions/hiv-vaccine-research-history.

“HIV Vaccine Development.” NIH: National Institute of Allergy and Infectious Diseases, 15 May 2019, www.niaid.nih.gov/diseases-conditions/hiv-vaccine-development.

“NIH and Partners Launch HIV Vaccine Efficacy Study.” NIH: National Institute of Allergy and Infectious Diseases, 30 Nov. 2017, www.niaid.nih.gov/news-events/nih-and-partners-launch-hiv-vaccine-efficacy-study.

“NIH and Partners to Launch HIV Vaccine Efficacy Trial in the Americas and Europe.” NIH: National Institute of Allergy and Infectious Diseases, 15 July 2019, www.niaid.nih.gov/news-events/nih-and-partners-launch-hiv-vaccine-efficacy-trial-americas-and-europe.

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In an effort to remain accountable to communities who have been negatively impacted by past and present medical injustices, the staff at Himmelfarb Library is committed to the work of maintaining an anti-discriminatory practice. We will uplift and highlight diverse stories throughout the year, and not shy away from difficult conversations necessary for health sciences education. To help fulfill this mission,  we’re proud to reach out to one of our own Faculty members, Dr. Carlos Rodriguez-Diaz to hear his perspective on the COVID-19 vaccine, and what made his journey to the field of public health truly unique. 

What inspired you to go into public health? How did you first get involved in HIV care and prevention?

I was inspired to pursue a career in public health by a family physician who was by head physician and was the primary health care provider to my family and almost everyone in the small town of Aguas Buenas, Puerto Rico where I was born and raised. Before my senior year in college, I had the opportunity to participate in a Summer Internship Program at the University of Michigan-School of Public Health. I had the opportunity to work with a Latino-serving organization and it was through this experience that I got involved in public health and HIV prevention. Then, I realized the privilege that I had as a young Latino gay man to have access to education and contribute to my community by engaging in public health training, practice, and research. I am now using my privilege to disrupt privileges. 

What brought you to GW?

After nearly a decade working at the University of Puerto Rico-School of Public Health, I felt it was the time to expand my experiences and contribute to public health efforts in Puerto Rico but from a different platform. I also wanted to be more engaged in public health initiatives at US national level. GW’s location in the US capitol was a very attractive, particularly after experiencing at first had how public health efforts in the US are hindered by the lack of representation and the colonial experience of Puerto Rico. Further, GW is an established institution with ample experience conducting research in areas of my interest and expertise. 

What has been the most rewarding aspect of your work?

The opportunity to work with community members to identify public health challenges and address these challenges.  

We see a rise in misinformation with the COVID-19 vaccine. What lessons do you think scientists and medical experts can learn from that? How can scientific research be more transparent and accessible to the public?

We need to listen and to be better communicators. Based on my experience, most of the questions people have about the COVID-19 vaccine are legitimate. People need to be listened to and must receive culturally appropriate information. As scientists, we need to work on our health communications skills. We might be experts in an area of knowledge, but that does not mean that we know how to communicate information to lay populations. We either develop skills to engage with multiple audiences or work with experts who can help us communicate effectively. Further, we should facilitate those scientists from minoritized populations (e.g., Latinos, Black, LGBTQ, Native Americans) to have access to mass media and platforms to reach out to their communities. No one else can speak to a community like a community member.

What are your future research related plans or areas of interest at this time? 

I plan to continue working with community-based organizations and other community leaders to develop strategies to reduce health inequities and health disparities. The beauty of conducting community-based participatory research is that we are constantly focusing on the priorities identified by the community rather than working on a rigid research agenda. I also expect to continue my engagement in research activities related to the Ending the HIV Epidemic. I am collaborating in community-centered projects to address social determinants of HIV in Washington, DC and Puerto Rico. I am also planning to continue to be engaged in COVID-19 related research with Latino populations.

We now have multiple vaccines for COVID and more are in development based on a wide variety of techniques. Do you see this progress as potentially helpful in the development of an HIV vaccine?

Yes. The SARS-CoV-2 vaccine effort organized extraordinary resources and unprecedented global collaborations. The scientific achievements of COVID-19 vaccines are now inspiring a renewed sense of urgency for the HIV vaccine development effort.

What advice, if any, do you have for students just starting out? 

Aim for what you are passionate about. Always be yourself. Never become someone else to achieve your goals. Listen to your mentors and once you achieve your goals, pay it forward. 

On behalf of the Himmelfarb library we would like to extend our thanks to Dr. Rodríguez-Díaz for participating in this interview! 

Published on
Non-binary flag.

In an effort to remain accountable to communities who have been negatively impacted by past and present medical injustices, the staff at Himmelfarb Library is committed to the work of maintaining an anti-discriminatory practice. We will uplift and highlight diverse stories throughout the year, and not shy away from difficult conversations necessary for health sciences education. To help fulfill this mission, today's blog post celebrates International Non-Binary Day!

July 14th is International Non-Binary Day! The first International Non-Binary Day took place in 2012 (Angulo, 2019). The date falls between International Women’s Day and International Men’s Day, making it an appropriate date on which to raise awareness of people who do not identify exclusively as man or woman. So what is non-binary? 

Non-binary refers to anyone whose gender identity isn’t categorized as female or male. While some non-binary people identify as both a man and a woman, others don’t identify with either of these gender categories (HRC Staff, 2020). While some non-binary people identify as transgender, many do not. “Non-binary identities are varied and can include people who identify with some aspects of binary identities, while others reject them entirely” (Stonewall Staff, 2006). Simply put, being non-binary is as unique and individual as the people who identify as non-binary. 

We can all be an ally to non-binary people. Some of the simplest things you can do to be inclusive involve being aware of how the language you use can have a positive impact on everyone, regardless of gender identity. Including your pronouns when you introduce yourself, in your email signatures and social media profiles can be a great starting point. When you introduce yourself, saying “Hi, my name is Jane and I use she/her pronouns” can be an easy way for other people to safely introduce their pronouns. This not only lets the person know that you are interested in using their correct pronouns, but also makes it easy for them to communicate their preferences to you if they wish. You may also consider using gender neutral language when you are addressing a group by replacing “ladies and gentleman” with “folks” or “everyone.” When mentioning relationships, consider using gender neutral terms such as parents (instead of father/mother), children (instead of sons/daughters), siblings (instead of brothers/sisters), or partner (instead of husband/wife, boyfriend/girlfriend). 

From a medical and health perspective, non-binary people often experience health disparities resulting from their non-binary identities. One qualitative study published in 2020 in the Journal of Sex Research “explored the unique ways that non-binary adolescents experience minority stress and how it influences their mental health and well-being” (Johnson et al., 2020). Identity invalidation (the refusal to accept someone’s identity as “real” or “true”) was experienced during interpersonal relationships, within the LGBTQ communitity, on an institutional level in school environments, and through a lack of representation in the media (Johnson et al., 2020). The data collected from this study suggests that “identity invalidation has deleterious effects on mental health and contributes to mental health disparities facing non-binary adolescents” (Johnson et al. 2020).

A study published in the Journal of Health Care for the Poor and Underserved in 2018 examined interactions between transgender and gender non-binary individuals and their health care providers and identified characteristics of positive and negative interactions. Characteristics of positive clinician-patient interactions included: the correct use of names and pronouns; use of gender neutral language when referencing relationships, anatomy, and procedures; clinician knowledge of and experience with transgender and non-binary health; and treatment of identity disclosure as routine (Baldwin et al., 2018). Characteristics of negative clinician-patient interactions included: misgendering; lack of information and experience with transgender and non-binary patients (which often led to irrelevant questions stemming from clinician curiosity); and transphobia that led to a denial of care or a referral to another provider - another form of denial of care (Baldwin et al., 2018). This study concluded that formal medical education and training programs need to provide education and experience related to gender diverse patients. “Adjusting patient intake protocol and forms at the system-level to incorporate gender-neutral terminology and facilitate the use of preferred names and pronouns” was all supported by this study (Baldwin et al, 2018). 

As we celebrate International Non-Binary Day this year, take some time to explore resources such as SMHS’s LGBTQIA+ Community Support page, and GW student groups such as GW Out for Health or Transgender and Non-Binary Students of GWU. One of the best ways to celebrate International Non-Binary Day is through education and learning more about the non-binary experience. The following video is a great starting point - take a look and learn what it’s like to be non-binary.

References:

Angulo, D. (2019, July 15). Between international women’s and men’s day is non-binary day! Outright Action International. https://outrightinternational.org/content/between-international-womens-and-mens-days-non-binary-day

Baldwin, A., Dodge, B., Schick, V. R., Light, B., Scharrs, P. W., Herbenick, D., & Fortenberry, J. D. (2018). Transgender and Genderqueer Individuals’ Experiences with Health Care Providers: What’s Working, What’s Not, and Where Do We Go from Here? Journal of Health Care for the Poor and Underserved, 29(4), 1300–1318. https://doi.org/10.1353/hpu.2018.0097

CBC News: The National (2021, June 28). What it’s like to be non-binary . YouTube. https://youtu.be/7Gr78THojrU

HRC Staff (2020, July 14). Celebrating the Diversity of the Non-Binary Community for International Non-Binary Day 2020. https://www.hrc.org/news/celebrating-the-diversity-of-the-non-binary-community-for-international-non

Johnson, K. C., LeBlanc, A. J., Deardorff, J., & Bockting, W. O. (2020). Invalidation Experiences Among Non-Binary Adolescents. The Journal of Sex Research, 57(2), 222–233. https://doi.org/10.1080/00224499.2019.1608422

Stonewall Staff (2006, July 21). 10 ways to step up as an ally to non-binary people. Stonewall. https://www.stonewall.org.uk/about-us/news/10-ways-step-ally-non-binary-people

Published on
Dr. Lawrence "Bopper" Deyton standing at a podium smiling.
(GW SMHS, 2017)

In an effort to remain accountable to communities who have been negatively impacted by past and present medical injustices, the staff at Himmelfarb Library is committed to the work of maintaining an anti-discriminatory practice. We will uplift and highlight diverse stories throughout the year, and not shy away from difficult conversations necessary for health sciences education. To help fulfill this mission, today's blog post features Dr. Lawrence “Bopper” Deyton, MSPH, MD. 

Lawrence “Bopper” Deyton has been inspiring School of Medicine and Health Sciences (SMHS) students since March 2013 when he returned to SMHS after 31 years of government service at the Food and Drug Administration (FDA), the Department of Veterans Affairs (VA), the National Institutes of Health (NIH), Health and Human Services Office of the Surgeon General, and stints serving the Assistant Secretary of Health and as a Congressional Aide. 

Deyton had an influential experience 46 years ago that “made me realize that massive education of the health and public health community needed to happen” (Roeder, 2019). The experience took place during a visit to the Harvard medical campus’ student health clinic for a sore throat while he was pursuing his Master in Public Health degree at Harvard. The physician who saw him for this complaint offered him a referral to a psychiatrist. After a moment's confusion, Deyton realized that the referral had nothing to do with his sore throat. “It was about me being gay” (Roeder, 2019). Having disclosed his sexual orientation on an intake form alongside answers to routine medical questions, he didn’t think it would be a barrier to obtaining medical care. 

Rather than accept this experience as just the way life is, Deyton has been working to be a positive influence for change within health care his entire career. In his current role as Senior Associate Dean for Clinical Public Health and Murdock Head Professor of Medicine and Health Policy at SMHS, Deyton has been instrumental in creating the “Patients, Populations, and Systems” course which integrates concepts of public health, population health, health policy, advocacy and social responsibility with the clinical coursework in an effort to create “clinician citizens.” Deyton says “We want [students] to understand social determinants of health and to take up the mantle of their own social responsibilities when they leave here, and how what they learn here at GW can be used to effect positive social change” (Dvorak, 2018).

“Bopper,” a childhood nickname he has gone by his entire life and his first spoken word, had already been developing a deep sense of social responsibility as an undergraduate student. While pursuing his bachelor’s degree at the University of Kansas in the early 1970’s, Deyton remembers seeing a “Gay is good - Stonewall” poster and making the connection that “there was something out there that would allow me to integrate my sexuality with something that was positive” (Andriote, 1999). By the time he was pursuing his Master of Science in Public Health degree at Harvard, Deyton was doing exactly that. Even before his visit to the doctor about his sore throat, he had already become active in the American Public Health Association’s (APHA) LGBTQ Caucus, which was formed to help “tackle stigma in health care” (Roeder, 2019).

After moving to Washington, D.C. to work as a health policy analyst, Deyton began volunteering with a group of of LGBT health professionals to provide services to gay men from a church basement (Roeder, 2019). In 1978, he co-founded what is now Whitman-Walker Health as “a health clinic for gay men and lesbians before AIDS redefined everything and the clinic became a hub for HIV treatment” (Sullivan, 2011). Deyton eventually left his health policy analyst job to attend medical school at GW in 1981.

While in medical school, Deyton found a copy of Morbidity and Mortality Weekly Report (MMWR) dated June 5, 1981 that described cases of a “rare pneumonia among young, previously healthy gay men in Los Angeles” in his student mailbox (Roeder, 2019). While reading this report on what would eventually be known as HIV/AIDS, Deyton recalls “my heart sank. I knew something awful was happening to my community” (Roeder, 2019). HIV/AIDS became personal for Deyton. He still keeps a blue address book with the names of personal and professional contacts from this time. Roughly a third, about 50 people, in this contact book died (Roeder, 2019). “It’s a totem of remembrance and survival. I’ll never throw it out” Deyton says (Roeder, 2019).

While completing his residency at the University of Southern California Los Angeles County Medical Center, Deyton applied for a competitive position at the NIH. He almost didn’t make it to his interview due to a blizzard that slammed the East Coast the day before his interview. After catching the first available flight and renting a limo to drive him because no taxis were available due to the storm, Deyton arrived to an empty NIH building, “save for a building security guard and one man who didn’t believe in snowstorms shutting down the government” (GW SMHS, 2017). This is how his friendship with Dr. Anthony Fauci began. 

As Dr. Fauci recalled during Deyton’s installation as the Murdock Head Professor of Medicine and Health Policy at SMHS, “the guard almost didn’t let him in, but he insisted, pleading with the guard - and this is a true story - he knew how compulsive I am and that I would be there and went up to the seventh floor, knocked on the door...I opened the door, and there began a 30-year relationship” (GW SMHS, 2017). Deyton got the NIH position. At the NIH, he played a crucial role in HIV/AIDS research during the early years of the 1990s epidemic, helping to lead more than 200 NIH-funded clinical trials on HIV therapeutics (Partnership for Public Service, 2021). He oversaw “clinical research on the development and approval of antiretroviral drugs and treatment strategies, including the first trials of combination therapies, the cornerstone of current HIV treatments” (GW SMHS, 2017). 

Dr. Lawrence "Bopper" Deyton standing next to Dr. Anthony Fauci.
(GW SMHS Facebook Page, 2017)

During the course of this research, Deyton helped recruit thousands of HIV/AIDS patients into clinical trials that had “previously been excluded, such as African Americans, drug users, and those with little or no access to health care” (Partnership for Public Service, 2021). At a time when activists such as ACT UP were demanding to be active participants in HIV/AIDS research, Deyton developed the first NIH-funded community-based research program that “included front-line providers in places like LGBT health clinics, homeless shelters, and IV drug use programs'' (Roeder, 2019). “I cannot say how cutting-edge his approach was at the time,” said Margaret Hamburg, FDA Commissioner who nominated Deyton for a Samuel J. Heyman Service of America Medal (Deyton was a finalist for this prestigious award). “It brought research to communities that needed it. He understood the disconnect between patients and research, and he found a new way to do testing and develop products” (Partnership for Public Service, 2021). 

By 1996, HIV/AIDS research had started to produce positive results. Deyton recalls being part of a Data and Safety Monitoring Board (DSMB) meeting in which the results of a double-blind NIH-funded study investigating if adding a third drug to suppress HIV would be more effective and extend survival. The unblinded results showed that the regimen was working! “It was one of the most powerful moments in my life. I remember sitting in the DSMB meeting and I started to cry, and I wasn’t the only one. People were living” (Roeder, 2019).

Deyton eventually left the NIH for a position at the US Department of Veterans Affairs as the director of HIV/AIDS treatment programs. At the time, the VA was the largest care provider for HIV-infected patients in the US (Sullivan, 2011). He became the Chief Public Health and Environmental Hazards Officer for the VA, overseeing all public health programs for the national VA health care system. Deyton then transitioned to the FDA, where he served as the first Director of the Center for Tobacco Products. In this role, he oversaw implementation and enforcement of the Family Smoking Prevention and Tobacco Control Act which, for the first time, gave FDA public health regulatory authority over tobacco products in the US.  

Now, as the Senior Associate Dean for Clinical Public Health and the Murdock Head Professor of Medicine and Health Policy at GW SMHS, Deyton continues his legacy of creating positive change within healthcare. With SMHS’s strong commitment to social responsibility, it’s a great place for Deyton to do just that! In addition to his innovative Patients, Populations, and Systems course curriculum mentioned earlier, Deyton has been outspoken about influencing change in accrediting bodies within healthcare. Accrediting bodies “want to change...but they don’t know how” Deyton says in the video below. 

“...I think the way we can help them do the right thing, is to learn from ACT UP, and learn from the gay rights movement, and learn from the women’s movement, and learn from the civil rights movement. Sometimes leaders just have to stand up, and take a stand, and march, and occupy... If we really believe [in] what we want to do, we have to stop wringing our hands, and take to the streets, and go tell our professional bodies what we need them to do.”

(UNM Health Sciences, 2015)

Deyton’s goal for the GW SMHS’ innovative Clinical Public Health curriculum and programs is to prepare GW students to not just be great clinicians at the bedside but also to recognize, speak up and act on those factors outside of the hospital and clinic that will improve their patients’ health. Deyton believes clinicians must use their experience and their voices to improve community health. A guiding theme in Deyton’s life, and one that he has shared with his students, has been to “Just speak. Say who you are and what you want to do, and don’t worry about what anybody else thinks” (Roeder, 2019). It’s no wonder that Deyton has been an inspiration to so many students and colleagues at SMHS! 

References:

Andriote, J.-M. (1999). Victory deferred: How AIDS changed gay life in America. The University of Chicago Press.

Dvorak, K. (2018, May 18). Observation: Social Responsibility. Medicine + Health, (Spring 2018). https://gwmedicinehealth.com/news/observation-social-responsibility

George Washington University School of Medicine & Health Sciences. (n.d.). Faculty Directory: Lawrence Deyton. SMHS Faculty Directory. https://apps.smhs.gwu.edu/smhs/facultydirectory/profile.cfm?empName=Lawrence%20Deyton&FacID=2047325353

George Washington University School of Medicine & Health Sciences. (June, 12, 2017). Lawrence “Bopper” Deyton installed as Murdock Head Professor of Medicine and Health Policy. SMHS News. https://smhs.gwu.edu/news/lawrence-%E2%80%9Cbopper%E2%80%9D-deyton-installed-murdock-head-professor-medicine-and-health-policy 

George Washington University School of Medicine & Health Sciences. (n.d.). Patients, populations, and systems courses. https://smhs.gwu.edu/academics/md-program/curriculum/clinical-public-health/patients-populations-and-systems-courses

George Washington University School of Medicine & Health Sciences. (2017). [Untitled image of Dr. Lawrence “Bopper” Deyton at Murdock Head Professor of Medicine and Health Policy Installation]. https://smhs.gwu.edu/news/lawrence-%E2%80%9Cbopper%E2%80%9D-deyton-installed-murdock-head-professor-medicine-and-health-policy

George Washington University School of Medicine & Health Sciences. (2017, June 5). Murdock Head Professor of Medicine and Health Policy Installation [Image of Dr. Lawrence “Bopper” Deyton and Dr. Anthony Fauci]. [Photo Album]. GWSMHS Facebook page. https://www.facebook.com/pg/GWSMHS/photos/?tab=album&album_id=1458177520888127

Partnership for Public Service. (2021). Lawrence Deyton. Service to America Medals Honorees. https://servicetoamericamedals.org/honorees/lawrence-deyton/

Roeder, A. (Fall 2019). The Translator. Harvard Public Health: Magazine of the Harvard T.H. Chan School of Public Health. https://www.hsph.harvard.edu/magazine/magazine_article/the-translator/

Sullivan, P. (2011, September 7). Lawrence Deyton, award nominee, heads FDA campaign against smoking. The Washington Post, http://proxygw.wrlc.org/login?url=https://www.washingtonpost.com/local/lawrence-deyton-award-nominee-heads-fda-campaign-against-smoking/2011/08/15/gIQABsMYAK_story.html

UNM Health Sciences. (2015, April 23). Beyond Flexner 2015 Insights: Lawrence “Bopper” Deyton [Video]. Vimeo. https://vimeo.com/125852781

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Published on 1 Comment on Student Organization Spotlight: Out for Health

Out for Health (OFH) is a student-led organization here at GW. The current leadership team - Katie Maehl, Aaryan Bhandari, and Emma Wellington - recently took over as co-presidents of the organization. They have a phenomenal team of advisors in Dean Deyton and Dr. Caggiula. I spoke with Katie about the history of OFH, the current state of the organization, and their hopes for the future.

While the name “Out for Health” was coined about seven years ago, there has been an organized LGBTQ+ med student group at GW for much longer. Dean Deyton recalls a GW chapter of the national AMSA LGBT group when he was a med student in 1981. In its current iteration, OFH serves as both an advocacy group, hosting educational events on LGBTQ+ healthcare, and a place to build relationships and a sense of community amongst the LGBTQ+ community at SMHS.

In their advocacy work, OFH has hosted a lecture series on a number of different topics, from facial feminization surgery to health policy. They hope to continue this in the future, specifically mentioning a follow-up to the health policy lecture looking at how the Biden administration has addressed health policy concerns that affect the LGBTQ+ community. Of course, COVID has put a bit of a damper on some of these things - all the lectures they hosted this past year were done via Zoom. Katie mentioned they hope to hold more in-person events in the Fall, though that’s still a bit up in the air.

COVID also impacted the community-building OFH strives for. It’s hard enough to start medical school in the middle of a pandemic, but to also transition to a leadership role in a student organization without those in-person connections you would usually build during your first year is even more difficult. Recently OHF has been exploring safely transitioning to in-person events so they can start creating more of those connections. They had a picnic with the residents and some attendings to hopefully build a broader community across the health sciences at GW, and are hoping to hold similar events once school is back in session. One of their big goals for the future is to build a presence at Pride that includes not just OFH but the whole LGBTQ+ community in the health sciences at GW. There are even ideas to connect with LGBTQ+ med students at other schools in the DC area.

I asked Katie what the GW community could do to best support OFH as they reorient themselves under the new leadership team and with the return to campus. Katie wasn’t entirely sure what needed support might look like, since there’s still so much up in the air at the moment. That being said, “listening, being present, and showing up for events” are all small steps we can take to let OFH know we are here for them. Personally, I also think we need to make sure we are connecting with and supporting not only OFH and their leadership team but all of the Class of 2024. While they’ve been a part of our GW community for a year, it’s been a vastly different experience compared to the typical first year experience. Those of us who have been established at GW for a while are in a position to bridge that gap and help make them feel a part of our community.

Out for Health has a lot of ideas and plans for the future. I cannot wait to see what Katie, Aaryan, and Emma come up with. If you would like to reach out to OFH, send them an email at gwofh@gwu.edu. They’re always looking to connect with people, and if you have suggestions for events those are always welcome!

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It’s June, and around the world many celebrate diversity and the beauty that comes with being who you are. Pride is not only a month that encourages those who struggle with their own identity to shed any doubt or fears, but it is also a time to remind everyone that there are many of us who are supportive and are wholeheartedly on your side. 

This is also something to consider: It gets better. 

Not only do we have a host of organizations who are here to offer help, but Washington D.C. also has clinics that are catered specifically to support those in the lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual community. 

Did you know, the Whitman-Walker Clinic offers not only medical and gender care, but mental, dental, legal, and youth & family support services as well? With multiple locations within the District, Whitman Walker is an excellent option to any who want quality healthcare in an environment where you will not be judged. Whitman Walker will not pry into your personal life, they are well known for letting you make informed decisions for yourself. GW also collaborates with the Whitman-Walker to train future health care providers via the Healing Clinic through which SMHS students have a unique opportunity to learn and conduct one-on-one HIV & STI testing and counseling at WWH clinic sites, mobile testing vehicles, and special events.

At Himmelfarb Library, we have a number of resources that can provide further insight on LGBTQIA healthcare. For example, we have physical and electronic copies of Lesbian, gay, bisexual, and transgender healthcare: A clinical guide to preventive, primary, and specialist care and online access to The Fenway guide to lesbian, gay, bisexual, and transgender health.

Some additional titles you can find at Himmelfarb include:

Many additional resources can be found through our catalog. If you are unable to find what you are looking for, you can always contact us at himmelfarb@gwu.edu or set up an appointment with a reference librarian to help you sharpen your research skills!  

Wishing you all a joyous and safe Pride filled month from the Himmelfarb library.

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Published on 1 Comment on Dr. David D. Ho: A First Responder in the HIV/AIDS Epidemic

Doctor David D. Ho is a Taiwanese-American physician and researcher whose work significantly impacted our understanding of HIV/AIDS and how to treat it. Born in Taiwan in 1952, Dr. Ho immigrated to the United States with his family when he was a child. He grew up in Los Angeles and after graduating from high school, enrolled in the California Institute of Technology. He graduated in 1974 with a Bachelor of Science in Biology & Physics and attended Harvard Medical School where he earned his MD in 1978. It was during his internal medicine residency at Cedars-Sinai Medical Center that Dr. Ho first encountered a patient exhibiting symptoms for a mysterious illness that would later be known as HIV. In a 2011 interview with Asian Scientist magazine, when asked how he became interested in researching HIV & AIDS, Dr. Ho said “I happened to be in the right place at the right time...I encountered a number of patients who presented with opportunistic infections suggesting that their immune system was impaired. It was a mystifying syndrome to doctors and scientists alike.” 

Towards the end of the 1980s and as more individuals were diagnosed with HIV, Dr. Ho became the founding Scientific Director and Chief Executive Officer of the Aaron Diamond AIDS Research Center (ADARC). The center grew out of the partnership between the Aaron Diamond Foundation, the Department of Health of the City of New York, the Public Health Research Institute and New York University School of Medicine. Dr. Ho and his team of researchers studied HIV replication in vivo and eventually proved the management of HIV replication through the use of antiretroviral therapy. This was a major breakthrough in the fight against HIV/AIDS as patients diagnosed with HIV had a treatment option that allowed them to live their life without being afraid of the virus. Since this breakthrough, Dr. Ho and his lab continues their research and searches for ways to prevent the transmission of HIV, while also researching potential vaccines for HIV. 

Dr. David D. Ho has received many honors and awards in recognition for his contributions to the fight against HIV/AIDS. For his discovery of antiretroviral therapy, he was named Time's Person of the Year in 1996. In 2001, he was awarded the Presidential Citizens Medal by then President Bill Clinton. He was also inducted into the California Hall of Fame in 2006. On December 1, 2020, World AIDS Day, Dr. Ho received the National Leadership Recognition Award from the National AIDS Memorial. Currently, he serves as the Clyde ‘56 and Helen Wu Professor of Medicine at Columbia University and he continues his research while serving as the Director for the Aaron Diamond AIDS Research Center.

Dr. Ho has published countless articles on his research over the course of his career. If you’re interested in learning more about his work, explore the Himmelfarb catalogue for articles such as ‘Time to Hit HIV, Early and Hard’ or ‘Engineering multi-specific antibodies against HIV-1’ and much more. Check out his conversation with Dr. Anthony Fauci during the 2020 Worlds AIDS Day National Conversation and his 2016 interview with TIME magazine.

References:

“Becoming American: The Chinese Experience . David Ho Bio | PBS.” PBS, www.pbs.org/becomingamerican/ap_pjourneys_bio3.html. Accessed 21 May 2021.

“David Ho Receives National Leadership Award from National AIDS Memorial.” Columbia University Irving Medical Center, www.cuimc.columbia.edu/news/david-ho-receives-national-leadership-award-national-aids-memorial. Accessed 21 May 2021.

“Faculty - David Ho.” Columbia University Department of Microbiology & Immunology, microbiology.columbia.edu/faculty-david-ho. Accessed 21 May 2021.

Mo, Steven. “AIDS Research Pioneer David Ho Talks To Asian Scientist Magazine.” Asian Scientist Magazine, 11 Sept. 2014, www.asianscientist.com/2011/06/features/aids-research-pioneer-david-ho-da-i.

“Our Legacy.” Aaron Diamond AIDS Research Center (ADARC), www.adarc.cuimc.columbia.edu/about-us/our-legacy. Accessed 20 May 2021.

Published on

In an effort to remain accountable to communities who have been negatively impacted by past and present medical injustices, the staff at Himmelfarb Library is committed to the work of maintaining an anti-discriminatory practice. We will uplift and highlight diverse stories throughout the year and not shy away from difficult conversations necessary for health sciences education. To help fulfill this mission, this week’s blog post will feature a conversation with Dr. Amanda Castel, MD, MPH.

Dr. Amanda Castel is a Professor of Epidemiology at GW. She received her BA in Biology from Brown, her MD from the University of Pennsylvania, and her MPH from Johns Hopkins. I was honored to speak with Dr. Castel about her work at GW, experiences as an infectious disease expert during a global pandemic, and her thoughts on health inequality and stigmatization.

From a young age, Dr. Castel wanted to be a doctor, and in particular a pediatrician. Born in Liberia in West Africa, Dr. Castel’s mother frequently told her about another baby born around the same time. They were both ill, but because Dr. Castel’s family is American they were able to fly her to the US for treatment. As she grew up, her family traveled internationally quite often for her parents’ work. She was able to see how other parts of the world deliver healthcare and was inspired by the idea she could “possibly make a difference and improve people’s lives.” During the course of her education, Dr. Castel took a year off to do a Fulbright Fellowship in Senegal, doing research on prevention and mother/child transmission of HIV. Through this experience, she caught the “public health bug” and decided to join her clinical interests with her public health experience. Speaking to Dr. Castel you can see her understanding of how privileged we are as Americans and her drive to create more equitable healthcare access.

After finishing her degrees, Dr. Castel worked in the CDC’s Epidemic Intelligence Service Program and was assigned to the Maryland Department of Health in their Communicable Disease Program. She describes the experience as being “a foot soldier. You are in the trenches, you’re working with county health departments… you’re doing all kinds of disease investigations.” This gave Dr. Castel the training to marry her clinical experience with her public health experience.

In early 2020, Dr. Castel watched as severely understaffed and under resourced health departments braced for the impending COVID-19 pandemic. On March 14th, 2020, Dr. Castel rolled up her sleeves, walked over to the DC Health Department, and told them “I’m here. What do you need?” In the early days of the pandemic, Dr. Castel recalls scrambling to keep ahead of the curve. The health department worked on case investigations with very limited contact tracing. The numbers were increasing so quickly they just didn’t have the bandwidth and workforce to keep up with them. As scary as those days were, from a scientific perspective they were “fascinating.” Learning how this virus worked, the transmission and symptomatology - it was a firsthand experience not many people get. Dr. Castel describes it as “professionally a very fulfilling experience.”

Alongside her work with the health department, Dr. Castel has been teaching infectious disease epidemiology at the GW School of Public Health. As part of that course, Dr. Castel tries to drive home the point that these diseases are everywhere, if you look at the news you can probably find something about an outbreak every day. January 2020, she and her students began tracking this new respiratory virus. As time went on and the pandemic progressed, these students had the opportunity to learn more about COVID within the course. When GW pivoted to online learning in March, that created a new set of challenges for educators. Dr. Castel commented on the difficulties that arise from not being in the same room as your students, that “the dynamic is different,” but even with these challenges “the students are continuing to learn and grow.” These same students are now working with health departments doing case investigations or other COVID response tasks. Those in the current cohort will be working in public health moving forward. Looking for a silver lining in times when finding them is hard, the preparation Dr. Castel gave these students is having a palpable impact on people’s lives. 

Given her research in HIV/AIDS, Dr. Castel was uniquely situated to understand the ways this pandemic might unfold. In July 2020, Dr. Castel and some of her colleagues from the School of Public Health published an article discussing the synergies between HIV and COVID-19. Despite the major differences between the two viruses, it is astonishing to consider the similarities. Looking back at the beginnings of the HIV epidemic, the process of learning “which populations were most at risk, how to get testing to people, how we prevent infections, contact tracing, these core public health methods” have all been applicable to COVID-19 as well. And what we have learned through these processes are incredibly similar. The populations most disproportionately affected, racial and ethnic minorities, are the same.

Dr. Castel has researched the social ramifications of HIV, the stigmatization and public misconceptions, and the way these intersect to make treating people living with HIV harder. She does see parallels with COVID-19, especially now as vaccines become more available. Seeing the different numbers coming out from Moderna, Pfizer, and Johnson & Johnson, Dr. Castel had a genuine concern that “the general public wouldn’t understand the nuances,” and that might translate into stigmatization based on the type of vaccine being offered. It might raise questions like “If you only offer me the one that’s less effective are you discriminating against me?” And that is part of why it is so important for medical professionals and public health professionals to be able to explain these differences to the public, to understand their fears and concerns and respond to them with the facts in a way they can understand. Dr. Castel felt this especially strongly “as an African American woman working in the field,” with friends and family coming to her with their questions and concerns. Translating that information can be difficult, but it’s a vital part of the work Dr. Castel does, and a crucial part of what she teaches her students.

Despite the difficulties of the past year, Dr. Castel is hopeful. The urgency with which the scientific community responded to the pandemic has the potential to impact other areas of healthcare as well. Perhaps there will be a chance to “take some of that innovation and technology and apply it to HIV research.” But she has tempered that hope with the understanding that “the calculus is different.” COVID-19 is a pandemic that has impacted everyone, put us all at risk. The population most at risk from exposure to HIV is not one that is prioritized in the same way. It’s a stark reminder that even in the United States healthcare is not inherently equitable. Despite the fact that HIV “drastically alters the world [of those infected] in the ways that COVID has altered the rest of ours” there is an unwillingness to apply the same sense of urgency to HIV. Hopefully, as we begin to return to some sense of normalcy, those of us in the health sciences will be empowered to advocate for this kind of research. Those of us in positions of privilege who can speak to the healthcare needs of stigmatized populations need to work on communicating those needs to the general public. We can advocate for change, and call on our government to end the cycle of failing people living with HIV. We need to reevaluate our current healthcare system and public health professionals, like Dr. Castel, are ready to rise to the occasion. Of the lessons we’ve learned from the COVID-19 pandemic, one of the most important is that with a sense of urgency, adequate funding, and research, it’s possible to develop long-term solutions to viruses and diseases that still harm marginalized communities.

To learn more about the history of HIV/AIDS health policy in the US, take a look at this article covering 35 years of policy. To learn more about advocating on behalf of people living with HIV/AIDS, read this commentary from Topics in Antiviral Medicine. To learn more about Dr. Castel’s work, browse her publications indexed in the Health Sciences Research Commons.

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