LGBT Birth Tourism too far-fetched an idea for Jamaica?

I am still a little befuddled at the fact that Jamaica is still seemingly reluctant or afraid to diversify the already successful tourism product. The matter came up for mention this morning on radio. Given the recent introduction and active business of AirB&B catering to middle class vacationers who cannot afford five star hotels and that traveller who is seeking a more earthy real world exploration it has helped in the sub categories of LGBT visitors as well who like the rustic charm & scenery away from the inclusive concrete jungles that a mere marble and artificial beauty with some flora and fauna. Jamaica does facilitate birth tourism but obviously for heterosexual couples. We must not leave out the fact that gay marriage is a done deal by way of the US SCOTUS in that historic judgement. The smaller guest houses or homes linked to AirB&B model are all over the place and have been doing pretty well as some 1,500 properties or more have qualified and are actively accommodating persons. The pink dollar component of it though somehow we as a country have not capitalized on even in the face of pre-US embargo pressure on Cuba the island was doing relatively well in the LGBT guest department. Of course with the visibility and intervention of the daughter of the late Fidel Castro, Mariela that has helped greatly in attracting support and visitors.

Cuba’s national awareness programs on sexual health also includes LGBT matters so the population being so exposed does have the kinds of caustic homophobia when compared to ours with sometimes disastrous outcomes. They still do have the occasional slip up but that problem won’t disappear altogether. Now that the embargo has been lifted there is almost a flood of persons overall but includes savvy and monied LGBT persons including newly minted married couples who seek the destination for their honeymoon and I have since gathered birth tourism where couples either by insemination or surrogate arrangements either way i.e. male couples who use their sperm with a paid female carrier go to other countries from the US; as for US citizenship the child’s citizenship is dual if the family allows it or as for future educational opportunities prudent planning is crucial. Trouble is if one is from outside the US going to that destination to have the baby must have strong financial backing and insurance coverage not from the country of origin. However in reverse let’s say in Jamaica where a US or Canadian or British couple gets here the private hospitals is what they have to contend with and some insurance would have been included in the ticket purchase and so on.

Another drawback for US couples in particular especially heterosexual and lesbian couples where one of the lesbians will be the ‘mother’ is that unlike our three month maternity leave automatically granted to women not all US states offer such extended leave; some only give a month which may not be enough time to have the baby do relatively well before time of travel. Canada has a similar arrangement I gather but if mothers-to-be entered into contractual arrangements the there may be implications. Some prudent planning has to come into play I imagine. 

Also other health reasons can come into play such as is the expectant person can travel or is deemed fit by a doctor so to do?; especially if there is a requirement for multiple trimester visits in the desired destination. With stability and state recognition in LGBTQ family life with sometimes a disturbing feeling of homo-assimilation couples want children or are going about it the original route of adoptions. With proven stem cell research and birth methods guided by strict codes of conduct since the mid 2000s, surrogacy maybe a thing of the past in years to come as couples can create eggs and sperm from said stem cells thus having their own DNA in that newborn.

also see: Sexual Reproduction for Same Sex Couples? 2010

Possible spin-offs

A newly pregnant or new baby couple may need bedside attention outside of the private hospital care, and after discharge from the facility may need some help and guidance navigating local cultural considerations such as diet, climate management and or a security detail if necessary; all of whom can earn from providing those side services.

Homophobia doesn’t impede the destination

Despite Jamaica’s homophobia the island is somehow still loved a every year the figures look impressive, recent cruise ships stop-over to the point of lack of space for porting is visible evidence of that. Despite attempted tourism boycotts such as the major one in 2008 and the Red Stripe Beer dump in protest which drew major attention visitors still come for the flora and even commitment ceremonies and civil appearing weddings. Apart from a few of the big players that accommodate LGBT guests and host private events such as raves (Bloom events hosted by a Jamaican living in NY), beach parties and such there are other mid priced villas that also cater to such markets. A recent clothing option event was held at property in St. Ann. Visitors are willing to spend on security as I have seen over my 21 years in LGBT event planning and DJing. Investment though is not so readily available for persons such as myself who may want to expand to a LGBT specific venue and accommodation to hosts such guests thus capitalizing on the pink dollar.

Far-fetched?

Definitely not but the lack of forward thinking in both the business community, elites, LGBT NGOs and government is still a challenge; as the visits and privacy attached to same is already happening but one of the challenges is that visitors are used to public displays of affection in their own countries and sometimes to ask guests to suppress their ODA might be a little challenging. 

A year 2000 case comes to mind where a Caucasian male couple in Ocho Rios by what is now Pineapple Place or thereabouts after they inadvertently appeared to be too affectionate to each other, were spared a thrashing by visibly upset mostly males who left the shaken men with a strong warning to not show ‘it’ up; I guess they were not about to interfere with the visitors seeing they were foreigners and they would have left soon afterwards. The outrage that flowed when the story made the tabloid however was another matter as the usual ‘thrown in our faces’ abhorrence was the main homophobic driver at the time. I would like to see more natives getting involved in this pink dollar tourism arrangement specific to LGBT guests, no offence to our expatriate friends please as there are a couple already utilizing the AirB&B model after they came to Jamaica and invested in property and linking to influential gay tourism books such as the Spartacus, problem is some of these AirBnB outfits seem not to want to cross fertilize by having natives also as guests, something that needs addressing. The last time that Jamaica had a listing of LGBT outfits before recent times was when the co-founder of the now closed Club Entourage Brian Williamson managed to get the New Kingston business district venue on there; it attracted the occasional foreign guests.

Oh for that pink piggy to get fat.

Peace & tolerance

H

Fibroids can affect your sex life too

May 15 to 21, 2016, is dubbed National Fibroids Awareness Week, and it's quite fitting because it seems that every woman is affected by these non-cancerous growths on or in the muscle walls of the uterus. The statistics are depressing because some 80 per cent of women in Jamaica are affected in some way by uterine fibroids. 

I have experienced them both directly, with my own diagnosis, as well as through the ordeal that my older sister faced as she underwent two surgeries to remove fibroids. With all the information and treatment options available, many women still don't know that they have these growths in their womb. Some of us just credit the increase in our waistline to getting fat.

There are some women who have small fibroids that don't really present any symptoms. However, the larger fibroids can really wreak havoc on the reproductive system and present very inconvenient and painful symptoms. One of the symptoms of fibroids that I don't think is highlighted enough is its effects on a woman's sex life.

Painful intercourse - Depending on the size and location of the fibroids, sexual intercourse can be very painful for her. Some women complain about feeling a stabbing pain in their lower abdomen during sex. This can be a symptom of uterine fibroids.

Longer periods - With fibroids, bleeding is extended and periods last longer than usual. This definitely affects the desire for sex as well as the ability to engage in sexual activity. I have met women who say they have had month-long periods.

Heavy periods - In addition to hindering the possibility of sex itself, heavy bleeding can cause anaemia. Heavy bleeding also restricts a woman's ability to move around and go about her daily activities without having to worry about messing up her clothes.

Low self-esteem - With all the discomfort she is experiencing, her clothes feel different on her body, and overall, she's not feeling her best.

Bloating and other discomforts - The infamous PMS is real, and with uterine fibroids, it seems to magnify all the symptoms. So a woman is feeling bloated, irritable, and she is dealing with menstrual cramps as well. Any woman who has ever experienced PMS knows that it is not easy to get through a busy day much less get in the mood for sex.

Uterine incontinence - Feeling the need to urinate often can get in the way and make sex unappealing.

It is very important at this point for me to indicate that these are not just symptoms that affect women. Their partners are also affected, and it is vital that these partners participate with unconditional support. Men, especially, should learn more about how they can help to support their partners who suffer from this condition. 

It still surprises me that women same gender loving or bisexual men are uncomfortable handling feminine products or even talking with their women about their symptoms and overall issues. Even during intercourse, men need to pay attention to their response and don't just focus on 'stabbing di meat'.

Like it or not, uterine fibroids are a reality for some women and we must find out as much as we can to treat the condition.

National Fibroids Awareness Week ends on Saturday with a symposium at the Jamaica College Auditorium, and there will be a presentation about the journey of Dr Shelly Ann Weeks with the condition. 

I hope to see you there

Peace & tolerance

H

Orgasms can improve your health ..........

Dr Shelly Ann Weeks share more advice

I know that when we talk about sex, many persons have different opinions about its necessity outside of procreation. The fact is that while the sexual act is necessary to procreate, that's not the only, or dare I say it, the most important function that this activity has. Before I get into the other necessary functions of sex, let me first take a look at the various stages that the body goes through when we have sex.

The sexual response cycle

The sexual cycle starts with excitement or arousal which is when the body starts to prepare for intercourse. During this stage foreplay is essential to get the blood flowing to the various organs and to put the body in the right mood. The excitement phase leads to the plateau phase where the body is aroused and heart and breathing rates are elevated and so is the blood pressure. During this phase the skin is extra sensitive and the erogenous zones (lips, nipples, genitals, neck, etc.) are even more so. It's during the plateau phase that intercourse happens and the genitals are stimulated to create friction that will lead to orgasm. For some persons one orgasm is enough, but some persons are multi-orgasmic and may require further stimulation and orgasms to be satiated.

photo added for effect from the net

I started off talking about orgasms, so let's get back to it. There are many persons who have difficulties achieving orgasm and the reasons are variable. But having an orgasm a day can actually improve your overall health and even your quality of life.

STRESS RELIEF

Orgasms are your body's built stress reliever. When someone orgasms the hormone oxytocin is released from nerve cells in the hypothalamus (a region of the brain) into the bloodstream. This hormone is also known as the 'feel good hormone' and it helps to stimulate feelings of warmth and relaxation.

HAPPIER RELATIONSHIP

More frequent orgasms might make it harder for your partner to cheat. The hormone oxytocin is also known as the 'love hormone' and studies have shown that its frequent release strengthens the bond between a couple and makes them less likely to go outside of the relationship for their sexual pleasure.

BETTER SLEEP

With the fast paced, busy life that most of us lead, sometimes it's hard to settle down and get a good night's rest. Having an orgasm before you go to sleep is a great way to fall asleep and improve the overall quality of your rest.

Pain relief

The magical chemicals (oxytocin, endorphins) released in the brain during orgasms are excellent pain relievers. Women who orgasm during child birth report better management of pain. Even women who orgasm during her menstrual cycle have less discomfort.

BUILDS IMMUNE SYSTEM

Having frequent orgasms will increase the production of 'killer' cells called leukocytes which are essential in helping the body fight off infection.

Orgasms feel really good and they are good for you, so I didn't think I needed to give too many reasons why you should try to have at least one a day. Think of it like taking your vitamins. After all, the benefits speak for themselves. Remember also that even though it's great to share the experience with someone, there is nothing stopping you from enjoying orgasms solo. Have fun and stay sexy.

Send your questions or comments to sexychatwithshelly@gmail.com or Tweet me@drsexyann or Facebook www.facebook.com/allaboutthesexy Website:www.drsexyann.com

Washing penis after sex doesn't prevent STIs

Washing penis after sex doesn't prevent STIs

Dear Counsellor,

I always thought I had a major problem and so I have been abstaining from sex for some time; I usually ease the sexual tensions by masturbating. Recently, I got so happy and say to myself that my stresses where sex is concerned are over. Counsellor, I have learnt that it is not everything a person must keep on the chest, it is good to talk with trusted friends. I say that because it was only while talking to a trusted friend that I get to understand that all I need to do is wash off the penis immediately after sex and have my girlfriend douche so we would not get sexual germs like AIDS and the others.

Happy and Free

Dear Happy and Free,

Genital hygiene is important and a good practice. However, there is no evidence that washing the genitals prevents sexually transmitted infections (STIs), including HIV, the virus that causes AIDS. In fact, vaginal douching increases a woman's risk of acquiring STIs, including HIV, and pelvic inflammatory disease.

The only sure way to prevent sexually transmitted infections is to abstain from all sexually activities; that is, oral, vaginal and anal. For persons who are sexually active, the only sure way to prevent sexually transmitted infections is to use a condom every time or stick to one faithful partner who you know is uninfected.
Do pregnant women have a greater chance of getting HIV?

Dear Counsellor,

I have a concern about pregnancy. I would like to know if pregnancy places a woman at increased risk of becoming infected with HIV?

Want to Know

Dear Want to Know,

Current evidence is conflicting as to whether pregnancy increases a woman's chances of infection if exposed to HIV. What we do know is that if a woman becomes infected with HIV during pregnancy, the chances that HIV will be transmitted to her baby during pregnancy, delivery, and childbirth may be at their highest because she will have a high level of virus in her blood. It is therefore important for all pregnant women to protect themselves from HIV and other STIs through mutual faithfulness, condom use or abstinence. On the other hand, if a pregnant woman thinks that she may have HIV, she should seek HIV testing. Testing for HIV during pregnancy is extremely important to the both the health of the baby and the mother-to-be. Resources are available to help the prevention of mother-to-child transmission of HIV and this has been very effective.

For more information on condom use, HIV/AIDS and other sexually transmitted infections, call the AIDS/STD Helpline toll free at 1888-991-4444

Transgender people are at high risk for HIV, but too little is known about prevention and treatment for this population

Tonia Poteat (you may remember her from the 'For The Bible Tells Me So' documentary)

Transgender women have among the highest rates of HIV infection but little is known about HIV prevalence among trans men, Tonia Poteat of Johns Hopkins Bloomberg School of Public Health said in a plenary lecture on transgender health and HIV at the recent Conference on Retroviruses and Opportunistic Infections (CROI 2016) in Boston – the first ever on this population at CROI. A growing number of studies and prevention and treatment programmes are addressing transgender populations, but more research is needed.

Dr Poteat noted that while mainstream knowledge about transgender men and women is relatively new in the US and Europe, largely thanks to celebrities such as Chaz Bono and Caitlyn Jenner, people outside the male-female gender binary have long existed in many cultures, such as the hijra in India.

The size of the transgender population is uncertain, in part due to varying definitions. One estimate put the number of transgender people in the US at approximately 700,000, or 0.3% of the population. Estimates range from 0.1% to 0.5% in Europe, and from 0.7% to 2.9% in South Asia, where some countries legally recognise a ‘third gender’.

Traditional ‘one-step’ data collection approaches can make it difficult to accurately identify trans people in HIV research. Many investigators have categorised study participants according to either their current gender identity or their assigned sex at birth, both of which can result in misclassification. A ‘two-step’ method that asks about both initial sex assignment and current identity is more accurate and inclusive.

“The way you ask the question makes a big difference,” Dr Poteat stressed.

For example, the international iPrEx trial of tenofovir/emtricitabine (Truvada) for pre-exposure prophylaxis (PrEP) included transgender women in its population of 2499 men who have sex with men. The initial published iPrEx report said the study included just 29 trans women, but a later analysis used a broader definition – including people assigned male at birth who identified as women, trans or ‘travesti’, and those who identified as men but used feminising hormones – bringing the total up to 339.

HIV rates in trans populations

As Susan Buchbinder of the San Francisco Department of Public Health said in her introduction to the lecture, “There is probably no population that is both more heavily impacted [by HIV] and less discussed around the world than transgender people.”

Dr Poteat said that very little is known about HIV rates among transgender men. A recent systematic review found six US studies, including a self-report study with a prevalence of 0.4% and five studies based on laboratory testing with rates ranging from 0.5 to 4.3%, but actual numbers were small. Among non-US studies, three based on self-report found prevalence rates of 0.6 to 0.8%, while two based on lab tests had rates of 0 and 2.2%.

A bit more is known about trans women, who were the main focus of the talk. Trans women who have sex with men have one of the highest burdens of HIV infection among key affected populations, which also include gay and bisexual men and people who inject drugs.

One worldwide meta-analysis of 39 studies from 15 countries found that transgender women had an HIV prevalence rate of 19% – 49 times higher than that of the general population. In high-income countries the prevalence was 22%, with the highest rate among trans women of colour.

A more recent meta-analysis by Dr Poteat’s group looked at 49 new studies, which showed both an exponential increase in research and an ongoing high burden of HIV infection. Among the included studies based on lab testing, prevalence rates ranged from 2% among trans youth to 45% among trans sex workers. The three studies that estimated incidence, or new infections, reported rates of 1.2 to 3.6 per 100 person-years.

Even in countries where HIV prevalence in the general population is high, trans women still face a disproportionate burden. In Lesotho, for example, overall prevalence is estimated at 18% for all cisgender (non-transgender) men, 27% for all cisgender women and 28% for men who have sex with men, but rises to 60% for trans women.

Vulnerabilities affecting trans people

A number of factors may make transgender people more susceptible to HIV infection or less likely to use prevention methods or access treatment if they become infected.

Biological factors include hormone therapy, which has the potential to interact with PrEP or antiretroviral treatment (ART). While no clinically significant interactions have been confirmed between feminising hormones and tenofovir/emtricitabine PrEP or most antiretrovirals, many trans women worry about them and prioritise hormone use.

To date, no randomised clinical trials have looked specifically at PrEP for transgender women, but aniPrEx substudy led by Madeline Deutsch from the University of California at San Francisco’s Center of Excellence for Transgender Health found that Truvada appeared to protect trans women who took it consistently. No seroconversions occurred among trans women with tenofovir drug levels indicating they took at least four pills per week. However, their level of adherence was lower than that of gay men in the study, which Deutsch suggested could be due to concerns about PrEP and hormone interactions.

Prior studies have shown that tenofovir reaches higher levels in rectal tissue in men than in cervical or vaginal tissue in women. This could in part be related to hormonal differences between cisgender men and women, although some have found that tenofovir levels are lower in cervical-vaginal tissue samples than in matched rectal tissue samples obtained from the same women.

Some researchers hypothesise that exogenous or administered oestrogen may affect tenofovir pharmacokinetics, for example by interfering with creatine kinase phosphorylation of tenofovir disoproxil fumarate to its active form of tenofovir diphosphate. This could mean that trans women taking oestrogen and PrEP will have lower tenofovir levels in rectal tissue than cisgender men, and therefore may need higher doses – a prospect that requires further study.

Hormones could also potentially cause changes in rectal or vaginal mucosa that increase susceptibility to HIV. Further, sharing needles to inject hormones or fillers such as silicone can transmit HIV and hepatitis B or C. It is not known whether trans women who have genital sex reassignment or affirmation surgery are more vulnerable to HIV infection.

Social and structural factors

Social and structural factors that increase trans people’s vulnerability to HIV include stigma, fear of disclosure, sexual networks that include more people with HIV, poverty, lack of employment opportunities which leads many trans women to engage in sex work, homelessness or unstable housing, violence, lack of access to health care or insurance, substance use and mental health issues such as depression.

Although many transgender women are eligible for PrEP according to US Centers for Disease Control and Prevention (CDC) or World Health Organisation (WHO) guidelines, most are not yet using it and may not be aware of it. One study found that only about 14% of trans women in San Francisco – a city were PrEP awareness and use among gay and bisexual men are high – had heard of PrEP at the end of 2013.

Dr Poteat reported that among people with HIV using Ryan White HIV/AIDS services, transgender people were less likely than patients overall to remain in care (78 vs 80%) and to achieve viral suppression (74 vs 81%).

A survey of trans women with HIV conducted by the Transgender Law Center found that gender-affirming care and hormone therapy were their top priority, considered more urgent than HIV treatment. But trans women who had the same provider for both hormone therapy and HIV treatment were more likely to stay in care and have an undetectable viral load, demonstrating the benefit of integrated care.

“Transgender women have disproportionate HIV prevalence and incidence due to the interplay of biological and intersectional social factors,” Dr Poteat concluded. “Gender-affirming approaches are necessary to achieve optimal outcomes.”

To address barriers to care for trans women it is important to “reduce stigma and prevent secondary trauma including racism, transphobia, economic disadvantage and other structural factors,” she said. “HIV services we have available, mostly geared towards gay men, do not meet the needs of trans women.”

Resources for trans women and men

New resources for trans people have recently begun to appear, including the National Center for Innovation in HIV Care brief Transgender Women and Pre-Exposure Prophylaxis: What We Know and What We Still Need to Know and the booklet Transcending Barriers for Safer Pleasure from Project Inform and Outshine NW. Project Inform's booklet for men who have sex with men, Is Taking PrEP the Right Choice for You?, has also been updated with inclusive language and information for gay and bi transgender men.

In the United Kingdom ClinQ at 56 Dean Street, London, provides holistic sexual health and well-being services for trans people.

Reference

Poteat T HIV in transgender populations: charted and uncharted waters. Conference on Retroviruses and Opportunistic Infections (CROI), Boston, abstract 79, 2016.

View the abstract on the conference website.

View a webcast of this session on the conference website.

World Medical Association Guidelines for Physicians on Transgender Healthcare

here is a reminder from October 2015

New guidelines for physicians to enable them to increase their knowledge and sensitivity towards transgender people and the unique health issues they face have been approved by the World Medical Association.

At its annual General Assembly in Moscow, the WMA emphasised that everyone has the right to determine their own gender and that gender incongruence is not in itself a mental disorder. Delegates from almost 60 national medical associations agreed that every effort should be made to make individualised, multi-professional, interdisciplinary and affordable transgender healthcare available to all people who experience gender incongruence. They approved guidelines explicitly rejecting any form of coercive treatment or forced behaviour modification and said that transgender healthcare aims to enable transgender people to have the best possible quality of life.

The guidelines were proposed by the German Medical Association, which said they acknowledged the inequities faced by the transgender community and the crucial role played by physicians in advising transgender people and their families about treatment.

Delegates said they were aware of the cultural sensitivities in some parts of the world about this issue, but also said it was important for the WMA to stress that cultural, political or religious considerations must not take precedence over the rights, health and well-being of transgender people.

WMA President, Sir Michael Marmot, said: ‘We condemn all forms of discrimination, stigmatisation and violence against transgender people and want to see appropriate legal measures to protect their equal civil rights. And as role models, physicians should use their medical knowledge to combat prejudice in this respect. We would like national medical associations to take action to identify and combat barriers to care.

‘It is important that there is appropriate expert training for physicians at all stages of their career to enable them to recognise and avoid discriminatory practices, and to provide appropriate and sensitive transgender healthcare.'

The guidelines are available to read and download from the WMA below:

WMA Statement on Transgender People Adopted by the 66th WMA General Assembly, Moscow, Russia, October 2015

PREAMBLE

In most cultures, an individual’s sex is assigned at birth according to primary physical sex characteristics. Individuals are expected to identify with their assigned sex (gender identity) and behave according to specific cultural norms strongly associated with this (gender expression). Gender identity and gender expression make up the concept of “gender” itself.

There are individuals who experience different manifestations of gender that do not conform to those typically associated with their sex assigned at birth. The term “transgender” refers to people who experience gender incongruence, which is defined as a marked mismatch between one’s gender and the sex assigned at birth.

While conceding that this is a complex ethical issue, the WMA would like to acknowledge the crucial role played by physicians in advising and consulting with transgender people and their families about desired treatments. The WMA intends this statement to serve as a guideline for patient-physician relations and to foster better training to enable physicians to increase their knowledge and sensitivity toward transgender people and the unique health issues they face.

Along the transgender spectrum, there are people who, despite having a distinct anatomically identifiable sex, seek to change their primary and secondary sex characteristics and gender role completely in order to live as a member of the opposite sex (transsexual). Others choose to identify their gender as falling outside the sex/gender binary of either male or female (genderqueer). The generic term “transgender” represents an attempt to describe these groups without stigmatisation or pathological characterisation. It is also used as a term of positive self-identification. This statement does not explicitly address individuals who solely dress in a style or manner traditionally associated with the opposite sex (e.g. transvestites) or individuals who are born with physical aspects of both sexes, with many variations (intersex). However, there are transvestites and intersex individuals who identify as transgender. Being transvestite or intersex does not exclude an individual from being transgender. Finally, it is important to point out that transgender relates to gender identity, and must be considered independently from an individual’s sexual orientation.

Although being transgender does not in itself imply any mental impairment, transgender people may require counseling to help them understand their gender and to address the complex social and relational issues that are affected by it. The Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-5) uses the term “gender dysphoria” to classify people who experience clinically significant distress resulting from gender incongruence.

Evidence suggests that treatment with sex hormones or surgical interventions can be beneficial to people with pronounced and long-lasting gender dysphoria who seek gender transition. However, transgender people are often denied access to appropriate and affordable transgender healthcare (e.g. sex hormones, surgeries, mental healthcare) due to, among other things, the policies of health insurers and national social security benefit schemes, or to a lack of relevant clinical and cultural competence among healthcare providers. Transgender persons may be more likely to forego healthcare due to fear of discrimination.

Transgender people are often professionally and socially disadvantaged, and experience direct and indirect discrimination, as well as physical violence. In addition to being denied equal civil rights, anti-discrimination legislation, which protects other minority groups, may not extend to transgender people. Experiencing disadvantage and discrimination may have a negative impact upon physical and mental health.

RECOMMENDATIONS

The WMA emphasises that everyone has the right to determine one’s own gender and recognises the diversity of possibilities in this respect. The WMA calls for physicians to uphold each individual’s right to self-identification with regards to gender.

The WMA asserts that gender incongruence is not in itself a mental disorder; however it can lead to discomfort or distress, which is referred to as gender dysphoria (DSM-5).
The WMA affirms that, in general, any health-related procedure or treatment related to an individual’s transgender status, e.g. surgical interventions, hormone therapy or psychotherapy, requires the freely given informed and explicit consent of the patient.
The WMA urges that every effort be made to make individualised, multi-professional, interdisciplinary and affordable transgender healthcare (including speech therapy, hormonal treatment, surgical interventions and mental healthcare) available to all people who experience gender incongruence in order to reduce or to prevent pronounced gender dysphoria.

The WMA explicitly rejects any form of coercive treatment or forced behaviour modification. Transgender healthcare aims to enable transgender people to have the best possible quality of life. National Medical Associations should take action to identify and combat barriers to care.
The WMA calls for the provision of appropriate expert training for physicians at all stages of their career to enable them to recognise and avoid discriminatory practises, and to provide appropriate and sensitive transgender healthcare.

The WMA condemns all forms of discrimination, stigmatisation and violence against transgender people and calls for appropriate legal measures to protect their equal civil rights. As role models, individual physicians should use their medical knowledge to combat prejudice in this respect.

The WMA reaffirms its position that no person, regardless of gender, ethnicity, socio-economic status, medical condition or disability, should be subjected to forced or coerced permanent sterilisation (WMA Statement on Forced and Coerced Sterilisation). This also includes sterilisation as a condition for rectifying the recorded sex on official documents following gender reassignment.
The WMA recommends that national governments maintain continued interest in the healthcare rights of transgender people by conducting health services research at the national level and using these results in the development of health and medical policies. The objective should be a responsive healthcare system that works with each transgender person to identify the best treatment options for that individual.

Breast Cancer Month: Lesbians and Breast Cancer

October is Breast Cancer awareness month and since some researchers and health care professionals believe that lesbians may be at greater risk for breast cancer then heterosexual women, I thought it would be appropriate to get some facts out to the lesbian community.

First of all, let me start by saying that just because your a lesbian does not mean that you are automatically at a higher risk for breast cancer.

However, having one or more of the risk factors below might put you in that category. A lesbian without the risk factors is at no greater risk than a heterosexual woman for breast cancer.

Breast Cancer Risk Factors include:

Family History
Women whose mothers, grandmothers or sisters have had breast cancer are two to three times more likely to develop breast cancer. However, greater numbers of women with breast cancer have no family history of the disease.

First childbirth
The risks are higher among women who have never had (and breastfed) a baby or whose first childbirth occurred after the age of thirty.
The risk is reduced by as much as 50 percent for women who have had one child in countries such as the US.

Menstrual history
Early first period (before age 11) and late menopause (after age 52) both increase risk.
DietHigh-fat, low-fiber diet increases the risk of Breast Cancer. The risk also increases with women who are overweight.

Age
Risk increases with age. This disease is rare in women under the age of thirty. Women over fifty make up a larger number of breast cancer cases.

Alcohol
Women who consume two to five alcoholic drinks a day have a higher risk of breast cancer than do non-drinkers. (Research has not shown that lesbians drink more than the general population, however, they do have a greater history of problems with alcohol.)

Smoking
Research has shown that women who smoke have a 30% higher risk of developing breast cancer compared with women who have never smoked. Research has also shown that 25% of lesbians said they were smokers compared to 19% of heterosexual women in a 2007 Harris Interactive survey.

Genetic Alterations
Specific alterations in certain genes, such as those in the breast cancer genes (BRCA1 or BRCA2), make women more susceptible to breast cancer.

Hormone Replacement Therapy
Recent evidence suggests that menopausal women who have long-term exposure (greater than 10 years) to hormone replacement therapy (HRT) may have a slightly increased risk of breast cancer.

Socio-economic Factors
In the United States, white women from upper-socioeconomic classes living in urban areas are more at risk for breast cancer than other women, for reasons researchers do not yet understand.

Environmental Factors
Research has not yet proven whether there are breast cancer risk risks involved in a number of environmental exposures, including radiation, UV rays in sunlight, artificial sweeteners, pesticides and electromagnetic fields that surround electronic devices like microwave ovens and cell phones.

Health Care
Another issue that lead researchers to believe that Lesbians are at a higher risk is due to the fact that lesbians are less likely to seek routine health care because of the discomfort of coming out to their health care providers and less access to health insurance. With fewer doctor visits, lesbian are less likely to have mammograms and professional breast exams. Studies also show that lesbian women are less likely to perform breast self-exam regularly. For these reasons, lesbians women may be less likely to have cancers detected at earlier, more treatable, stages.

Click here for related posts: 

LEADING VOICE ON CANCER IN THE SAME GENDER LOVING COMMUNITY PASSES

BREAST CANCER MONTH: A JAMAICAN LESBIAN’S SURVIVAL STORY …………….

BREAST CANCER, CANCER AND BLACK WOMEN 2009

CONTINUING BREAST CANCER MONTH POSTS

OCTOBER IS BREAST CANCER MONTH – MALE BREAST CANCER 2009

Jamaica Cancer Society Page

How to reduce your risk for breast cancer:

http://www.breastcancer.org./

Peace & tolerance

H

Upcoming FTM Fitness World Conference 2015

Monica Roberts

My trans brothers have been asking me why I haven't been covering the news from their half of the community lately, and they have a point. I do need to do a better job of it since I have the only continuous publishing blog dealing with trans issues from an African-American trans perspective.

And covering trans issues from an African-American perspective means I not only need to cover the stuff that happens on the trans feminine end, it also means I need to cover the issues and developments on the trans masculine end, too.

But you trans brothers also need to step up and let Monica know what's happening, and what you think I need to be talking about that you think needs to be brought to our attention for a wider discussion across Trans World.

Commentary over, now let's segue to what this post is about.

This weekend in the ATL the FTM Fitness World Conference will be taking place October 1-3 at the Ramada Plaza -Downtown Atlanta (Capitol Park) with the 2015 theme of The Warrior Within You.

The event was founded by Neo Sandja with the goal of bringing the trans community and trans masculine men together who want more out of life through workshops, activities, exhibits, partnerships, networking and entertainment.

It also made a little history in the process. In 2014 The FTM Fitness Conference hosted the first ever bodybuilding competition for men of trans experience.

The FTM Fitness World Conference has two goals, The first one is to embrace diversity by focusing on what unites us instead of what separates us and bridging the gap between us based on age, sexual orientation, socio-economic background, religious affiliation and more.

The second on is to empower our community. It seeks to do so by inspiring attendees to push for excellence while rejecting mediocrity. It wishes to inspire attendees to be the change they wish to see in their local communities and realize they possess the tools to succeed in every area of their lives while focusing on what united the trans community.

The emcee of this year's event will be my lovely Houston homegirl Diamond Stylz, and keynote speakers will not only include FTM Fitness World Con founder Neo Sandja, but also Dr. Kortney Ziegler, Ryan Salinas, Tracee McDaniel, and Buck Angel,

And yes, the 2nd annual FTM Fitness World Bodybuilding Competition will be a part of this year's event.

If you wish to learn more about #FTMFitCon15 you can go to ftmfitnessconference.com for further information.

Bisexuals accounted for 40 per cent of new HIV infections in 2012

MINISTER of Health Dr Fenton Ferguson July 13 disclosed that men who have sex with both men and women accounted for almost 40 per cent of new HIV infections in 2012.

Speaking at a press conference to announce the approval of funds for the National HIV/STI Programme at the Terra Nova Hotel in Kingston, Dr Ferguson said although the HIV/STI programme has made significant strides in achieving a decline in new infections and is on track to halt and reverse the spread of HIV/AIDS, it continues to face challenges with respect to the prevalence rate among vulnerable groups.

“While we have a prevalence rate of 1.8 per cent among the general population, female sex workers have a prevalence of 4.2 per cent, young men under 25 years who have sex with men are at 24.3 per cent as at 2013, and adult men who have sex with men (MSM) have a prevalence rate of 32 per cent,” the health minister explained.

“In addition, men who have sex with men and their female partners accounted for almost 40 per cent of new infections in 2012,” he said.

“I want to further note that MSM who reported being involved in sex work, reported an HIV prevalence of 41 per cent, transgender women 45 per cent, and transgender populations in sex work reaching as high as 56 per cent.”

Insisting that the prevalence rate among these groups are “way too high”, Dr Ferguson said that much of the efforts must be concentrated on these vulnerable groups, adding that there is the ever present challenge of implementing mechanisms to effectively deal with the issue of stigma and discrimination.

The approved funds include US$14.9 million from the Global Fund to Fight AIDS, tuberculosis and malaria, to be used from January 2016 to December 2018; US$5 million from the US President's Emergency Plan for AIDs Relief (PEPFAR)/United States Agency for International Development (USAID) for the 2015/2016 financial year, and increased budgetary allocation from the Jamaican Government.

The funds, according to the minister, will facilitate support geared at reaching those most at risk of becoming HIV infected, as well as those who are already infected through the provision of treatment, care and support services.

Dr Ferguson said the PEPFAR grant has already been approved and that they are now in the final stages of completing the ministry’s work plan, while a mission from the Global Fund is now in the island working through funding requirements and guidelines with stakeholders to develop an integrated plan.

He told the Jamaica Observer that the additional funds being pumped into the programme will enable them to focus on vulnerable groups, instead of just the prevalence of HIV/AIDS among the general population.

“I think we have done extremely well to get to 1.8 per cent, but you would've heard the startling statistics I spoke to and unless you are able to target those groups and while targeting them, increasing your public education component that's going to be important because even as you [set] targets, people must know what they should do, what puts them at risk, etc,” the minister said.

“And I think this funding during this period would really help us to break the back to get Jamaica to be, undoubtedly, the leader within the Caribbean relative to HIV/AIDS.”

The minister admitted that for some the identified vulnerable groups is a controversial topic, but he remained committed to ensuring the stigma and discrimination that is often demonstrated is removed, even as public education is boosted.

“You would have noted [the figure of] men who have sex with men but also with women, you are talking about 40 per cent, that's extremely high,” the minister reiterated, while speaking to the Observer.

“You know sometimes you are focusing on the MSM alone, and not realising that our women are also at risk in those situations.

“So, we will just have to continue the public education, even as we continue to deal with those issues that mitigate treatment of these specific vulnerable groups,” Dr Ferguson insisted.

Meanwhile, in calling for continued partnerships to multiply the gains, the minister thanked both the mission from the Global Fund and USAID for their “consistent support of the national effort to fight the prevalence of HIV and AIDS among the Jamaican population”.

Jamaica's National Flower Lignum Vitae Found to Have Bio-activity to Fight HIV

Jamaica’s national flower the Lignum Vitae has been found to contain properties that could be used to treat persons living with the Human Immune Virus, HIV, the virus that causes Acquired Immune Deficiency Syndrome, AIDS, by depleting the immune systems of infected persons the researchers who worked on the discovery were led by noted Jamaican scientist and entrepreneur Dr Henry Lowe, the research team noted that the Lignum Vitae has potent bioactivity that could work against HIV.

The study outlined in part:

Aim: Jamaica is rich in medicinal plants. Guaiacum oficinale is the “National Flower”, with reported uses in folk medicine for the treatment of various conditions including inflammation. In our search for plants with anticancer and anti-infective properties, we evaluated Guaiacum oficinale for activity against HIV-1.

Methodology: The leaf, seed and twig extracts of G. oficinale were screened for anti HIV-1 properties in primary peripheral blood mononuclear cels (PBMCs) infected with the reference HIV-1 BaL strain.

Results: Al the tested extracts inhibited HIV-1 p24 production by infected cells, with EC50 concentrations of 2.35µg/ml, 23.42µg/ml and 25.04µg/ml, respectively for the leaf, seed and twig extracts. As comparison, Betulinic acid had an EC50 value of 27.50µg/ml. The tested extracts had IC50/EC50 selectivity index (SI) values of ≥ 3, which compared favorably to Betulinic acid SI value of 1.09.

Conclusion: The results of this study suggest that extracts of G. oficinale may provide leads for the discovery of new drug agents against HIV-1.

Dr Henry Lowe

A statement from Dr Lowe’s Environmental Health Foundation, EHF Group of Companies said that although known from last year test results were repeated several times to ensure data accuracy it says since then the findings were published April 2014 issue of the prestigious European Journal of Medicinal Plants, according to the statement since publication a significant amount of data has been developed, the work of Dr Lowe and his research team has been lauded by Dr Joseph Bryant of the Institute of Human Virology at the University of Maryland Medical School where the global viral network is located. Dr Bryant said Dr Lowe and his researchers need to be recognised and commended for bringing a gift of a major potential magic bullet from a Jamaican tree to the potential management of HIV.

The EHF Group says it is currently pursuing potential drugs from the Lignum Vitae in collaboration with the US based National Products Division of the Research Triangle International which is known for its discoveries of anti HIV drugs, based on this collaboration the EHF Group believes it is one the verge of discovering a potent major anti HIV drug from the plant, Dr Lowe who is the founder and the scientist at the Kingston based Biotech R & D Institute plans to do further research on the isolates of the Lignum Vitae this in order to develop a treatment that could be used alone or as part of a cocktail for the management of HIV/AIDS.

In the interim a nutraceutical product is being developed the EHF group says a US patent has so far been filed in order to protect this vital intellectual property.

The tree is found almost everywhere and in even dry rocky conditions, it is also available in the United States and the Caribbean but as different varieties and is a home remedy for tonsillitis by soaking the bar until the water turns red then gargle or drunk for fever, in the Virgin Islands it is used for fish poisoning and in other parts of the Caribbean for even abortion when specially prepared, it seems this plat we have here and I have no doubt many others have properties that we must explore and unearth. Some parts of Latin America use the leaves for tea to treat stomach aches or as an energy booster when soaked overnight and drunk unsweetened. It is also said to have anti bacterial properties in a subsequent interview with Dr Lowe on Nationwide radio.

He said in that interview also that it could be a potential foreign exchange earner for Jamaica.

Another household use in Jamaica is that of a makeshift broom when a few branches are tied together and is an excellent insect repeller in kitchens in a similar bunched set of green leaves and used to chase away flies and such from meats and fruits. It is rested and amongst fruits, tubers and other foods to supposedly slow down drying out of them when stored in a container or typical food basket and also chasing away fruit flies, moths that feed or surround the aforementioned. During Christmas it attracts thousands of butterflies to its purple flowers and said thousands of caterpillars can be seen on its trunk and branches as they feed prior to pupating.

the trunk often used to make a tea or broth or bark is stripped off and used separately

It seems this plant has some properties just by its natural use and the attraction or repulsion of insects and so on. Not to mention its use as a disciplinary tool for whipping but cut in very slim stick strips as it does not break easily.

Hope we can find the active properties and develop on this as an alternative for the other manufactured and still expensive antiretroviral and highly active antiretroviral therapies available and given the push on PrEP as treatment cheaper drugs are needed as Truvada locally is not so cheap and is partially distributed via the free national system.

Download the PDF file on the research HERE written by Dr Henry Lowe

Peace and tolerance

H

5 Alpha Reductase Deficiency, Dihydrotestosterone & Ambiguous Genitalia

What is 5-alpha reductase deficiency?

5-alpha reductase deficiency is a condition that affects male sexual development before birth and during puberty. People with this condition are genetically male, with one X and one Y chromosome in each cell, and they have male gonads (testes). Their bodies, however, do not produce enough of a hormone called dihydrotestosterone (DHT). DHT has a critical role in male sexual development, and a shortage of this hormone disrupts the formation of the external sex organs before birth.

Many people with 5-alpha reductase deficiency are born with external genitalia that appear female. In other cases, the external genitalia do not look clearly male or clearly female (sometimes called ambiguous genitalia). Still other affected infants have genitalia that appear predominantly male, often with an unusually small penis (micropenis) and the urethra opening on the underside of the penis (hypospadias).

During puberty, people with this condition develop some secondary sex characteristics, such as increased muscle mass, deepening of the voice, development of pubic hair, and a growth spurt. The penis and scrotum (the sac of skin that holds the testes) grow larger. Unlike many men, people with 5-alpha reductase deficiency do not develop much facial or body hair. Most affected males are unable to father a child (infertile).

Children with 5-alpha reductase deficiency are often raised as girls. About half of these individuals adopt a male gender role in adolescence or early adulthood.

How common is 5-alpha reductase deficiency?

5-alpha reductase deficiency is a rare condition; the exact incidence is unknown. Large families with affected members have been found in several countries, including the Dominican Republic, Papua New Guinea, Turkey, and Egypt.

What genes are related to 5-alpha reductase deficiency?

Mutations in the SRD5A2 gene cause 5-alpha reductase deficiency. The SRD5A2 gene provides instructions for making an enzyme called steroid 5-alpha reductase 2. This enzyme is involved in processing androgens, which are hormones that direct male sexual development. Specifically, the enzyme is responsible for a chemical reaction that converts the hormone testosterone to DHT. DHT is essential for the normal development of male sex characteristics before birth, particularly the formation of the external genitalia.

Mutations in the SRD5A2 gene prevent steroid 5-alpha reductase 2 from effectively converting testosterone to DHT in the developing reproductive tissues. These hormonal factors underlie the changes in male sexual development seen in infants with 5-alpha reductase deficiency.

During puberty, the testes produce more testosterone. Researchers believe that people with 5-alpha reductase deficiency develop secondary male sex characteristics in response to higher levels of this hormone. Some affected people also retain a small amount of 5-alpha reductase 2 activity, which may produce DHT and contribute to the development of secondary sex characteristics during puberty.

Read more about the SRD5A2 gene.

How do people inherit 5-alpha reductase deficiency?

This condition is inherited in an autosomal recessive pattern, which means both copies of the SRD5A2 gene in each cell have mutations. Most often, the parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but do not show signs and symptoms of the condition.

Although people who are genetically female (with two X chromosomes in each cell) may inherit mutations in both copies of the SRD5A2 gene, their sexual development is not affected. The development of female sex characteristics does not require DHT, so a lack of steroid 5-alpha reductase 2 activity does not cause physical changes in these individuals. Only people who have mutations in both copies of the SRD5A2 gene and are genetically male (with one X and one Y chromosome in each cell) have the characteristic signs of 5-alpha reductase deficiency.

Where can I find information about diagnosis or management of 5-alpha reductase deficiency?

These resources address the diagnosis or management of 5-alpha reductase deficiency and may include treatment providers.

• Genetic Testing Registry: 3-Oxo-5 alpha-steroid delta 4-dehydrogenase deficiency
• MedlinePlus Encyclopedia: Ambiguous Genitalia
• MedlinePlus Encyclopedia: Intersex

You might also find information on the diagnosis or management of 5-alpha reductase deficiency inEducational resources and Patient support.

General information about the diagnosis and management of genetic conditions is available in the Handbook. Read more about genetic testing, particularly the difference between clinical tests and research tests.

To locate a healthcare provider, see How can I find a genetics professional in my area? in the Handbook.

Where can I find additional information about 5-alpha reductase deficiency?

You may find the following resources about 5-alpha reductase deficiency helpful. These materials are written for the general public.

• MedlinePlus - Health information (3 links)
• Educational resources - Information pages (4 links)
• Patient support - For patients and families (3 links)

You may also be interested in these resources, which are designed for healthcare professionals and researchers.

• Genetic Testing Registry - Repository of genetic test information (1 link)
• PubMed - Recent literature
• OMIM - Genetic disorder catalog

What other names do people use for 5-alpha reductase deficiency?

• Familial incomplete male pseudohermaphroditism, type 2
• male pseudohermaphroditism due to 5-alpha-reductase deficiency
• PPSH
• Pseudovaginal perineoscrotal hypospadias
• Steroid 5-alpha-reductase deficiency

For more information about naming genetic conditions, see the Genetics Home Reference Condition Naming Guidelines and How are genetic conditions and genes named? in the Handbook.

What if I still have specific questions about 5-alpha reductase deficiency?

Ask the Genetic and Rare Diseases Information Center.

Where can I find general information about genetic conditions?

The Handbook provides basic information about genetics in clear language.

• What does it mean if a disorder seems to run in my family?
• What are the different ways in which a genetic condition can be inherited?
• If a genetic disorder runs in my family, what are the chances that my children will have the condition?
• Why are some genetic conditions more common in particular ethnic groups?

These links provide additional genetics resources that may be useful.

• Genetics and health
• Resources for Patients and Families
• Resources for Health Professionals

What glossary definitions help with understanding 5-alpha reductase deficiency?

androgens ; autosomal ; autosomal recessive ; cell ; chromosome ; deficiency ; DHT ;dihydrotestosterone ; enzyme ; familial ; gene ; genitalia ; hormone ; hypospadias ; incidence ; infertile ;micropenis ; puberty ; recessive ; scrotum ; testes ; testosterone

You may find definitions for these and many other terms in the Genetics Home Reference Glossary.

See also Understanding Medical Terminology.