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.

The hunt for the perfect condom continues

Condoms prevent the spread of disease and, of course, unwanted pregnancy. Globally, more than 5 billion are sold each year, but is there still room for improvement?

Since 1988, the 1st of December has been dedicated to raising awareness, fighting stigma and commemorating those lost to the disease.

World AIDS Day was the first global health day, and each year since 1995, the president of the United States has made an official proclamation.

By the end of 2012, there were 3.5 million people living with HIVglobally and an estimated 2.3 million new HIV infections.

Sub-Saharan Africa is the worst hit by the epidemic. In some countries, 20% of the population are infected. However, nowadays, Central Asia and Eastern Europe are experiencing the fastest spread of the disease.

On a positive note, since 2001, new infections have fallen by 33% and the number of children newly infected by HIV has dropped by 52%.

The battle is clearly not over. Science is dedicated to discovering better treatment, more effective prevention and, eventually, the cure for this most pervasive and destructive disease.

Mahua Choudhury, PhD, assistant professor at the Texas A&M Health Science Center Irma Lerma Rangel College of Pharmacy, is part of this push.
The future of condoms

Chowdhury has come up with an ingenious and revolutionary design for a new condom. Rather than latex, which many people are either allergic to or simply dislike, she plans to use a hydrogel infused with plant-based antioxidants.

The hydrogel in question is a strong, elastic polymer that consists predominantly of water. It is already used in contact lenses, so the challenge of safety testing is at least partially removed.

What makes this condom particularly special is the addition of a plant-based antioxidant. This compound has been found to have anti-AIDS properties. If this innovative condom breaks, the antioxidant is released and prevents the virus from replicating.

But the innovation does not end there. These particular antioxidants - flavonoids - are also predicted to heighten sexual enjoyment.
What is a flavonoid antioxidant?

Flavonoid antioxidants are found in many fruits, vegetables, leaves and grains. Some types of flavonoids, like quercetin, are already available in supplement form.

These flavonoid antioxidants can enhance feelings of pleasure by promoting the relaxation of smooth muscle and raising arterial blood flow. Thirdly, flavonoids help keep nitric oxide levels elevated, which work to stimulate and maintain erection.

Chowdhury's mission was to create a condom that would not only be an effective AIDS barrier, but also something that people would actually want to use. She says:

"If you can make it really affordable, and really appealing, it could be a life-saving thing."

Funding will come from the Grand Challenge in Global Health award courtesy of the Bill & Melinda Gates Foundation. The award was set up to fund individuals working to solve pressing global health challenges.

The competition this year was focused on finding an extremely low-cost, latex-free condom. Choudhury was one of 54 applicants selected out of 1,700 to receive the funding.

The condom is not yet ready for market - extra testing is needed - but the product is well underway. "We are trying to find how fast the enmeshed antioxidant can release, and we don't know if it will automatically release, or if you have to apply pressure," Chowdhury says.

Over the next 6 months or so, the final testing will have been completed. The potential benefits of a condom that people actively want to wear and that protects against AIDS with a double-edged attack are obvious.

also see:

World’s first condom specifically designed for anal sex 2013

Non-Daily PrEP Study Raises Doubts of Its Real-World Applicability

Researchers have published in the New England Journal of Medicine their findings from the IPERGAY trial of an intermittent dosing schedule of Truvada (tenofovir/emtricitabine) as pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM). Preliminary results from the study, which found that the non-daily dosing protocol reduced the risk of HIV infection by 86 percent in the double-blind, placebo-controlled trial, were presented at the February 2015 Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle and the 20th International AIDS Conference in Melbourne, Australia, in July 2014.

In the published study, the study investigators cautioned that PrEP’s effectiveness in this trial may have been exaggerated by the fact that the placebo arm was discontinued early. The relative brevity of the time participants spent in the placebo phase—a median nine months, compared, for example, with 1.2 years in the global iPrEx study of daily PrEP—may have inflated the results, as the participants may have become less adherent if more time had passed.

The researchers also cautioned that the IPERGAY findings may not apply to individuals who follow the study’s PrEP dosing protocol and take fewer than 15 pills per month, which was the median number of pills the men in the study took. Previous research has estimated that taking four daily doses of Truvada per week confers maximum protection against HIV. The protection the men in IPERGAY’s Truvada arm experienced may be more related to their taking the drug at about that frequency, rather than the particulars of the actual dosing schedule.

Participants were recruited at six sites in France and one in Canada between February 2012 and October 2014. Four hundred MSM were randomized into two groups; 201 received a placebo and 199 received Truvada. At enrollment, the participants all reported condomless anal intercourse with at least two partners during the previous six months.

The participants were instructed to take two doses between two and 24 hours before intercourse, or one pill if the most recent dose was taken between one and six days before. If intercourse did occur, they were to take one dose every 24 hours after that first dose, until they had taken two pills since the last time they had anal sex. The participants all received enough tablets to take one per day throughout the study.

Participants made clinic visits four and eight weeks after they were enrolled in the trial and then every eight weeks after that. At each visit they received a comprehensive package of HIV and sexually transmitted infection (STI) prevention services, including counseling, free condoms and lubricant, STI and HIV testing, and any necessary STI treatment.

The researchers measured use of Truvada or the placebo by having participants bring their pill bottles to each study visit so that unused tablets could be counted. The first 113 people to be enrolled also had their blood tested for levels of the two components of Truvada. The test could detect if at least one pill had been taken within nine days. Adherence was also measured through computerized interviews.

On October 23, 2014, the trial’s independent data safety monitoring board, after determining that those in the Truvada arm were experiencing a considerable reduction in HIV risk, recommended the discontinuation of the placebo arm. The current analysis reflects data collected during the double-blind phase of the trial, through January 2015. The study has since continued under an open-label protocol in which all participants know they are receiving Truvada.

Forty-nine participants (12 percent) dropped out of the study. All told, participants contributed 431 person-years of follow-up (person-years reflect the cumulative years participants spend in a study), with a median of 9.3 months per person. (The 25th percentile was 4.9 months and the 75th percentile 20.6 months.)

The participants in both arms of the study took a median 15 tablets per month, with a 25th to 75th percentile range of 11 to 21 tablets in the Truvada group and 9 to 21 tablets in the placebo group. There was considerable variability in the individual and overall patterns of pill taking during the study.

Eighty-six percent of the participants in the Truvada arm had detectable tenofovir at the study visits, and 82 percent had detectable emtricitabine at the visits. Eight people in the placebo group (4 percent) had detectable Truvada, including three that were receiving post-exposure prophylaxis (PEP).

According to the computer interviews, 28 percent of the participants did not take Truvada or the placebo at all, 29 percent took the assigned drug at a suboptimal level, and 43 percent took it correctly.

The computerized interview findings contrast the drug-testing figures, for one, because only the first 113 of the 400 participants who enrolled had their drug levels tested. According to the study’s lead author, Jean-Michel Molina, MD, chief of the department of infectious diseases at Paris’s Hôpital Saint-Louis, these particular participants may have been more likely to adhere because they enrolled earlier. Also, since the drug tests only indicate that someone took at least one pill during the previous nine days, a test showing detectable drug may be indicative of an individual who fell into the suboptimal category or the ideal adherence category.

The participants did not report changing their sexual practices during the study.

Forty-one percent of those in the Truvada group and 33 percent of the placebo group were diagnosed with an STI during the study. Thirty-nine percent of the STIs were rectal infections. Eighty-one participants (20 percent) were diagnosed with chlamydia, 88 (22 percent) with gonorrhea, 39 (10 percent) with syphilis, and 5 (1 percent) with hepatitis C virus (HCV).

Research suggests Hep C can transmit sexually among MSM, and there isconsiderable evidence of an emerging epidemic of sexually transmitted HCV among HIV-positive MSM. HIV-negative MSM appear to be at lower risk, for reasons that are poorly understood. Two people out of more than 600 MSM receiving PrEP through a San Francisco clinic have contracted hep C, apparently sexually, leading to a call from physicians for regular screening of the virus among PrEP users.

Sixteen participants contracted HIV during the IPERGAY study, two in the Truvada group (for an incidence of 0.91 per 100 person-years) and 14 in the placebo group (for an incidence of 6.6 per 100 person years). This meant the Truvada group had an 86 percent lower risk of HIV. The estimate range for this risk reduction was wide, 40 to 98 percent, which means that the true risk reduction may lie anywhere in between those figures.

The two members of the Truvada arm who did contract HIV were not taking the drug at the time: At the visits when they tested positive for the virus, they returned a respective 60 and 58 of the 60 pills they were given at the study visit eight weeks prior, and neither had detectable Truvada in their blood.

No one in the study experienced grade 3 or 4 adverse health events. Gastrointestinal side effects, including nausea, vomiting, diarrhea, abdominal pain and other GI disorders, occurred among 14 percent of the participants in the Truvada group, compared with 5 percent in the placebo group.

Thirty-five members (18 percent) of the Truvada group and 20 members (10 percent) of the placebo group experienced elevations in serum creatinine levels, an indication of potential problems with kidney function. All but one of these elevations were grade 1 and none led the participants to discontinue participation in the study. Two participants (1 percent) in the Truvada group had a transient decrease in creatinine clearance to below 60 milliliters per minute.

To read the study, click here.

Aphrodite's P.R.I.D.E Jamaica, APJ Launches website

visit the site HERE 

the website was made possible by donations from individual supporters in 2015 via fundraising activities

 

closing ceremony of Seizmic Project training, also see: Aphrodite's P.R.I.D.E Jamaica's 'Seismic' Project wraps .

audience members at website launch chat a bit before the screening and after discussions

Founded February 14th 2010 by a group of lesbian and transgender individuals and straight allies with some thirty years experience combined to address the then invisibility of said groups in the general sphere of representation on community issues and TBL advocacy.

the aims included in its original outlook:

About Us

We are Aphrodite’s PRIDE. We operate as a Non-Profit Organization in Jamaica focusing on issues as they relate to the Jamaican Lesbian, Transgender (M→F & F→M) and Female Bisexual (LTB) Communities. 

Our Mission 

Our Mission is to create an environment conducive to positive intra and inter-community relations, encourage personal development (AGENCY) and improve self-esteem and create behavior change. We hope to achieve this by utilizing various methods of engagement and interventions. 

Our Core Values 

We are guided by our core values of Ethics & Integrity, Accountability, Mutual Respect, Compassion, Social Responsibility, Empowerment, Team Work and Balance

Our Priorities 

Our priorities include but are not limited to issues as they relate to Outreach, Personal Development, Enterprise Training, limited Crisis Intervention & limited Healthcare within the Lesbian, Transgender & Female Bisexual Communities. 

Our Core Competencies 

We seek to address intra and inter-community relationship issues by trying to find creative realistic solutions while promoting the celebration of our diversities. 

Our Impact 

We acknowledge the importance of thinking ‘Outside the Box’ in terms of achieving our goals; so through programs and community education we hope to set important precedents which will help our efforts in creating an environment conducive to such. Also, by encouraging involvement in sporting & cultural activities we hope to promote healthier lifestyles and encourage more social responsibility. In creating a Safe Zone it is our hope that we will positively influence the lives of all in our community; particularly survivors of isolation, marginalization, discrimination, victimization or silenced by society’s restrictive gender norms and socialization. 

visit their website HERE 

Peace & tolerance

H