Category Archives: In the News

Most recent news concerning sexual health

PA Dept of Health: What You Need to Know About Monkeypox

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From the PA Department of Health…

Monkeypox is not a sexually transmitted disease and does not spread easilyOpens In A New Window between people. However, anyone who has extremely close personal contact — mostly skin-to-skin — including direct contact with monkeypox rash, scabs, or body fluid from a person with monkeypox, can get it and should take steps to protect themselvesOpens In A New Window.  

Take the following steps to prevent getting monkeypox: 

  • Avoid close, skin-to-skin contact with people who have a rash that looks like pimples or blisters. 
  • Do not touch the rash or scabs of a person with monkeypox. 
  • Do not kiss, hug, cuddle or have sex with someone with monkeypox. 
  • Do not handle or touch the unwashed bedding, towels, or clothing of a person with monkeypox. 
  • Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially before eating or touching your face and after you use the bathroom. 
  • Do not share eating utensils or cups with a person with monkeypox. 
  • If you have symptoms or test positive, isolate yourself until the rash heals to avoid transmitting monkeypox to others.

If you think you have developed monkeypox (if you have symptoms), please talk to your healthcare provider or contact 877-PA-HEALTH. Providers can help ensure you are tested if appropriate, and if necessary, receive treatment for monkeypox. If you test positive you will need to isolate (avoid contact with others) until the rash heals. 

If you have been exposed to someone who has monkeypox, you may need to receive the vaccine, although not everyone will need a monkeypox vaccine.

Read the full article.

For more information on monkeypox, the Pennsylvania Department of Health also provides a monkeypox FAQ sheet.

As monkeypox spreads, know the difference between warning and stigmatizing people

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From NPR…

The global monkeypox outbreak appears to mostly affect men who have sex with other men. A study published in the New England Journal of Medicine found that 98% of people diagnosed with the virus between April and June in more than a dozen countries identify as gay or bisexual men, and the WHO says that 99% of U.S. cases are related to male-to-male sexual contact.

That means that the public health systems can target their messaging and interventions to the specific communities most at risk. But it also carries the risk of stigmatizing those populations, while sowing complacency in others that could still be vulnerable.

Public health experts stress that monkeypox is relevant to everyone, since it can spread through skin-to-skin contact and potentially contaminated objects like clothing or towels. And viruses can infect anyone. The U.S. has already documented two cases of monkeypox in children, for example. “While we may be seeing clusters primarily in certain groups of people, viruses do not discriminate by race, by religion, or by sexual orientation,” infectious disease researcher Dr. Boghuma Titanji told NPR.

Read the full article on NPR.

Health Alert – Cases of Monkeypox Reported in U.S. 

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Cases of monkeypox have been identified in travelers from countries where the disease is considered an endemic. As a result, the Centers for Disease Control and Prevention (CDC) has issued a Health Advisory in the United States.  

As of June 3rd, 21 cases in the U.S. have been confirmed or suspected, including one case in Pennsylvania. As per the State Department of Health, there is a possibility the disease may spread.  Monkeypox symptoms involve a characteristic rash, preceded by a fever, swelling of the lymph nodes, and other non-specific symptoms such as malaise, headache, and muscle aches. In the most recent reported cases, symptoms included lesions in the genital and anal regions. Note that the disease may be confused with more commonly seen infections like syphilis, chancroid, and herpes. The average incubation period for symptom to develop is 5 to 21 days.

Human-to-human transmission occurs through large respiratory droplets and by bodily fluids (like saliva and semen that can be transmission during sex) or coming in direct contact with a lesion. Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact (like kissing) is more likely to spread the disease.  

There is no specific treatment for monkeypox virus infection. However, the CDC reports that antivirals used to treat smallpox may prove beneficial. Monkeypox is generally mild and patients recover in a few weeks. The mortality rate is less than 1 percent in developed countries. There have been no deaths related to the monkeypox cases in the US so far.

There are FDA approved vaccines available to prevent monkeypox but these are not commercially available but are being made available to close contacts of known cases.

If you think you may be infected, contact your doctor’s office or local hospital first, for instructions. Going into your doctor’s office, or an emergency room, risks spreading the disease.  

For more information about monkeypox, you can go to the CDC’s Health Advisory page. (https://wwwnc.cdc.gov/travel/notices/alert/monkeypox) 

Is this natural hormone making gay men super horny?

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From queerty.com…

Are you permanently horny or constantly scrolling your phone in search of sex? Sex is great. Gay sex is even better. But perhaps all that scrolling is having a detrimental effect on your life?

A new study has found that men who display hypersexual behavior, often have elevated levels of the hormone oxytocin.

Researchers at Umeå University in Sweden looked at 64 men with a clinical diagnosis of hypersexual disorder. The results were recently published in the Journal of Clinical Endocrinology & Metabolism.

Hypersexual disorder is when you have an excessive preoccupation with sexual fantasies, urges or behaviors to the extent it has a negative impact on your life.

Around half of the hypersexual participants were enrolled in a seven-week cognitive behavior therapy program to help them address their behavior. They also gave routine blood samples for the study.

The study discovered that men with hypersexuality had almost twice the levels of oxytocin as the control group.

Read the full article on queerty.com.

CDC urging gay and bisexual men to get the meningococcal vaccine after an outbreak in Florida

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From USA Today…

The U.S. Centers for Disease Control and Prevention is urging gay and bisexual men to get the meningococcal vaccine after an outbreak in Florida has led to an increase in cases. 

Multiple meningitis cases have been reported across the state in the past few months, and some involved college students and those living with HIV, according to a news release from the CDC. 

“Anyone who has been exposed or develops symptoms should be evaluated by a health care provider right away,” the release from the Florida Department of Health of Leon County said. “This is a rare but potentially devastating infection.”‘

Read the article on USA today.

Are Straight Men Having Gay Sex Closeted? This Prof Thinks Not in Provocative New Book

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From Edge Media Network…

…University of British Columbia sociology professor Tony Silva offers new insight on sexual attraction, behavior and their implications in his book “Still Straight: Sexual Flexibility Among White Men in Rural America.”

“Drawing upon interviews with 60 white men from rural areas in the United States over three years, Silva delves into the sex lives of straight men who have hookups, sexual friendships, and secretive loving relationships with other men, but remain mostly attracted to women and strongly identify with straight culture,” writes the website Straight in an interview with Silva.

In his book Silva asserts “that the men he focuses on in his book aren’t closeted, bisexual, or experimenting, and that they aren’t a version of the tortured love story in ‘Brokeback Mountain’,” writes Straight.

In his findings, Silva says that the men he interviewed were primarily married and attracted to women, but for reasons such as boredom and fears of attachment with a female partner, turn to sex with men. “These men think that sex with men is a lot less complicated with no attachment. I find it particularly interesting and ironic that their conservative beliefs about gender actually encourage them to have sex with men.”

Read the full article.

National Black HIV/AIDS Awareness Day Puts Focus on Need to Address Equity and Drivers of HIV Disparities in U.S.

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From HIV.gov…

By: Harold J. Phillips, MRP, Senior HIV Advisor and Chief Operating Officer for Ending the HIV Epidemic: A Plan for America, Office of Infectious Disease and HIV/AIDS Policy, U.S. Department of Health and Human Services.

This year’s National Black HIV/AIDS Awareness Day (NBHAAD) observance comes amidst a national dialogue on systemic racism and calls for a greater focus on equity in all our work. We should use this opportunity to examine and address historic inequities experienced by Black Americans. For the HIV community, this means working to understand and address the circumstances that put people at risk for HIV or that create barriers to HIV care and treatment.

Black Americans continue to be disproportionately affected by HIV compared to other racial/ethnic groups. According to CDC data,

  • Black Americans represent 13% of the U.S. population, but 41% of people with HIV in the U.S. in 2018.
  • 42% of new HIV infections in 2018 were among Black Americans.
  • Among the estimated 161,800 people in the U.S. with undiagnosed HIV, 42% (67,800) are Black. That means that nearly one in seven Black Americans with HIV are unaware of their HIV status and are not receiving the care they need to stay healthy and prevent transmission to others.

Fewer Black Americans in HIV care are virally suppressed: In 2018, 60% of Blacks, 64% of Latinos, and 71% of whites with diagnosed HIV were virally suppressed.

The recently released HIV National Strategic Plan (HIV Plan) makes clear the disproportionate impact of HIV among Black Americans, and includes Black women, transgender women, people who inject drugs, and Black gay, bisexual, and other men who have sex with men among its designated priority populations. The HIV Plan notes that focusing efforts on priority populations will reduce HIV-related disparities, which is essential to the nation’s effort to end the HIV epidemic by 2030.

Read the full article.

Second Open Letter on COVID-19 Focuses on Nondiscrimination, Data Collection and Economic Harm for LGBTQ Communities

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From the Gay and Lesbian Medical Association…

On April 21, 2020, GLMA, Whitman-Walker Health, the National LGBT Cancer Network, the National Queer Asian Pacific Islander Alliance, the New York Transgender Advocacy Group, and SAGE issued a second open letter to public health officials, healthcare institutions and government leaders on the impact of COVID-19 on LGBTQ communities. The letter, joined by 170 organizations, called for action to protect LGBTQ patients from discrimination and to include sexual orientation and gender identity in data collection efforts related to the pandemic. The letter also called for action to address the economic harm to LGBTQ communities from the pandemic.

To read the full second open letter and list of signatories, click here.

The letter released on April 21 is a follow-up to an open letter signed by more than 150 organizations issued by the six coordinating organizations on March 11, 2020. Information on the first letter is available here.

Important COVID-19 Resources:

Health Alert: LGBT people may be at higher risk from COVID-19

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From the Bay Area Reporter…

More than 100 organizations sent an open letter to medical groups and the news media stating that LGBT people are at greater risk from the novel coronavirus due to other social and medical issues that affect the LGBT community.

Scout, who goes by one name, is a bisexual and trans man who is the deputy director of the National LGBT Cancer Network. That organization took the initiative on drafting the letter, which was released March 11, and gathering co-signers.

Scout is the deputy director of the National LGBT Cancer Network

Local organizations that signed the letter include Equality California, Horizons Foundation, National Center for Lesbian Rights, the San Francisco LGBT Community Center, and the Transgender Law Center.

The letter highlights three issues that may put LGBTs at greater risk during the COVID-19 epidemic: higher tobacco use than among the general population, higher rates of cancer and HIV-infection, and instances of discrimination on account of sexual orientation and gender identity (COVID-19 is the respiratory disease caused by the novel coronavirus.)

“We’re really concerned because we know that whenever there’s a health issue, the pre-loaded issues in our community create an issue for us,” Scout, a Ph.D., said in a phone interview with the Bay Area Reporter March 16. “We have more social isolation, more smoking. But we know how to offset that. As coronavirus expands so fast, we wanted to let the public health community know we can take steps to avoid another health disparity.”

Read the full article on the Bay Area Reporter Website.

Young men unaware of risks of HPV infection and need for HPV vaccination

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From Eurekalert.com…

Young sexual minority men — including those who are gay, bisexual, queer or straight-identified men who have sex with men — do not fully understand their risk for human papillomavirus (HPV) due to a lack of information from health care providers, according to Rutgers researchers.

A Rutgers study published in the Journal of Community Health, examined what young sexual minority men — a high-risk and high-need population — know about HPV and the HPV vaccine and how health care providers communicate information about the virus and vaccine.

About 79 million Americans are infected with HPV, with about 14 million becoming newly infected each year, according to the Centers for Disease Control and Prevention. As a sexually transmitted infection, HPV can lead to several types of cancer, including anal and penile cancer, and is particularly concerning for sexual minority men due to the high prevalence of HIV and smoking in this community and the low HPV vaccination rates overall among men.

Read the full article.

Health Alert: Rates of STDs climbed for the fourth consecutive year in the US

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Rates of syphilis, gonorrhea and chlamydia have climbed for the fourth consecutive year in the United States, the Centers for Disease Control and Prevention (DCD) announced recently. Last year, nearly 2.3 million US cases of sexually transmitted diseases (STDs) were diagnosed, which is the highest number ever reported.

Chlamydia, which remained the most common, is easily transmitted during any form of sexual activity. If not treated, chlamydia can cause permanent damage to the reproductive system. In men, the infection can spread to the tube that carries sperm from the testicles, causing pain and fever.

If not treated, gonorrhea can cause severe and permanent health issues, including problems with the prostate and testicles in men or problems with pregnancy and infertility in women. Gonorrhea is also typically treated with antibiotics but the threat of antibiotic-resistant gonorrhea persists nationwide. 

Syphilis can affect the heart, nervous system and other organs if left untreated. Syphilis is most often transmitted through sexual contact and is 100 percent curable with antibiotics.

Gonorrhea and chlamydia can infect other sites of the body such as the rectum and the throat and diagnosis requires a swab of each site. A urine test alone is not sufficient to diagnose STDs of the throat and the rectum. Additionally, all of these infections can be transmitted through unprotected oral sex.

It is important to remember that even if you don’t have symptoms, you can still be infected. If you’re sexually active, you should get tested for a full range of STDs, including the ones listed here. Don’t be shy about asking your doctor for a full screening. If you need to find free, confidential testing in your area, you can check the PA Department of Health listing here.

Health Alerts are presented by the Pitt Men’s Study and the HIV Prevention and Care Project at the University of Pittsburgh, with funding from the State Department of Health.

State-level PrEP utilization data now available from AIDSVu

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From HIV.gov…

Since PrEP is one of the newer HIV prevention tools, understanding more about who is using it is important to better tailoring HIV prevention efforts at the national, state, and community levels. PrEP, or pre-exposure prophylaxis, is when people at high risk for HIV take HIV medicine daily to lower their chances of getting infected with HIV. AIDSVu has released the first-ever publicly available data and interactive maps of PrEP use by state from 2012 through 2016, stratified by sex and age.

The new maps from AIDSVu show more than 77,000 people were prescribed PrEP in 2016, with an average 73 percent increase year over year in persons using PrEP across the U.S. from 2012 – when the drug TDF/FTC was approved by the FDA for use as PrEP – to 2016. However, approximately 1.1 million people in the U.S. are at substantial risk for HIV exposure and could benefit from PrEP, according to analysis presented by the Centers for Disease Control and Prevention (CDC) at CROI 2018 earlier this year.

The data presented on AIDSVu reveal that the growth and distribution of PrEP use has been inconsistent across different sexes, age groups, and geographic regions. For example, the Southern U.S. accounted for more than half (52 percent) of all new HIV diagnoses in 2016 but represented only 30 percent of all PrEP users in 2016. That same year, women comprised 19 percent of all new HIV diagnoses but made up only seven percent of all PrEP users.

Read the full article.

‘Double discrimination,’ loneliness contribute to bisexual health disparities, study says

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From NBC News online…

“Double discrimination” and loneliness put bisexual individuals at “higher risk for poor mental health outcomes,” according to a recent study out of American University. The study compared the mental health of bisexual men and women to that of gay men, lesbians and heterosexuals.

“Bisexual people face double discrimination in multiple settings — bisexual people are often invisible, rejected, invalidated [and] stigmatized in the heterosexual community as well as the traditional LGBTQ communities,” Ethan Mereish, an assistant professor at American University and the study’s lead author, told NBC News. “Given that isolation and discrimination, bi people might be experiencing increase factors that might make them more lonely or isolated.”

Previous research has shown that lesbian, gay and bisexual individuals broadly face higher rates of mental health issues than their straight counterparts. Yet there are mental health disparities that the bisexual community faces at higher rates than even gays and lesbians. That said, the American University study surveyed 503 bisexual adults ranging in age from 18 to 64 to hone in on their unique minority stressors and the effects they have on mental health.

“This study adds to the growing body of research confirming that bisexual people face unique mental health disparities [that are] closely related to stigma and discrimination [they face] from straight, gay and lesbian communities,” Heron Greenesmith, a senior policy analyst at LGBTQ advocacy organization Movement Advancement Project, said. “Internal stigma adds another barrier to bisexual people.”

Greenesmith, whose organization has compiled a number of studies and reports that point to the relatively poor health of the bisexual community, said this latest study makes it “even more clear that the bisexual community needs tailored mental health services.”

Read the full article.

PATF changes name to reflect exapanded services

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From the Pittsburgh AIDS Task Force…

As of September 26, 2017, Pittsburgh AIDS Task Force will be Allies for Health + Wellbeing! The name change follows a period of significant expansion for the agency and is in keeping with feedback given by current and potential clients. The new name also pays homage to the agency’s founders.

In 1985, the volunteers who formed the Pittsburgh AIDS Task Force were truly allies fighting against HIV/AIDS on a number of fronts. They fought for the dignity, rights and humanity of those were dying of AIDS. They fought against rampant discrimination and fear. These allies fought to prevent HIV transmission by disseminating accurate information to the community and by offering free anonymous screenings.

Today, we continue to be on the side of people living with HIV, working with them to maximize their health and quality of life. From primary medical care to housing, to a food pantry and, soon, onsite mental health services, Allies for Health + Wellbeing delivers integrated services with a holistic approach. We have also expanded services for those at risk of HIV, including Pre-exposure Prophylaxis (PrEP), treatment for sexually transmitted infections and viral hepatitis, as well as primary medical care.

With a new name comes a new logo and a whole new brand image. Our new brand image will be unveiled at a launch party on September 26th.

Antibiotic-resistant Gonorrhea on the rise: Are you at risk of drug-resistant STD?

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From techtimes.com…

The World Health Organization (WHO) has warned that gonorrhea, a common sexually transmitted disease, has become harder and sometimes even impossible to treat. Neisseria gonorrhoeae, the bacteria that causes the STD, is so smart it evolves to develop resistance against the antibiotics used to treat infection. [Read the WHO report here]

WHO said that decreasing use of condom, poor infection detection rates, urbanization and travel, as well as inadequate or failed treatments all contribute to the rising cases of antibiotic-resistant gonorrhea. “WHO reports widespread resistance to older and cheaper antibiotics. Some countries — particularly high-income ones, where surveillance is best — are finding cases of the infection that are untreatable by all known antibiotics,” WHO said in a statement. WHO experts said that oral sex is driving the spread of super-gonorrhea. In the United States, about two-thirds of those between 15 and 24 years old have had oral sex.

Teodora Wi, from the WHO, said that when antibiotics are used to treat infections of the throat such as normal sore throat, these get mixed with the Neisseria species in the throat, which can lead to resistance.

What makes matters more worrying is that many people with gonorrhea in the throat are not aware they are infected and are more likely to transmit the infection via oral sex. “In the US, resistance [to an antibiotic] came from men having sex with men because of pharyngeal infection,” Wi said.

Read the full article.

Is technology increasing the rate of STDs among certain populations?

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by Laurie Saloman, MS

It’s known that men who have sex with men tend to have disproportionately high rates of sexually transmitted diseases (STDs) compared with the general population, particularly African American and Latino men. A new study has discovered a link between the methods that these men use to find sexual partners and STD infection rates.   The study, conducted by scientists at the Centers for Disease Control and Prevention (CDC), was comprised of 853 African American and Latino men who lived in Chicago, Illinois, Kansas City, Missouri, and Fort Lauderdale, Florida, who indicated that they had engaged in sex with at least 1 man during the previous year. The men were recruited either online or through some form of community outreach. Questions included their HIV status, whether they identified as gay or bisexual, how many male partners they’d had in the previous 3 months, and whether they used the Internet (via computer) and mobile-phone applications (apps) to look for sex partners.

Read the full article.

Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University.

Gay men syphilis rates over 100x greater than straight men

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From medpagetoday.com…

The first state-specific analysis of syphilis among men who have sex with men (MSM) shows they have dramatically higher incidence than men whose only sexual partners are female, the CDC is reporting.

Data from 2015, analyzed with a new methodology, show that the incidence of primary and secondary syphilis among MSM was 309.0 cases per 100,000 people, compared with 2.9 per 100,000 among men who reported sex with women only, according to Alex de Voux, PhD, of the CDC’s epidemic intelligence service, and colleagues at the CDC and Emory University in Atlanta.

The disparity was even more marked when the rate among MSM was compared with the 1.8 cases per 100,000 population seen among women, the researchers reported in the April 7 issue of Morbidity and Mortality Weekly Report.

County-by-county data from the U.S. Census Bureau’s American Community Survey included the number of households with a male head-of-household and a male partner, De Voux and colleagues reported, and that information could be used to estimate the MSM population per county.

For the syphilis analysis, the researchers used data from the 44 states that had information on the sex of partners in at least 70% of reported cases. Those states accounted for 83.4% of all 23,872 reported cases in 2015, De Voux and colleagues reported.

State-specific incidence rates among MSM ranged from 73.1 per 100,000 population in Alaska to 748.3 in North Carolina, the investigators found. Syphilis incidence among MSM was highest in the South and West and four of the five states with the highest rates among MSM — Louisiana, Mississippi, North Carolina, South Carolina, and New Mexico — were in the South.

The overall syphilis among MSM was 167.5 times the rate among women, with state-specific rate ratios ranging from 63.7 in Louisiana to 2,140.3 in Hawaii, De Voux and colleagues reported.

Interestingly, the highest overall syphilis rate in the U.S., seen in 1946, was 70.9 cases per 100,000 population — a rate exceeded by the lowest state-specific rate among MSM in 2015: the 73.1 cases per 100,000 observed in Alaska.

The researchers cautioned that the data are based on 44 states and might not reflect the nation as a whole. Similarly, the estimates rely on the American Community Survey data; under-reporting of same-sex households would skew the outcome.

As well, they noted, the analysis did not include cases in which the sex of partners was unknown and if MSM are less likely than other men to report the sex of their partners, the findings might under-estimate the rate of disease among MSM.

Finally, De Voux and colleagues cautioned, not all cases of syphilis are diagnosed and reported.

Editor’s note: To find free Syphilis testing near you, got to gettested.cdc.gov.

AIDS United: Republicans’ American Health Care Act will “worsen treatment and care for people living with HIV”

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Press release from AIDS United…

AIDS United opposes the American Health Care Act as released by House Republicans on March 6th. The American Health Care Act would, if passed, strongly affect and potentially worsen treatment and care for people living with HIV and the provision of HIV prevention services for people at risk for infection. AIDS United works toward an end to the HIV epidemic by reaching outcomes described in the National HIV/AIDS Strategy and the many state-specific efforts to curb and finally end the epidemic. These outcomes include reducing HIV incidence, increasing access to care and improving health outcomes for people living with HIV, and reducing HIV-related health disparities.

The American Health Care Act undermines these goals. The replacement of premium subsidies with refundable tax credits will hurt the ability of low income people, including people living with HIV, to afford up-front payment of health plan premiums. Under this system thousands of people will lose coverage. These people will then be subject to a 30 percent penalty in their future cost of coverage because of continuous coverage requirements. These same requirements will hurt people who lose their jobs and will also make it more difficult for people to change jobs or move across the country. The bill also places a higher cost burden on older Americans by allowing higher premium as people age. This will result in much higher costs and lower access to care for lower income people. Finally, the bill effectively repeals Medicaid expansion in under three years at the end of 2019. Such a repeal will result in a loss of health coverage for millions of Americans, including people living with HIV and other chronic conditions.

Read the full press release.

Professor Matt G. Mutchler examines HIV prevention with focus on communication among young Black gay and bisexual men

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From csudhnews.com…

Professor of sociology Matt G. Mutchler’s research over the past 20 years into HIV prevention and treatment issues, especially within the African American community, has garnered him more than 15 external research awards and respect as an expert in the field. In addition to serving as a faculty member at California State University, Dominguez Hills, he is currently a visiting professor with the Center for AIDS Prevention and Study at University of California, San Francisco, and director of community-based research with AIDS Project Los Angeles.

Mutchler’s more recent work addresses sexual communication among African-American gay and bisexual males and their close friends, and other sexual health issues related to gay men. He also investigates HIV treatment adherence programs.

Mutchler brings his expertise in community-based research to the CSUDH’s Urban Community Research Center (UCRC), where he serves as director. The multi-disciplinary, sociology-based applied research center focuses on the needs, problems and solutions that arise in urban areas. The center also offers CSUDH students hand-on research experience as they collaborate with CSUDH faculty, and a number of governmental, community-based, and university/research institutions, such as AIDS Project Los Angeles (APLA), Charles R. Drew University, Spectrum, REACH LA, and the RAND Corporation.

Mutchler recently shared insights about his studies and findings, the challenges and rewards of conducting his research within the African American community, and his latest work.

Read the interview with Professor Mutchler on csudhnews.com.

 

LGBTs would be disproportionately affected by the repeal of the ACA

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Matt Baume writes in the Huffington Post:

If the ACA is repealed, as Republicans are trying to do, not only would 32 million people lose health care, according to the Congressional Budget Office, but LGBTs would be disproportionately affected. And “disproportionately affected” is a phrase which here means “get sick and die.” For example, HIV treatment can cost thousands of dollars per month. Insurance companies that don’t want to pay for that treatment could just refuse to cover all gay people on the basis that gay men are more likely to be HIV positive. Or they could raise monthly premiums just for gays. Or they could create a lifetime cap, so you pay into their system and then as soon as you need expensive treatment, they drop you. All this was legal until the ACA banned it.