Showing posts with label Gay Doctor. Show all posts
Showing posts with label Gay Doctor. Show all posts

December 3, 2018

This Angel Doctor is Responsible For Lowering HIV Rates/Deaths in NYC, Young and Gay He Was in The Middle of It



 On a brisk November afternoon at Mount Sinai Comprehensive Care Clinic in Manhattan, Dr. Demetre Daskalakis sat in a brightly lit exam room, clicking away on a keyboard as his next patient walked in. The patient was in his 50s, and his first question was about his mental health. He felt depressed, but he didn’t know why. The patient recently stopped smoking and drinking, and an abdominal pain had him worried. He said his libido was nonexistent, even though he had a regular partner.

“How much of it do you think is because of your brain, and how much of it is because of your penis?” Daskalakis asked. He peppered his patient with questions about the nature of his erectile dysfunction. 

Eventually, Daskalakis discussed the patient’s HIV viral load and CD4 count, markers of the progress of his HIV infection. The patient’s blood tests indicated his viral load remains undetectable — meaning the amount of HIV in his blood is so low, thanks to HIV medications, that he can’t transmit the virus sexually.

                                                                        Demetre Daskalakis speaks at the formal dedication ceremony of New York City AIDS Memorial Park at St. Vincent's Triangle on Dec. 1, 2016.

Daskalakis, 45, updated his patient’s cholesterol medication and wrote him prescriptions for six Viagra tablets and a flu shot. He gave the man a hug goodbye and, before he walked out, said “Text me.”

Daskalakis still sees patients, as he has since the late 1990s, but today he’s just moonlighting as a clinician. The infectious disease specialist squeezes his patients in around the busy schedule of his main job: deputy commissioner for the Division of Disease Control at the New York City Department of Health and Mental Hygiene, one of the world’s largest public health agencies.

                                                                   


Demetre Daskalakis speaks at the formal dedication ceremony of New York City AIDS Memorial Park at St. Vincent's Triangle on Dec. 1, 2016.Erik McGregor / Sipa USA via AP 

Since joining the city’s health department in 2013, Daskalakis has promoted a framework for treatment and prevention strategy that he calls “status-neutral care,” which uses the same approach to initial patient care regardless of one’s HIV status. This type of care is intended to reduce HIV stigma and encourage frank discussions about sexual health, HIV risk and prevention options.

Today, the results of “status-neutral care” are beginning to be seen in public health data. On Thursday, the city released its annual raw data on diagnoses, which showed a record low 2,157 new HIV diagnoses in 2017, a 5.4 percent drop from 2016. The decline is most dramatic among men who have sex with men, whose rate of new infections is estimated to be 35 percent lower than 2013.

‘RADICAL GAY DOCTOR’

Before entering the municipal public health world, Daskalakis earned a reputation as “a progressive, radical gay doctor,” according to Mark Harrington, the executive director of Treatment Action Group, an HIV/AIDS organization.

During a 2012-2013 meningitis outbreak in New York City, Daskalakis went straight to those most at risk — including men who have sex with men, patrons of commercial sex venues and weekenders in Fire Island — and set up a popup vaccine clinic, occasionally dressed in drag as a nurse to take the edge off the injection. The effort was so successful that by August 2013, the outbreak was contained, and officials credited this aggressive vaccination campaign with halting it, according to The New York Times. Shortly after the meningitis campaign, a position opened at the NYC Department of Health for assistant commissioner of the Bureau of HIV/AIDS Prevention and Control. Daskalakis said his “email sort of exploded with people saying, ‘Hey, you should apply for this.’” He threw his hat in the ring and was offered the job, and as he was deciding whether to accept the offer, he said his mind was made up after he received an email from Mark Harrington, saying, “History’s calling. Are you going to answer?”

Harrington recalled telling Daskalakis, “This kind of opportunity won’t come around again, and you’ve got a new [mayoral] administration, you’ve got a governor committed to ending the AIDS epidemic.”

Daskalakis said this made him realized the job offer came at an “opportune moment in the history of HIV in New York City.”

“There was an effort that was motivated by the community to look at New York City and New York State as a place where we could prove that we could end an epidemic of HIV,” he explained.

NEW WAVE OF ACTIVISM

Around 2012, Harrington said it became clear that “we had the tools to bring down the rate of new HIV infections so drastically that it was possible — even without a cure or vaccine — that we could essentially end the epidemic in places where there was access to high-quality treatment and prevention.”

Part of the reason it was possible, he added, was the passage of the Affordable Care Act in 2010, which meant more young people and poor people were eligible for health insurance than ever before.

                                                                               Bottles of antiretroviral drug Truvada.

The way to end the HIV epidemic without a cure or a vaccine, according to Harrington, is by scaling up the use of two novel prevention tools: PrEP and TasP.

PrEP means “pre-exposure prophylaxis,” and it involves taking a daily Truvada pill to prevent HIV infection. Studies proving PrEP works were published in 2011. Since then, the government has recommended that more and more people consider the drug. This November, the U.S. Preventive Services Task Force recommended that doctors assess all Americans’ HIV risk, and counsel patients to take PrEP if they are at risk, including women who recently had any sexually transmitted infection, vastly increasing the number of people recommended to take the drug.

TasP means “treatment as prevention” and is a moniker given to the realization that HIV positive people can’t transmit the virus through sex if they are undetectable. Until 2015, treatment guidelines had HIV patients wait until their immune systems began to weaken before starting medication. Studies proving that starting treatment early helps HIV patients and also blocks transmission were published between 2008 and 2015.

“We were treating people late, and in many cases too late, to block transmission,” Harrington explained. When studies were published proving PrEP and TasP were both safe and beneficial, health bodies around the world overhauled their HIV guidelines and recommended that many millions more people begin taking antiretroviral drugs in order to control the HIV epidemic.

Harrington said this realization drove a “new wave of activism” at the 2012 International AIDS Conference in Washington, D.C. Activists began to talk about an idea that had been abandoned after the failure of HIV vaccine and cure trials: ending the epidemic.

In 2014, soon after Daskalakis joined the NYC Department of Health, New York Governor Andrew Cuomo announced the formation of “Ending the Epidemic,” a task force that would be responsible for devising a plan to use these new tools to draw down the state’s historically high HIV incidence. Daskalakis sat on the panel and was instrumental in developing the state’s robust PrEP program.

‘ENDING THE EPIDEMIC’

“The definition of ending HIV is a mathematical one,” Daskalakis explained. If New York City could get new infections down below 750 a year by 2020, he said new "transmission would no longer be fueling the epidemic."

When Daskalakis started work at the NYC Department of Health, he did so at a moment when it was suddenly possible, with proper inputs of political will and cold hard cash, to use antiretroviral drugs to engineer an end to HIV transmission in the city. The political will of Mayor Bill de Blasio and Governor Andrew Cuomo, he explained, helped secure the funding needed to scale up the distribution of expensive medications like Truvada.

                                                                                          

Some of the language in this new HIV/AIDS prevention paradigm was coined by Daskalakis himself: “status-neutral care.” In an article in Open Forum Infectious Diseases, a medical publication, Daskalakis described status-neutral care as a “multidirectional continuum [that] begins with an HIV test and offers 2 divergent paths depending on the results; these paths end at a common final state,” which is the prevention of HIV transmission.

Daskalakis overhauled the city’s sexual health programs to make them status-neutral. STD clinics were renovated, streamlined and rebranded as “sexual health clinics.”

“All the services had to look alike, whether you're HIV-positive or negative, and the idea was that if you come in and you are newly diagnosed with HIV you get started on meds on the same day of your diagnosis,” he explained. “If you are at risk for HIV, and you test HIV-negative, we don't dilly dally and wait. We start you PrEP that same day.”

Ad campaigns that had attempted to shame people out of contracting HIV instead distilled prevention down to a simple formula: “New boo? Get tested!” That’s because in the status-neutral-care continuum, getting tested is the first step to getting a patient enrolled in PrEP or TasP.

An advertisement from the New York City Department of Health and Mental Hygiene.NYC Dept. of Health and Mental Hygiene / NYC DOHMH

Gone were the scare-tactic campaigns of the Bloomberg administration (one infamous YouTube ad showed a close up view of anal cancer). They were replaced by joyful, brightly colored ads that encouraged people to come in for STD testing. Joining those ads were public awareness campaigns aimed at underserved communities with higher-than-average HIV incidence, like Spanish speakers, transgender women and heterosexual women of color. For the past several years, New York City subways and buses have been plastered with health department PrEP ads.

'REAPING THE BENEFITS'

The success of New York City’s revolutionary HIV prevention program is seen in the city’s declining rate of new HIV infections, but its success stark when compared to jurisdictions that haven’t implemented status-neutral care, or scaled up access to health care. The hotspots of HIV transmission today are in some of the poorest states that have refused to expand Medicaid, like Mississippi.

Daskalakis said his efforts prove the concept works, but he points to the challenges inherent in a model based on the distribution of expensive medications. “A lot of people doing this work are going from, ‘So now we can do it, we know we can,’ to 'How do you create sustainability?'”

Daskalakis describes the city’s new status-neutral-care regime as “the steam engine that's rolling through HIV in New York City and mowing it down in a pretty aggressive way.”

“We're reaping the benefits by consistently seeing HIV incidence decrease,” he said. Last week, in an announcement of the record low HIV incidence, the City of New York said the new data shows it is on target to meet its Ending the Epidemic goals by 2020.

March 13, 2018

Male Psychiatrist While Treating Male Patients to Abandon Their Sexual Orientation, Was Having Sex with Them

A panel of the College of Physicians and Surgeons of Ontario’s discipline committee found Dr. Melvyn Iscove engaged in sex acts with two male patients on different occasions during therapy sessions.
 A panel of the College of Physicians and Surgeons of Ontario’s discipline committee found Dr. Melvyn Iscove engaged in sex acts with two male patients on different occasions during therapy sessions.  (ANDREW LAHODYNSKYJ / TORONTO STAR FILE PHOTO)

Maybe Melvyn the impulsive Psychiatrist was testing his patients to see if they were cure? or may be he was testing himself?  It seems to me he knew the answer to both questions. He knew the sexual orientation of a human being is more important than even which sex he/she are. He was well educated and gay, that is why he knew. People are what they believe to be together with what they show to be (the product of their actions). Why not make a lot of money in something that can not be cured and at times be compensated for it twice by the same patient? I think that is what Malvyn thought and he was doing thruout his career. And this is where it hurts tremendously;"Two patients, now at the age of 40, reported that they were abused when they were 20-years-old"   
๐ŸฆŠAdam.      
 Toronto Star picture of Marvyn. He must've been younger than 72 in this picture. Either that or Toronto water is the Fountain of Youth


[By JACQUES GALLANT Legal Affairs Reporter]

A long-time Toronto psychiatrist, who believes homosexuality is a “sexual disorder” that can be overcome, has been found guilty by Ontario’s medical regulator of sexually abusing two of his male patients. 

Dr. Melvyn Iscove, 72, was described in a decision of the College of Physicians and Surgeons of Ontario’s discipline committee as having a “special interest in the treatment of patients with problems related to homosexuality.”

He also engaged in mutual masturbation and oral sex with two male patients on different occasions during therapy sessions, and once had anal intercourse with one of them in his office, the committee found. 

“Neither complainant described any emotional or romantic aspects of the sexual activity with Dr. Iscove, and both said that at some point, they thought that the sexual activity was part of the therapy and an attempt to cure them of homosexuality by engaging in the acts, rather than fantasizing about them,” the five-member discipline panel wrote in a decision released this week. 

Theories on homosexuality being an illness have long been discredited — the World Health Organization removed it from its list of mental illnesses in 1992 — and in 2015, Ontario became the first province to ban so-called “conversion therapy” that purported to change an individual’s sexuality. 

As for Iscove, he denied the sexual abuse allegations, which mostly date back to the 1990s and early 2000s. His licence was immediately suspended after the guilty findings pending a penalty hearing that has yet to be scheduled. 

During a penalty hearing, doctors found to have had sex with a patient automatically lose their licence.

“We're both very disappointed with the result, obviously,” said Iscove’s lawyer, Alfred Kwinter. “Dr. Iscove has always denied the allegations, he continues to do so, and he's seriously considering an appeal.” 

Iscove testified in his own defence, and the discipline panel noted that he studied and applied the theories of Dr. Edmund Bergler, a psychoanalyst who theorized on homosexuality in the 1950s. Passages of Bergler’s writings introduced at Iscove’s discipline hearing included “All attempts to prove homosexuality to be anything but an illness had in my opinion failed” and “there are no happy homosexuals.” 

The discipline panel found Iscove tried to “soften the effect of these passages, but in the end, endorsed or at least accepted them.” 

“Dr. Iscove also became evasive in responding to questions as to whether homosexuality should be considered an illness, and whether it was capable of being ‘cured,’ despite that these views were clearly held by Dr. Bergler.” the panel wrote. 

“Given that Dr. Iscove had admittedly devoted his professional life to studying and applying the theories of Dr. Bergler, it was not clear to the committee why Dr. Iscove refused to acknowledge that he agreed with Dr. Bergler on these points.”

According to the panel’s decision, Iscove testified that his patient population includes “a range of problems such as marital conflict, and ‘sexual disorders,’ such as frigidity, over-sexuality and homosexuality.”

“He stated that these patients only became responsive to his therapy when they were ready to fight it (i.e., the homosexuality),” the panel said.

Both patients’ identities are covered by a publication ban. Now in their 40s, both men — who the panel noted didn’t know each other until the discipline proceedings — came forward in recent years, about incidents that took place when they were younger. The panel believed the incidents occurred as described by the patients. 

Patient A had been referred to Iscove for treatment for depression and anxiety “associated with fears he was gay,” when he was in his twenties. The man, who considered Iscove a father figure, testified that Iscove would directly ask him about fantasies involving the two of them.

Patient A testified that one day Iscove embraced him and that the doctor said: “What are you thinking you want to do?” and then “You may touch me if you like,” and the patient then touched Iscove’s erect penis through his pants. 

“The sexual activity subsequently progressed to Dr. Iscove removing his penis from his trousers, then Patient A doing the same,” the panel wrote. “This progressed on later occasions to mutual masturbation and oral sex. Patient A estimated that such activity occurred on between 10 and 20 occasions with oral sex occurring on one-third of the episodes.” 

Patient B began seeing Iscove in the late ’80s when he was 18, after his parents recommended he see Iscove for depression and anxiety. The patient testified that at the time, he did not have any concerns about his sexuality, and that his relationships had been entirely heterosexual up to that point. 

He said he was encouraged throughout his therapy to read material by Bergler, the 1950s theorist on homosexuality, and that at every appointment, he was asked about his dreams and fantasies, “especially with respect to homosexual feelings.” 

“Fantasies that involved heterosexual relationships were identified by Dr. Iscove as being a way of denying his homosexuality,” the panel wrote. “Patient B firmly believed that Dr. Iscove was attempting to ‘cure’ his homosexuality.”

The two began engaging in sexual activity around 2007, the panel wrote. 

“(Patient B) considered beginning a homosexual affair with an unspecified male. After discussing this with Dr. Iscove, who persuaded him that a random partner was undesirable, Dr. Iscove made it known that he, himself, would be available,” the panel wrote. 

They engaged in mutual masturbation and oral sex on a number of occasions, and Patient B testified he once brought a condom asking Iscove to penetrate him, which he did. 

The panel also found that Iscove committed professional misconduct regarding boundary issues, including selling a juicer to Patient B, trying to sell personal items to Patient A, and inviting Patient A to an opera rehearsal as his guest.

TheStar.com

It is adamfoxie's 10th๐ŸฆŠAnniversay. 10 years witnessing the world and bringing you a pieace whcih is ussually not getting its due coverage.




November 22, 2017

The Struggle to Find a Gay Physician in Rural America and Coming Out to Your Straight Doctor




Finding the perfect doctor can be a feat for anyone.
And a poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health finds that 18 percent of all LGBTQ Americans refrain from seeing a physician for fear of discrimination.
One of those people is 20-year-old Alex Galvan. The moment right before he told his doctor earlier this year that he is gay and sexually active felt like a nightmare. Galvan lives in rural Tulare County in California's Central Valley. He wanted to start a regimen of medication that helps prevent HIV infection, an approach called "pre-exposure prophylaxis," or PrEP.

Alex Galvan remembers his last thought before coming out to his doctor earlier this year: "Oh gosh, here it goes."
Ezra David Romero/Valley Public Radio
"Sitting in the waiting room was kind of like, 'you got this, you're just asking for a medication to help you,' " Galvan says, remembering what was going through his head before he came out to the doctor. "He's not going to flip out. And then the moment before was, 'Oh gosh, here it goes.' "
His doctor didn't know about PrEP, and Galvan thought he was going to be rejected. Instead, his physician educated himself.
"I was kind of scared that he didn't know what it was, but I was also relieved because I let him do most of the research," Galvan says. "Yeah, and then I cried a little bit in the car, because I didn't know what just had happened and it all kind of blurred together."
Pediatrician Kathryn Hall knows about these concerns all too well. She has been practicing medicine in Tulare County for over a decade, and time and time again, her patients tell her they're afraid to come out to their other doctors. A few years ago, she got so fed up that she surveyed more than 500 nearby doctors asking them basic questions about being welcoming. 
"I made the bar very, very low because we just didn't get much education on LGBT health in medical school," says Hall. "That is starting to change."
Around 120 doctors responded to Hall's survey, and most of them said they would be happy to serve this group. Hall says there are lots of ways that doctors can make it clear they're accepting — a little rainbow flag on the door or taking out ad in a local magazine.
"Many of the physicians that I know are LGBT-friendly, but patients don't know that and are very afraid that they're being judged," Hall says.

Vargas coached Galvan through his fear of coming out to his doctor and how to help educate the physician about treating a gay man.
Ezra David Romero/Valley Public Radio
A few years ago, Nick Vargas was having trouble finding an LGBTQ-friendly doctor in this agricultural region of California. He had just moved from the Bay Area to the town of Visalia, about an hour south of Fresno, where he leads a LGBT center, called The Source. He says he had to educate his new physician about how to treat a gay man. That led the 40-year-old to want to help others find doctors and get prescriptions for PrEP.
"Once you tell them, they want to be able to help," Vargas says. "But they have to ask for it. And then they have to learn how to administer it, how to follow up, and that's a process and it's out of the scope of what they normally do." 
Vargas says he now has a great relationship with his doctor, but it took a year for him to get on the drug. Now part of his job at The Source is to refer people to LGBTQ-friendly physicians. People like Alex Galvan who was so nervous about coming out to his doctor.
In fact, Vargas helped Galvan muster the courage to come out and ask for PrEP. Now Galvan has been on it for almost a year.
"It allows me to have fun and to go out and enjoy myself," says Galvan.
And more than that, coming out to his doctor is helping him take control of his life and health care.
"All it takes is that is that little bit of a jump, and that little bit of a push to go, 'I need this,' " Galvan says.
Galvan is now encouraging other friends in rural Tulare County to actively seek out a doctor who will care for all their health needs.

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