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Making Blood Donation More Inclusive

Ayako Miyashita Ochoa of the UCLA Luskin Social Welfare faculty spoke to ABC News about the lifting of restrictions that had prevented gay and bisexual men from donating blood. The strictest U.S. Food and Drug Administration rules, dating to the early days of the HIV/AIDS epidemic, were based not on an individual’s risk but on belonging to a specific group. These policies were “incredibly blunt” and furthered stigma and discrimination, Miyashita Ochoa said. Now, a single risk-assessment tool that includes questions about sexual health is used for all would-be donors. While some may feel uncomfortable answering questions about sexual activity, “these questionnaires are intended to keep our blood supply safe,” Miyashita Ochoa said, adding that the rule changes promise to reduce stigma and encourage more people to donate. “I think that we are moving to a place where our policies are reflecting better the science and certainly our expectations as a society to not discriminate,” she said.


 

Lifting of Blood Donation Ban Will Save Lives, Address Stigma

Ayako Miyashita Ochoa of the UCLA Luskin Social Welfare faculty wrote an article for The Conversation on the U.S. Food and Drug Administration’s easing of restrictions on blood donation by gay and bisexual men. The last documented HIV transmission through a U.S. donor’s blood occurred nearly 15 years ago, Miyashita Ochoa wrote. While precautions around HIV exposure were reasonable in the 1980s, “the science has changed,” she said. The lifting of the ban will lead to an estimated 2% to 4% increase in the blood supply, potentially saving more than a million lives. She added, “Removing gender and sexual orientation from the risk assessment for blood donation will take the U.S. one step further in addressing stigma and discrimination against men who have sex with men.” Miyashita Ochoa also discussed the issue on WOSU’s “All Sides” (beginning at minute 37), commenting that COVID-19-era blood shortages spurred the move toward science-based policies that ensure that supplies are safe and sufficient for the nation’s health needs.


 

Holloway on Stigmas Surrounding HIV/AIDS and Mpox

Ian Holloway, professor of social welfare and director of the Southern California HIV/AIDS Policy Research Center, spoke to the Los Angeles Times about parallels between the stigmas associated with HIV and AIDS in the past and the recent outbreak of the virus mpox. Public messaging around health threats plays a vital role in how people affected by such conditions are treated. Misinformation and stigma surrounding mpox can discourage people from getting proper care, Holloway said. “The effect that it has is similar to the early days of HIV/AIDS because it kept people away from testing and treatment, and overall created a lot of shame and mental health challenges,” Holloway said. “It’s unfortunate to see those parallels play out.” However, Holloway said messaging around the mpox outbreak has been more inclusive than it was around AIDS, showing that government leaders are doing a better job of responding to new viral threats.


 

How Telehealth Can Expand Access to HIV Prevention Strategies

In 2020, only 25% of people who could benefit from pre-exposure prophylaxis (PrEP), a medication that reduces the risk of acquiring HIV, were prescribed it. Using telehealth to provide PrEP — an approach known as “tele-PrEP” that predates the COVID-19 pandemic — shows potential for expanding access to PrEP use in the United States. A new report from the Kaiser Family Foundation, funded in part by the Southern California HIV/AIDS Policy Research Center (SCHPRC), takes a deep dive into the tele-PrEP landscape, from the types of providers offering the service to the successes of the approach and the barriers that remain. “This report marks an important step forward in understanding how tele-PrEP is being implemented in California, the state with the largest number of tele-PrEP users,” said Ian Holloway, a UCLA Luskin professor of social welfare and co-director of SCHPRC. “This novel approach to providing PrEP services has the potential to increase access to this HIV prevention strategy.” Drawing from in-depth interviews with representatives from major telehealth companies and other providers that offer PrEP, the study identifies a wide range of operational models and financing structures — differences that have implications for clients, providers and businesses. While tele-PrEP offers an additional avenue for some people to access services, significant challenges remain, including insurance barriers, policies that hamper uptake, and knowledge gaps among both individuals and providers, the study concludes.


 

Miyashita Ochoa on Outdated Blood Ban for Gay Men

Adjunct Assistant Professor of Social Welfare Ayako Miyashita Ochoa spoke to North Carolina Health News about policies that continue to bar some gay men from donating blood. Miyashita Ochoa explained that at the beginning of the AIDS epidemic, there was no test for HIV or AIDS, and scientists weren’t sure how it was transmitted. “The policy itself was a reflection of that,” she said. “It also obviously targeted specifically the populations that were hardest hit by HIV and AIDS.” Over time, the policies endured despite advances in science. Miyashita Ochoa pointed out that a lot has changed since the 1980s, including what we know about HIV transmission and the efficacy of prevention measures. To combat a shortage in the blood supply caused by the COVID-19 pandemic, the FDA relaxed restrictions in 2020 to include men who have not had sex with men for three months. Advocates, however, argue for an end to all bans of gay and bisexual men.


Examining the Science Behind Decriminalizing Sex Work

Governments have cited protection of public health as a rationale for outlawing sex work, yet evidence shows that decriminalizing the trade increases health and safety and reduces the risk of disease, according to a new policy brief from researchers at UCLA. Released on International Sex Worker Rights Day, the brief reviews global data showing that the public health justification for criminalization and regulation of sex work is not supported by science. “There is scant evidence that criminalizing the sex trade has any positive effects on public health and the health of sex workers,” the brief states. Instead, it cites empirical studies linking criminalization to a rise in sexually transmitted infection and HIV transmission, as well as an increased risk of violence against sex workers. The authors draw a distinction between sex work, which is consensual, and sex trafficking, which is based on force, fraud or coercion or involves the participation of minors. The policy brief calls for further study on how laws and policies related to the sex trade can improve public health. While decriminalization may not fully eliminate the stigma and victimization of sex workers, the authors argue that “by removing criminal liability from the picture, approaches that seek to integrate sex workers into society can advance both human rights and labor rights of communities made vulnerable by multiple systems of oppression.” The policy brief was issued by researchers from UCLA’s Center for HIV Identification, Prevention and Treatment Services, Southern California HIV/AIDS Policy Research Center and Global Lab for Research in Action in partnership with the Sex Workers Outreach Project — Los Angeles.


 

Luskin Summit Looks at Sexual Health in the COVID-19 Era

The sixth Luskin Summit webinar, “Sexual Health: Hooking Up With Home-Based Testing and Telemedicine,” featured a panel of experts in health care, medicine, research and policy. Moderator Ayako Miyashita Ochoa, adjunct assistant professor of social welfare, explained that while the COVID-19 pandemic has presented new challenges for health care delivery, it has also served as an opportunity to integrate remote practices into sexual health care services. Associate Professor of Social Welfare Ian Holloway highlighted the resilience of sexual health care providers in their ability to pivot to remote care during the pandemic. “Telehealth is here to stay,” he said. Leah Millheiser, senior vice president of medical affairs for the telemedicine company Hims & Hers, noted that many patients who avoided physician offices out of fear of judgment or embarrassment are now taking advantage of telehealth services. Sonali Kulkarni, medical director of the Division of HIV/STD Programs for the Los Angeles County Department of Public Health, said that testing is an essential part of the strategy to address rising rates of sexually transmitted diseases. According to Holloway, physical distancing measures in place around the world have had a significant impact on the mental health of gay and bisexual men. Alex Garner of the Gay Sexuality and Social Policy Initiative at UCLA Luskin has been working on ways to promote and provide public health information on gay social networking apps while still respecting them as unique, cultivated spaces for men to connect with one another and to mitigate experiences of loneliness and isolation during the pandemic. — Zoe Day


Holloway on Slow Uptake of HIV Prevention Medication

Associate Professor of Social Welfare Ian Holloway was featured in an Instinct Magazine piece about a multi-year study of PrEP familiarity and use among gay and bisexual men. PrEP, a preventative medicine for people at risk for HIV, can be highly effective when taken as prescribed. Holloway’s study found that while gay and bisexual men are more familiar with PrEP than in the past, many are still not using the medicine. “We are heartened to see an increase in PrEP familiarity in this relatively short period of time,” said Holloway, faculty director of the Gay Sexuality and Social Policy Initiative at UCLA Luskin. “But growth in favorable attitudes was modest, as was the increase in PrEP use among sexually active gay and bisexual men.” Looking forward, Holloway hopes to learn more about why PrEP use is still not very popular among at-risk men. The research was also featured in media outlets including Out and Edge.


Vulnerable Communities Slow to Adopt Key Strategy to Stop HIV’s Spread

Taking a daily pill to prevent HIV transmission is one of the most effective biomedical strategies available to combat the virus’ spread, yet use of this health regimen remains low among vulnerable communities, according to a new paper by Ian Holloway, associate professor of social welfare. The research showed that more than 90% of sexually active gay and bisexual men are familiar with the regimen, known as PrEP, or pre-exposure prophylaxis, yet fewer than 8% use it. Black and Latino men have particularly low usage rates, according to the paper just published in PLOS ONE. To measure attitudes toward PrEP, researchers commissioned the Gallup analytics firm to conduct three surveys of gay and bisexual men across the United States between 2016 and 2018. During this time, the study found:

  • Awareness of the regimen increased from 59.8% to 92%.
  • Uptake by those eligible for PrEP rose from 4.1% to 7.8% — a rate that remains disappointingly low.
  • Of those who reported using PrEP, 33.3% discontinued the regimen.

While further research is needed to fully understand reasons for low usage and high discontinuation rates, factors likely include stigma, medication costs, concerns about side effects and lack of access to health care. In addition, “the COVID-19 pandemic has created further obstacles to PrEP access but also opportunities to talk about the sexual health and well-being of gay and bisexual men,” said Holloway, faculty director of the Gay Sexuality and Social Policy Initiative at UCLA Luskin. Data for Holloway’s paper came from the Generations Study focusing on LGBTQ health and well-being, which is led by Ilan H. Meyer of UCLA Law’s Williams Institute.

Miyashita Ochoa on HIV Criminalization Laws

A Body Pro article about the human rights and public health implications of laws targeting HIV-positive and LGBTQ populations cited Ayako Miyashita Ochoa, adjunct assistant professor of social welfare. In California, people living with HIV can be prosecuted for specific offenses, Miyashita Ochoa explained. These laws are most likely to be enforced in marginalized communities, she said, noting that sex workers account for 95% of HIV-related prosecutions in the state. In addition, Miyashita Ochoa, who is also associate director of the UCLA California HIV/AIDS Policy Research Center, interviewed filmmaker and activist Marco Castro-Bojorquez about the role of HIV criminalization data in shifting the policy landscape. Human rights advocates are working to modify or repeal laws that single out people living with HIV while continuing to criminalize the behavior of people who intend to harm or infect others.