This November, Chicago will hold elections for the Chicago Board of Education (CBE) for the first time. Based on a law passed in 2021, the Chicago Board of Education will transition from a seven-member board appointed by the mayor to a 21-member elected board. This will eventually make the CBE the largest school board in any major city. The CBE oversees Chicago Public Schools (CPS), a large public school system that educates an average of 325,000 students annually. Deciding who sits on school boards is one of the most important decisions we make as voters!

History of Chicago School Board Elections

The upcoming transition to a fully elected CBE is part of years-long attempts to see reforms to the board. Since the 1870s, the selection of CBE positions rested in the hands of the mayor. In 1988, CPS experienced what is still the longest strike in its history, lasting nearly three weeks. During this strike, there were calls to reform the CBE, including the potential to directly elect CBE members to increase community input. In response, the Illinois General Assembly passed the Chicago School Reform Act. This Act created local school councils (LSCs) for each CPS school composed of teachers, parents, community members, and a student representative at the high school level. These councils were responsible for issues like hiring and evaluating principals and approving the school site budget. The Act also created a School Board Nominating Commission consisting of 23 parents, community members, and five members appointed by the Mayor of Chicago who would recommend nominees for all the CBE seats to the mayor. The results of these new reforms were mixed. Some schools thrived under this new local council system, while others struggled due to dysfunction or a lack of expertise on how to manage schools. While the LSCs would stay in place, due to the inconsistent results of the Chicago School Reform Act, in 1995 the power to appoint members to the Chicago school board was put solely back in the hands of the mayor. Giving the ability to appoint members of the CBE back to the mayor would only increase calls for a fully elected school board.

The decades-long call by advocates for an elected CBE is rooted in the belief that there must be more accountability of the CBE to the public through regular elections. Pro-CBE election advocates point to the closure of multiple schools on the city’s South and West sides, which disproportionately affect Black and Latinx low-income families. There is also a large concern over the lack of transparency.  Advocates state that mayor-appointed CBEs give special-interest groups with large funding the upper hand in influencing local politics. There has been an expansion of privately-run, non-union charter schools that advocates point to as a major priority of Chicago’s board over the years. Both former Mayors Richard M. Daley and Rahm Emanuel were avid proponents of privatizing education and replacing regular public schools with non-unionized charter schools and people believe their CBEs reflected the push in that direction. Advocates state that not allowing parents of CPS students and community members the ability to elect CBE members greatly limits the ability of CBEs to meet the needs of minority CPS students. While advocates do point to the more diverse CBE appointments by former mayor Lori Lightfoot and current mayor Brandon Johnson, they feel elections will allow the majority of CPS students, who are 47% Latinx and 35% Black compared to 11% white, to have a greater voice and access to resources.

How will the new school board elections work?

The move towards a fully elected school board will happen in a couple of phases. This November, voters will elect 10 of the new 21-member board while the other 11 seats will be appointed by the mayor. The CBE school board will spend the next two years as a half-elected, half-appointed school board. In 2026 voters will elect the full number of school board seats. For this November’s election, Illinois lawmakers divided Chicago into 10 districts. On Nov. 5, residents of each district will elect a school board member to represent them for two years. On or before Dec. 16, 2024, Mayor Brandon Johnson will appoint 10 school board members — one from each district — and a board president to serve two-year terms. For example, District 1 is made up of two parts: 1A and a 1B. If the winning candidate in District 1 lives in 1A, the mayor must appoint someone who lives in 1B. If the winner in District 2 lives in 2B, the mayor must appoint someone who lives in 2A, and so on. The districts have been drawn with the intention that anyone running in that district is reflective and knowledgeable of the demographics and needs of students in those districts.

The Chicago school board votes on the district’s annual multi-billion dollar budget determines the metrics for how well schools are performing, authorizes contracts with vendors to bus students to and from school, clean classrooms and hallways, and even operates entire schools under charter agreements. This is an opportunity for Chicagoans to be involved in supporting the needs of CPS students. You can visit the Chicago Board of Elections to learn more about the school board elections and to see a list of candidates. You can read furtherabout school boards to better understand how school boards are at the forefront of providing or eliminating inclusive and equitable environments and the effect on LGBTQ+ students.

To learn more about how Howard Brown Health contributes to vital advocacy work and has an impact on local, state, and federal policymaking, please visit our Advocacy webpage. 

Forget what you thought about OB/GYN healthcare, someone’s life may depend on it.  

We’re diving into a vital topic that affects many trans men and transmasculine folks out there: reproductive health and gynecological care. A visit to your local OB/GYN isn’t just for cisgender women. So, let’s talk about why it’s crucial for trans men and non-binary individuals, what situations call for birth control, and why keeping tabs on your reproductive health is a big deal.

Why Reproductive Care for Trans Men Matters

First things first, let’s clear something up: not all trans men have a vagina or cervix, and not all trans men need gynecological care or birth control. In fact, not all cis women have a vagina or cervix. Whatever the case is, genitals don’t impact your gender identity. Your reproductive organs, however, can and do impact your health. That’s where Howard Brown Health is stepping in to make sure everyone gets the care they need, regardless of their identity or experience.

 Here are some things to keep in mind: 

• Hormone Therapy: Many trans men opt for hormone therapy (HRT) as part of their transition journey. While this can lead to changes like facial hair growth and voice deepening, it certainly doesn’t eliminate the need for regular OB/GYN visits. And when you’re in those visits, you should advocate for yourself: a recent study from our research team showed that when compared to cis women, trans men on HRT were significantly less likely to receive screenings for bacterial vaginosis at their visits than cis women were. Other related studies have shown that this decreased rate of testing also occurs with HPV, cervical cancer, STIs, and more. You owe it to yourself and your wellbeing to keep your reproductive health front-of-mind.
• Preventing Unplanned Pregnancy: No matter what you hear, HRT is NOT effective as birth control. If you’re sexually active with a partner who produces sperm and not looking to start a family, birth control is essential. Regular birth control methods like oral contraceptives, IUDs, or injections can help you take control of your reproductive choices and ensure you can focus on your relationships and, if you want, build a family on your own terms.  
• Menstrual Health: Even if you’re on HRT, you might still get periods if you haven’t had gender-affirming surgery. Since this can be a recurring traumatic experience for trans men, regular competent gynecological care is especially important to help manage unpleasant symptoms and minimize the discomfort you may feel during that time.

• Menstrual Health: If you still experience menstruation, your OB/GYN can help manage it, whether through hormone therapy or other methods.
• Birth Control Options: We said it before, we’ll say it again: don’t rely on HRT to prevent pregnancies, it is not a reliable and effective form of birth control. Discuss birth control methods with your healthcare provider to find the one that suits your needs and lifestyle best. There are a lot of options!
• Family Planning: Some trans men may want to be the gestational carrier of their child. If that sounds like you or your partner, our Alternative Insemination program might be a good fit for you.

Consequences of Neglecting Reproductive Health 

Now, let’s talk about what can happen if you neglect your reproductive health as a trans man. Ignoring this aspect of your health can lead to several issues: 

Whether or not you’re on HRT, whether or not you’ve had gender-affirming surgery, taking care of your reproductive health is essential. It’s all about making informed choices, ensuring your health fits with your gender identity and life goals, and avoiding any unwanted surprises. Remember, your health is your power, so take charge and prioritize it.  

OB/GYN Services at Howard Brown Schedule an Appointment

They may be farther down the ballot, but school board elections are some of the most important decisions we make as voters.

School boards are responsible for a wide range of academic, legal, and financial issues impacting our students’ quality of education. For example, boards often approve curricula, evaluate student achievement, and oversee the hiring of superintendents; all of the day-to-day things that impact our children’s lives. As such, their decisions have far-reaching consequences for students, families, and communities. In Illinois, school board members represent the interests of two million public school children.

In recent years, school boards across the country have been leading the attempts to eliminate inclusive learning and erode safe and affirming classrooms for LGBTQ+ students and students of color. 16 states currently have some form of restriction or ban on LGBTQ-related curricula including “Don’t Say Gay” bills and at least 18 states have imposed bans or restrictions on teaching topics of race and gender. It’s these types of attacks that make it important to understand how school boards function and be as informed as possible on who should be on your community’s school boards when it comes time to vote.

What Are the Functions of a School Board?

Illinois has over 850 school districts. There is one school board for every school district. We did the math. There are nearly 6,000 members that serve on school boards in Illinois. Most school boards in Illinois are comprised of 5 – 15 members with four-year terms. These boards hire and evaluate superintendents, who oversee the day-to-day management and policies of school districts set in place by school boards. School boards approve budgets and set spending priorities around classroom resources and educational materials like laptops, textbooks, and art supplies. School boards also determine critical policies impacting students, including disciplinary action, COVID-19 safety requirements, anti-bullying initiatives, police presence on campuses, and criteria for suspensions and expulsion. School boards can only enact a decision or policy by majority vote. Members of the public are welcome to attend school board meetings to listen and observe, but only board members vote to enact policies. This makes it imperative to understand who you are electing on school boards as they are the active voice for the needs of students.

Due to a law passed in 2021, the school board for Chicago will, during the next few years, triple from a seven-member board appointed by the mayor to a 21-member elected board. This will eventually make the Chicago School Board the largest school board in any major city. This first of these voter-elected board members will be on this year’s general ballot in November.

How School Board Elections Impact LGBTQ+ Students?

School board members must engage in tough community conversations on how to handle critical and pressing issues such as school security, racial and gender equity, and public health concerns. There are several school boards across the country that are reducing, or eliminating completely, safe and affirming spaces for students in an already hostile climate for LGBTQ+ students and students of color.  For example:

• In 2022, the Miami-Dade School Board, one of the largest school districts in the U.S., rejected a resolution to observe October 2022 as LGBTQ History Month. 
• In August 2023, the Chino Valley Unified School District in San Bernardino County instituted a new policy requiring parental notification when students change their gender identity at school.
• Some school boards in California are voting to ban Pride flags, or making it difficult to form LGBTQ+ clubs like Gay/Straight Alliances.
• In 2023, the Francis Howell School Board in Missouri voted to stop offering Black History and Black Literature in the predominantly white suburban area of St. Louis and revoked an anti-racism resolution and ordered copies removed from school buildings.

The increasing number of school boards enacting aggressive anti-LGBTQ+ and students of color is happening in an already hostile climate for these students. In 2024, the American Civils Liberty Union (ACLU) is already tracking 156 anti-LGBTQ+ bills including sports and bathroom bans for trans students, eliminating the teaching of LGBTQ+ history in classrooms and banning books containing queer characters. For students of color there is an increasing number of book bans aimed at the histories of people of color and a coordinate attack to ban Critical Race Theory (CRT) curriculum in K-12 even though most primary and secondary schools do not teach CRT and is almost exclusively taught in higher education settings.

These policies are having negative effects on students. According to The Trevor Project, nearly 1 in 3 LGBTQ young people said their mental health was poor most of the time or always due to anti-LGBTQ policies and legislation and a majority of LGBTQ+ students reported verbal abuse because fellow students thought they were LGBTQ+. This is increasing rates of mental health difficulties, isolation, suicidal thoughts, and more.

Final Thoughts

We all know how difficult school can be, regardless of your sexual orientation, gender expression, or race. It is our duty to ensure that our communities’ children can live and learn in a safe and inclusive environment. School boards can take an active role in promoting equity and making sure all students get a high-quality education. They partner with superintendents, teachers, families, students, nonprofits, employers, and local colleges to break down barriers to learning, open real-world learning opportunities, and create pipelines to college and career. You can learn more about school boards by visiting the Illinois Association of School Boards.

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To learn more about how Howard Brown Health contributes to vital advocacy work and has an impact on local, state, and federal policymaking, please visit our Advocacy webpage. 

Historically, the fields of medicine and dentistry evolved very separately. So it wasn’t like dentistry developed as a subspecialty of medicine. As a result, I think that dentists and physicians just concentrated on just our own individual professions. I think this mindset crept into the general population, where people began to see their dental health as very separate from their general health. You see your dentist to take care of your teeth, and you see your doctor to take care of the rest of your body. Never mind the fact that your teeth and your mouth are part of your body, those things had to be handled separately and don’t affect each other. Right?  

So should it be that way? Myself and a lot of other medical and dental professionals will say: absolutely not, it’s all interconnected. If you have inflammation in your mouth (like gum disease), that’s a chronic infection in your mouth. Infections spread, so it doesn’t just stay localized in your mouth. If it’s not treated, something we see as strictly ‘dental’ like gum disease can impact other parts of your body, especially if you’re living with diabetes, cardiovascular disease, HIV, or other chronic conditions.  

It’s wonderful to be able to immediately look at a patient’s medical history and background and know that, okay, these are things I need to keep in mind when I see this person. Because oftentimes the dental care that we provide needs to be adjusted based on medications that people may take, medical conditions they may be living with, and many other factors. So being connected with medical providers helps us provide better care, it makes a huge difference. It really does.

Unfortunately, dental health always seems to be at the bottom of the list for people. Because dental care is often so expensive and requires a completely different type of insurance, seeing a dentist is usually not a high priority for anyone who’s low-income or struggling with finances. Our country’s health system has decided that dental care is a luxury rather than a necessity, which does many people a huge disservice.

Framing dental care as something extra or uncommon means that most people don’t decide to go to the dentist until something really bad is happening in their mouth. So when people come see us for the first time, they often have severe issues that need extensive and urgent treatment. But if people were able to come see a dentist on a regular basis, they could’ve taken smaller preventative measures that would have kept severe issues from happening in the first place.

That’s why I think organizations like Howard Brown are so important. We provide service that many people otherwise would not be able to get, because we will work with you regardless of whether you have insurance and regardless of your ability to pay. For me, that is one of the best things about working in dental care at Howard Brown.

I once had the opportunity to take care of a patient who was missing one of her front teeth. As a result, she was extremely self-conscious and would never smile. When we finally saw one another again after I was able to fix her smile, she was like, “Oh my gosh. I cannot believe how much more my coworkers talk to me! My cheeks hurt from smiling so much!” Her coworkers told her they had thought she was rude because she never smiled and rarely spoke. But that was so far from the truth, she was just self-conscious. We were able to do a lot more than just improve her dental health: we were able to help restore her confidence and connect with other people. 

And it’s not just people who are low-income or uninsured: even people with dental insurance don’t seek dental care as often as they should because there is this perception that going to the dentist is always going to be painful. But what we find is that avoiding that discomfort often leads to more pain in the long run. Most people who come to us are already in pain because of chronic issues that have gone unaddressed. Sometimes people may have trauma from past experiences with a dentist that went poorly or were extremely painful. We understand and try to hold space for that in our clinics.

If you’re fearful of going to the dentist, we encourage you to come to us just for a consultation. Just come and meet us. We don’t have to do any dental work during the first appointment, we can just talk through your worries and figure out how to help make you feel more comfortable seeking care. Working inside someone’s mouth requires a lot of trust, and we’ll do anything to earn it.  

Working inside someone’s mouth requires a lot of trust, and we’ll do anything to earn it.  

Dr. Teofilo limosnero

As of fall 2023, we now operate two dental clinics: one in Englewood and one in Northalsted. Our first clinic dental clinic opened in Englewood in 2018 after tremendous effort from our Chief Dental Officer, Dr. Robin Gay. It would not have been possible without her. I worked with her to provide comprehensive, affordable dental care to patients on the South Side for five years until last fall, when we opened the new Dr. Harrison Mackler Dental Center on the North Side.

To close with some ever-necessary reminders: there is no substitute for seeing your dentist regularly. Despite whatever a new miracle toothbrush or gadget says, you should always see a dentist regularly. If for some reason you can’t see a dentist, at the bare minimum you should be brushing, flossing, and eating healthy. Those are all the things that are going to help you long term.

If you’re looking for excellent and comprehensive dental care, you can make your first appointment with us online at the link below. We hope to see your smile soon!

Become A Dental Patient

You read that right, “From Couple to Throuple.” Peacock’s new show presents us with four couples that have decided they want to add a third and make their couple a “throuple” and follows them over the course of several weeks full of Bachelor-style dates, experiments, and drama. Ashmal and Rehman, Chicago locals and the couple at the center of much of the drama this season, sat down with us for a quick chat about their time on the show, polyamory, authenticity, and mental health.

There are very few illustrations of polyamory in the media at the moment. Maybe an off-hand line from Parks and Recreation or “Sister Wives” on TLC. What knowledge did you have surrounding polyamory going into this experience?

Ashmal: “Honestly, for me, I knew about it, but I didn’t even have the terminology. You only hear the word polygamy, but then hearing the word polyamory and defining that was new. I think the biggest thing was that I knew so little about how many ways there are to do polyamory. I think the experience has a big educational aspect to it; there’s no right way to do this. I learned terms like triad and comet partner; we could go all through the terms. So going into it, I didn’t know that much, which kind of I think was perfect because we were just there to learn. Since we didn’t have that many preconceived notions, it didn’t feel like we were comparing ourselves to what it should be; that was a nice thing. Not having those preconceived notions allowed us to freely explore it.”

Did it occur to you that you are sort of breaking ground when it comes to representing polyamory on TV?

Rehman: “I think going into it as far as representation, Ashmal and I both, we have very diverse backgrounds ourselves. He’s bisexual; I was gay, but I’m a little bit more questioning my sexuality now. Also, our ethnic backgrounds, religious backgrounds… there are so many different parts of us. I think we’re so confident in ourselves and who we are that we went into it just saying we’re just going to be ourselves. We just have to fully be comfortable with ourselves and not necessarily worry about how we’re representing our different identities or even the poly community. Especially when it comes to polyamory, like Ashmal said, we were brand new to it. We knew we could possibly make a lot of mistakes and we were okay with that. We wanted to take the risk to really learn a little bit more about this lifestyle and see where it can go.”

Ashmal: “In terms of representing people who want to maybe explore polyamory, I think the cool part about it is that we kind of were doing that before going on the show, we just didn’t know the terminology. I think the cool thing is that it’s also representation for people who maybe are in a similar boat, but they just didn’t know there’s a term for it. There’s a whole community for it. I hope that people watch it and they learn and they’re like, ‘Oh, there’s others like us!’ I feel like a lot of people don’t realize that that’s what they’re kind of doing until they’re seeing the show, and then they feel it’s something they can pursue.”

The show is pretty upfront about showing the throuples having sex. What kind of sexual health resources existed for you on-set, given that people were swapping sexual partners every week?

Ashmal: “I’m glad you bring that up, because that was actually something very important to us. A few months before filming we did a full health STI panel and then days before we did another one. So we kind of were going in there knowing there’s already that base level of knowledge of everyone’s been through the same process. And yeah, they did have the condoms, but you might’ve noticed I also said they have no lube, which I was like, “Come on!” Then they did get it immediately, so that was nice. They listened.”

Rehman: “We also did a sexual health training to go over the basics and make sure we understood what the risks were and what the different STIs look like and all that. So that was definitely helpful. They took it very seriously. I felt comfortable to just kind of engage and be the way that we are normally outside of the show.”

Ashmal: “Consent was also really huge and you could always feel comfortable to say no to anything. They [production] even had told us, in the middle of something, if you just don’t feel comfortable, all you have to do is just stand on the side of your bed and someone will step in. I think just that level of comfort I’ve not had in regular sexual situations. So that was nice.”

As these relationship-focused reality shows have increasingly high-stakes, what mental health resources existed for you? How did you prioritize that during your time on the show?

Ashmal: “We had the on-camera therapist, but then they also have another therapist check-in with us during our non-filming days. Because it’s a psychologist who specializes in television, I would joke, ‘I have Kyle Richard’s therapist!’ But I think it was nice that we had check-ins whenever we needed. The big thing that they kind of told us about, but we didn’t experience until after coming back, was that you go from being there, where everything is secret secret, you’re doing your experience and you come back and it’s just a lull period. I’m just back at home sending emails at work and it’s just like this emptiness. I’m glad we had each other, and the welfare team would check in on us weekly and then monthly to see how we were.”

As the show has been airing, how have you dealt with the world being able to see into your relationship?

Ashmal: “For me personally, going on the show at all was a big deal. Before this, I was out on my Instagram, to my friends and most of my family. But you know there’s people that would still think we were just roommates or we were friends – and you let them because it’s easier. I got on there and I had to remind myself that there’s no way I can minimize my sexuality. There’s no way you can straight-wash yourself. Just fully go into it. I think I had a moment where I was like, ‘I don’t think I’ve ever come out this big.’ I think the gayest way to come out is on television. So then we just started having fun and then we had each other and the rest of the cast also. I was like, ‘Everything’s going to be okay.’ It’s been really positive.”

Rehman: “I just had to remember the confidence that I have in myself and who I am as a person and just own it and not let anybody take that away from me. Then also realizing who are the important people in my life, and knowing that their opinions and their feelings about us doing this experience matter more than anyone else. Everybody else is going to have an opinion either way. At the end of the day, Ashmal and I showed up to this experiment and it was very real. Watching the episodes, especially seeing myself, it was a very real process for me. It was a rollercoaster, but that’s what life is, and I want to experience life to the fullest. I just kept telling myself: ‘We went through this. It was tough. It’s not for the faint of heart, but I did it and I’m proud that I did it.’ It was a year ago. So I think we could both confidently say that we’re very different people from when we filmed this. It is definitely fun to watch ourselves back to kind of see how much we’ve grown even in just that year.”

Ashmal: “There was some family who were going to see me be queer on main, I was like, ‘I think the important thing is they’re going to see that I’m still me, I’m still being me, and I’m still the same guy.’ I think we’re really proud of just being ourselves throughout it.”

The “Where Are They Now” segment revealed that the three of you are now single. Looking back on it, would you do it again? Would you recommend that someone else do it?

Rehman: “I think for me, I am definitely happy that we did this experience. I think we both just learned so much about ourselves. For me in particular, watching myself back, there are so many things that I learned about myself that maybe I can improve on or maybe I can work on to become a stronger and better version of myself. So I would never want to take that back. And at the end of the day, we showed up, we were real, we were our authentic selves, and that is part of life. What happens in the end is part of life. It was just another thing that happened in our lives and we dealt with it and we’re dealing with it. My main thing is just really looking at the positives that came out of this and starting these conversations around polyamory. I think it was scary. It was a risk for us, but hopefully something good will come from this.”

Ashmal: “I’m so glad we did it too, because one thing that we really focused on is we did this experience that is always going to connect us; we can’t share that with anyone else. That’s so cool. We were even joking, if we start dating someone, that person is going to be so jealous and insecure of the fact that they can’t do this, they can’t have this experience to look back on. I think we’ve really focused on the humor of the situation and the cool experiences and the people we’ve met. Just being here in LA and staying with our friends from the show, it’s so fun. We have a whole new community now, and I think that’s the good thing to focus on.”

What advice would you give to someone who has a friend or family member in a polyamorous relationship?

Ashmal: “I think just most importantly, don’t feel weird about asking questions and being honest. I think even when we were exploring it, we knew it was a new experience and we were still figuring it out. So it’s normal for other people to have questions. Like if you want to invite that friend to hangout, but maybe not all of their partners, think about it like a monogamous relationship. How they would feel? They would feel like, ‘Oh, you don’t like my partners.’ So it’s just nice to extend the courtesy. But as always, if you have questions, ask! Having these conversations is what is most important.”

What advice would you give to someone who is interested in being in a polyamorous relationship?

Rehman: “I think just try it out and do your research first, but just understand that no relationship is the same. So you can read everything, you can talk to people and get their experiences, but at the end of the day, you’re an individual relationship, so you just have to figure out what works best for you, what works best for you and your partner or partners, and then go from there. I feel like sometimes people try and fit into this mold of what they think it’s supposed to be, even with polyamorous relationships, and you just have to realize that they’re all different. Even from the show, all of our relationships as far as the different couples and throuples go, they’re all so different. The coolest thing about it was to see that, oh, they’re doing polyamory in a slightly different way that we are, but that’s okay because they figured out what works for them and we figured out what works for us. But just take risks like any normal, any monogamous relationship, this would just be another risk that you’re taking and trying to figure out if it works.”

Ashmal: “The research part is so important. Just really do your research because just the terminology can really affect the dynamics. We learned the term ‘primary partner’ and then ‘additional partners’, and it just sets the expectations of what polyamory is going to be for you and your partners. If you go into it without even the knowledge of how to express what you want, I think it makes it harder because you feel lost, your partner feels lost, your other partner feels lost. So that baseline education I think is very important.”

Ashmal: “I will give a warning that what they don’t tell you about polyamorous communication is that the texting is crazy, texting one person and then you’re texting the other person and you have your group message. So if you’re responding to the group message but not a partner, you have to send your other two messages. Oh, it is a minefield.”

Any final thoughts to share?

Rehman: “I think, again, just continuing to normalize polyamory and have conversations around this. I feel like especially sometimes in the LGBTQ+ community, even talking about open relationships, you have some people that have very strong opinions either way. At the end of the day, this is just another way to go about having relationships. And it’s okay because like we said, we’re both normal people. He’s an attorney. I work for a bank. We live pretty just normal, boring lives, but we went on a TV show and experienced this and took a huge risk and are entering into a lifestyle that maybe isn’t the majority. Like I said, it’s just another way to do things, and it shouldn’t be something that’s taboo. It shouldn’t be something that is looked down upon. And I hope the more this becomes normalized and more integrated into society, people will feel more comfortable being themselves. People are interested in it, but I feel like there’s still some stigma around it. So hopefully this will help break some of that up.”

Ashmal: “And I’ve been getting a lot of people who have been reaching out, and there’s just one term when people are saying, ‘We’re so proud of you for being so unapologetically yourself.’ I think my thing with that term is where the true liberation and the true ease really comes from. I don’t take pride in being told like, ‘Oh, you’re so unapologetically yourself.’ I have nothing to apologize for, I’m just being myself. No one has anything to apologize just for being themselves. I think just celebrate people instead of being like, ‘Oh, well, normally that’s so weird what you’re doing, but congratulations for doing it.’ “

What is next for the two of you separately or together?

Ashmal: “We actually do have something in the works coming soon, just how we navigate this next chapter, being besties and going about life. So stay tuned for that. That’s all I can say right now.”

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Couple to Throuple season one is streaming now on Peacock.

Click the buttons below to learn more about Howard Brown Health’s sexual and mental health resources.

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A conversation with Howard Brown Health Board Member B. Pagels-Minor: entrepreneur, public speaker, and advocate for change.

As the Howard Brown Health Board of Directors begins the search for a new class of board members, we spoke with B. Pagels-Minor about their experience on the board, their commitment to healthcare, and what advice they would give to future board members.

My name is B. Pagels Minor. My pronouns are they, them, and theirs, and I am the founder of Divergent Ventures, which is a venture firm that invests in Middle America. And I also am the co-founder of The Wealth Salons, which is a financial wellness platform that works to help support people building their wealth and keeping their wealth. I’m also a longtime board member of the Howard Brown Health Board. I actually am entering my final six months here on the board. I can’t believe it’s been nine years, but in some ways it feels like I’ve actually grown up with Howard Brown.

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I’m from a very small town in Mississippi. The most popular thing it’s known for is being very close to where Elvis was born. The very first time I got on a flight was to go to Chicago for a cousin’s wedding. I remember at 12 being amazed by that. Because, you know, my family was very country, and I mean that in the most affectionate possible way. When I go home, we have fish fries, and I honestly miss them desperately because while I love California and its smoothies, nothing beats a fish fry. 

I ended up going to college in Evanston at Northwestern. I was so fortunate that one of my professors, Myron Kwan, a gay Asian American professor, recommend I take an internship with a local non-profit, the Lesbian Community Cancer Project. I applied, got the internship, and I spent the summer working alongside Howard Brown Health employees, asking women about gynecological visits. If you want to get to know people in the city, that’s the best way: asking about results and being okay doing it, helping them however you can.  

I was grateful to be a part of the process when the Lesbian Community Cancer Project became Lesbian Community Care Project, and then eventually Women’s Healthcare at Howard Brown Health. We made the decision to merge because we knew we could do more to support women in Chicago by being part of Howard Brown Health. At the time, Howard Brown Health didn’t have a reputation for helping women. We wanted to change that and knowing the scale at which Howard Brown Health operated, we knew we could do it.  

Later in 2015, I applied to be on the board of Howard Brown. The cool thing about my work there is that as an intern, I understood what Howard Brown could do. When I was diagnosed with thyroid cancer in my junior year of college, I had insurance, but it wasn’t enough for my treatment. When I needed tests, I went to Howard Brown. It wasn’t just because I worked there.  

When I got treatments, I couldn’t be around people due to radioactive iodine being used on me. I was quarantined in my room without access to the outside world. A volunteer from Howard Brown Health dropped off the full collection of Gilmore Girls to distract me from my isolation. So yes, I’m a fan, proud of it. I love it. My mom and dad couldn’t be there, but that volunteer was. She sat outside my door and talked to me. Howard Brown Health made sure I felt okay and seen.  

That’s one reason I was committed to Howard Brown. It’s one reason I’m still committed, even though my disease was curable. The worst thing for someone who’s sick is to feel alone and sad. Keeping my spirits uplifted and making sure I knew I mattered was a tremendous factor in my recovery. It supercharged my ability to do other things. 

By the time I got to Howard Brown, I kind of had a laissez-faire relationship with healthcare. I ended up on a softball team with the person who would end up being my provider at Howard Brown Health. They said, “Hey B, let’s run all of your blood tests!” From my test results, we formulated a plan. Between vaccines, supplements, and lifestyle changes, my health was transformed. It was like this game-changing understanding that there’s ways that you can fine-tune your body to be more effective. I was delighted in it.

I love the fact that there were doctors who were just like, “Hey, I see some weird stuff going on here. Let’s ask some basic questions. And since you don’t know, we’re going to teach you so you can have better outcomes.” 

Howard Brown’s expansion forced us to become better and smarter, humbling ourselves when we didn’t know things. It’s been an honor to get this separate experience in healthcare management by being part of the board. 

What people need to understand about the board is that because Howard Brown Health is a federally qualified health center (FQHC), at least 51% of our board members must be patients. Our goal is not just to meet the minimum requirement: we aim for 100% patient representation on the board because patient experience is paramount. 

I have a personal connection to Howard Brown as a patient managing a disease. When I moved to California, I remained a patient at Howard Brown. I provided feedback about the blood draw experience, and it improved. Having patients on the board is crucial because they bring firsthand experiences and drive positive changes. 

To be on the board, you can be a current patient or former employee. We want individuals who understand the community’s needs, and our board reflects the diversity of our patient population; people who are Black, Asian, Latine, lesbian, trans, gay, gender-expansive, polyamorous, and more sit on our board. 

While we value diversity, we also seek specific expertise, such as financial, legal, medical, and people management. The application process is rigorous, involving a thorough review, interviews, and careful selection based on the needs of the board. We take this seriously. 

Our board meetings involve committees, each handling different aspects. Committees like governance, executive, and quality assurance contribute significantly to the board’s day-to-day activities. The executive committee, on which I serve, addresses various opportunities and challenges that may arise. The experience is challenging but rewarding, as we collectively strive to fulfill our responsibility to the community, ensuring the best possible care for the 38,000 individuals served by Howard Brown Health each year. 

I was like, “Who’s going to say anything? I’m here every day and I pull my weight, right?” That’s all we care about because it’s all about the work. 

It goes down to the DNA of every Howard Brown employee. I’ve been around Howard Brown since 2006; almost 18 years. The DNA of Howard Brown employees has not changed much. It’s full of very mission-oriented people. It’s people who could potentially get paid a lot more doing other things but choose to work at Howard Brown because they understand what they’re doing is literally going to change lives. 

Someone who is community-based, who can talk to folks, tell us what we’re doing wrong and be willing to help us be better? That’s super valuable. Historically people used to always talk about value related to money, but we’ve tried to think about value in new ways. What social capital do you possess? What insight can you offer? Whenever a board has representation across all categories of humans, I’ve found it to be much more effective. 

And remember, we have more than one opportunity to get involved. So obviously, there’s the board of directors. We also have the community advisory board. And then we also have the Vernita Gray board as well.  

Most importantly, statistics tell us that people from historically under-invested-in communities tend not to apply to things unless they’re a perfect match. I say, “Just apply. Go for it.” Worst case scenario, we respond back to you and say, “Hey, you seem amazing. Would you consider joining this other board?” That’s not a bad proposition. We are a group of volunteers, but we’re also almost all people,who have had challenges in our lives. So, we all know what it feels like to be rejected. We try not to do anything like that in our process. Our goal is to get everyone involved because this is big work, and it’s a lot easier when we can break off pieces and then split it up and all take a little piece.  

I had never had any queer friends before because I didn’t even realize I was part of that community since I grew up in a place that didn’t see people like me. I didn’t even know my friends at BYC were unhoused. We would just be in the clubs, we would be out eating tacos, whatever. When we finally got close enough, they were like, “Oh, I’ve been unhoused.” Then they’d come crash on my couch. My first time going to BYC was as a senior in college. After seeing what they did and seeing my friends feel whole for the first time, I decided that was a place I wanted to support.  Now to see it with its own building, with its own facility, with a space that makes people feel so safe and so cared for, you know, it feels like a real dream come true. That’s exactly the type of exciting stuff that we get to do.  

It’s only because we scrimped and saved. We try our best to create these programs and possibilities, despite their not necessarily being very profitable. It’s the challenge of running a nonprofit: you must be nimble and figure out how to do these things, even when they can’t pay for themselves. So, finally giving BYC a permanent home just feels beautiful. 

You can have the chance to create change like that too. To make progress for the people you know, for the community around you, and for those that need it most. How will you get involved? 

Every queer person can imagine the day: a pink pastel Valentine’s Day filled with traditional displays of love for a romantic partner. A rose, maybe some chocolates, or dinner out to a new place. These celebrations look a lot like the heteronormative love we’ve been conditioned to desire and subconsciously replicate. Queer intimacy on Valentine’s Day can be hard to find.

What if this Valentine’s Day, we dedicated time to appreciating all of the wonderful intimacy that our lives contain? What if we used Valentine’s Day to celebrate friends, lovers, or even strangers? Think about it: almost everything we’re taught about intimacy relates to gender norms and the context of a heterosexual relationship. How different would Valentine’s Day look if we added other types of flowers to our bouquet of roses?

According to The Trevor Project, LGBTQ+ youth who found their family, school, or community to be affirming had much lower rates of attempting suicide. As it stands, queer people are twice as likely to have a mental health condition and trans individuals are four times as likely to have one. Isolation and lack of intimacy can play a large part in generating the feelings of depression or hopelessness that many queer people in our country display.

Clear some room in your metaphorical Valentine’s Day vase: we know there is room in our lives for a bouquet of beautiful relationships and intimacies. Scroll down to learn about all the ways we can relate to one another!

Intimacies of The Body

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Intimacies of The Mind

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Intimacies of the Heart and Soul

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A Bouquet of Intimacy

When it comes down to it, we have an abundance of ways we connect with people. Big or small, intentional or not, every day represents countless opportunities to enrich our own life and the lives of others. Our vase is full, not only of roses, but of freesias, daisies, lilies, and more.

Intimacy is the opposite of loneliness. By stitching ourselves to other people wherever we can, we fight the depression, isolation, and sorrow that can often affect queer people.

Regardless of your identity, promoting kindness, vulnerability, and intimacy in our daily lives can help grow the kind of world that we are proud to call home. If you are in need of mental health resources or want to become a patient here at Howard Brown Health, visit the links below:

Behavioral Health Group Therapy

CRACKING THE CODE: ANAL HEALTH 101

Today is World Cancer Day, and in observance of that we wanted to take a minute to educate you on one type of cancer that doesn’t get enough attention: anal cancer. Yup, butts. We’re talking about butts. 

I’ll say that in med school, anal health wasn’t a focus; it was just about prostate exams. We all gathered round and got to feel a prostate; that was that. After becoming a doctor and spending years in primary care, I shifted my focus to LGBTQ+ health at Rush University Medical Center, leading the charge in that area. A physician I had referred many anal health patients to asked me to join his practice, and at first I was like, “I don’t want to do that. That’s why I refer it out.” But eventually, with everything going on in medicine and everything I had seen, I said, “Let’s give this a shot.” I ended up here by recognizing the demand for LGBTQ+ health and following where it led me. 

In anal health, our main emphasis is on screening and preventing anal cancer, particularly among people engaging in anal sex, especially men who have sex with men. The main thing that I run into are symptoms like bleeding, itching, or lumps, though those don’t necessarily indicate anal cancer. While I certainly understand that discussing this topic can be uncomfortable, at Howard Brown we recognize and navigate our community’s sensitivities while still providing the vital care they need. I have patients who have experienced trauma related to that area and need careful consideration, but I also have patients who will joke around and make sex jokes during procedures. So, it can really go both ways. 

We also know that outside of Howard Brown, patients may encounter obstacles like discrimination or discomfort when discussing anal health. To mitigate harm, we aim to refer patients within our organization to experienced, affirming providers.  

When it comes to your butt – regardless of sexual orientation – engaging in anal activities can strain the body. Being mindful of what’s normal or not is crucial for cancer screening and overall health. In essence, the more you use your butt, the more attention it deserves for maintaining good health. So, make sure you know what’s going on down there: a small mirror, your camera phone, or a partner can all help you keep tabs on what your body looks like. 

We have been testing and evolving our anal health screening guidelines here at Howard Brown and we are unique in providing procedural guidance for all our doctors. Our organization-wide awareness ensures that all providers can refer patients appropriately and conduct screenings themselves. In many other organizations, screenings are lacking and anal health specialists are rare. Patients are often referred to colorectal surgeons for this care, but they tend to focus more on surgery than discussing issues like pain or difficulty with sex.

Here at Howard Brown Health, we want to know if bottoming is going well for you or not. We’ll recommend some toys to try or ways you can reduce discomfort, too. We’re not squeamish. So let’s get into some specifics.

BOOTY BASICS

Start Small

When it comes to engaging in anal activities, I encourage exploration but emphasize the importance of proceeding thoughtfully. Gradual progression is key, especially for those who may have been inactive for a while. Rushing into substantial activities can lead to fissures and complications, requiring downtime before returning to such activities. You can’t become a size queen overnight. 

Soothe Irritation

Avoid Straining

When it comes to bowel movements, prioritize avoiding straining. We all love to sit down and scroll TikTok on the toilet, but avoid sitting for too long. It’s essential not to spend excessive time on the toilet, as it worsens conditions like hemorrhoids. Increasing fiber intake and staying hydrated are more effective than relying solely on tools like squatty potties.

Don’t Overdo(uche) It

When douching, gentleness is key, especially with firm-tipped devices to prevent scratches. Shower shots and the like are convenient, but your anus doesn’t need power washing. Only douche when necessary, avoiding unnecessary or excessive pressure. Constant douching isn’t natural for our bodies. With the advent of cruising apps, some people may feel the need to be “ready to go” at all times, even at the grocery store. Don’t. It’s easy to pour your friend a drink and hit the bathroom quickly before anything happens. Over-douching and practices like that can contribute to irritation and the risk of conditions like anal cancer. 

BUTT OUT, CANCER!

Which brings us to the final and maybe most important point of this post. Anal cancer.  

Anal cancer is relatively rare, but certain factors increase the risk. Living with HIV, regardless of undetectable levels, is a significant risk factor. Because of this, Howard Brown Health has dedicated time and resources to making sure we are screening our patients for anal cancer. Additionally, high-risk strains of the Human Papilloma Virus (HPV), especially type 16, are linked to anal cancer. Other minor risk factors include tobacco use, a history of anal or genital warts, and low T cell counts (for those with HIV). For a comprehensive list of screening guidelines published this week by IANS, check out this article.

For those with HIV, regular screenings are recommended at ages 35 and up. For others with risk factors, screenings are recommended around age 45, following new guidelines. These are flexible and symptomatic cases may require earlier screening. People with a history of receptive anal sex should discuss this with their primary care provider. If you’re around 25, focus on getting the HPV vaccine for reduced risk. Gardasil is the most common HPV vaccine and while it is primarily used to prevent cervical cancer, its role in preventing anal cancer is gaining recognition.

In the fight against misinformation, prejudice, and stigma, education and evidence play vital roles. The bottom line: everyone has a butt and it’s okay to discuss any issues you’re having with it. On World Cancer Day, prioritize your well-being, get screened if necessary, and join us in spreading awareness about anal cancer. Stay healthy! 

Our Anal Health Program About Dr. Rauch

Taken from the podcast episode “Episode 55 – Healthcare From Home! Using Telehealth to Care For Our Most Vulnerable With Dr. Sam Lin” from Charting Queer Health. Listen here!

Early in my career as a healthcare provider I took a dive into telehealth, looking at women’s health, sexual health, and marginalized populations. I quickly realized the potential that telemedicine has, specifically for medical abortion, believe it or not. I was an early adopter of that in 2001, almost 17 years before the pandemic. Now, we live in a time where we are focused on trying to do as much as possible, virtually. As we know, after the pandemic, everything is different. What does good medicine look like through a screen? How does telemedicine help us advance health care?  

Like I said, I was an early adopter of technology that looked at ways of doing medicine virtually. Before that, I always thought telemedicine was telephone. That’s what I thought the origin was; that you got on the phone, and you were supposed to call someone. Telemedicine. That’s actually not far off. It was coined by this guy, Thomas Byrd in 1970, and if you take two Greek words, telos and medikos, which means “healing” and “at a distance”, respectively. So quite literally, telemedicine is just that; healing at a distance. It’s been around as long as technology has been around. During World War I, you used a telegraph to inform about casualties or the needs of medical supplies. When the telephone was first invented, they were looking at ways to send heart tones through telephone wires and have physicians at one location be able to diagnose patients in another. They applied the same science to kids with croup or cough. So, we’ve always looked at ways to integrate technology and healthcare. It’s had a long history that most folks don’t realize. The pandemic heightened this need, but technology has always existed. It just became oh so obvious that it’s not going anywhere now.  

Telemedicine allows us some unique loopholes legally, as well. There was a ship in international waterways that was sending mail order birth control to folks in a nearby country because technically the ship existed outside the lines of what was legal for that country. That was maybe a decade or so ago. Now, when you start getting into services like that, things like Hormone Replacement Therapy (HRT) comes to mind as well. This is a service for folks that are transgender or non-binary, and here at Howard Brown Health, serving transgender, non-binary, and gender-non-conforming people is a cornerstone of the organization. So naturally we’re looking at how to expand these services, virtually. Having that kind of protection of a digital service, especially as states across the country attempt to limit access to them, could be life changing for a lot of people. 

It is important that we frame telehealth within these current hot-button healthcare issues, whether it’s reproductive health care, or whether it’s gender affirming health care. Prior to the pandemic, there was really no insurance buy-in. We had internet, we had zoom, we had all these things before 2020, but we didn’t have the infrastructure or the reimbursement from important players, like the insurance industry. It wasn’t mass utilized at that point because people didn’t know how they were going to pay for it or what the value was. Until the pandemic. A lot of programs had to pivot overnight, as we all did with life. The question became, “How do we keep going? How do we sustain healthcare and contact with our patients through other means?” Now I think in this post-pandemic climate, we’re looking at laying the foundation in a meaningful and thoughtful way. Telemedicine is not a fad. It’s here to stay. It’s a part of the soul of healthcare now, for good. 

When people think about telehealth, they might be thinking about quick, low grade treatments for things. It’s a project of ours here at Howard Brown Health to involve more primary care with telemedicine. We can use telehealth for really anything that where don’t need a physical exam. The things you cannot use telehealth for are services where you need to have something on your body examined. But if you had joint pain or if you had some kind of sciatica pain, there are things that I could walk you through, via telehealth, like stretches and exercises. Seeing someone in their living space is really helpful and quite important diagnostically, but I can’t put my hands on your body physically. It’s not going to replace the physical exam; one thing’s not going to overwhelm or replace the other. However, the capacity for us to do remote monitoring for chronic diseases is huge. Especially for conditions like blood sugar control in diabetics, where you could just get a constant update that’s sent to your provider so they can track how your blood sugars are moving, or how your heart rate is if you have congestive heart failure, or monitoring for antiretroviral medications to make sure that like your HIV levels are in range. The possibilities are exciting. 

There is no federal agency or regulatory body for telehealth specifically. With the introduction of the Public Health Emergency Act during the pandemic, a lot of the regulations on what is considered acceptable or appropriate for seeing patients were suspended. Especially in terms of prescribing controlled substances. However, the Public Health Emergency Act officially expired May 11. 2023. The good news is, the DEA has issued an extension of permissions to continuing electronic prescribing of controlled substances, including testosterone. The extension is set through December 31, 2024. This means that we can absolutely provide PrEP follow up visits, STI concerns, referrals, medication refills, and HIV follow up through telemedicine as well. I am pushing for expansion to our hormone therapy program, although it is still all just within the borders of Illinois for now. 

Another example laws surrounding telemedicine was the concern around the Ryan Haight Act of 2008, which was employed because of nefarious websites where folks were able to get opioids online and there were unfortunately deaths that were a consequence of that. So, the FDA went, “How are we going to regulate these drugs? We really want to make sure you have an in-person visit with the provider that can authorize these medications. That’s going to be really important.” So that was implemented because of that crisis. So now the DEA is looking at ways that we can all move forward in a more thoughtful, constructive way in regards to controlled substances. It’s a hard stop; you’re going to have to see someone in person if you’re going to be prescribed opioids or any schedule two or three drugs. We’re just kind of preparing for it right now. But here at Howard Brown Health, we have other concerns too. Testosterone is a schedule 3 drug. It’s a life-changing medication for hormone replacement therapy for patients seeking gender affirming care. That drug is essential and vital for that community. These restrictions are problematic given the in-person requirement; a lot of gender-non-conforming patients do not feel comfortable visiting a doctor in person. It may not be physically safe to do so. I am committed to looking at ways that we can move forward thoughtfully to ensure that the services aren’t disrupted for these patients.  

In addition to allowing a provider to see a patient in their living space, I think there’s some benefits to seeing someone in their home when they are unable to communicate or cannot advocate for themselves. To have family members nearby that can help facilitate for elderly parents or someone who may have communication or neurological deficits, people that are able to fill in the picture for the clinician? That’s helpful.  

My other heart project is I look at digital equity and digital inclusion. Those are the cornerstones of the telemedicine program I’m trying to build here at Howard Brown Health. Digital equity is everyone having access to technological services and these digital resources. Sometimes I’m operating out of the south side of Chicago, where we have certain spots that are spotty for internet connectivity. I can’t rewire that, but I can try to help folks, whether that’s a remote van service where we can bring iPads to you and you can connect with the clinician, or something else. It’s a project that we’re thinking about; helping folks connect to their clinicians.  

The digital inclusion part is how well you can participate in this technological experience. What is your health literacy, what’s your technological literacy? How well can you capitalize on this experience with your healthcare? Howard Brown Health has a suite of Aging Services programs designed to help our elders live their best life in all areas. I want everyone to feel capable and competent online, so everyone can get the most out of their healthcare.  

Unfortunately, a lot of metrics for success or drivers of profit in a lot of healthcare organizations is how many patients you can see. Telehealth could be considered advantageous where that’s concerned; you don’t have to wait for a patient to make their way down the hallway into the clinic room. You can just click start and they’re there. On the other hand, there’s no substitute for spending your time with your doctor; building that relationship and trust is crucial. So does telehealth help us hit our bottom lines, at the cost of patient experience? 

Well, it depends on what the patient’s expectations are. If a patient wants to still be seen in person, in-person clinics are always going to exist. It is a question of what makes them feel confident and well taken care of, because even if they have like the best telehealth visit ever and it’s super long, as long as they don’t feel like it’s the same kind of experience, then it’s going to mar that memory for them, even if they get great care. Folks that feel comfortable with technology, that are interested in technology, or that want to engage in that will, I think that’ll always exist.  

 

I will argue that telehealth is not a perfect solution for meeting productivity metrics. You often have to do a lot of tech troubleshooting with patients. They log in, they have connectivity issues, they don’t know how to open the Zoom link, the sounds off, they’ve muted themselves. You have to spend a lot of time troubleshooting. Besides, in our system patients are still required to meet with a medical assistant first and collect a little bit of data, like their vitals. We still have what we call a “rooming process” where a patient is in a virtual room. They’re not in a physical space, but they’re still meeting with multiple people and progressing through the steps of their appointment. It still takes a little bit of time.  

As for the future of telemedicine, I have some big pipe dreams. My focus point, specifically for Howard Brown Health, is looking at gender-expansive care and expanding services for that kind of care in multiple capacities, especially when it comes to medical aesthetics – making sure you look the way you want to. Let’s just say, for example, hormone therapy. A patient may have an interest in that. They would fill out a medical history and intake form that we would create for them. They would give us documentation, their insurance coverage, some things like that. They would basically enroll themselves. We would have to do some verification on our back end, but they would submit a request based off their profile. A provider at a different point would review the information and would then send lab requests for that patient to be screened. If it was for HRT, we check their baseline hormone levels. If everything comes back good, we then write them a prescription for medicine without ever actually seeing the patient. That’s an example of an asynchronous medical journey. It is great for very specific health issues that can be managed in these very specific ways. It allows the patient to engage on their time without the stress of scheduling an appointment and managing a calendar.  

A lot of times my patients are in the car or going through a drive-through, getting food on their lunch break. Or even in bed; I have all kinds of stories. Asynchronous care would be a way that if, at three in the morning, someone was like, “You know what? I have this really weird itchy infection and I’m kind of worried that I have an STI!” They could send a message, describe their symptoms, create a profile, and someone will get back to them within a few hours to follow-up. The same process can be applied to PrEP. With specific areas of health conditions, I think this would open a whole world.  

There are already organizations that are operating in that way, so I can’t wait for Howard Brown Health to get on board, too.  Not to mention the constant innovation that is happening with our tech; who knows how the biometric data that your phone and watch and earbuds take from you may factor into healthcare in the future. 

The last thing I thought was interesting is the way that we think about healthcare. We, as a society, like to think of healthcare as an isolated individual experience. HIPAA exists for a reason, after all. But it’s intriguing to think of health as a part of a community; really embedded in a patient’s life — not just their medical symptoms — but their identity and their community. Telehealth physically brings a healthcare experience into somebody’s home, which I think is a powerful concept. If you’re a patient thinking about your overall health, it might be easy to compartmentalize that. “I think about my health when I am at the doctor’s office.” With telemedicine, if you’re going about your day, working from home, and then you quick jump on a call, suddenly you’re addressing that health concern in a space that you’re in all the time. It grounds the conversation, your treatment, and how you perceive yourself in a much different way. Telehealth is more intimate because you’re coming into a patient’s world rather than the reverse. There’s also a sense of ownership.  I think there’s some interesting psychology in that. 

That’s the take home; expanding all facets of healthcare delivery to fit a patient’s needs, whatever they may be. If you’re someone who wants your food brought to your door, your dog walked for you, and your doctor on your phone screen, great. See you soon. If you want the experience of heading into a clinic and seeing your care team in person, great. See you soon. I have two little kids and it’s a pain in the butt to try to get both my children anywhere, so telehealth appointments really benefit my life in that way.  

Overall, I want to remind you that Howard Brown affirms who you are. That means in all spaces, we see you and we hold space for you and for your care. I speak specifically for my TNB community; there’s a lot of benefit in the physical safety that Howard Brown Health provides. We want to give everyone the opportunity to seek care in a safe space, whatever that feels like to you.  

It’s my mission to create a solid foundation and to lay a groundwork that is sustainable and thoughtful and meaningful for the future of telehealth, because it’s not going anywhere. It will try to do the greatest good for folks. That’s the goal.  

Schedule An Appointment

_{Taken from the Charting Queer Health Episode “Getting A Handle on Alcohol.” Listen to the full interview here.}

Whether you’re regretting that last champagne toast from New Years or you’ve been on a sober journey, alcohol has soaked into our culture in almost every area. We drink to celebrate and to mourn; we drink with friends, coworkers, and family. Sometimes, we drink for almost no reason at all. Start out the year by reviewing what we know about alcohol, what it does to you, and how you can improve your own relationship with it.  

First, let’s explore the language distinction between alcoholism, alcohol use disorder, and general alcohol use from both a healthcare and cultural perspective. In addiction medicine, language matters due to stigmatization. “Alcohol use disorder” is the preferred term over “alcoholism” or “abuse.” Avoiding moralized language is crucial as alcohol use disorder is considered a disease. 

Circumstances, such as lifestyle and environment, significantly influence alcohol use. The NIAAA’s criteria create a spectrum, recognizing that relationships with alcohol vary. It’s not a black-and-white situation, and the spectrum allows for nuanced assessments and risk stratification. Age and context matter; what may be acceptable for a young adult might not be for an older individual. Society often perceives these scenarios differently, but the key is recognizing the spectrum and understanding the complexities involved. 

In discussing alcohol use disorder, the NIAAA doesn’t categorize people by gender but focuses on psychological aspects. I don’t shame my patients; I practice harm-reduction instead, as shame can worsen psychiatric conditions like addiction. The disorder’s diagnosis, based on DSM criteria, doesn’t rely on drink quantity. Genetic factors, family history, adverse childhood experiences, and mental health issues contribute to this diagnosis.

Growing up, we all receive health class lessons full of scare tactics regarding drugs, cigarettes, and alcohol. As adults, there are some real consequences to heavy drinking that we should be mindful of. There are also some ways we can avoid lasting consequences.  

WHAT ALCOHOL DOES TO YOU

First off, the more you drink, the more at risk you are going to be for developing various physiologic consequences like depression, anxiety, and more. A lot of people can confirm that waking up the morning after a hazy evening with a phone full of texts can be anxiety-inducing. Other negative health consequences from alcohol can be severe. It has toxic effects on our gastrointestinal tract, not to mention the liver; that’s probably the most well-known organ it affects. It can cause acute liver inflammation, also called hepatitis, or over long periods of time cause fibrosis and scarring of the liver called cirrhosis and liver failure. Alcohol can cause stomach inflammation, otherwise known as gastritis. It affects our cardiovascular system. It can contribute to high blood pressure. It has effects on our our blood. Alcohol can actually have directly toxic effects on the bone marrow and can result in anemia. Not to mention alcohol disrupts sleep and can destabilize mood and exacerbate an underlying mental illness. Alcohol is powerful. It affects every part of our body. 

For people who are trying to cut back, I recommend alternating between alcohol and non-alcoholic beverages, starting with a non-alcoholic drink for hydration. Eating before drinking can also be helpful. Counting drinks using apps can provide warnings to avoid overconsumption.

The difficulty arises when practical strategies, though good in theory, become challenging in drinking. Maintaining control over the amount consumed and making sound decisions under the influence of alcohol is… really hard. Things like counting drinks, remembering to drink water, and other strategies are usually not front of mind when you’re drinking. That’s not to mention the challenges alcohol poses to other people, especially as it relates to consent. Let’s say you hook up with someone drunk; you obviously consented at the time, but maybe you wouldn’t have made that decision sober. This kind of murky decision making is a big part of what makes alcohol so problematic. 

Ultimately, you should always take responsibility for your actions while drunk. We need to move beyond trivializing alcohol’s effects and laughing off our hangovers, and instead acknowledge the simultaneous cultural ease and difficulty in discussing alcohol, with all its complex and challenging realities.  

MEDICATIONS:

There are a variety of medications a doctor can prescribe to help with Alcohol Use Disorder. A medication that’s commonly used is Acamprosate. Acamprosate is thought to work by stabilizing the balance of certain neurotransmitters in the brain, which may be disrupted by chronic alcohol use. 

You may have heard of a medication that makes you sick when you drink; that medication is called Disulfuram. It’s primarily used in patients that want to be completely alcohol free and want to take a pill that forces them not to drink because they know if they do, they will get sick; they get physically ill. It’s unpleasant enough to convince a patient not to drink at all. Probably the most commonly used medication is Naltrexone. Naltrexone is an anti-opioid medication, otherwise known as an Opioid Antagonist. It turns out, our brain responds to alcohol like it responds to drugs. So, we can treat them with the same kind of pill that interrupts all the good vibes our brain gets, making alcohol less addictive. You can still drink while taking the medication. It will not block intoxication; it will not make you sick. What it does is it prevents that it interrupts that whole cascade of dopamine-to-endorphins reward system. 

These medications, when used as part of a comprehensive treatment plan, can be effective in helping individuals reduce or quit their alcohol consumption. It’s important to note that medication alone is usually not sufficient and combining it with psychotherapy and peer support can enhance treatment outcomes. If someone is considering medication for alcohol use disorder, they should consult with a healthcare professional to determine the most appropriate option based on their individual needs and health history. 

Of course, there are programs that exist for someone struggling with alcohol use as well. There are partial hospital programs, otherwise known as IOP programs. These are programs where you go for several hours, multiple times a week. It’s almost like going to school. You’re meeting with counselors, you’re in groups, you’re doing various projects basically to help you enter recovery. This works in tandem with medication, psychotherapy, and peer support.  

Recovery with peers is a viable option, the most famous of which is AA or Alcoholics Anonymous. I always hear a lot of rhetoric about AA; there’s a lot of hand waving and arm wringing about it, but AA can be extremely effective and has been for millions of people. There’s also other peer support groups like SMART Recovery or Refuge Recovery. There are also apps! You can talk to people and message with people who are also trying to remain alcohol free or reduce their use. You can even be linked with people who are in the same number of days of sobriety as you, so you could be like, “Oh, we’re on day 10 and, you know, I’m kind of struggling with this!” Then you have a partner in the journey who gets what you’re going through. 

Here at Howard Brown, we have a pretty robust network of primary care. So, if patients feel like they’re struggling with alcohol use, they should talk to their doctor or provider about it. I’ve had other providers at Howard Brown reach out to me for their patients as well; it’s an extremely collaborative environment amongst the providers. We’ve called hospitals for our patients that have been hospitalized to help them in terms of substance use disorders to see what can be done. We’ve referred people to medically managed withdrawal, also known as detox from Howard Brown. It’s definitely something that can be tackled in-clinic.  

For opiate use disorders, we have a program at Howard Bround which includes peer support, which is amazing. Hopefully one day we can expand this program; I want to really expand it to methamphetamine use, and alcohol use, but that has challenges.  

Bottom line, if you’re struggling with alcohol use, there are very effective treatments that can really help you. There is a life in recovery. I think for a lot of people, their block is that they can’t imagine a life without alcohol. But there is an extraordinarily rich life for people in recovery from alcohol. My patients who are in long term remission of alcohol use or other substance use tell me that they feel better than they ever have and that they’re happier and they’re having more fun than they’ve ever had. So, recovery is totally possible; if you feel like you need it, just talk to your doctor about it. I also think if you’re somebody that has embarked on the process of being sober or reducing your alcohol consumption, talking about it is huge. I know for a lot of people, seeing friends or acquaintances talking about it has been helpful and freeing for them to start their own journey with sobriety. I think just, just talking about it on any level, regardless of how serious you’re taking it or how successful you’ve been is important to normalize that conversation. 

Queer communities are already at increased risk for substance use disorders and mental health conditions; we should normalize this discussion, normalize sober gathering spaces, and offer sobriety resources for anyone that wants them. Together we can take care of our own and allow us all to live our best lives, whether that is with a drink in hand or not. 

If you want to learn more or begin your own journey towards recovery, check out the resources below.

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Health Insurance Marketplace Enrollment Has Started – this time with SOGI questions!

The Affordable Care Act’s (ACA) open marketplace enrollment began on November 1^st and goes until January 15^th. However, apply for coverage by December 15^th if you want your coverage to start January 1^st. Outside of this annual enrollment window, you may be able to enroll or make changes to your health insurance if you have a qualifying life event such as marriage, birth of a child, or loss of other coverage. This year the marketplace enrollment form will ask 3 new, optional questions focused on sexual orientation and gender identity (SOGI). Gathering SOGI information has been encouraged by the Biden-Harris Administration to better assess, understand, and meet the needs of LGBTQI+ individuals who have long been overlooked.

Here is what you can expect:
The introductory screen will feature an explanation for why the form is asking SOGI questions:
“How this information will be used. We share responses to “sex” with the insurance company when you enroll in a plan. This information may also be shared with agencies like your state Medicaid or CHIP, if anyone in the household is eligible for these programs. If a person is pregnant, be sure to select Female so that they can tell us about the pregnancy later in the application. That way, we’ll make sure they’re eligible for coverage to keep them and their baby healthy.”

The new questions you will see on the open enrollment form with their answer options:

Sex assigned at birth: “What was (first name)’s sex assigned at birth?”
Female
Male
A sex not listed (free text option)
Prefer not to answer

Gender identity: “What’s (First Name) gender identity?”
Female
Male
Trans female
Trans male
A gender identity that is not listed (free text option)
Not sure
Prefer not to answer

Sexual orientation: “What’s (first name) sexual orientation?”
Lesbian or gay
Straight
Bisexual
A sexual orientation that is not listed
Not sure
Prefer not to answer

The inclusion of SOGI questions for Open Marketplace Enrollment is an effort to better understand LGBTQ+ communities and our healthcare access needs. LGBTQ+ communities have historically faced health insurance coverage disparities. For example, prior to the implementation of the Affordable Care Act (ACA), LGBTQ+ individuals routinely faced discrimination in health insurance such as being denied coverage or charged higher premiums due to having pre-existing conditions like HIV/AIDS, gender dysphoria, mental health issues, and substance use disorder. The nondiscrimination protections through Section 1557 of the ACA as well as the expansion of Medicaid have been critical steps forward in addressing these insurance disparities. The ACA prohibited insurers from denying coverage or charging more based on pre-existing health conditions, and also mandated coverage for essential health benefits. After the ACA’s coverage expansions went into effect, the percentage of LGB+ people without insurance decreased substantially, from 17.4% in 2013 to 8.3% in 2016.

While the ACA helped make significant strides in expanding insurance coverage for LGBTQ+ people, uninsured rates in this population increased after 2016 and many insurance challenges still persist. For example, insurance companies still routinely refuse to cover many gender-affirming services that are life-saving and necessary for trans people. Based on a 2020 survey by CAP, coverage for gender-affirming care was denied for 46% of transgender respondents, and only partially covered for 48% of transgender respondents[S1] [BJ2] . These rates of denial and partial coverage were even higher for transgender people of color. Additionally, many health insurers continue to exclude coverage for specific medical services that could be considered “cosmetic,” but are often necessary and effective for treating gender dysphoria. For example, one study of 101 U.S. health insurance carriers found that nearly half (47%) of the carriers had broad exclusions for hair removal therapies regardless of medical necessity, compared to just 12% of carriers that covered medically necessary facial hair removal.

[S3] [BJ4] Insurance coverage for PrEP has also been a recent area of concern for many LGBTQ+ individuals. For example, a recent court ruling in Texas (Braidwood v. Becerra) overturned the ACA requirement to cover PrEP—and other preventive services—at no cost-sharing. The case is already being appealed and many states have already taken action to preserve access to preventive services. Even so, for those in need of PrEP, this ruling creates a lot of uncertainty around insurance coverage and access to PrEP. Lack of insurance is a major barrier to PrEP given how expensive the medication can be.

Gathering SOGI information during open enrollment is crucial for tackling these ongoing insurance challenges. This data provides insights into demographic information, health conditions, geographic disparities, socioeconomic status, utilization patterns, barriers to care, health insurance coverage disparities, and trends over time. This data can be used to identify and address insurance coverage disparities and it supports targeted outreach to LGBTQ+ communities. This information will also assist policymakers in effective planning and implementation of strategies to ensure accessible and tailored healthcare for diverse populations. The information shared in enrollment surveys is safe, secure, and cannot be shared with state entities that could cause harm to these communities. The ACA marketplace ensures the security of enrollment data through measures like data encryption, strict access controls, and privacy protections.

For more information, check out the following resources:

Healthcare.gov – How We Use Your Data

FAQ about Affordable Care Act Implementation

Transgender Health Care on the Marketplace

Long-lasting injectable PrEP like Apretude may be the key to defeating HIV and protecting our community. 

Cheeky titles aside, we are past due to dive into a game-changer that’s topping the world of HIV prevention: Injectable PrEP. Whether you’re part of the LGBTQ+ community or an ally, knowing about this innovative form of prevention is essential. So, let’s get into the nitty-gritty of what PrEP is, what injectable PrEP means, how it works, and how you can get your hands on it. 

What’s PrEP, anyway? 

PrEP, short for Pre-Exposure Prophylaxis, is a groundbreaking HIV prevention strategy. It involves taking a daily pill like Truvada (or its unbranded equivalent and alternatives) to drastically reduce the risk of HIV transmission. PrEP has been a game-changer in HIV prevention, providing an effective tool for individuals who are at higher risk of contracting HIV. It is also one of our best tools for wiping out the existence of new HIV diagnoses entirely, but unfortunately only 30% of people who could benefit from PrEP have access to it or have been prescribed it.  Part of Howard Brown’s mission is crafting a more compassionate tomorrow, and that includes access to PrEP in all of its forms, no matter your situation.

Introducing Injectable PrEP

Injectable PrEP is the solution we’ve been needing! It’s like a superhero power-up for HIV prevention. Instead of taking a pill every day, you can get a shot of long-acting PrEP every two months. Yes, you read that right, every two months! It’s a game-changer for people who find it challenging to stick to a daily routine.  It ups the chances of a patient being able to stick with the medicine (pun intended), which results in decreased HIV transmission!

Getting Your Injectable PrEP

Getting your hands on injectable PrEP is easier than ever. Here’s how you can do it: 

• Find a PrEP-Friendly Provider: Look for healthcare providers in Chicago, like Howard Brown Health, who offer injectable PrEP. Many LGBTQ+ clinics and HIV centers are well-versed in this new form of prevention.
• Assess Your Eligibility: Your provider will assess your risk factors and make sure injectable PrEP is the right choice for you. Don’t be afraid to ask questions and discuss your concerns and remember to advocate for yourself! You know what is best for you. 
• Schedule Your Shots: Once you’re cleared for injectable PrEP, you’ll schedule appointments to receive the shots every two months. It’s as easy as a regular check-up! 
• Remember, You’re in Control: Whether you choose daily PrEP or injectable PrEP, the power is in your hands. Pick the option that works best for your lifestyle and prioritize your sexual health. 

What If I Don’t Have Insurance, Or It Won’t Be Covered? 

Navigating insurance, or the lack of it, can be a beast for anyone, but especially so if that beast happens to be a new medication that insurance companies may not understand the need for. Recently, state and federal laws have mandated free PrEP for all, but the bills are hazy on whether or not that includes injectable PrEP. Luckily, Medicaid covers all forms of PrEP, especially the injectable variety. However, there are private insurance companies that still may not cover PrEP, or may only cover the cost of the medication, and not the cost of the associated lab work. Additionally, “PrEP for all” has come under attack as large pharmaceutical companies continue to pressure our government against giving their medications away for free. 

Will You Get The Jab? Let Us help.

Injectable PrEP is a game-changer in HIV prevention, offering a convenient and effective alternative to those burdensome daily pills. For those of us in Chicago, getting access to this innovative form of protection is easier than ever. Contact our team here at Howard Brown Health.  Don’t let HIV prevention be a hassle; take control of your sexual health with injectable PrEP. Stick it to HIV and stick it in with injectable PrEP—you’ve got this!  

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