Mount Sinai Researchers Play a Prominent Role in a Wide Probe Into Long COVID

Updated on Jul 25, 2023 | Featured, Research

RECOVER—Researching COVID to Enhance Recovery—is a nationwide initiative dedicated to understanding why some people develop long-term symptoms following COVID-19 infection. Recently, for the first time, the project yielded outcomes that are expected to help standardize the definition of long COVID toward these goals.

The researchers created a scoring system based on the symptoms that most clearly distinguished patients previously infected with COVID-19 from those who had not. Their work was published online May 25 in the Journal of the American Medical Association.

“This initiative is driven by our shared vision to deepen our understanding of one of the most perplexing maladies of our times and to inform recovery and treatment of individuals who grapple with persistent symptoms following COVID-19 infection and learn why they do, so that we can find the most targeted solutions to help patients,” says Alexander Charney, MD, PhD, Associate Professor of Psychiatry, Genetics and Genomic Sciences, Neuroscience, and Neurosurgery, and Director of The Charles Bronfman Institute of Personalized Medicine at the Icahn School of Medicine at Mount Sinai.

Click here to watch an episode of Mount Sinai’s Road to Resilience podcast titled “The Long Battle With Long COVID.”

Of the 37 symptoms studied, 12 were identified that set those with long COVID apart: post-exertional malaise, fatigue, brain fog, dizziness, gastrointestinal issues, heart palpitations, loss of sexual desire or performance, loss of smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Based on those symptoms, the investigators found that 23 percent of participants with a prior COVID-19 infection crossed the study threshold for long COVID.

“This is the first step of a series of studies that will be published using RECOVER data that will provide critical insights about the incidence, risk factors and pathophysiology of long COVID. This information will be vital for managing the large number of patients afflicted by this emerging condition,” says Juan Wisnivesky, MD, DrPH, Professor of Medicine at Icahn Mount Sinai, a clinical epidemiologist who is one of the primary leads of the RECOVER adult cohort study at the Mount Sinai site.  Dr. Wisnivesky is Chief of the Division of General Internal Medicine for the Mount Sinai Health System.

“Our overarching goal for RECOVER is to continue refining the definition of long COVID and to understand the biological causes of the condition. As a major hub for RECOVER enrollment and given the richly diverse communities that we serve—along with our grit—we are uniquely positioned to do just that.” — Alexander Charney, MD, PhD

The results were based on a survey in which 9,764 patients self-reported their symptoms. Next, data from the survey will be compared against lab and imaging results to validate the current findings.

“Until we establish a unifying framework to define it, it’s like we’re flying a plane without navigation,” Dr. Charney says when describing recent developments to come out of the Long COVID RECOVER multi-center study on which Mount Sinai is a co-author. “Defining long COVID in different ways will similarly get us varied answers. Only by creating a clear and uniform definition of long COVID can we accurately diagnose and begin the road to effective treatments. This study brings us closer to that goal of uniformity.”

On the hotly debated vaccination question—in another RECOVER study development—co-author Girish Nadkarni, MD, MPH, noted a preliminary signal in the data showing that being vaccinated was associated with a lower risk of long COVID. Dr. Nadkarni is the Irene and Dr. Arthur M. Fishberg Professor of Medicine, Director of The Charles Bronfman Institute of Personalized Medicine, and Chief, Division of Data Driven and Digital Medicine (D3M), Department of Medicine at Icahn Mount Sinai.

Mount Sinai colleagues in the Department of Psychiatry are leveraging RECOVER biospecimens to gain deeper insights into the cognitive and behavioral manifestations seen in long COVID.

Led by Scott Russo, PhD, Professor of Neuroscience and Director of the Center for Affective Neuroscience and Brain Body Research Center at Icahn Mount Sinai, the research will explore immune-mediated mechanisms underlying the emergence of depression and anxiety observed in this cohort. The work could inform the identification of biomarkers and enhance understanding of psychiatric symptoms associated with the disorder.

Dr. Russo and his team will also use RECOVER MRI data to measure changes in the penetrability of the blood-brain barrier associated with immune alterations and depression in long COVID.

Additional RECOVER brain initiatives, led by a team including Dr. Wisnivesky, Alex D. Federman, MD, MPH, and Jacqueline H. Becker, PhD, will conduct one of the first randomized clinical trials to investigate a potential therapeutic intervention for brain fog, a condition that affects many long COVID patients. Dr. Federman is Professor of Medicine and Director of Research for the Division of General Internal Medicine. Dr. Becker is a neuroscientist and Assistant Professor of Medicine.

Notably, Judith Aberg, MD, FIDA, FACP, the George Baehr Professor of Medicine, Dean of System Operations for Clinical Sciences, and Chief of Infectious Diseases, is a member of the RECOVER Pathobiology and Interventions Task Force. The task force recently published a white paper emphasizing the need for therapeutic interventions for individuals with long COVID. As the Principal Investigator, Dr. Aberg oversees the master contract for upcoming interventional trials sponsored by RECOVER.

“One of the exciting aspects of RECOVER is the collaboration of multi-disciplinary teams across Mount Sinai Health System engaged in interventional trials to improve the quality of life of those with long COVID,” says Dr. Aberg.

Sean Liu, MD, PhD, Medical Director of the COVID-19 Clinical Trials Unit, will lead a study evaluating the use of antivirals to treat long COVID based on the hypothesis that SARS-CoV-2 may persist in certain parts of the body and that a prolonged antiviral course may eliminate these hidden virus reservoirs.

Sarah Humphreys, MD, Assistant Professor of Medicine, will be the local Principal Investigator at Mount Sinai’s Center for Post-COVID Care. Other upcoming trials expected include interventions to improve cognitive function (the RECOVER-NEURO trial) and to address sleep disturbances (the RECOVER-SLEEP trial).

Mariana G. Figueiro, PhD, Professor at the Department of Population Health Science and Policy and Director of the Light and Health Research Center, is one of the Co-Principal Investigators nationally for RECOVER-SLEEP. The upcoming clinical trial will investigate the impact of light, alone and in combination with melatonin, on sleep in long COVID. The Center will serve as the core hub for this research protocol.

“Our overarching goal for RECOVER is to continue refining the definition of long COVID and to understand the biological causes of the condition.  As a major hub for RECOVER enrollment and given the richly diverse communities that we serve—along with our grit—we are uniquely positioned to do just that,” says Dr. Charney.

Read more about Research at Mount Sinai

Achievement and Promise—Celebrating Mount Sinai’s Outstanding Class of Graduating Master’s Students

Updated on Jul 28, 2023 | Featured

Tina Aswani-Omprakash, MPH, gave an impassioned speech that drew a lengthy applause and standing ovation.

For the master’s students who had just completed their academic studies at the Graduate School of Biomedical Sciences at the Icahn School of Medicine at Mount Sinai, there was much to celebrate—achievement at the highest level, resilience during challenging times, and the knowledge and skills they now possess as they advance their careers.

There were 223 graduates in the Class of 2023 across nine programs: Master of Science in Biostatistics, Master of Science in Biomedical Science, Master of Health Administration, Master of Science in Health Care Delivery Leadership, Master of Science in Biomedical Data Science, Master of Science in Clinical Research, Master of Science in Genetic Counseling, Master of Science in Epidemiology, and Master of Public Health.

At a commencement ceremony held on Friday, June 23, at Stern Auditorium, there was a celebration of what the graduates had achieved and the promise that they hold for a world rocked by the COVID-19 pandemic.

Click here to meet six new graduates and an alumna from Mount Sinai’s master’s programs and learn more about their experiences and passions.

In an impassioned speech that drew a lengthy applause and standing ovation, student speaker Tina Aswani-Omprakash recounted how she endured a life-threatening case of inflammatory bowel disease (IBD), the umbrella term for Crohn’s disease and ulcerative colitis, which derailed an early career in finance.

She spoke about a seven-year stretch of 20 surgeries and failed medications, and the 12 years she was forced to remain silent. “It was a difficult coming out story for me, as mine was a journey mired in cultural stigmas toward Western medicine and life-saving ostomy surgery,” revealed Ms. Aswani-Omprakash. “Nevertheless, I felt that it was something that had to be shared and that had to be de-stigmatized because I didn’t want anyone else suffering in shame or silence like I had for so many years.”

When she created an immensely successful blog, Own Your Crohn’s, and heard from IBD patients from all over the world, “I knew I was destined to pursue public health,” she said, adding that it took her four years to complete the Master of Public Health program and graduate with this year’s class.

Along the way, Ms. Aswani-Omprakash formed an alliance with gastroenterologists and patient advocates to create the nonprofit South Asian IBD Alliance and led a global effort to help better understand phenotypes of disease by race and ethnicity, among other notable efforts. Today, she is working in Mount Sinai’s Division of Gastroenterology (where Crohn’s disease, named after Burrill B. Crohn, MD, who, with two other Mount Sinai gastroenterologists first described the disease) doing clinical research involving wearable devices.

“Here I am, nearly 40 years old, restarting my life and telling you all that you, too, can make a difference,” Ms. Aswani-Omprakash told her fellow graduates. “Never let any illness, or age, or any setbacks in your life hold you back from achieving your dreams and pursuing the change you wish to see in the world.”

Eric J. Nestler, MD, PhD, welcomed the graduates.

Presiding over the ceremony were Eric J. Nestler, MD, PhD, Dean for Academic Affairs at Icahn Mount Sinai and Chief Scientific Officer for the Mount Sinai Health System, and Marta Filizola, PhD, Dean of the Graduate School of Biomedical Sciences.

Dr. Nestler told the graduates that they were now positioned to take on new challenges in the aftermath of the COVID-19 pandemic. While “the virus itself is now endemic and joins many other routine viruses…our society is facing an accelerated uptick in the emotional consequences of the social deprivation, inflation, and other challenges the pandemic brought,” Dr. Nestler said. “It is not surprising that we are now facing a second pandemic, this one involving stress-related illnesses, namely, depression, post-traumatic stress disorder, anxiety, and drug addiction.”

He added with optimism: “Your advanced training at Mount Sinai prepares you all to take on these and other major challenges facing us with the boldness and creative solutions they require. I am confident that you and your generation will make a difference and leave our local, national, and global communities a better place than we find them today.” Dr. Nestler is also Nash Family Professor of Neuroscience and Director of The Friedman Brain Institute.

Marta Filizola, PhD, congratulated the graduates on their many achievements.

Dr. Filizola congratulated the graduates on their many achievements. “You have seen your studies through and added to your growing abilities, and now, when you are needed most, you will be applying your new skills,” she said. “We’ve worked together to prepare you to meet some of the greatest challenges these fields have ever faced, and we know you are ready for them.”

She also recognized the remarkable diversity of the class, which “makes our institution stronger. The backgrounds our students brought to our programs spread across nationalities, socioeconomics, race, gender, and sexuality, and have been an asset to all of our experiences. Diverse opinions in science, research, and health care are critical, and these various backgrounds have broadened each of our perspectives.” Dr. Filizola is also the Sharon & Frederick A. Klingenstein/Nathan G. Kase, MD Professor of Pharmacological Sciences, Professor of Neuroscience, and Professor of Artificial Intelligence and Human Health.

Carlos del Rio, MD, a world-renowned clinician and epidemiologist, received an honorary Doctor of Science degree for his trailblazing work in understanding, preventing, and effectively treating infectious diseases, with a special focus on research into the early diagnosis of HIV, and more recently, COVID-19 infection. Dr. del Rio is the Leon L. Haley, Jr. MD Distinguished Professor of Medicine and the Interim Dean at Emory University School of Medicine, and Professor of Global Health of Epidemiology at the Rollins School of Public Health.

In a speech to the graduates, Dr. del Rio acknowledged, “You have done most of your studies during a time of an unprecedented pandemic…As I reflect on my own career, I realize that it was defined by a pandemic, the HIV pandemic, that was first recognized in 1981.”

World-renowned clinician and epidemiologist Carlos del Rio, MD, received an honorary Doctor of Science degree.

He added that he continues to be concerned about how any new pandemic—and the current epidemics of gun violence, opioid use, and misinformation about public health—will impact the graduates’ lives and careers.

Dr. del Rio concluded his speech with an easy-to-remember bit of practical advice to help graduates navigate their future endeavors.

“Stay H-I-P,” he said. “That’s it: Stay H-I-P.” He explained: “The ‘H’ is for humility, a willingness to learn from anyone, any time, at any venue.” It “also stands, for honesty…leading with your heart…for humor, and also for healing. The ‘I’ is for imagination and intellectual curiosity…The ‘P’ is for passion…it also stands for pause…and also for perspective, to encourage and respect differences. Stay HIP, and you will be successful.”

The graduates celebrated commencement with their families and friends.

Why a Master’s Degree? Mount Sinai’s Graduate Students Share Their Experiences and Aspirations

Updated on Jul 14, 2023 | Featured

Seven master’s graduates at Mount Sinai’s Graduate School of Biomedical Sciences at the Icahn School of Medicine at Mount Sinai discuss their educational journeys and how they are using their master’s degrees to explore new paths and careers in the following Q & A.

Award-Winning Research With a Top Mentor—How Denise Iliff Excelled in the Master of Science in Biomedical Science Program

“Mount Sinai is such a strong research institution, which was very important to me. The diversity of labs is really what attracted me. Also, Mount Sinai has an incredible array of faculty from virtually all areas of science that a student would want to pursue.”

Read the Q & A

How Analyzing Genetic Variants to Predict Alzheimer’s Disease Risk Put Raj Vaza on a Path to a Career as a Physician-Scientist

“… The classes are exceptional. The Machine Learning for Biomedical Data Science course I just finished was the most informative and tied together everything I’ve been learning throughout the years.”

Read the Q & A

Adina Singh Earned a Master of Public Health (MPH) Degree as a First Step Toward Addressing Health Care Disparities in Her Community

“Once I realized the health disparities among New Yorkers, particularly for minorities and immigrants, I knew I wanted to be part of the solution. That’s why I chose public health. By focusing specifically on health care management, I will be able to initiate and implement programs that people can access and also learn how to practice self-advocacy confidently when seeking care.”

 Read the Q & A

Justine Marcinek Explores Occupational and Environmental Health Issues as She Gets a Master of Public Health (MPH) Degree

“I think it’s important that scientific research outcomes are translated into actionable information that people can understand, and use, to make well-informed health decisions.”

 Read the Q & A

Alumna Spotlight: Erica Palladino, MPH, Is Making an Impact on Maternal Health With her Master of Public Health Degree

“I’m thankful to Mount Sinai for highlighting the importance of health literacy within maternal health and making me realize that this is one of those areas where we can really make a difference.”

Read the Q & A

Daniel Han Pursues His Passion for Health Care Management With a Master of Health Administration (MHA) Degree

“Ultimately, I want to make a meaningful impact on patient outcomes and the overall delivery of health care services.”

Read the Q & A

A Desire to Gain New Skills in Strategy, Policy, and Patient Advocacy Led Susan Khalil, MD, to the Master of Science in Health Care Delivery Leadership Program

“I thought a master’s degree would help me develop leadership skills. The program has taught me to think in different ways, to think not just about clinical outcomes, but also about health care on a population level and about ways to innovate change in health care.”

 Read the Q & A

“We Treated Patients With Elite Nursing Care”: 106-Year-Old Alum Recalls Training She Received at Beth Israel School of Nursing

Updated on Jul 14, 2023 | Alumni, Featured, Nursing, School

Belle Herman Weiss, retired nurse and oldest-known alum of Mount Sinai Phillips School of Nursing (formerly Beth Israel School of Nursing)

At 106 years old, Belle Herman Weiss, RN, is thought to be the oldest living alum from the Beth Israel School of Nursing, now the Mount Sinai Phillips School of Nursing (founded in 1902), and one of the oldest living nurses in New York. Belle, who retired years ago and lives in Westchester County, fondly recalls her time in nursing school, which she began at just 16 years old—during a time when harmful diseases were widespread and difficult to treat.

“I enjoyed all the experiences I had to go through in nursing school,” says Belle, who graduated in 1936. “I loved being with a lot of other young women and having a goal to achieve.”

A good student who loved studying medicine, Belle was fascinated with figuring out patients’ diagnoses, which she compares to being a detective solving medical mysteries. “My favorite subjects were anatomy and physiology. I had a good memory and I was able to remember all the bones and their function. I enjoyed being able to recite the different parts of the body and what they did,” she says.

However, the lack of penicillin and treatments for infectious diseases in the 1930s and 1940s made nursing a challenging—and potentially dangerous—career path. She remembers contracting a skin lesion from tuberculosis at a hospital she worked in, noting she was “very lucky” it did not spread to her chest.

“It was a very difficult time, and [we were] studying at a bad time,” says Belle of being a nursing student. But she says many nurses managed to avoid infections by donning the cloth masks, rubber gloves, and gowns available at the time, and especially, routinely washing their hands. “Luckily, most of us stayed pretty healthy,” she says.

After graduating from the Beth Israel School of Nursing, Belle received a public health degree from New York University, which she says aided her when she later worked for The Willard Parker Hospital in Manhattan, where many patients had polio and were cared for in iron lungs (large horizontal machines that patients would lie in, which stimulated breathing). Medical technology in those days, she explains, was far more rudimentary and cumbersome to work with. For example, intravenous (IV) therapy—a routine therapy administered by nurses today using prepackaged components and fluids—was rarely ordered in the 1930s and 1940s. When it was, nurses had to prepare all the separate components—a glass bottle of saline, a separate rubber stopper and tubing, and a metal needle—and it was quite a process.

How were IVs given in the 1940s and 1950s? 106-year-old nurse Belle Herman Weiss explains:

First you got the IV pole. Then you went into the utility room and you got a sterilized package that contained the container that you were going to put the saline in. Then you got the connection of tubing, and then you got the needle that went with it. Then you got the saline that you had to pour into it. You had to get this glass container connected to the rubber tubing and put a stopper on the tubing so it wouldn’t leak out. Then you filled the container with the saline from a big bottle and hung it on the pole. Then you let the air run out, and then you connected the needle. Before you called a physician to get them to put the IV in, you had to wrap two hot water bottles around the container to warm the fluid to room temperature. That’s how an IV was given.

She says hospitals also lacked antibiotics. In their absence, she says doctors would order “bodily irrigations”—treatments that involved washing out the nose, eyes, ears, throat, and other orifices, in the hope it would wash away disease.

“We used to have a saying, ‘If in doubt, wash it out,’” Belle says, adding that nurses also kept patients healthy by routinely bathing them “head to toe.”

After retiring from nursing at age 70, Belle worked in a doctor’s office as an administrator until she was 92. She put her nursing degree and training to good use over her long career—working at hospitals throughout New York City, Long Island, and Westchester County, as well as on an ambulance, where she helped transport patients with communicable diseases. She says she enjoyed taking care of people, and particularly loved her pediatric patients. One little girl who died from kidney disease stands out to her the most.

“I can still picture her sometimes, walking around her little crib, and reaching out her arms for me to pick her up,” she says. “Those memories stick with me.”

While Belle enjoyed a storied nursing career—in addition to getting married in 1943 and having three children, including a daughter who is an advanced practice nurse in Westchester County—the two-and-a-half years she spent training at the Beth Israel School of Nursing are still fresh in her memory. She remembers the intensive 12-hour work schedules, and still recalls the names of many fellow students and head nurses she trained with. The nursing program was very disciplined, she says, and helped her acquire valuable experience for her nursing career.

“I did get a very good training,” remembers Belle of the Beth Israel School of Nursing.  “We treated the patients with elite nursing care.”

Learn more about the Phillips School of Nursing at Mount Sinai.

New Study Explores Links Between Women’s Reproductive System and Mental Health Disorders

Updated on Jul 6, 2023 | Featured, Psychiatry, Your Health

Both psychiatric disorders and disorders of the reproductive system are common in women of reproductive age. Often, they co-occur. “There is a lot of overlap between these two disease classes—but very little research into why that is,” says Nina Zaks, MS, Clinical Research Scientist in the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai.

She wanted to learn more about that overlap. Together with Magdalena Janecka, PhD, Assistant Professor, Psychiatry, and Genetics and Genomic Sciences, and other colleagues, she spearheaded a systematic review and meta-analysis to probe the association between mental health and reproductive system disorders in women. Their paper was published in JAMA Network Open in April.

The analysis revealed some interesting patterns—and shone a light on how much more remains to be discovered.

Psychiatric and Reproductive System Disorders: Increased Odds

Nina Zaks, MS

The analysis included 50 qualitative and quantitative studies, each of which explored co-occurring psychiatric diagnoses and reproductive system disorders. The research team cast a wide net, considering a range of psychiatric diagnoses including depression, anxiety, psychosis, and neurodevelopmental disorders such as autism. On the reproductive system side, the team looked into diagnoses such as inflammatory diseases of the female pelvic organs, non-inflammatory disorders of the genital tract, and ovarian dysfunction.

The overlap between the disease classes, they found, is significant. In women with polycystic ovary syndrome (PCOS) and chronic pelvic pain, for instance, the odds of affective disorders were approximately 1.7 to almost four times greater than in women without the disorders. But the team also showed that the overlap between many other psychiatric and reproductive disorders simply has not been studied yet, revealing a considerable gap in knowledge, with potentially serious implications for women’s health.

Overall, the literature shows that women with reproductive system disorders have two to three times the odds of having psychiatric disorders compared to women without those conditions. “We see comorbidity between psychiatric and reproductive disorders everywhere we look,” Dr. Janecka says. “Despite that, there is so much about that comorbidity that has not yet been studied. It’s an urgent research priority to address this.”

Looking for Links in Mental Health and the Reproductive System

What can account for the overlap? Unfortunately, most studies in this area don’t dig into the possible causes, according to the researchers.

Scientists have suggested a number of possible explanations for the association between reproductive system and mental health disorders. For example, stress and quality of life factors associated with mental illness could affect menstrual cycles and reproductive function. Psychiatric medications might interfere with reproductive function. It’s also possible that some underlying genetic causes contribute to both types of disorders.

Though much more research is needed, there are reasons to suspect biological causes for the connection, at least in some cases. “From a mechanism standpoint, it makes sense. Many psychiatric diagnoses present differently between females and males, possibly due to a hormonal component,” Dr. Janecka notes. “Better understanding this connection will provide us with some insight into these mechanisms, while also improving quality of life for patients.”

Polycystic Ovary Syndrome: PCOS and Depression

Magdalena Janecka, PhD

Among the studies that Dr. Janecka’s team analyzed, the largest portion focused on PCOS. Those studies showed that women with PCOS have an increased rate of depression, anxiety disorders, and bipolar disorder.

PCOS is relatively common, affecting as many as 5 to 10 percent of women of reproductive age. The condition is associated with symptoms such as infertility, obesity, acne, and excessive hair growth. One explanation for the increased risk of psychiatric diagnoses in women with PCOS is that those symptoms interfere with quality of life or body satisfaction and self-esteem. However, some emerging evidence suggests that is only part of the story, the researchers found.

The studies suggest that obesity and infertility appear to exacerbate psychiatric symptoms in women with PCOS, but don’t fully explain them. Indeed, genetic factors may play a role in both conditions. In a twin study, for instance, researchers found that the risk of depression was higher not only in people with PCOS, but also in the twin who did not have the syndrome. That implies a possible genetic cause that might increase the risk of both conditions.

 Chronic Pelvic Pain

Another subset of the research the team examined focused on chronic pelvic pain. The condition affects one in seven women in the United States. In some cases, the pain can be traced to problems such as endometriosis. But for many women, the cause of their chronic pelvic pain remains elusive.

Unsurprisingly, chronic pelvic pain is associated with significantly higher rates of depression, the researchers found. Physical pain may not be the only explanation, however. “A number of studies showed that women who had chronic pelvic pain had an increased rate of childhood sexual trauma,” Ms. Zaks says. “This might point toward an environmental explanation for the increased rate of psychiatric diagnoses.”

 Psychiatric Research at Mount Sinai and Beyond

Learning more about the shared mechanisms might help researchers better understand the development of both psychiatric and reproductive system disorders and could point to new directions for treatment.

The findings also suggest that physicians should do more to screen for and treat co-occurring disorders. “It may be that if you address a patient’s reproductive problems, psychiatric treatments may be more successful,” Dr. Janecka says.

The two researchers plan to continue exploring some of these associations in greater detail, but they hope they won’t be the only ones to dig deeper. “We know this association exists, and we know there’s a gap in the research. The data are there, just waiting to be studied,” Ms. Zaks says.

“One of the main things that struck us is how little is known,” Dr. Janecka adds. “This is just the starting point.”

The Importance of Affirming LGBTQ+ Health

Updated on Jul 6, 2023 | Featured, Your Health

Pride Month, which fell on June, was a time for celebration, reflection, and remembrance of LGBTQ+ struggles and achievements. Throughout the United States’ history, the LGBTQ+ community has faced various health challenges and inequities, from the HIV/AIDS epidemic in the 1980s to the mpox outbreak last year.

Although LGBTQ+ individuals’ access to health care has improved compared to decades prior, various health concerns and disparities remain pertinent, says Erick Eiting, MD, MPH, Medical Director for the Emergency Department at Mount Sinai Beth Israel and for the Urgent Care Center at Mount Sinai-Union Square.

During Pride Month, Dr. Eiting and Antonio Urbina, MD, Medical Director of the Institute of Advanced Medicine, discussed health topics LGBTQ+ individuals should keep in mind, even as they celebrate the progress that has been made.

STI Testing: What’s Important?

Who should be thinking about getting tested for sexually transmitted infections (STIs)? Anyone who is sexually active should be considered for sexual health screening, although some groups may be more at risk, says Dr. Urbina.

While there is no hard rule for how often one should get tested, health providers at Mount Sinai offer screening every three months. These should include not only testing at genital sites, but also others including the throat and anal/rectal regions.

“That’s especially important because oftentimes, someone can have an STI in those compartments and they don’t have any symptoms at all,” says Dr. Urbina, “so the only way that you’re going to be able to detect them is if you actually swab or screen those areas as well.”

Common tests for gonorrhea, chlamydia, and syphilis help detect infection and initiate treatment if needed. But other important tests include those for HIV, meningococcal meningitis, and human papillomavirus for vaccination and preventive purposes, Dr. Urbina adds.

HIV: Counseling, Testing, Treatment, Management

As it is hard to know, through initial conversations, which patients might be at risk for HIV, it is incredibly important for health providers to make sure they are not using judgmental language or biases during their interactions, says Dr. Eiting.

“It’s really important for everybody to know their status,” notes Dr. Eiting.

Telling someone that they are HIV-positive when they don’t already know is probably one of the most difficult conversations to have, he adds.

It is really important for people to know that having HIV is considered by the medical community these days as a chronic disease that is oftentimes well-managed with medication, Dr. Eiting says. It is also important for them to have a support system in place so that they may transition into living their lives with the condition, since HIV isn’t the same kind of disease that it was decades ago.

Learn more about HIV/AIDS services at Mount Sinai

It is important for people who test negative for HIV to consider the possibility of being on pre-exposure prophylaxis, or PrEP. In addition to a daily pill that can be taken, there is now a long-acting injectable PrEP that is given every two months by intramuscular injection into the buttocks.

“I think it’s all about empowering patients to taking steps that best fit their lifestyles for prevention,” says Dr. Urbina.

As a result of advancements in modern medicine, there are now people with HIV living into their 90s, and more attention needs to be placed on this elderly group. They tend to exhibit a little more physical vulnerability and frailty due to having lived with the virus for so long, says Dr. Urbina. More aggressive screening for malignancies or bone density loss are recommended too.

Mental Health and Substance-Use Disorders

LGBTQ+ people have been observed to have higher rates of psychosocial issues, including depression and substance-use disorder, and health institutions need to reach out to serve these communities better, says Dr. Urbina.

What is PrEP?

Pre-exposure prophylaxis, or PrEP, is a pill or injection that lowers the risk of getting HIV from sex by about 99 percent, according to the Centers for Disease Control and Prevention. Using PrEP, however, does not prevent other sexually transmitted infections (STIs).

Read more about PrEP and how to access it

“I think it’s important for us to sometimes take pause and take stock and remember that even though Pride Month is a month of celebration, and to acknowledge how far we’ve come, we have to remind ourselves that it can often be a time when it really enhances isolation for patients who are feeling that as well,” says Dr. Eiting.

Seeking help for mental health or addiction can be daunting for patients due to stigma. But health providers at clinics across the city, including at Mount Sinai, are being trained to make access comfortable and judgment-free, and so patients should not hesitate to tap those resources when needed, Dr. Eiting says.

Affirming Across the Entire Spectrum

Even though the L in LGBTQ+ comes first, the lesbian community can sometimes be forgotten with respect to health care, notes Dr. Eiting. It is important for health providers to be aware of things like breast cancer or cervical cancer screening for this population.

Studies suggest that some lesbian and bisexual women get less routine health screenings than their heterosexual counterparts due to various factors, including fear of discrimination or low rates of health insurance.

Transgender health care encompasses not just gender-affirming surgeries, but also primary care. For transgender patients, sometimes seeking health care can be stressful because if the conversations are not conducted in a respectful way, they can cause dysphoria.

But stigma should not get in the way of having people live their fullest lives, and transgender individuals should take stock of what their health needs are and have conversations with their doctors, says Dr. Urbina.

Given the current climate of anti-transgender sentiment and legislation across the country, health providers should acknowledge that these developments do leave an impact on their transgender patients. “It’s just important for us to acknowledge that that’s out there… and to make sure that we’re using principles of trauma-informed care whenever we’re talking to our patients about their health care,” says Dr. Eiting.

Read more about how Mount Sinai is empowering health care for LGBTQ+ communities

How to Find an LGBTQ+ Experienced Medical Provider and Why That’s Important

Clearing Misconceptions About Gender-Affirming Care for Transgender and Gender-Diverse People

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