Pre Exposure Prophylaxis for HIV

By Russell Rooms, MSN, APRN
•
24 Apr, 2021
•

Pre Exposure Prophylaxis (PrEP) is a proven way to prevent spreading the HIV virus.

What are you waiting on?

Your whole life you have taken vaccinations to prevent getting life threatening diseases (Hopefully!?! That is another blog for another day). Think about it, as a child you were given immunizations against diseases like polio and measles. Hopefully you have also been vaccinated against Hepatitis A & B, and Human Papilloma Virus (HPV) since they are some specific diseases that effect our community. Although we don't have a vaccination for HIV yet, we do have the next best thing... A medication that when taken daily can prevent the transmission of the HIV virus. There are millions of people that are on PrEP reaping the reward of being able to feel safer when having sex the way they want without having to rely on the known or unknown status of the person they are engaging with. Let's discuss some of the reasons that we have heard that people don't use PrEP.

Reasons that people don't use PrEP...

1) PrEP is to Expensive
You may have heard, that PrEP costs $2000 per month. That is the retail cost for PrEP, but there are multiple ways that you can get PrEP at no cost. For those that are insured there is co-pay assistance through the company that makes Truvada (currently the only medication approved for PrEP) that will cover the cost of the prescription. Let's say your insurance pays 80% of the cost of PrEP. That means that the insurance will pay $1600 for PrEP and then the co-pay card will cover the other $400 so you pay nothing. For those that are not insured, there is the Advancing Access Program through the company that makes Truvada provides full coverage of the medication when there is no insurance or otherwise the cost is not covered. So the drug can be paid for!

What about the lab and medical office visit? There are also innovative programs that have created ways to have this cost covered as well. In Oklahoma, Diversity Family Health has partnered with Guiding Right, Inc. to cover the cost of laboratory work and clinical costs to ensure that patients have comprehensive medical oversight These same programs are available in other communities as well it may just take some research to find them.

2) People will think I am a slut
Slut shaming is a common stigma that cause people to not talk about and address an epidemic that can literally kill people in our community. There are a number of patients that seek me out because the have been shamed by other medical professionals because instead of reducing the risk while satisfying an innate need to have sex and intimacy with other humans they think they should not have sex or only with one individual. Claims that people on PrEP are promiscuous or irresponsible doesn't make any sense. Actually these individuals are more responsible for preventing not only themselves getting HIV but by not getting HIV prevents others from getting HIV. These people should be considered hero's in the fight against HIV/AIDS.

Where we have gone off track is thinking that this is a morale issue when it is really a safety issue and every person should be able to reduce their risk of contracting HIV and still lead the sex life that they want regardless of the frequency or non-monogamy. That said a number of individuals are taking PrEP in monogamous relationships with HIV+ people who didn't have the luxury of having a preventative medication before becoming HIV positive. We don't hold people to the same standard who are taking medication to prevent other diseases or conditions like obesity, high cholesterol or diabetes. Those that would be doing the shaming are obviously not educated about the epidemic that is facing all people regardless of sexual orientation or gender identity. Even though the gay community and certain subsets at even higher rates have a greater chance of contracting HIV does not discriminate and will infect any person that it comes in contact with. This kind of rhetoric is reminiscent of discussions around oral contraceptives several decades ago, or even the HPV vaccine more recently. Multiple studies have shown that these things do not cause people to become more "promiscuous". Stepping down from this soap box...

3) The Side Effects of PrEP are Terrible
There are some side effects when you start taking PrEP, most commonly headache, nausea, and abdominal pain. These are common side effects when your body gets introduced to a number of new agents and the side effects go away after about a week or so.

4) I Have to Take PrEP the Rest of My Life
Actually this is a myth. You only need to take PrEP during the season in your life that you are at risk. If you stop having sex with people who have an unknown status like getting into a monogamous relationship with someone who doesn't have any other sex partners and is HIV negative then you don't need to continue taking PrEP. The only exception is if you had Hepatitis B, Truvada would have been keeping the Hepatitis B at bay and you would still need to take medication for Hepatitis B. In a medically supervised program your provider should test for Hepatitis B before starting you on PrEP.

These are just a few of the common reasons people give for not taking PrEP. Don't let excuses keep you from protecting yourself from getting HIV. I would love to hear about your reason for not taking PrEP or more importantly be part of getting you protected against HIV by prescribing your PrEP. If you are in Oklahoma contact me at Diversity Family Health and schedule an appointment today.

To get more information about PrEP watch the video HERE.

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Transgender Health

By Ralph Cornelius, DNP, APRN • March 28, 2025

March 31 is Transgender Day of Visibility , a day to honor the strength and resilience of transgender individuals while advocating for inclusivity and access to care. At Diversity Family Health, we recognize that health is a vital part of living authentically. Let’s explore steps transgender individuals can take to prioritize their health and well-being.

Establish Regular Primary Care Visits

Regular visits with a primary care provider (PCP) are essential for overall health. These visits help monitor for common health concerns, including high blood pressure, diabetes, and cholesterol, which can impact anyone, regardless of gender identity. For transgender individuals, PCP visits are also an opportunity to ensure gender-affirming care aligns with your overall health goals.

Keep Gender-Affirming Hormone Therapy (GAHT) Monitored

If you are on GAHT, regular monitoring of hormone levels and associated health markers like liver function, bone density, and cardiovascular health is critical. Maintaining the right balance in therapy not only supports your gender-affirming journey but also reduces risks of potential side effects.

Stay Up-to-Date on Cancer Screenings

Transgender individuals should follow cancer screening guidelines based on anatomy and hormone use. For example:

Breast Cancer: Trans women on estrogen and trans men with breast tissue should follow screening recommendations.
Cervical Cancer: Trans men with a cervix should get Pap smears as recommended.
Prostate Cancer: Trans women with a prostate should discuss prostate cancer screening with their provider.

Your healthcare provider can tailor a screening plan that works for your body and unique needs.

Protect Your Mental Health

Mental health is just as important as physical health. Transgender individuals often face unique stressors, such as discrimination or lack of support, that can lead to anxiety, depression, or other mental health challenges. Seeking affirming therapy or joining LGBTQ+ support groups can make a big difference in maintaining emotional well-being.

Stay Current on Vaccinations and Preventive Health

Vaccines, such as HPV, hepatitis A and B, and influenza, are crucial for preventing disease. Discuss any additional vaccines you might need, such as meningitis or COVID-19, with your provider. Preventive measures, like PrEP for HIV prevention, can also be vital for some individuals.

Your Health is Worth Celebrating

Transgender Day of Visibility is a reminder to celebrate who you are and take charge of your health. At Diversity Family Health, we’re proud to provide comprehensive, gender-affirming care in a supportive environment. Your health journey is unique, and we’re here to support you every step of the way.

Let’s celebrate you—today and every day!

Additional Resources:

The Truth About Anti-Aging Skincare: What Actually Works

By Radonna Hood, APRN-CNP • March 14, 2025

Aging is inevitable, but looking older than you feel doesn’t have to be. With the right skincare routine, you can maintain a youthful appearance and keep your skin healthy for years. But with so many products promising miracle results, it’s important to separate fact from fiction. Here’s what actually works when it comes to anti-aging skincare.

1. Sunscreen Is Non-Negotiable
If you do nothing else for your skin, wear sunscreen. UV exposure is the leading cause of premature aging, leading to wrinkles, sunspots, and loss of elasticity. A broad-spectrum sunscreen with at least SPF 30 should be applied daily, even when it’s cloudy or cold.
2. Retinoids Are the Gold Standard
Retinoids, including retinol and prescription-strength tretinoin, are some of the most effective anti-aging ingredients available. They increase cell turnover, improve collagen production, and reduce fine lines and wrinkles. Start with a lower strength to minimize irritation and gradually increase as your skin adjusts.
3. Hydration and Moisturization Matter
Dry skin accentuates wrinkles and fine lines. A good moisturizer with ingredients like hyaluronic acid, glycerin, and ceramides helps maintain hydration and strengthens the skin barrier. Well-hydrated skin looks plumper and healthier.
4. Vitamin C for Brightening and Protection
Vitamin C is a powerful antioxidant that helps fight free radical damage, brightens skin, and boosts collagen production. Using a vitamin C serum in the morning, before applying sunscreen, can improve overall skin tone and texture over time.
5. Exfoliation (But Not Too Much)
Regular exfoliation removes dead skin cells, allowing better absorption of skincare products and revealing fresher skin. However, over-exfoliating can damage your skin barrier. Stick to chemical exfoliants like AHAs or BHAs a few times a week instead of harsh scrubs.
6. Lifestyle Plays a Huge Role
Skincare products can only do so much if your lifestyle doesn’t support healthy skin. Staying hydrated, eating antioxidant-rich foods, getting enough sleep, and managing stress all contribute to youthful skin. Smoking and excessive alcohol consumption accelerate aging and should be avoided.
7. Consistency Is Key
There’s no overnight fix for aging skin. The best results come from a consistent routine using scientifically backed ingredients. Stick with your skincare regimen and be patient—visible improvements take time.

Final Thoughts Anti-aging skincare isn’t about looking younger at all costs; it’s about maintaining healthy, radiant skin as you age. Focus on proven ingredients, protect your skin from the sun, and adopt a holistic approach to skincare. With the right habits, your skin will thank you in the years to come.

What Are Social Determinants of Health?

By Jewelle Scott • February 10, 2025

When we think about being healthy, we often think about our bodies, like making sure we don’t get sick or going to the doctor. But did you know that our health is also affected by things in our daily lives, like where we live, if we have enough food, or if we feel safe? These are called *Social Determinants of Health*, and they can have a big effect on how healthy we are.

In this post, we'll talk about what these “social determinants” are, how they affect your health, and how you can talk to your doctor or nurse about these problems so they can help you find resources to make things a little easier.

What Are Social Determinants of Health?

Social determinants of health, or SDOH, are things in our lives that aren’t directly related to our bodies but still affect our health. They include:

1. **Money and Jobs** : If a family has a low income or if someone doesn’t have a job, it can be hard to afford things like healthy food, medicines, and trips to the doctor.

2. **Home and Neighborhood** : This includes things like housing (where you live) and the safety of your neighborhood. If a neighborhood doesn’t feel safe or clean, or if there isn’t reliable transportation, it can make it harder to stay healthy or go to the doctor.

3. **Education** : If someone hasn’t had access to much education, it might be harder to understand health information or find ways to stay healthy.

4. **Social Connections** : This means the people around you, like friends, family, and neighbors. If someone doesn’t have much support or if they face discrimination, they may feel more stressed or even sad.

5. **Access to Healthcare** : This means being able to see a doctor, get medicines, and find hospitals or clinics close by. If someone doesn’t have easy access to these things, they may struggle to stay healthy.

How Do Social Determinants Affect Your Health?

Social determinants of health can create *health disparities*, which are differences in health outcomes among different groups of people. Here are some examples:

Low Income: If a family doesn’t have enough money, they might skip doctor’s visits or can’t buy medicines they need. This can lead to health problems getting worse over time.

Housing Problems: If someone doesn’t have a stable place to live, they might feel stressed and have trouble keeping up with their health.
Food Insecurity: Not having enough healthy food can lead to health problems like obesity, diabetes, and heart disease.

When we’re dealing with things like housing problems, money worries, or lack of food, it can be hard to focus on staying healthy because the focus is on just surviving the day.

How to Talk to Your Provider About These Problems

Your provider wants to help you with your overall health, which includes understanding the challenges you face outside of their office. Here are some tips for talking to them about these things:

Think About What You Need Help With: Try to be clear about what problems you’re facing. Is it hard to afford food? Are you worried about paying for medicine? Making a list can help you share these things with your provider.
Be Honest It’s okay to tell your provider what’s really going on. They aren’t there to judge you but to help you.
Ask for Resources: Many clinics and hospitals have social workers or patient advocates who can help you find local resources. Some places offer things like food assistance, transportation help, and other services.
Talk About How You’re Feeling: If these problems are making you feel stressed, anxious, or sad, let your doctor or nurse know. They may be able to connect you with mental health resources too.

Resources That Can Help

If you’re dealing with challenges related to social determinants, there are programs and places that might be able to help:

Community Health Centers: These clinics often provide medical care at a lower cost or with a sliding fee scale.
Food Banks and Pantries: Local organizations can help provide food if you’re struggling with food costs.
Housing Assistance: Many states have programs to help people who are experiencing housing issues.
Social Services: Your healthcare provider may refer you to people who specialize in helping you find local resources, such as financial counseling or job support.

Remember

Social determinants of health can make a big difference in how healthy we feel. But if you talk to your provider about the problems you’re facing, they can help you find support and resources. You don’t have to go through it alone—there are people and programs that want to help you succeed, not just in your health but in your life.

Beginning in 2025, our clinicians will start asking about topics like your mental health and social factors that might impact your health during follow-up visits. This information will help us better understand any gaps in resources within our community and identify ways to improve support. Your comfort is our priority, so please know that it’s completely okay if you choose not to answer these questions. We want our clinic to be a safe, open place where you feel comfortable sharing and receiving care. Our goal is to keep providing you with the best possible support and healthcare.

HPV Awareness and Cancer Prevention

By Ralph Cornelius, DNP, APRN • January 10, 2025

January marks Cervical Cancer Awareness Month , a time to highlight the importance of screening and prevention. While cervical cancer awareness is often focused on individuals with a cervix, it's crucial to expand the conversation to include anal cancer, particularly in the LGBT+ community.

Cervical Cancer Screening for Trans Men and Nonbinary Individuals

For transgender men and nonbinary people with a cervix, cervical cancer screenings can be challenging due to discomfort, gender dysphoria, or previous negative experiences in healthcare settings. At Diversity Family Health, we prioritize trauma-informed and affirming care to ensure all our patients feel safe during these critical screenings.

The Link Between HPV and Anal Cancer

Human papillomavirus (HPV) is the leading cause of cervical and anal cancers. Individuals who are HIV-positive or engage in receptive anal sex may have an increased risk of anal cancer, making regular screening and prevention a priority.

How You Can Protect Yourself

Get Vaccinated: The HPV vaccine is highly effective in preventing the strains of HPV most associated with cervical and anal cancers. It’s recommended up to age 45 for those who haven’t yet been vaccinated.
Screen Regularly: Pap smears and anal cytology (where appropriate) are vital for early detection of precancerous changes.
Practice Safe Sex: Using condoms and dental dams can reduce HPV transmission.

By taking these steps, you can reduce your risk of HPV-related cancers and live a healthier life. Contact us today to schedule your HPV vaccine or screening!

Recognizing Anxiety and Depression

By Jewelle Scott APRN, FNP-C • December 4, 2024

As the seasons change and days get darker earlier in the afternoon, many people begin to feel their mood shift. While it’s normal to feel down or anxious every now and then, it’s important to be able to recognize when these feelings are not normal. Knowing the signs and learning some easy ways to cope can help you or someone you care about manage these feelings better.

What is Anxiety?

Anxiety often shows up as intense worry that’s hard to control. It can make you feel nervous or even panicked, with signs like a fast heartbeat, trouble focusing, feeling restless, and sometimes a hard time falling asleep. Anxiety might also cause you to worry about things that aren’t likely to happen. Sometimes anxiety can also cause feelings of nausea, abdominal cramping, headache, and tense muscles.

What is Depression?

Depression, on the other hand, is more about feeling sad or hopeless for long stretches. It can make you lose interest in activities you usually enjoy, and you might feel overly tired, lack motivation to do activities, or have trouble sleeping or eating. Depression can also cause you to feel isolated from others or think negative thoughts often. With depression, this may cause you to be more irritable and easily overwhelmed.

Easy Coping Skills You Can Try

Dealing with anxiety and depression can take time, but here are some simple tips to help manage these feelings day by day:

Breathing Exercises: Take deep breaths to help calm your body and mind. Try “square breathing” by inhaling for four seconds, holding for four, exhaling for four, and holding again.
Challenge Negative Thoughts : When you start to think negatively, try asking yourself if there’s real evidence for these thoughts. This can help you see things more clearly and calm down a bit.
Set Small Goals : Even if it’s something simple, like taking a short walk or finishing a small task, reaching a goal can boost your mood and give you a feeling of accomplishment.
Stay Connected with Others : Spending time with friends or family, even for a little bit, can lift your spirits. Support groups can also help you meet others who understand what you’re going through.
Create a Daily Routine : Having a regular routine can bring stability. Try to wake up, eat, and go to bed around the same times every day to help balance your energy.
Practice Gratitude : Writing down things you’re thankful for—even small things—can help you focus on positive moments instead of stress or sadness.

When to Get Help

Sometimes, anxiety and depression need more help than self-care can offer. Here are signs it may be time to talk to a counselor or therapist:

Feeling sad or anxious for more than a few weeks
Struggling with daily tasks, school, or relationships
Feeling hopeless or thinking about self-harm

Counselors and therapists can help you learn new ways to manage these feelings. You can start by talking to a parent, teacher, or your provider, who can help you find a professional.

Getting Support

If you or someone you know needs immediate help, call the 988 Suicide & Crisis Lifeline, which is available 24/7. Remember, recognizing that you need support is a strong first step, and there are people ready to help you feel better.

Learning about anxiety and depression and using some of these tips can help make day-to-day life easier and brighter. You don’t have to go through it alone—support is always available when you need it. If you feel like you are struggling with your emotions and moods don’t hesitate to reach out to your provider at Diversity Family Health.

New Cancer Screening Test at Diversity Family Health

By Dr. Ralph Cornelius, APRN • November 26, 2024

Cancer is often detected at a late stage, limiting treatment options and impacting outcomes. However, when discovered early, there may be more treatment possibilities and improved prognoses. We are proud to now offer the Galleri® multi-cancer early detection test* to our patients.

Galleri is a groundbreaking test that screens for a shared signal across dozens of different cancers, including many that currently lack recommended screening methods. In clinical studies, Galleri detected cancer signals from over 50 types of cancer through a simple blood draw.

KeyPoint's to remember:

Galleri is a screening tool, not a diagnostic test. A positive result requires follow-up diagnostic testing to confirm cancer.
The test identifies active cancer but does not assess genetic risk for future cancer development.
Not all cancers can be detected in the blood, and both false positive and false negative results can occur.

To learn more about the Galleri test, visit galleri.com or watch this informational video.

Empower your health decisions by contacting us for an appointment to see if Galleri is right for you.

*The Galleri test is recommended for adults at increased risk of cancer, typically those aged 50 and older, and should be used alongside existing cancer screening methods, not as a replacement.

* The Galleri test is not commonly covered by insurance and current cost is $900 to perform.

Mental Health During the Holidays

By Dr. Ralph Cornelius • November 8, 2024

The holiday season can be a time of joy, but it can also bring added stress, anxiety, and depression, especially for those in the LGBT+ community. These months can feel isolating for individuals who may not have supportive families or those struggling with mental health issues.

How are You Feeling?

If you're feeling down, it's essential to reach out for help. Mental health screenings for depression and anxiety can be done quickly in your provider’s office. Symptoms such as persistent sadness, lack of interest in activities, fatigue, or anxiety may indicate that it’s time to talk to someone.

Treatment Options:

There are various treatment options available:

Counseling/Therapy: Cognitive Behavioral Therapy (CBT), talk therapy, and other forms of counseling can help manage symptoms of depression and anxiety.
Medication: For some, medications such as antidepressants or anti-anxiety medications may be necessary. Work with your healthcare provider to find a treatment that’s right for you.

Managing Seasonal Affective Disorder (SAD):

Seasonal Affective Disorder (SAD) is a form of depression that occurs during the winter months when there’s less sunlight. Symptoms include low energy, sleeping too much, and feeling hopeless. Treatment options include light therapy, vitamin D supplements, and regular physical activity.

Remember, mental health is just as important as physical health. Reach out to your provider if you're struggling this holiday season.

Breast Cancer Awareness Month

By Ralph Cornelius • October 15, 2024

October is Breast Cancer Awareness Month, a time to promote the importance of breast cancer screenings and early detection, especially within the LGBT+ community. While breast cancer predominantly affects cisgender women, it's essential for everyone, including transgender patients, to be vigilant about their breast health.

Breast Cancer Screenings for Trans Patients:

For Trans Women: Trans women who have undergone hormone therapy with estrogen for at least five years may be at an increased risk for breast cancer. Regular mammograms may be recommended starting at age 50 or sooner, depending on your healthcare provider’s advice.
For Trans Men: Trans men who have not had top surgery, or who retain some breast tissue after surgery, should still consider regular breast cancer screenings. Mammograms may be necessary based on your remaining breast tissue and personal risk factors.

Mammograms and Self-Exams:

Mammograms: These are one of the most effective early detection tools. It’s recommended that people between the ages of 50 and 74 undergo a mammogram every two years, but your provider may recommend starting earlier depending on your risk.
Self-Exams: Monthly self-exams are a great way to stay aware of any changes in breast tissue. Look for lumps, skin changes, or nipple discharge, and report any concerns to your healthcare provider right away.

Support for Patients Undergoing Breast Cancer Treatment:

If you're diagnosed with breast cancer, remember that you're not alone. Support groups, counseling, and patient advocacy services are available to help you through treatment, whether it's surgery, chemotherapy, or radiation.

Remember, early detection saves lives. Schedule your screening today!

Smoking Cessation

By Ralph Cornelius, DNP, APRN-CNP • October 3, 2024

Smoking disproportionately affects the LGBT+ community, and individuals living with HIV are at even higher risk for smoking-related illnesses. It’s time to take control of your health and quit smoking.

Smoking in the LGBT+ Community:

According to the CDC, approximately 20.6% of LGBT+ adults smoke , compared to 14.9% of heterosexual adults. This disparity may be due to stress, stigma, and targeted marketing by the tobacco industry toward the LGBT+ community.

Take Control of Your Health:

During your next visit, talk to your healthcare provider about smoking cessation. Providers can screen for tobacco use and provide resources such as:

Behavioral Counseling: Therapy or support groups to help you stay on track.
Nicotine Replacement Therapy (NRT): Products like nicotine patches or gum.
Prescription Medications: Medications such as varenicline (Chantix) and bupropion (Zyban) can help reduce cravings and ease withdrawal symptoms.

Resources for Support:

There are numerous resources available to help you quit:

Quitlines: Free phone-based services like 1-800-QUIT-NOW.
Online Support: Websites like smokefree.gov offer tailored support for the LGBT+ community.
Apps: There are many apps available to help track progress and provide motivation.

Quitting smoking is one of the best things you can do for your health, especially if you’re living with HIV. Reach out for support today—your future self will thank you!

Immunizations for the Fall Season

By Dr. Ralph Cornelius • September 20, 2024

As fall approaches, it's essential to stay updated on recommended vaccinations to protect yourself and your community. For those in the LGBT+ community and individuals living with HIV, certain immunizations are especially important.