Top 10: Trans widow continued her fight

araguz2

VOWING TO WIN | Nikki Araguz says she will appeal her case all the way to he U.S. Supreme Court if necessary. (Courtesy of Nikki Araguz)

No. 8

The Texas Constitution defines marriage as between one man and one woman, but how will the state define “man” and “woman”?

Transgender marriage cases in Dallas and Houston could force the Texas Supreme Court — or even the U.S. Supreme Court — to ultimately decide the thorny issue.

In Houston, transgender widow Nikki Araguz has appealed a district judge’s ruling denying her death benefits from her late husband, Thomas Araguz III, a volunteer firefighter who was killed in the line of duty in 2010.

The judge, Randy Clapp, granted summary judgment to Thomas Araguz’s family, which filed a lawsuit alleging the couple’s 2008 marriage is void because Nikki Araguz was born male, and Texas law prohibits same-sex marriage.

The Araguz family’s argument relies heavily on a San Antonio appeals court’s 1999 ruling in Littleton v. Prange, which found that gender is determined at birth and cannot be changed.

However, LGBT advocates say the Littleton ruling is unconstitutional, goes against medical science and isn’t binding in other parts of the state, where it has not always been followed.

In Dallas, a district judge apparently reached the opposite conclusion from Clapp this November — denying a similar motion for summary judgment.

James Allan Scott, a transgender man, is seeking a divorce settlement from his wife of 13 years, Rebecca Louise Robertson. However, Robertson wants to have the marriage declared void because Scott was born a biological female.

District Judge Lori Chrisman denied Robertson’s motion for summary judgment, which leaned heavily on Littleton. The judge provided no explanation for her ruling allowing the matter to proceed as a divorce, at least for now.

It’s unclear whether Texas Attorney General Greg Abbott plans to intervene in the Dallas case. Abbott has intervened in same-sex divorce cases in Austin and Dallas, seeking to block them. But thus far he has stayed above the fray on transgender marriage, even though it presents overlapping issues.

After a transgender woman and a cisgender woman applied for a marriage license in 2010, the El Paso County clerk requested a ruling from Abbott about whether to grant it. But Abbott opted not to weigh in, with his office saying it would instead wait for court rulings in the Araguz case. The El Paso couple was later able to marry in San Antonio, where the county clerk went by Littleton v. Prange.

In response to the Araguz case, a bill was introduced in the Texas Legislature this year to ban transgender marriage. The bill would have removed proof of a sex change from the list of documents that can be used to obtain marriage licenses. Strongly opposed by LGBT advocates, it cleared a Senate committee but never made it to the floor.

Trans advocates said the bill also would have effectively prohibited the state from recognizing their transitioned status — or, who they are — for any purpose.

The problem for socially conservative lawmakers is, they can’t have it both ways. Marriage is a fundamental right that courts have said can’t be taken away from a person completely. So no matter what, Texas will be forced to allow a version of same-sex marriage.

Which is why some believe the cases could help undo the marriage amendment.

— John Wright

This article appeared in the Dallas Voice print edition December 30, 2011.

—  Kevin Thomas

Offering HIV patients a new look

Cosmetic surgeon Anthony Caglia specializes in working with patients to reduce the effects of wasting syndrome

DAVID TAFFET  |  Staff Writer
taffet@dallasvoice.com

An ever-evolving array of HIV/AIDS medications has transformed what was once a terminal illness that claimed its victims quickly into a chronic ailment that has to be managed long term — allowing people with HIV/AIDS to live much longer, much healthier lives.

But those medications come with a price. For many HIV/AIDS patients, that price is AIDS Wasting Syndrome, the involuntary loss of more than 10 percent of body weight accompanied by more than 30 days of either diarrhea or weakness and fever.

The syndrome also includes lipoatrophy, the gradual loss of fatty tissue and collagen in the face that results in sunken cheeks and deep lines in the face. As collagen production slows, the cheekbones slowly begin to protrude.

For some, that may seem a small price to pay. But for many others, lipoatrophy can have a significant impact on self-esteem, and that, in turn, can seriously impact a patient’s overall health.

But medical science has found ways to address the issue, and Richardson cosmetic surgeon Anthony Caglia is one of those that specializes in fighting the effects of lipoatrophy.

Caglia works with facial fillers and serves on the HIV Advisory Board of Suneva Medical Inc., a company that manufactures the filler Artefill.

Artefill is approved to correct wrinkles around the smile lines but may have applications for other parts of the face such as the cheeks, Caglia said. In fact, Caglia pioneered the use of facial fillers such as Artefill on persons with AIDS Wasting Syndrome.

Caglia said that he usually uses a filler to create thicker skin to replace the lost fat. Then he uses a product to stimulate the body to produce its own natural collagen.

“Artefill has microspheres in it and it doesn’t biodegrade,” Caglia said. That makes the product a longterm solution.

Caglia said that in contrast, Sculptura, a similar product, is a biostimulator. The particles biodegrade over two years, but it stimulates the body to create its own new collagen.

He said that using facial fillers like Artefill gives some quick results but “takes from five to eight months” to get back to their previous appearance.

“And they might need touch-ups” — or “maintenance” — “in 12 to 16 months,” the doctor added.
Caglia said most people he sees with HIV have undetectable viral loads but he said that people with low T-cell counts do just as well.

Costs

The treatment is expensive. Artefill, for example, costs $1,200 per syringe. The number needed varies per person.

“One patient had 13 syringes and two more since then,” Caglia said.

But he said there are patient assistance programs underwritten by the manufacturers of the products.

Generally, people with income under $40,000 can get on an assistance program and treatment is prorated with incomes up to $100,000.

Caglia suggested that even those who never considered cosmetic treatment because of the cost may qualify.

Medicaid is beginning to look at these treatments as more than cosmetic and is looking at covering the procedure for some persons with HIV, he said. And as government programs begin to cover it, private insurance carriers find it harder to deny coverage.

For others, payment plans are available.

The benefits

As people with HIV live longer with better medications and return to work, Caglia said, the facial filler treatments serve more than vanity. They may help someone get a job.

Caglia talked about one of his patients who was leading an OK life, but not looking good. But then at Parkland, the man heard someone say something that spurred him to inquire about treatment: “Oh, there’s one of those gay guys.”

He knew it was because of his gaunt, sunken cheeks.

Another patient slipped him Caglia’s card and said, “Someone takes care of this.”

Most people just get used to that look until someone else points it out to them.

Complications from treatment with fillers may include bumps and nodules, Caglia said, but added, “It’s about technique.”

Treatment takes about an hour and Caglia said he is very methodical, massaging the product evenly through the skin and agitating the cells to produce new collagen and avoid the bumps that occur when the product is not administered properly.

“There’s an artistry in reshaping the face,” the doctor said.

Dr. Anthony Caglia, Derm Aesthetics and Laser Center, 670 W. Campbell Road, Suite 150, Richardson. www.dermlasercenter.net. 972-690-7070.

This article appeared in the Dallas Voice print edition Jan. 14, 2011.

—  John Wright