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Updated: 10 hours 22 min ago

Rate of Young Women Getting Sterilized Doubled After ‘Roe’ Was Overturned

June 27, 2024

HELENA, Mont. — Sophia Ferst remembers her reaction to learning that the Supreme Court had overturned Roe v. Wade: She needed to get sterilized.

Within a week, she asked her provider about getting the procedure done.

Ferst, 28, said she has always known she doesn’t want kids. She also worries about getting pregnant as the result of a sexual assault then being unable to access abortion services. “That’s not a crazy concept anymore,” she said.

“I think kids are really fun. I even see kids in my therapy practice, but, however, I understand that children are a big commitment,” she said.

In Montana, where Ferst lives, lawmakers have passed several bills to restrict abortion access, which have been tied up in court. Forty-one states have bans or restrictions on abortion, according to the Guttmacher Institute, and anti-abortion groups have advocated for restricting contraception access in recent years.

After Roe was overturned in June 2022, doctors said a wave of young people like Ferst started asking for permanent birth control like tubal ligations, in which the fallopian tubes are removed, or vasectomies.

New research published this spring in JAMA Health Forum shows how big that wave of young people is nationally.

University of Pittsburgh researcher Jackie Ellison and her co-authors used TriNetX, a national medical record database, to look at how many 18- to 30-year-olds were getting sterilized before and after the ruling. They found sharp increases in both male and female sterilization. Tubal ligations doubled from June 2022 to September 2023, and vasectomies increased over three times during that same time, Ellison said. Even with that increase, women are still getting sterilized much more often than men. Vasectomies have leveled off at the new higher rate, while tubal ligations still appear to be increasing.

Tubal ligations among young people had been slowly rising for years, but the ruling in Dobbs v. Jackson Women’s Health Organization had a discernible impact. “We saw a pretty substantial increase in both tubal ligation and vasectomy procedures in response to Dobbs,” Ellison said.

The data wasn’t broken out by state. But at least in states, like Montana, where the future of abortion rights is deeply uncertain, OB-GYNs and urologists say they are noticing the phenomenon.

Kalispell, Montana-based OB-GYN Gina Nelson said she’s seeing women of all ages, with and without children, seeking sterilization because of the Supreme Court’s Dobbs decision.

She said the biggest change is among young patients who don’t have children seeking sterilization. She said that’s a big shift from when she started practicing 30 years ago.

Nelson said she believes she is better equipped to talk them through the process now than she was in the 1990s, when she first had a 21-year-old patient ask for sterilization. “I wanted to respect her rights, but I also wanted her to consider a number of future scenarios,” she said, “so, I actually made her write an essay for me, and then she brought it in, jumped through all the hoops, and I tied her tubes.”

Nelson said she doesn’t make patients do that today but still believes she is responsible for helping patients deeply consider what they’re requesting. She schedules time with patients for conversations about the risks and benefits of all their birth control options. She said she believes that helps her patients make an informed decision about whether to move forward with permanent birth control.

The American College of Obstetricians and Gynecologists supports Nelson’s practice.

Louise King, an assistant professor of obstetrics at Harvard Medical School, who helps lead ACOG’s ethics committee, said providers are coming around to the idea of listening to their patients, not deciding for them whether they can get permanent contraception based on age or whether they have kids.

King said some young patients who ask about sterilization never go through with the procedure. She recalled one of her own recent patients who decided against a tubal ligation after King talked with them about an IUD.

“They were scared of the pain,” she said. But after she reassured the patient that they’d be under anesthesia and unable to feel pain, they went ahead with the intrauterine device, a reversible birth control method.

Helena-based OB-GYN Alexis O’Leary sees a divide between younger and older providers when it comes to female sterilization. O’Leary finished her residency six years ago. She said older providers are more reluctant to sterilize younger patients.

“I will routinely see patients that have been denied by other people because of, ‘Ah, you might want to have kids in the future.’ ‘You don’t have enough kids.’ ‘Are you sure you want to do this? It’s not reversible,’” she said.

That’s what happened to Ferst when she first tried to get a tubal ligation.

She asked her doctor for one after having an IUD for about a year. Ferst recalls her male OB-GYN asking her to bring in her partner at the time, who was a male, and her parents to talk about whether she could get sterilized.

“I was shocked by that,” she said.

So Ferst stuck with her IUD. But the uncertainty of abortion rights in Montana persuaded her to ask again.

She has found a younger OB-GYN who has agreed to sterilize her this year.

This article is from a partnership that includes MTPR, NPR, and KFF Health News.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Federal Budget Constraints May Hurt Older Americans With HIV

June 26, 2024

Researchers say that by the end of the decade, 70 percent of people in the United States living with HIV will be older than 50. Thanks to advances in medicine, the diagnosis is no longer a death sentence.

“I’ve been fortunate to take care of some people with HIV for over 30 years,” said Melanie Thompson, a physician in Atlanta who said she is frequently told by patients, “You’re my longest relationship.”

But there’s a catch: People living with HIV are at increased risk for other health problems, such as diabetes, depression and heart disease.

As their health needs increase, more is required of the Ryan White HIV/AIDS Program, the comprehensive federal system that provides HIV primary medical care, medications and essential support services for low-income people living with the virus.

But core funding for the national network of clinics hasn’t changed much in the past decade.

According to a KFF analysis, inflation-adjusted spending has dropped from a peak in the early 2000s, despite the program serving tens of thousands of new patients.

Laura Cheever, who oversees the Ryan White program, said budget constraints make it hard to prioritize the needs of older people with HIV, especially when many people with the virus haven’t been diagnosed or aren’t receiving services at all.

“When a lot of people aren’t getting care, how do you decide where that next dollar is spent?” Cheever said.

President Biden’s budget request for fiscal 2025 asks for a funding bump of less than 1 percent for the program.

The latest infusion of funding for Ryan White — about $466 million since 2019 — came as part of a federal initiative to end the HIV epidemic by 2030.

But that program, launched by the Trump administration in 2019, was targeted by House Republicans last year in their push to slash the budget of the Centers for Disease Control and Prevention.

Their argument? The initiative, launched just a year before the global coronavirus pandemic drew resources and attention from other public health priorities, wasn’t meeting its goal to cut new HIV infections dramatically by 2030.

Around the same time, Republicans were threatening a different HIV program from a different GOP administration: the President’s Emergency Plan for AIDS Relief, or PEPFAR, launched by George W. Bush.

Republicans held up reauthorizing the program, which has helped millions around the world, over rumors its dollars funded abortions.

Advocates worry these cases signal a larger erosion in bipartisan support for HIV prevention and treatment that threatens to undermine years of progress lowering transmission and mortality rates — especially if older people with the virus don’t get adequate care.

“It’s tragic and shameful that elderly people with HIV have to go through what they’re going through without getting the proper attention that they deserve,” said Jules Levin, executive director of the National AIDS Treatment Advocacy Project, who, at age 74, has been living with HIV since the 1980s.

“This will be a disaster soon without a solution.”

This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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US Judge Finds California in Contempt Over Prison Mental Health Staffing

June 26, 2024

SACRAMENTO, Calif. — A federal judge has found top California prison officials in civil contempt for failing to hire enough mental health professionals to adequately treat tens of thousands of incarcerated people with serious mental disorders.

Chief U.S. District Judge Kimberly Mueller on June 25 ordered the state to pay $112 million in fines at a time when the state is trying to close a multibillion-dollar budget deficit. The fines have been accumulating since April 2023, after Mueller said she was fed up with the state prison system’s inadequate staffing despite years of court orders demanding that the state address the issue.

“The sanctions imposed here are necessary to sharpen that focus and magnify defendants’ sense of urgency to finally achieve a lasting remedy for chronic mental health understaffing in the state’s prison system,” Mueller said in her order in the long-running class-action lawsuit.

The ongoing harm “caused by these high vacancy rates is as clear today as it was thirty years ago and the harm persists despite multiple court orders requiring defendants to reduce those rates,” she added.

Mueller ordered the state to pay the fines within 30 days and said they “will be used exclusively for steps necessary to come into compliance with the court’s staffing orders.” She ordered California to keep paying additional fines for each month the state remains in violation of court orders.

The ruling was unwelcome news for Gov. Gavin Newsom, who is struggling with a budget deficit that’s forcing reductions in numerous state programs.

The contempt finding “is deeply flawed, and it does not reflect reality,” said Diana Crofts-Pelayo, a Newsom spokesperson. “Amid a nationwide shortage of mental health therapists, the administration has led massive and unprecedented efforts to expand care and recruit and retain mental health care professionals.”

California Department of Corrections and Rehabilitation spokesperson Terri Hardy said the state will appeal Mueller’s order. Prisoners “often have greater access to mental health care in custody than what presently exists for people outside” because of the state’s “extraordinary steps to expand access to mental health care,” Hardy said.

Mueller’s contempt finding comes as Newsom, a Democrat, has prioritized improving mental health treatment statewide, partly to combat California’s seemingly intractable homelessness crisis. His administration has argued that Mueller is setting impossible standards for improving treatment for about 34,000 imprisoned people with serious mental illnesses — more than a third of California’s prison population.

Attorneys representing prisoners with mental illness vehemently disagree.

“It’s very unfortunate that the state officials have allowed this situation to get so bad and to stay so bad for so long,” said Ernest Galvan, one of the prisoners’ attorneys in the long-running litigation. “And I hope that this order, which the judge reserved as an absolute last resort, refocuses officials’ attention where it needs to be: bringing lifesaving care into the prisons, where it’s urgently needed.”

As part of her tentative contempt ruling in March, Mueller ordered Newsom personally, along with five of his top state officials, to read testimony by prison mental health employees describing the ongoing problem during a trial last fall.  

The other five were the directors of his departments of Corrections and Rehabilitation, State Hospitals, and Finance; the corrections department’s undersecretary for health care services; and the deputy director in charge of its statewide mental health program.

Mueller limited her formal contempt finding to Corrections Secretary Jeff Macomber and two aides, Undersecretary Diana Toche and Deputy Director Amar Mehta.

“Fundamentally, the overall record reflects defendants are following a ‘business as usual’ approach to hiring, recruitment and retention that does very little if anything to transform the bureaucracy within which the hiring practices are carried out,” Mueller wrote.

Mueller had ordered state officials to calculate each month what they owe in fines for each unfilled position exceeding a 10% vacancy rate among required prison mental health professionals. The fines are calculated based on the maximum annual salary for each job, including some that approach or exceed $300,000.

The 10% vacancy limit dates to a court order by Mueller’s predecessor more than 20 years ago, in 2002, in the class-action case filed in 1990 over poor treatment of prisoners with mental disorders.

The $112 million in pending fines for understaffing is one of three sets of fines Mueller imposed.

She imposed $1,000-a-day fines in 2017 for a backlog in sending imprisoned people to state mental health facilities. But that money, which now tops $4.2 million, has never been collected, and Mueller postponed a planned hearing on the fines after prisoners’ attorneys said the state was making improvements.

In April 2023, Mueller also began assessing $1,000-a-day fines for the state’s failure to implement court-ordered suicide prevention measures. A court-appointed expert said his latest inspection of prisons showed the state was still not in full compliance.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Los Angeles County Approves Medical Debt Relief for Residents

June 25, 2024

LOS ANGELES — Los Angeles County supervisors voted unanimously Tuesday to buy up and forgive millions of dollars in medical debt as part of a comprehensive plan to tackle a $2.9 billion burden that weighs on almost 800,000 residents.

The measure, authored by supervisors Janice Hahn and Holly Mitchell, allows the county to enter into a pilot program with Undue Medical Debt, previously known as RIP Medical Debt, a national organization that relieves patients of what they owe by purchasing their medical debt for pennies on the dollar then retiring it.

“Medical debt is largely out of people’s control, but it is devastating families across L.A. County, especially for people living on the brink of poverty,” Hahn said before the vote. “Luckily for us, this is low-hanging fruit. I think we have a moral obligation to seize this opportunity.”

The debt purchase measure is part of a larger county initiative that includes efforts to prevent the debt from accumulating in the first place, such as boosting hospital financial assistance programs and tracking hospital debt collection practices.

The Hospital Association of Southern California raised objections to the county’s overall plan in a letter to the Board of Supervisors, saying it unfairly singled out hospitals and citing a study that said one-time debt relief programs did not improve patient mental well-being. The hospital association declined to speak with KFF Health News further about the debt forgiveness pilot program.

Hahn’s office estimates the county’s $5 million public health investment will help 150,000 residents and eliminate $500 million in debt. The public health department said it hopes to launch the pilot in the coming months and provide Angelenos relief this year. According to Mitchell’s staff, more money could be allocated in the future if the pilot goes well.

Health care debt burdens 4 in 10 adults in the U.S., according to a KFF Health News investigation, and disproportionately affects people of color, low-income people, and families with children. In January, LA County found such debt weighed on 785,000 adults in 2022 and at least doubled the likelihood that patients would delay or forgo health care or prescriptions. The county labeled it a public health issue on par with diabetes and asthma.

Los Angeles County is part of a growing wave of local governments addressing medical debt. Cook County, home to Chicago, invested $12 million with Undue Medical Debt in 2022 to erase $1 billion in debt for its residents. In March, Arizona announced it would commit up to $30 million to medical debt relief.

“This is not a miracle that’s going to relieve all of this burden,” said Allison Sesso, CEO of Undue Medical Debt. “But it’s a worthwhile effort, given the amount of money and how relatively inexpensive it is to relieve a lot of these debts.”

While the program provides immediate relief, the county acknowledged it’s a short-term approach that doesn’t prevent residents from incurring more debt in the future. Mona Shah of Community Catalyst, a national health equity and policy organization, endorsed LA County’s approach of pairing one-time debt forgiveness with other efforts to tackle the root causes of medical debt.

“We don’t want to ever deny that relief, but we really need to focus on preventing medical debt from happening in the first place,” Shah said. “Otherwise, it just ends up being this vicious cycle where you’re relieved, and then the next day you can be back in the same situation again.”

Shah said she also has concerns that these programs let hospitals off the hook for the failures of their legally required financial assistance programs for low-income patients. Nonprofit hospitals, which are exempt from most taxes, are required to provide charity care, and in California it is required of all hospitals.

Undue Medical Debt typically partners with hospitals or physician groups to identify people who make below 400% of the federal poverty line or whose debt is shown by hospital financial records to be more than 5% of their annual income. They then negotiate a purchase price, acquire the debt, and retire it.

Sesso thinks most of these patients would likely have been eligible for hospital financial aid in the first place. However, many patients don’t know these programs exist or are put off by cumbersome approval processes.

Sesso said her organization uses patient eligibility reviews as an opportunity to engage hospitals on how they could improve their policies.

Yolanda Vera, health and wellness senior deputy in Mitchell’s office, said the county understands that a one-time debt relief program isn’t a cure-all but sees value in providing immediate relief.

“We have to try every tool we can to improve the economic well-being in our community,” Vera said. “And this is one of them.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Therapists Learn How To Help Farmers Cope With Stress Before It’s Too Late

June 25, 2024

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing “988,” or the Crisis Text Line by texting “HOME” to 741741.

GRINNELL, Iowa — The farmers’ co-op here is a center of hope every spring. It’s where farmers buy seed and fertilizer for the summer’s crops, and where they seek tips to maximize their harvest of corn and soybeans.

But on a recent morning, a dozen mental health professionals gathered at the Key Cooperative Agronomy Center to discuss why so many farmers quietly struggle with untreated anxiety and depression.

Studies have concluded that suicide is unusually common among farmers. Researchers believe it’s not just because many farmers have other risk factors, such as rural addresses and access to guns.

The tragic trend has caught the attention of the U.S. Department of Agriculture, which sponsors training sessions like the one in Grinnell to help health care professionals learn how to talk to farmers about the pressures they face in wringing a living out of the land.

“A lot of them are born to it. They don’t have any choice,” family therapist David Brown explained to the session’s participants. He noted many farms have been passed down for generations. Current owners feel that if they fail, they would be letting down their grandparents, parents, children, and grandchildren.

Brown, who works for Iowa State University Extension and Outreach, led the training in Grinnell. He said farmers’ fate hinges on factors out of their control. Will the weather be favorable? Will world events cause prices to soar or crash? Will political conflicts spark changes in federal agricultural support programs? Will a farmer suffer an injury or illness that makes them unable to perform critical chores?

Brown said surveys show many farmers are reluctant to seek mental health care, partly because they think therapists or doctors couldn’t understand their lives.

Tina Recker, a mental health therapist in northeastern Iowa, attended the training session. She has lived on farms, and she has seen how the profession can become a person’s entire identity. “It’s just farm, farm, farm, farm,” she told the group. “If something goes wrong with it, that’s your whole world.”

It’s difficult to estimate how much of farmers’ increased risk of suicide is due to their profession.

Part of the reason for the elevated rate could be that many farmers are middle-aged or older men, who tend to be more at risk in general. “But it’s broader than that for sure,” said Edwin Lewis, a USDA administrator who helps oversee efforts to address the situation.

The Grinnell training session was part of a federal program called the Farm and Ranch Stress Assistance Network. Lewis said the program, which also funds counseling hotlines and support groups, spends $10 million a year.

Jason Haglund sees the issue from multiple angles. He’s a mental health advocate who farms part-time near the central Iowa town of Boone. He and his brother-in-law raise corn and soybeans on the 500-acre farm where Haglund grew up. His family has farmed in the area since the 1880s. His parents hung on despite going into bankruptcy during the 1980s farm crisis, and he embraces his role as caretaker of their legacy.

Haglund is trained as an alcohol and drug addiction counselor, and he co-hosts an Iowa podcast about the need to improve mental health care.

He said it can be stressful to run any kind of family business. But farmers have a particularly strong emotional tie to their heritage, which keeps many in the profession.

“Let’s be honest: Farming at all these days isn’t necessarily a good financial decision,” he said.

Farmers traditionally have valued self-sufficiency, he said. They try to solve their own problems, whether it’s a busted tractor or a debilitating bout of anxiety.

“With the older generation, it’s still, ‘Suck it up and get over it,’” Haglund said. Many younger people seem more willing to talk about mental health, he said. But in rural areas, many lack access to mental health care.

Farmers’ suicide risk is also heightened by many of them owning guns, which provide an immediate means to act on deadly impulses, Haglund said.

Guns are an accepted part of rural life, in which they are seen as a useful tool to control pests, he said. “You can’t go into a rural community and say, ‘We’re going to take your guns away,’” he said. But a trusted therapist or friend might suggest that a depressed person temporarily hand over their guns to someone else who can safely store them.

Haglund said health care professionals shouldn’t be the only ones learning how to address mental stresses. He encourages the public to look into “mental health first aid,” a national effort to spread knowledge about symptoms of struggle and how they can be countered.

A 2023 review of studies on farmer suicides in multiple countries, including the U.S., cited cultural and economic stresses.

“Farmers who died by suicide, particularly men, were described as hard-working, strong, private people who took great pride in being the stoic breadwinners of their families. They were often remembered as members of a unique and fading culture who were poorly understood by outsiders,” wrote the authors, from the University of Alberta in Canada.

Rebecca Purc-Stephenson, a psychology professor who helped write the paper, said health professionals face two challenges: persuading farmers to seek help for mental stress, then encouraging them to keep coming back for therapy.

Back at the training in Iowa, instructors urged mental health professionals to have flexible schedules, and to be understanding when farmers postpone appointments at the last minute.

Maybe one of their animals is sick and needs attention. Maybe a machine broke and needs to be fixed immediately. Maybe the weather is perfect for planting or harvesting.

“Time is money,” said Brown, the therapist leading the training.

The session’s lessons included what to ask and not ask when meeting farmers. A big no-no is inquiring right away about how much land they are working. “If you ask them how many acres they’re farming, that’s like asking to see their bank account,” warned Rich Gassman, director of Iowa’s Center for Agricultural Safety and Health, who assisted with the lesson.

It would be better to start by asking what they enjoy about farming, the instructors said.

Many farmers also need to talk through emotional issues surrounding when, how, or even if the next generation will take over the family operation.

Tim Christensen, a farm management specialist for Iowa State University Extension and Outreach, said some standard advice on how to deal with stress could backfire with farmers.

For example, he said, a health care professional should never advise a farmer to relax by taking a couple of weeks off. Most of them can’t get away from their responsibilities for that long, he said.

“There’s a common saying on the farm: No good vacation goes unpunished.”

Warning Signs of Mental Struggle

The American Foundation for Suicide Prevention lists these signs that a person might be considering suicide:

  • The person talks about killing themselves, feeling hopeless, having no reason to live, being a burden to others, feeling trapped, or having unbearable pain.
  • The person increases their use of alcohol or drugs, sleeps too much or too little, displays fatigue or aggression, withdraws from activities and family and friends, visits or calls people to say goodbye, gives away possessions, or searches online for a way to end their life.
  • People considering suicide often seem depressed, anxious, irritable, angry, ashamed, or uninterested in activities. In some cases, they may appear to feel sudden relief or improvement in their mood.
  • People in crisis can reach the national 988 Suicide & Crisis Lifeline by calling or texting “988.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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US Surgeon General Declares Gun Violence ‘a Public Health Crisis’

June 25, 2024

U.S. Surgeon General Vivek Murthy declared firearm violence a public health crisis, as gun deaths and injuries punctuate daily life in America.

On nearly every day of 2024 so far, a burst of gunfire has hit at least four people somewhere in the country. Some days, communities have endured four or five such shootings.

The nation’s top doctor called on policymakers to consider gun safety measures such as bans on assault weapons and high-capacity ammunition magazines and universal background checks for all firearm purchases. His advisory also urges a “significant increase” in funding for research on gun injuries and deaths, as well as greater access to mental health care and trauma-informed resources for people who have experienced firearm violence.

In 2022, more than 48,000 people were killed by guns in the U.S., or about 132 people a day, and suicides accounted for more than half of those deaths, according to data from the Centers for Disease Control and Prevention. An additional 200-plus Americans seek emergency care for firearm injuries each day, according to estimates from Johns Hopkins University research. No federal database records nonfatal gun injuries.

The Office of the Surgeon General does not set or carry out gun policy, but historically its reports and warnings have nudged policymakers and lawmakers to act.

Murthy, a physician, told KFF Health News he hoped to convey the broader toll of gun violence on the nation and the need for an urgent public health response. He cited soaring gun deaths among children and teens and noted that “the mental health toll of firearm violence is far more profound and pervasive than many of us recognize.”

“Every day that passes we lose more kids to gun violence,” Murthy said, “the more children who are witnessing episodes of gun violence, the more children who are shot and survive that are dealing with a lifetime of physical and mental health impacts.”

Firearm-related homicides over the past decade and suicides over the past two decades have driven the sharp rise in gun deaths, the advisory says.

Guns are the leading cause of death for children and teens, with higher death rates among Black and Hispanic youths. Researchers from Boston University found that during the height of the covid pandemic, Black children were 100 times as likely as white children to experience gun injuries. Hispanic and Asian children also saw major increases in firearm assault injuries during that time, that study showed.

Joseph Sakran, executive vice chair of surgery at John Hopkins Hospital in Baltimore and chief medical officer for Brady United Against Gun Violence, said the surgeon general’s declaration is a “historic moment that sounds the alarm for all Americans.”

But Sakran added: “It cannot stop here. We have to use this as another step in the right direction. No one wants to see more children gunned down.”

Murthy has long said gun violence should be framed as a health issue. He argued that the approach has been successful in combating significant societal problems, citing tobacco control efforts that took hold following the then-surgeon general’s landmark 1964 report concluding that smoking cigarettes causes lung cancer and other diseases.

“We saved so many lives, and that’s what we can do here, too,” Murthy said.

Murthy’s move is one of several recent Biden administration actions designed to combat gun violence, as most gun-related measures remain political nonstarters in Congress. Federal officials have allowed states to use Medicaid dollars to pay for gun violence prevention, and the White House has called on hospital executives and doctors to gather more data about gunshot injuries and to routinely counsel patients about the safe use of firearms.

While available data points to tragic outcomes across American communities, government officials and public health researchers have long been stymied by sparse federal funding devoted to gun violence research and the scope of its health effects.

“I’ve been studying gun violence for about 33 years now and there’s still some really basic and fundamental questions I can’t answer,” said Daniel Webster, a gun violence researcher at Johns Hopkins University.

“To really understand gun violence, you need to do more than just look at publicly available surveillance data,” he said. “You need to actually do in-depth studies involving the populations at highest risk for shooting or being shot.”

A Brady analysis found that of the 15 leading causes of death in the U.S., firearm injuries received the third-lowest amount of federal research funding through the National Institutes of Health for each person who died. The only causes of death that garnered less research funding through NIH were poisonings and falls, according to the analysis.

Sonali Rajan, an adjunct associate professor of epidemiology at Columbia University who researches the effects of gun violence on children, said political leaders and others need to reframe the debate on gun violence from crime to public health.

“We are raising a whole generation of children for whom exposure to gun violence is normal,” Rajan said.

In Michigan, “we had a kid survive the Oxford High School shooting only to go to Michigan State University and see another mass shooting,” she said. “It is unbelievably shameful.”

Serving as President Joe Biden’s surgeon general since 2021, Murthy has, at times, caused political controversy with his views on gun violence.

Over a decade ago, former President Barack Obama nominated Murthy to be the nation’s top doctor. But Murthy’s support for a federal ban on the sale of assault weapons and ammunition and additional restrictions on gun purchases drew the ire of the National Rifle Association, as well as Republicans and some Democrats in Congress. The U.S. Senate narrowly confirmed Murthy to the job in December 2014, more than a year after his nomination.

Murthy has previously issued advisories on social isolation and loneliness, youth mental health, and the well-being of health workers. He said gun violence comes up in many of his conversations with young people about the mental health challenges they’re facing.

“Fears around gun violence have really pervaded so much of the psyche of America in ways that are very harmful to our mental health and well-being,” Murthy said.

Many other causes of death are treated differently as to understanding the problems and developing solutions, Webster said. But “that’s generally not what we’ve done with gun violence. We’ve oversimplified it and overpoliticized it.”

As Sakran put it: “As we look at firearm injuries, there’s arguably no public issue that’s as urgent.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Jóvenes latinos gay ven un porcentaje cada vez mayor de nuevos casos de VIH; piden financiación específica

June 24, 2024

Charlotte, Carolina del Norte. — Cuatro meses después de buscar asilo en Estados Unidos, Fernando Hermida comenzó a toser y a sentirse cansado. Primero pensó que estaba resfriado. Luego aparecieron llagas en su ingle y empezó a empapar su cama de sudor. Se hizo una prueba.

El día de Año Nuevo de 2022, a los 31 años, supo que tenía VIH.

“Pensé que me iba a morir”, dijo, recordando el escalofrío que le recorrió el cuerpo cuando revisaba sus resultados. Luchó por navegar un nuevo y complicado sistema de atención médica. A través de una organización de VIH que encontró en internet, recibió una lista de proveedores médicos en Washington, DC, donde estaba en ese momento. Pero no le devolvieron las llamadas durante semanas.

Hermida, que solo habla español, no sabía a dónde ir.

Para cuando Hermida recibió su diagnóstico, el Departamento de Salud y Servicios Humanos de Estados Unidos (HHS) llevaba adelante desde hacía unos tres años una iniciativa federal para acabar con la epidemia de VIH en la nación, invirtiendo cada año cientos de millones de dólares en ciertos estados, condados y territorios con las tasas de infección más altas.  

El objetivo era llegar a las aproximadamente 1.2 millones de personas que viven con VIH, incluidas algunas que ni siquiera lo saben.

En general, las tasas estimadas de nuevas infecciones por VIH han disminuido un 23% desde 2012 hasta 2022. Pero un análisis de KFF Health News y Associated Press comprobó que la tasa no ha bajado para los latinos (que pueden ser de cualquier raza) tanto como para otros grupos raciales y étnicos.

Si bien en general los afroamericanos continúan teniendo las tasas más altas de VIH en el país, los latinos representaron la mayor parte de los nuevos diagnósticos e infecciones de VIH entre hombres gays y bisexuales en 2022, según los datos disponibles más recientes, en comparación con otros grupos raciales y étnicos.

Los latinos, que constituyen aproximadamente el 19% de la población de Estados Unidos, representaron alrededor del 33% de las nuevas infecciones por VIH, según los Centros para el Control y Prevención de Enfermedades (CDC). El análisis halló que los latinos están experimentando un número desproporcionado de nuevas infecciones y diagnósticos en todo el país, con las tasas de diagnóstico más altas en el sureste.

Oficiales de salud pública en el condado de Mecklenburg, en Carolina del Norte, y el condado de Shelby, en Tennessee, donde los datos muestran que las tasas de diagnóstico han aumentado entre los latinos, dijeron a KFF Health News y AP que no tienen planes específicos para abordar el problema del VIH en esta población, o que éstos aún no se han finalizado.

Incluso en lugares con buena cantidad de recursos como San Francisco, en California, las tasas de diagnóstico de VIH aumentaron entre los latinos en los últimos años mientras disminuían entre otros grupos raciales y étnicos, a pesar de los objetivos del condado de reducir las infecciones entre los latinos.

“Las disparidades de VIH no son inevitables”, dijo en un comunicado Robyn Neblett Fanfair, directora de la División de Prevención del VIH de los CDC. Señaló las inequidades sistémicas, culturales y económicas, como el racismo, las diferencias de idioma y la desconfianza en los médicos.

Y aunque los CDC proporcionan algunos fondos para grupos minoritarios, defensores de las políticas de salud para los latinos quieren que el HHS declare una emergencia de salud pública con la esperanza de dirigir más dinero a las comunidades latinas, argumentando que los esfuerzos actuales no son suficientes.

“Nuestra invisibilidad ya no es tolerable”, dijo Vincent Guilamo-Ramos, co-presidente del Consejo Asesor Presidencial sobre VIH/SIDA.

Perdido sin un intérprete

Hermida sospecha que contrajo el virus mientras estaba en una relación abierta con un compañero masculino antes de llegar a Estados Unidos. A fines de enero de 2022, meses después que comenzaran sus síntomas, fue a una clínica en la ciudad de Nueva York que un amigo lo ayudó a encontrar para finalmente recibir tratamiento para el VIH.

Demasiado enfermo para cuidarse solo, Hermida finalmente se mudó a Charlotte, Carolina del Norte, para estar más cerca de su familia y con la esperanza de recibir atención médica más constante. Se inscribió en una clínica de Amity Medical Group que recibe fondos del Programa Ryan White de VIH/SIDA, un plan de la red de seguridad federal que atiende a más de la mitad de los diagnosticados con VIH en la nación, independientemente de su estatus migratorio.

Después que se conectó con gestores de casos, su VIH se volvió indetectable. Pero dijo que, con el tiempo, la comunicación con la clínica se volvió menos frecuente y no recibía ayuda regular de un intérprete durante las visitas con su médico, que hablaba inglés.

Un representante de Amity confirmó que Hermida fue cliente, pero no respondió preguntas sobre su experiencia en la clínica.

Hermida dijo que tuvo dificultades para completar el papeleo para mantenerse inscrito en el programa Ryan White, y cuando su elegibilidad expiró, en septiembre de 2023, no pudo obtener su medicación.

Dejó la clínica y se inscribió en un plan de salud a través del mercado de seguros de la Ley de Cuidado de Salud a Bajo Precio (ACA). Pero Hermida no se dio cuenta que la aseguradora le exigía pagar una parte de su tratamiento para el VIH.

En enero, el conductor de Lyft recibió una factura de $1,275 por su antirretroviral, el equivalente a 120 viajes, dijo. Pagó la factura con un cupón que encontró en línea. En abril, recibió una segunda cuenta que no pudo pagar. Durante dos semanas, dejó de tomar la medicación que mantiene al virus indetectable, y por ende no transmisible.

“Estoy que colapso”, dijo. “Tengo que vivir para pagar la medicación”. Una forma de prevenir el VIH es la profilaxis previa a la exposición, o PrEP, que se toma regularmente para reducir el riesgo de contraer el VIH a través del sexo o el uso de drogas intravenosas. Fue aprobada por el gobierno federal en 2012, pero la adopción no ha sido uniforme entre los diferentes grupos raciales y étnicos: los datos de los CDC muestran tasas de cobertura de PrEP mucho más bajas entre los latinos que entre los estadounidenses blancos no hispanos.

Los epidemiólogos dicen que el buen uso de PrEP y el acceso constante al tratamiento son necesarios para construir resistencia a nivel comunitario.

Carlos Saldana, especialista en enfermedades infecciosas y ex asesor médico del Departamento de Salud de Georgia, ayudó a identificar cinco grupos de transmisión rápida de VIH que involucró a unos 40 latinos gay y hombres que tienen sexo con hombres desde febrero de 2021 hasta junio de 2022. Muchas personas en el grupo dijeron a los investigadores que no habían tomado PrEP y que les resultaba difícil entender el sistema de salud.

Saldana dijo que también experimentaron otras barreras, incluida la falta de transporte y el miedo a la deportación si buscaban tratamiento.

Defensores de políticas de salud para los latinos quieren que el gobierno federal redistribuya los fondos para la prevención del VIH, incluyendo pruebas y acceso a PrEP. De los casi $30 mil millones en dinero federal que se destinaron a servicios de atención médica para el VIH, tratamiento y prevención en 2022, solo el 4% se dirigió a la prevención, según un análisis de KFF.

Los defensores sugieren que más dinero podría ayudar a llegar a las comunidades latinas a través de esfuerzos como la divulgación basada en la fe en iglesias, pruebas en clubes durante fiestas latinas, y en capacitar a personal bilingüe para que realice las pruebas.

Aumentan las tasas latinas

El Congreso ha asignado $2.3 mil millones a lo largo de cinco años para la iniciativa Ending the HIV Epidemic, y las jurisdicciones que reciben el dinero deben invertir el 25% en organizaciones comunitarias.

Pero esta iniciativa no requiere dirigirse a determinados grupos, incluidos los latinos: delega en las ciudades, condados y estados la tarea de idear estrategias específicas.

En 34 de las 57 áreas que reciben dinero, los casos van en la dirección equivocada: las tasas de diagnóstico entre los latinos aumentaron de 2019 a 2022 mientras que disminuían en otros grupos raciales y étnicos, halló el análisis de KFF Health News-AP.

A partir del 1 de agosto, los departamentos de salud estatales y locales deberán presentar informes anuales de gastos sobre el financiamiento en lugares que representan el 30% o más de los diagnósticos de VIH, dijeron los CDC. Antes, solo se requería esto en un pequeño número de estados.

En algunos estados y condados, el financiamiento de la iniciativa no ha sido suficiente para cubrir las necesidades de los latinos. Carolina del Sur, que vio las tasas entre latinos casi duplicarse de 2012 a 2022, no ha expandido las pruebas móviles de VIH en áreas rurales, donde la necesidad es alta entre los latinos, dijo Tony Price, gerente del programa de VIH en el departamento de salud del estado.

Carolina del Sur solo puede pagar a cuatro trabajadores comunitarios de salud enfocados en la divulgación sobre el VIH, y no todos son bilingües.

En el condado de Shelby, Tennessee, hogar de Memphis, la tasa de diagnóstico de VIH entre los latinos aumentó un 86% de 2012 a 2022. El Departamento de Salud dijo que recibió $2 millones en financiamiento de la iniciativa en 2023 y, aunque el plan del condado reconoce que los latinos son un grupo objeto, la directora del departamento, Michelle Taylor, dijo: “No hay campañas específicas solo entre los latinos”.

Hasta ahora, el condado de Mecklenburg, en Carolina del Norte, no incluyó objetivos específicos para abordar el VIH en la población latina, donde las tasas de nuevos diagnósticos se han más que duplicado en una década, pero disminuyeron ligeramente entre otros grupos raciales y étnicos.

El departamento de salud ha utilizado fondos para campañas de marketing bilingües y concientización sobre la PrEP.

Mudarse por la medicina

Cuando llegó el momento para Hermida de empacar y mudarse a la tercera ciudad en dos años, su prometido, que está tomando PrEP, sugirió buscar atención en Orlando, Florida.

La pareja, que eran amigos en la escuela secundaria en Venezuela, tenía algunos familiares y amigos en Florida, y habían escuchado sobre Pineapple Healthcare, una clínica de atención primaria sin fines de lucro dedicada a apoyar a los latinos que viven con VIH.

La clínica está en un consultorio al sur del centro de Orlando. El personal, mayoritariamente latino, viste camisetas turquesa con estampado de piñas, y se escucha con más frecuencia español que inglés en los cuartos de atención y en los pasillos.

“En su esencia, si la organización no es dirigida por y para personas de color, entonces solo somos una idea de último momento”, dijo Andres Acosta Ardila, director de divulgación comunitaria en Pineapple Healthcare, quien fue diagnosticado con VIH en 2013.

“¿Te mudaste reciente [mente], ya por fin?”, preguntó la enfermera Eliza Otero, quien comenzó a tratar a Hermida cuando todavía vivía en Charlotte. “Hace un mes desde la última vez que nos vimos”.

Todavía necesitan trabajar en bajar su colesterol y presión arterial, le dijo. Aunque su carga viral sigue siendo alta, Otero dijo que debería mejorar con atención regular y constante.

Pineapple Healthcare, que no recibe dinero de la iniciativa federal, ofrece atención primaria completa principalmente a hombres latinos. Allí, Hermida obtiene su medicación para el VIH sin costo porque la clínica es parte de un programa federal de descuento de medicamentos.

En muchos sentidos, la clínica es un oasis. La tasa de nuevos diagnósticos para los latinos en el condado de Orange, Florida, que incluye Orlando, aumentó alrededor de un tercio desde 2012 hasta 2022, mientras que disminuyó un tercio para otros. Florida tiene la tercera población latina más grande de Estados Unidos y tuvo la séptima tasa más alta de nuevos diagnósticos de VIH entre latinos en la nación en 2022.

Hermida, que tiene pendiente su caso de asilo, nunca imaginó que obtener medicación sería tan difícil, dijo durante el viaje de 500 millas de Carolina del Norte a Florida. Después de habitaciones de hotel, trabajos perdidos y despedidas familiares, espera que su búsqueda de tratamiento consistente para el VIH, que ha definido su vida en los últimos dos años, finalmente pueda llegar a su fin.

“Soy un nómade a la fuerza, pero bueno, como dicen mi prometido y mis familiares, yo tengo que estar donde me den buenos servicios médicos”, dijo.

Esa es la prioridad ahora, agregó.

KFF Health News y The Associated Press analizaron datos de los Centros para el Control y Prevención de Enfermedades de Estado Unidos sobre el número de nuevos diagnósticos e infecciones de VIH entre estadounidenses de 13 años y más a nivel local, estatal y nacional.

Esta historia utiliza principalmente datos de tasas de incidencia —estimaciones de nuevas infecciones— a nivel nacional y datos de tasas de diagnóstico a nivel estatal y de condados.

Bose produjo esta historia desde Orlando, Florida. Reese, desde Sacramento, California. La periodista de video Laura Bargfeld colaboró con este informe.

The Associated Press Health and Science Department recibe apoyo de la Fundación Robert Wood Johnson. AP es responsable de todo el contenido.

Un proyecto de KFF Health News y The Associated PressCo-publicado por Univisión Noticias CRÉDITOS

Reporteros:Vanessa G. SánchezDevna BosePhillip ReeseCinematografía:Laura BargfeldFotografía:Laura BargfeldPhelan M. EbenhackEdición de video:Federica NarancioKathy YoungEsther PovedaVideo adicional:Federica NarancioEsther PovedaProducción de video:Eric HarkleroadLydia Zuraw

Editores:Judy LinErica HunzingerEditor de datos:Holly HackerRedes sociales:Patricia VélezFederica NarancioEsther PovedaCarolina AstuyaNatalia BravoJuan Pablo VargasKyle ViterboSophia EppolitoHannah NormanChaseedaw GilesTarena LoftonTraducción:Paula Andalo Corrección:Gabe Brison-Trezise

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Young Gay Latinos See Rising Share of New HIV Cases, Leading to Call for Targeted Funding

June 24, 2024

CHARLOTTE, N.C. — Four months after seeking asylum in the U.S., Fernando Hermida began coughing and feeling tired. He thought it was a cold. Then sores appeared in his groin and he would soak his bed with sweat. He took a test.

On New Year’s Day 2022, at age 31, Hermida learned he had HIV.

“I thought I was going to die,” he said, recalling how a chill washed over him as he reviewed his results. He struggled to navigate a new, convoluted health care system. Through an HIV organization he found online, he received a list of medical providers to call in Washington, D.C., where he was at the time, but they didn’t return his calls for weeks. Hermida, who speaks only Spanish, didn’t know where to turn.

By the time of Hermida’s diagnosis, the U.S. Department of Health and Human Services was about three years into a federal initiative to end the nation’s HIV epidemic by pumping hundreds of millions of dollars annually into certain states, counties, and U.S. territories with the highest infection rates. The goal was to reach the estimated 1.2 million people living with HIV, including some who don’t know they have the disease.

Overall, estimated new HIV infection rates declined 23% from 2012 to 2022. But a KFF Health News-Associated Press analysis found the rate has not fallen for Latinos as much as it has for other racial and ethnic groups.

While African Americans continue to have the highest HIV rates in the United States overall, Latinos made up the largest share of new HIV diagnoses and infections among gay and bisexual men in 2022, per the most recent data available, compared with other racial and ethnic groups. Latinos, who make up about 19% of the U.S. population, accounted for about 33% of new HIV infections, according to the Centers for Disease Control and Prevention.

The analysis found Latinos are experiencing a disproportionate number of new infections and diagnoses across the U.S., with diagnosis rates highest in the Southeast. Public health officials in Mecklenburg County, North Carolina, and Shelby County, Tennessee, where data shows diagnosis rates have gone up among Latinos, told KFF Health News and the AP that they either don’t have specific plans to address HIV in this population or that plans are still in the works. Even in well-resourced places like San Francisco, California, HIV diagnosis rates grew among Latinos in the last few years while falling among other racial and ethnic groups despite the county’s goals to reduce infections among Latinos.

“HIV disparities are not inevitable,” Robyn Neblett Fanfair, director of the CDC’s Division of HIV Prevention, said in a statement. She noted the systemic, cultural, and economic inequities — such as racism, language differences, and medical mistrust.

And though the CDC provides some funds for minority groups, Latino health policy advocates want HHS to declare a public health emergency in hopes of directing more money to Latino communities, saying current efforts aren’t enough.

“Our invisibility is no longer tolerable,” said Vincent Guilamo-Ramos, co-chair of the Presidential Advisory Council on HIV/AIDS.

Lost Without an Interpreter

Hermida suspects he contracted the virus while he was in an open relationship with a male partner before he came to the U.S. In late January 2022, months after his symptoms started, he went to a clinic in New York City that a friend had helped him find to finally get treatment for HIV.

Too sick to care for himself alone, Hermida eventually moved to Charlotte, North Carolina, to be closer to family and in hopes of receiving more consistent health care. He enrolled in an Amity Medical Group clinic that receives funding from the Ryan White HIV/AIDS Program, a federal safety-net plan that serves over half of those in the nation diagnosed with HIV, regardless of their citizenship status.

His HIV became undetectable after he was connected with case managers. But over time, communication with the clinic grew less frequent, he said, and he didn’t get regular interpretation help during visits with his English-speaking doctor. An Amity Medical Group representative confirmed Hermida was a client but didn’t answer questions about his experience at the clinic.

Hermida said he had a hard time filling out paperwork to stay enrolled in the Ryan White program, and when his eligibility expired in September 2023, he couldn’t get his medication.

He left the clinic and enrolled in a health plan through the Affordable Care Act marketplace. But Hermida didn’t realize the insurer required him to pay for a share of his HIV treatment.

In January, the Lyft driver received a $1,275 bill for his antiretroviral — the equivalent of 120 rides, he said. He paid the bill with a coupon he found online. In April, he got a second bill he couldn’t afford.

For two weeks, he stopped taking the medication that keeps the virus undetectable and intransmissible.

“Estoy que colapso,” he said. I’m falling apart. “Tengo que vivir para pagar la medicación.” I have to live to pay for my medication.

One way to prevent HIV is preexposure prophylaxis, or PrEP, which is regularly taken to reduce the risk of getting HIV through sex or intravenous drug use. It was approved by the federal government in 2012 but the uptake has not been even across racial and ethnic groups: CDC data show much lower rates of PrEP coverage among Latinos than among white Americans.

Epidemiologists say high PrEP use and consistent access to treatment are necessary to build community-level resistance.

Carlos Saldana, an infectious disease specialist and former medical adviser for Georgia’s health department, helped identify five clusters of rapid HIV transmission involving about 40 gay Latinos and men who have sex with men from February 2021 to June 2022. Many people in the cluster told researchers they had not taken PrEP and struggled to understand the health care system.

They experienced other barriers, too, Saldana said, including lack of transportation and fear of deportation if they sought treatment.

Latino health policy advocates want the federal government to redistribute funding for HIV prevention, including testing and access to PrEP. Of the nearly $30 billion in federal money that went toward things like HIV health care services, treatment, and prevention in 2022, only 4% went to prevention, according to a KFF analysis.

They suggest more money could help reach Latino communities through efforts like faith-based outreach at churches, testing at clubs on Latin nights, and training bilingual HIV testers.

Latino Rates Going Up

Congress has appropriated $2.3 billion over five years to the Ending the HIV Epidemic initiative, and jurisdictions that get the money are to invest 25% of it in community-based organizations. But the initiative lacks requirements to target any particular groups, including Latinos, leaving it up to the cities, counties, and states to come up with specific strategies.

In 34 of the 57 areas getting the money, cases are going the wrong way: Diagnosis rates among Latinos increased from 2019 to 2022 while declining for other racial and ethnic groups, the KFF Health News-AP analysis found.

Starting Aug. 1, state and local health departments will have to provide annual spending reports on funding in places that account for 30% or more of HIV diagnoses, the CDC said. Previously, it had been required for only a small number of states.

In some states and counties, initiative funding has not been enough to cover the needs of Latinos.

South Carolina, which saw rates nearly double for Latinos from 2012 to 2022, hasn't expanded HIV mobile testing in rural areas, where the need is high among Latinos, said Tony Price, HIV program manager in the state health department. South Carolina can pay for only four community health workers focused on HIV outreach — and not all of them are bilingual.

In Shelby County, Tennessee, home to Memphis, the Latino HIV diagnosis rate rose 86% from 2012 to 2022. The health department said it got $2 million in initiative funding in 2023 and while the county plan acknowledges that Latinos are a target group, department director Michelle Taylor said: “There are no specific campaigns just among Latino people.”

Up to now, Mecklenburg County, North Carolina, didn’t include specific targets to address HIV in the Latino population — where rates of new diagnoses more than doubled in a decade but fell slightly among other racial and ethnic groups. The health department has used funding for bilingual marketing campaigns and awareness about PrEP.

Moving for Medicine

When it was time to pack up and move to Hermida’s third city in two years, his fiancé, who is taking PrEP, suggested seeking care in Orlando, Florida.

The couple, who were friends in high school in Venezuela, had some family and friends in Florida, and they had heard about Pineapple Healthcare, a nonprofit primary care clinic dedicated to supporting Latinos living with HIV.

The clinic is housed in a medical office south of downtown Orlando. Inside, the mostly Latino staff is dressed in pineapple-print turquoise shirts, and Spanish, not English, is most commonly heard in appointment rooms and hallways.

“At the core of it, if the organization is not led by and for people of color, then we're just an afterthought,” said Andres Acosta Ardila, the community outreach director at Pineapple Healthcare, who was diagnosed with HIV in 2013.

“¿Te mudaste reciente, ya por fin?” asked nurse practitioner Eliza Otero. Did you finally move? She started treating Hermida while he still lived in Charlotte. “Hace un mes que no nos vemos.” It’s been a month since we last saw each other.

They still need to work on lowering his cholesterol and blood pressure, she told him. Though his viral load remains high, Otero said it should improve with regular, consistent care.

Pineapple Healthcare, which doesn’t receive initiative money, offers full-scope primary care to mostly Latino males. Hermida gets his HIV medication at no cost there because the clinic is part of a federal drug discount program.

The clinic is in many ways an oasis. The new diagnosis rate for Latinos in Orange County, Florida, which includes Orlando, rose by about a third from 2012 through 2022, while dropping by a third for others. Florida has the third-largest Latino population in the U.S., and had the seventh-highest rate of new HIV diagnoses among Latinos in the nation in 2022.

Hermida, whose asylum case is pending, never imagined getting medication would be so difficult, he said during the 500-mile drive from North Carolina to Florida. After hotel rooms, jobs lost, and family goodbyes, he is hopeful his search for consistent HIV treatment — which has come to define his life the past two years — can finally come to an end.

“Soy un nómada a la fuerza, pero bueno, como me comenta mi prometido y mis familiares, yo tengo que estar donde me den buenos servicios médicos,” he said. I'm forced to be a nomad, but like my family and my fiancé say, I have to be where I can get good medical services.

That’s the priority, he said. “Esa es la prioridad ahora."

KFF Health News and The Associated Press analyzed data from the U.S. Centers for Disease Control and Prevention on the number of new HIV diagnoses and infections among Americans ages 13 and older at the local, state, and national levels. This story primarily uses incidence rate data — estimates of new infections — at the national level and diagnosis rate data at the state and county level.

Bose reported from Orlando, Florida. Reese reported from Sacramento, California. AP video journalist Laura Bargfeld contributed to this report.

The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is responsible for all content.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

A Project of KFF Health News and The Associated PressCo-Published by Univision Noticias CREDITS

Reporters:Vanessa G. SánchezDevna BosePhillip ReeseCinematography:Laura BargfeldPhotography:Laura BargfeldPhelan M. EbenhackVideo Editing:Federica NarancioKathy YoungEsther PovedaAdditional Video:Federica NarancioEsther PovedaWeb Production:Eric HarkleroadLydia Zuraw

Editors:Judy LinErica HunzingerData Editor:Holly HackerSocial Media:Patricia VélezFederica NarancioEsther PovedaCarolina AstuyaNatalia BravoJuan Pablo VargasKyle ViterboSophia EppolitoHannah NormanChaseedaw GilesTarena LoftonTranslation:Paula Andalo Copy Editing:Gabe Brison-Trezise

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It’s Called an Urgent Care Emergency Center — But Which Is It?

June 24, 2024

One evening last December, Tieqiao Zhang felt severe stomach pain.

After it subsided later that night, he thought it might be food poisoning. When the pain returned the next morning, Zhang realized the source of his pain might not be as “simple as bad food.”

He didn’t want to wait for an appointment with his regular doctor, but he also wasn’t sure if the pain warranted emergency care, he said.

Zhang, 50, opted to visit Parkland Health’s Urgent Care Emergency Center, a clinic near his home in Dallas where he’d been treated in the past. It’s on the campus of Parkland, the city’s largest public hospital, which has a separate emergency room.

He believed the clinic was an urgent care center, he said.

A CT scan revealed that Zhang had a kidney stone. A physician told him it would pass naturally within a few days, and Zhang was sent home with a prescription for painkillers, he said.

Five days later, Zhang’s stomach pain worsened. Worried and unable to get an immediate appointment with a urologist, Zhang once again visited the Urgent Care Emergency Center and again was advised to wait and see, he said.

Two weeks later, Zhang passed the kidney stone.

Then the bills came.

The Patient: Tieqiao Zhang, 50, who is insured by BlueCross and BlueShield of Texas through his employer.

Medical Services: Two diagnostic visits, including lab tests and CT scans.

Service Provider: Parkland Health & Hospital System. The hospital is part of the Dallas County Hospital District.

Total Bills: The in-network hospital charged $19,543 for the two visits. BlueCross and BlueShield of Texas paid $13,070.96. Zhang owed $1,000 to Parkland — a $500 emergency room copay for each of his two visits.

What Gives: Parkland’s Urgent Care Emergency Center is what’s called a freestanding emergency department.

The number of freestanding emergency rooms in the United States grew tenfold from 2001 to 2016, drawing attention for sending patients eye-popping bills. Most states allow them to operate, either by regulation or lack thereof. Some states, including Texas, have taken steps to regulate the centers, such as requiring posted notices identifying the facility as a freestanding emergency department.

Urgent care centers are a more familiar option for many patients. Research shows that, on average, urgent care visits can be about 10 times cheaper than a low-acuity — or less severe — visit to an ER.

But the difference between an urgent care clinic and a freestanding emergency room can be tough to discern.

Generally, to bill as an emergency department, facilities must meet specific requirements, such as maintaining certain staff, not refusing patients, and remaining open around the clock.

The freestanding emergency department at Parkland is 40 yards away from its main emergency room and operates under the same license, according to Michael Malaise, the spokesperson for Parkland Health. It is closed on nights and Sundays.

(Parkland’s president and chief executive officer, Frederick Cerise, is a member of KFF’s board of trustees. KFF Health News is an editorially independent program of KFF.) The hospital is “very transparent” about the center’s status as an emergency room, Malaise told KFF Health News in a statement.

Malaise provided photographs of posted notices stating, “This facility is a freestanding emergency medical care facility,” and warning that patients would be charged emergency room fees and could also be charged a facility fee. He said the notices were posted in the exam rooms, lobby, and halls at the time of Zhang’s visits.

Zhang’s health plan required a $500 emergency room copay for each of the two visits for his kidney stone.

When Zhang visited the center in 2021 for a different health issue, he was charged only $30, his plan’s copay for urgent care, he said. (A review of his insurance documents showed Parkland also used emergency department billing codes then. BCBS of Texas did not respond to questions about that visit.)

One reason “I went to the urgent care instead of emergency room, although they are just next door, is the copayment,” he said.

The list of services that Parkland’s freestanding emergency room offers resembles that of urgent care centers — including, for some centers, diagnosing a kidney stone, said Ateev Mehrotra, a health care policy professor at Harvard Medical School.

Having choices leaves patients on their own to decipher not only the severity of their ailment, but also what type of facility they are visiting all while dealing with a health concern. Self-triage is “a very difficult thing,” Mehrotra said.

Zhang said he did not recall seeing posted notices identifying the center as a freestanding emergency department during his visits, nor did the front desk staff mention a $500 copay. Plus, he knew Parkland also had an emergency room, and that was not the building he visited, he said.

The name is “misleading,” Zhang said. “It’s like being tricked.”

Parkland opened the center in 2015 to reduce the number of patients in its main emergency room, which is the busiest in the country, Malaise said. He added that the Urgent Care Emergency Center, which is staffed with emergency room providers, is “an extension of our main emergency room and is clearly marked in multiple places as such.”

Malaise first told KFF Health News that the facility isn’t a freestanding ER, noting that it is located in a hospital building on the campus. Days later, he said the center is “held out to the public as a freestanding emergency medical care facility within the definition provided by Texas law.”

The Urgent Care Emergency Center name is intended to prevent first responders and others facing life-threatening emergencies from visiting the center rather than the main emergency room, Malaise said.

“If you have ideas for a better name, certainly you can send that along for us to consider,” he said.

Putting the term “urgent” in the clinic’s name while charging emergency room prices is “disingenuous,” said Benjamin Ukert, an assistant professor of health economics and policy at Texas A&M University.

When Ukert reviewed Zhang’s bills at the request of KFF Health News, he said his first reaction was, “Wow, I am glad that he only got charged $500; it could have been way worse” — for instance, if the facility had been out-of-network.

The Resolution: Zhang said he paid $400 of the $1,000 he owes in total to avoid collections while he continues to dispute the amount.

Zhang said he first reached out to his insurer, thinking his bills were wrong, before he reached out to Parkland several times by phone and email. He said customer service representatives told him that, for billing purposes, Parkland doesn’t differentiate its Urgent Care Emergency Clinic from its emergency department.

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BlueCross and BlueShield of Texas did not respond to KFF Health News when asked for comment.

Zhang said he also reached out to a county commissioner’s office in Dallas, which never responded, and to the Texas Department of Health, which said it doesn’t have jurisdiction over billing matters. He said the staff for his state representative, Morgan Meyer, contacted the hospital on his behalf, but later told him the hospital would not change his bill.

As of mid-May, his balance stood at $600, or $300 for each visit.

The Takeaway: Lawmakers in Texas and around the country have tried to increase price transparency at freestanding emergency rooms, including by requiring them to hand out disclosures about billing practices.

But experts said the burden still falls disproportionately on patients to navigate the growing menu of options for care.

It’s up to the patient to walk into the right building, said Mehrotra, the Harvard professor. It doesn’t help that most providers are opaque about their billing practices, he said.

Mehrotra said that some freestanding emergency departments in Texas use confusing names like “complete care,” which mask the facilities’ capabilities and billing structure.

Ukert said states could do more to untangle the confusion patients face at such centers, like banning the use of the term “urgent care” to describe facilities that bill like emergency departments.

Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

Emily Siner reported the audio story.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Presidential Politics, Polka and Wisconsin

June 18, 2024

Wisconsin, the land of fried cheese curds and the Green Bay Packers, is one of a half-dozen key battleground states where President Biden is trying to make health care a key issue in his expected November matchup with former president Donald Trump.

Biden narrowly won Wisconsin in 2020, after it went for Trump in 2016. And while recent polling indicates that Trump now holds a slight edge, many people here still can’t figure out whom to vote for, or whether to vote at all. Across the state, the rising cost of health care is high on their list of concerns.

A Wisconsinite to my core, I wanted to gauge what is motivating voters. Among the best places to understand the state’s mood are the many summertime polka festivals that draw voters of all political stripes.

This past weekend, for instance, I met Bob Prelipp, 79, at the Birnamwood Polka Days in Birnamwood, population about 700.

A Republican who served in Vietnam during his stint in the Navy, Prelipp voted for Trump in 2016, then switched to Biden in 2020. Prelipp said Trump angered him with his comments disparaging military veterans.

After Trump supporters stormed the U.S. Capitol on Jan. 6, 2021, “I knew I couldn’t vote for him again,” Prelipp said. “I can’t believe we can’t find a better Republican candidate. I’m still trying to decide what to do.”

His veteran health care has improved remarkably under Biden, yet he still can’t stomach voting for him. “I’m not happy with Biden,” he said. “Everything is getting so unaffordable, even health care.”

Birnamwood is in a rural part of the state that’s ruby red — Trump hats pepper the crowd and Trump flags dot the landscape. Biden supporters are more visible in liberal, heavily populated cities like Madison and Milwaukee.

Greg Laabs, a tuba player in a local polka band, proudly displays a Trump sticker on his instrument.

“There are thousands of people coming across the border,” Laabs said, expressing concern over a Democratic president providing immigrants lacking legal residency access to health care — an idea he recalled Vice President Harris supporting in 2019 and that California has passed. “We cannot support the whole world.”

Meanwhile, Biden and members of his administration are trying to win over voters by touting major Obamacare expansions while promising to do more to expand access to care, especially in rural communities.

“Nine million more people have health care because of fights this administration has taken,” Neera Tanden, Biden’s domestic policy adviser, said last week in the city of Rothschild, announcing an $11 million federal investment in the health-care workforce. “There’s a clear choice.”

But Wisconsin voters at the Rothschild town hall-style event told Tanden and Health and Human Services Secretary Xavier Becerra that the state losing hospitals and clinics has upended access.

“We had a hospital that’s been serving our community for over 100 years close very suddenly,” said Michael Golat, an independent voter who lives in the town of Altoona and believes Biden would prioritize health care, yet says the president must do more to expand access to health care and mental health treatment. “It’s really a crisis here.”

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Americans With HIV Are Living Longer. Federal Spending Isn’t Keeping Up.

June 17, 2024

DECATUR, Ga. — Malcolm Reid recently marked the anniversary of his HIV diagnosis on Facebook. “Diagnosed with HIV 28 years ago, AND TODAY I THRIVE,” he wrote in a post in April, which garnered dozens of responses.

Reid, an advocate for people with HIV, said he’s happy he made it to age 66. But growing older has come with a host of health issues. He survived kidney cancer and currently juggles medications to treat HIV, high blood pressure, and Type 2 diabetes. “It’s a lot to manage,” he said.

But Reid’s not complaining. When he was diagnosed, HIV was sometimes a death sentence. “I’m just happy to be here,” Reid said. “You weren’t supposed to be here, and you’re here.”

More than half of the people living with HIV in the United States are, like Reid, older than 50. Researchers estimate that 70% of people living with the virus will fall in that age range by 2030. Aging with HIV means an increased risk of other health problems, such as diabetes, depression, and heart disease, and a greater chance of developing these conditions at a younger age.

Yet the U.S. health care system isn’t prepared to handle the needs of the more than half a million people — those already infected and those newly infected with HIV — who are 50 or older, say HIV advocates, doctors, government officials, people living with HIV, and researchers.

They worry that funding constraints, an increasingly dysfunctional Congress, holes in the social safety net, untrained providers, and workforce shortages leave people aging with HIV vulnerable to poorer health, which could undermine the larger fight against the virus.

“I think we’re at a tipping point,” said Melanie Thompson, an Atlanta internal medicine doctor who specializes in HIV care and prevention. “It would be very easy to lose the substantial amount of the progress we have made.”

People are living longer with the virus due in part to the development of antiretroviral therapies — drugs that reduce the amount of virus in the body.

But aging with HIV comes with a greater risk of health problems related to inflammation from the virus and the long-term use of harsh medications. Older people often must coordinate care across specialists and are frequently on multiple prescriptions, increasing their risk for adverse drug reactions.

Some people face what researchers call the “dual stigma” of ageism and anti-HIV bias. They also have high rates of anxiety, depression, and substance use disorders.

Many have lost friends and family to the HIV/AIDS epidemic. Loneliness can increase the risks of cognitive decline and other medical conditions in older adults and can lead patients to stop treatment. It isn’t an easy problem to solve, said Heidi Crane, an HIV researcher and clinician at the University of Washington.

“If I had the ability to write a prescription for a friend — someone who’s supportive and engaged and willing to go walking with you twice a week — the care I provide would be so much better,” she said.

The complexity of care is a heavy lift for the Ryan White HIV/AIDS Program, the federal initiative for low-income people with HIV. The program serves more than half of the Americans living with the virus, and nearly half of its clients are 50 or older.

“Many of the people aging with HIV were pioneers in HIV treatment,” said Laura Cheever, who oversees the Ryan White program for the Health Resources and Services Administration, or HRSA. Researchers have a lot to learn about the best ways to meet the needs of the population, she said.

“We are learning as we go, we all are. But it certainly is challenging,” she said.

The Ryan White program’s core budget has remained mostly flat since 2013 despite adding 50,000 patients, Cheever said. The Biden administration’s latest budget request asks for less than half a percent bump in program funding.

Local and state public health officials make the bulk of the decisions about how to spend Ryan White money, Cheever said, and constrained resources can make it hard to balance priorities.

“When a lot of people aren’t getting care, how do you decide where that next dollar is spent?” Cheever said.

The latest infusion of funding for Ryan White, which has totaled $466 million since 2019, came as part of a federal initiative to end the HIV epidemic by 2030. But that program has come under fire from Republicans in Congress, who last year tried to defund it even though it was launched by the Trump administration.

It’s a sign of eroding bipartisan support for HIV services that puts people “in extreme jeopardy,” said Thompson, the Atlanta physician.

She worries that the increasing politicization of HIV could keep Congress from appropriating money for a pilot loan repayment program that aims to lure infectious disease doctors to areas that have a shortage of providers.

Many people aging with HIV are covered by Medicare, the public insurance program for people 65 and older. Research has shown that Ryan White patients on private insurance had better health than those on Medicare, which researchers linked to better access to non-HIV preventive care.

Some 40% of people living with HIV rely on Medicaid, the state-federal health insurance program for low-income people. The decision by 10 states not to expand Medicaid can leave older people with HIV few places to seek care outside of Ryan White clinics, Thompson said.

“The stakes are high,” she said. “We are in a very dangerous place if we don’t pay more attention to our care systems.”

About 1 in 6 new diagnoses are in people 50 or older but public health policies haven’t caught up to that reality, said Reid, the HIV advocate from Atlanta. The Centers for Disease Control and Prevention, for instance, recommends HIV testing only for people ages 13 to 64.

“Our systems are antiquated. They, for some reason, believe that once you hit a certain number, you stop having sex,” Reid said. Such blind spots mean older people often are diagnosed once the virus has destroyed the cells that help the body fight infection.

In acknowledgment of these challenges, HRSA recently launched a $13 million, three-year program to look at ways to improve health outcomes for older people living with HIV.

Ten Ryan White clinics across the United States participate in the effort, which is testing ways to better track the risk of adverse drug interactions for people taking multiple prescriptions. The program is also testing ways to better screen for conditions like dementia and frailty, and ways to streamline the referral process for people who might need specialty care.

New strategies can’t come quickly enough, said Jules Levin, executive director of the National AIDS Treatment Advocacy Project, who, at age 74, has been living with HIV since the 1980s.

His group was one signatory to “The Glasgow Manifesto,” in which an international coalition of older people with HIV called on policymakers to ensure better access to affordable care, to ensure patients get more time with doctors, and to fight ageism.

“It’s tragic and shameful that elderly people with HIV have to go through what they’re going through without getting the proper attention that they deserve,” Levin said. “This will be a disaster soon without a solution.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Montana Creates Emergency ‘Drive-Thru’ Blood Pickup Service for Rural Ambulances

June 17, 2024

Crystal Hiwalker wonders if her heart and lungs would have kept working if the ambulance crew had been able to give her a transfusion as the blood drained from her body during a stormy, 100-mile ride.

Because of the 2019 snowstorm, it took 2.5 hours to drive from her small town of Lame Deer, Montana, to the advanced trauma center in Billings.

Doctors at the Billings Clinic hospital revived Hiwalker and stopped the bleeding from her ruptured ectopic pregnancy. They were shocked that she not only survived after her heart stopped beating and she lost nearly all her blood, but that she recovered without brain damage.

The Montana State Trauma Care Committee, which works to reduce trauma incidents and to improve care, later realized the ambulance that carried Hiwalker had passed near two hospitals that stocked blood. What if Hiwalker had access to that blood on her way to Billings, committee members asked.

That realization, and question, inspired committee members to create the Montana Interfacility Blood Network, which they say is the first program of its kind in the U.S. The network allows ambulance crews to pick up blood from hospitals and transfuse it to patients on the way to the advanced care they need.

“We kind of came up with the idea of having a blood handoff — like driving through a fast-food restaurant drive-thru — and picking up blood on the way,” said Gordon Riha, a trauma surgeon at the Billings Clinic trauma center, where Hiwalker was treated. Riha said timely blood transfusions can prevent death or permanent brain injury.

The network is aimed at rural patients, who face elevated rates of traumatic injuries and death, said Alyssa Johnson, trauma system manager for the state of Montana.

“We have to get more creative. We don’t have a blood bank on every corner, and we don’t have a Level 1 trauma center on every corner,” Johnson said.

Network leaders say the program has helped at least three patients since it launched in 2022. They hope it will be used more in the future.

Hiwalker is excited about the program.

“I’m so glad that something like this got started, because it would save a lot of lives from where I live,” she said.

Hiwalker said she has heard about people bleeding to death after car crashes, gunshot wounds, and stabbings in her rural community. Johnson said work injuries, cancer, gastrointestinal problems, and childbirth can also cause serious bleeding.

The Montana trauma committee began discussing the blood network a few months after Hiwalker’s brush with death. First, it created a map of 48 facilities with blood banks. Then, it created guidelines for how hospitals, blood banks, ambulances, and labs must communicate about, package, transport, document, and bill for the blood.

The network is used only during emergencies, which means there’s no time to test patients’ blood types. So it uses only type O red blood cells, which can be transfused safely into most patients.

The receiving hospital — not the one that provided the blood — is responsible for billing patients’ insurance for the blood. The cost depends on how much blood patients need but typically ranges from several hundred dollars to more than a thousand, said Sadie Arnold, who manages the blood bank at Billings Clinic.

Arnold said blood must be stored in a lab and managed by professionals with specific degrees, clinical experience, and board certifications.

Some rural hospitals lack space for a lab or money to recruit these specialists, Arnold said. Or they may not need blood often enough to justify storing a product that can expire and — especially during the current national blood shortage — is needed elsewhere. The network uses blood that has a maximum shelf life of 42 days.

Rural hospitals that do store blood may have only small amounts on hand. A rural Montanan with severe bleeding experienced that firsthand when he went to the nearest hospital, which had only one unit of type O blood, according to a report on the blood network. But thanks to the new program, ambulance medics picked up more blood from a hospital halfway through an 80-mile drive to the trauma hospital.

Ideally, rural patients with serious bleeding would be transported by medical helicopters or airplanes outfitted for transfusions. But, as in Hiwalker’s case, flying can be impossible during bad weather. That can mean hours-long ambulance rides. Some towns in northeastern Montana, for example, are more than 250 miles away from the nearest advanced trauma center.

“This was truly designed for kind of that last-ditch effort,” Johnson said. When “we’re out of options, we’ve got to get the patient moving towards a larger center, and we can’t fly.”

The blood handoff may involve the ambulance stopping at the second hospital, Johnson said. But during one incident, a police officer picked up the blood and delivered it to the ambulance at a highway exit, she said.

Ambulances may also pick up a paramedic or nurse to provide the transfusion along the way, since many rural ambulance crews are staffed by emergency medical technicians, who in Montana aren’t authorized to do so.

Medics in other cities and states, including ones with rural areas, have started performing blood transfusions in ambulances and helicopters, said Claudia Cohn, chief medical officer of the national Association for the Advancement of Blood & Biotherapies.

She said researchers are also interested in the potential of using frozen and freeze-dried blood products, which could be helpful in rural areas since they’re easier to store and have longer shelf lives.

Johnson said the Montana Interfacility Blood Network is the only program she knows of specifically aimed at rural patients and involving ambulances picking up blood from hospitals along their routes. She said the network is gaining interest from other states with large rural regions, including Oregon.

Hiwalker said receiving a blood transfusion in the ambulance could have prevented her near-death experience and the trauma her husband faced from seeing her suffer as he rode in the ambulance with her. She’s glad her ordeal led to an innovation that is helping others.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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