Washington, DC, United States (KaiserHealth) – The U.S. is in the middle of a steep and sustained increase in sexually transmitted diseases.
So how are public health officials responding?
In northwest Oregon’s Clackamas County, health officials have decided to ask anyone who comes in with an STD who their sexual partners are – and then track those partners down.
That job falls to two women: registered nurse Mary Horman and disease intervention specialist Liz Baca. They do most of the work over the phone, telling people they’ve had a partner (no name is revealed) who has tested positive for gonorrhea, HIV, chlamydia or syphilis.
It’s a difficult conversation. And many people can’t be reached via phone. So about once a week, Horman and Baca jump into a car and start knocking on doors.
“It can definitely be scary at times,” Baca said, “especially those rural areas where you’re really relying on the GPS to get you there, and sometimes there are roads that lead you to nowhere.” So far, they haven’t gotten lost.
Plenty of residents in the county’s outskirts own firearms, Baca said, and are comfortable displaying them if they feel they need to protect their property.
“I always try to make myself visible and not be fidgety,” she said. Her goal is to approach with as much warmth as possible, saying, “‘I have a nurse with me.’ Or, ‘My name is Liz, and I work for Clackamas County.'”
The women travel as a pair and never enter a home, she said. And they always carry a cellphone to keep the home office informed of their whereabouts.
On the afternoon I caught up with them, Horman and Baca already had been challenged by a dog and had to leave a trailer park empty-handed. They had the right location, but didn’t know which door to knock on. And they couldn’t just ask around, because neighbors might guess why the health department is tracking someone down, and that would be a breach of medical privacy.
They next called on a 64-year-old laborer, whom we’re identifying only as Larry for those same privacy reasons. He agreed to talk with them, in hopes of warning other people about the substantial risks of syphilis.
Carol Bush, 58, of Elkins, W.Va., expects to lose coverage Oct. 1 because her job is ending.
It’s an unfortunate irony: Elkins has served for the past three years as a navigator helping people in her community find coverage in the health law marketplaces. Federal officials have largely scrapped that program.
The Trump administration cut funding by more than 80 percent during the past two years, saying it had no proof that navigators were helping people find coverage. Only if consumers signed up in the presence of the navigator was a session considered a success.
Bush had coverage through the University of West Virginia, which has a navigator contract that ends at the end of this month. Without employer coverage, Bush said, the cheapest insurance she could find would be about $1,100 a month. She won’t qualify for a federal subsidy to lower her premium because of her family’s income. Her husband is insured through Medicare.
Although she said she has strongly considered going without insurance because of the cost, she knows she needs it.
“In all honesty, I’ve always had some kind of health insurance, and the thought of being without it worries me,” she said. “I can’t risk getting seriously ill and incurring enormous debt at this point in my life. Peace of mind has a value too.”
Shenandoah Community Health Center, a federally funded health clinic in Martinsburg, W.Va., has started to see an increase in uninsured patients the past year, although it’s still below levels it saw before the health law’s coverage expansion began in 2014, said CEO Michael Hassing. Hassing said he believes many patients have dropped coverage, thinking the ACA’s individual mandate was repealed.
“Folks say, ‘I don’t need to have it anymore,’ and they let it go,” he said.
While the GOP failed last year to repeal the law, Congress was able to strip out one of its key features – the individual penalty for not having coverage. The vote last December eliminated that penalty starting in 2019 – meaning Americans are still required this year to have health coverage or face the consequences on their 2018 taxes.
– Provided by Kaiser Health News.
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