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PaperclipPerfector  2mo ago (text post)   35696 thread views

Culture War Roundup for the week of February 3, 2025

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Reuters: Health clinics grapple with US funding squeeze

It seems funding hasn't been fully restored and a lot of affected clinics don't have sufficient cash reserves:

Three community health centers near Richmond, Virginia, were forced to shut down after federal funds used to pay staff salaries remained inaccessible since last week, said Virginia Community Healthcare Association spokesperson Joe Stevens.

As of Friday, another nine centers across Virginia also could not access federal funds but continued to see patients by tapping into reserve funds.

"They will need money in the next week," said Stevens. "We don't know why some centers can access funds and some cannot."

In Virginia, community health centers provide medical, dental, behavioral health, pharmaceutical and substance use services for approximately 400,000 patients. For much of the state's rural areas, the centers are the only option for primary care, said Stevens.

One center that was still unable to access federal funds is in southwestern Virginia, where the next closest option for medical care is more than an hour's drive, he said. Most providers were able to access Medicaid and grant monies once the spending freeze was rescinded. However, some say they are still cut off from payments used for essential care, including medical, dental, prescription drugs and behavioral health.

And, of course, problems with transgender-serving clinics and federal grants for STI prevention and treatment:

Late last week, some healthcare centers that provide HIV prevention services and care for transgender patients received notices that grants issued by the U.S. Centers for Disease Control and Prevention would be terminated. The letters cited the Trump administration's orders on diversity and gender identity, according to three recipients of the notices.

A spokesperson for the U.S. Centers for Disease Control and Prevention referred questions about the grants to the Department of Health and Human Services.

St. John's Well Child and Family Center, a network of public health centers in South and Central Los Angeles, cannot access $746,000 remaining from a $1.6 million grant used to provide prevention, testing and treatment for about 500 transgender people at risk of HIV, sexually transmitted infections, tuberculosis and hepatitis C.

"We have made a decision not to cut back any programs because of any threats from the federal government," said St. John's President Jim Mangia.

St. John's has joined a lawsuit filed by California's attorney general contesting the funding cuts. Mangia says he will seek private funding to make up the loss.

The LGBT Life Center in Norfolk, Virginia, received a letter stating $6.3 million of the organization’s funding, or 48% of its annual budget, would be terminated, said spokesperson Corey Mohr. The center provides medication and monitoring to 400 patients with HIV.

I'm curious what the LGBT Life Center's grant was for, given that St. John's had 25% more patients. Maybe it was specific to HIV-positive patients and treatment is genuinely more expensive than prevention? But I had thought PrEP, PEP, and ART were the same medication at different doses, and that progression of HIV to AIDS is very uncommon, so that wouldn't make much sense.

St. John's Well Child and Family Center, a network of public health centers in South and Central Los Angeles, cannot access $746,000 remaining from a $1.6 million grant used to provide prevention, testing and treatment for about 500 transgender people at risk of HIV, sexually transmitted infections, tuberculosis and hepatitis C.

When I was younger, I had developed pretty libertine attitudes about human sexuality and I still mostly have the same gut feelings, but every now and then, I bump into things that make me think the conservatives have a point. This is roughly $3K per person for STI testing and treatment. Why? Why do these people insist on doing such consistently risky behavior that they need constant STI surveillance? Even being somewhat promiscuous doesn't result in constant infections, the behavior here really just has to be completely outside the range of anything that most people would consider normal. As you note, the other Life Center apparently spends about five times that much per capita, clocking in over $15K per person.

Making everyone else pay for egregiously bad behavior is just galling.

This stuff never stays confined to one community forever. In addition, the US medical system guarantees anyone access to healthcare (if they don’t pay for it, the state and/or all insurance users do), so you’ll be paying for much more expensive AIDS treatment in the long haul. If reducing promiscuity is the goal, cutting funding for PrEP seems like a poor place to start; gay men were highly promiscuous even at the height of the AIDS pandemic (that is in fact how it happened) and I doubt they will become less so today, when the disease is more easily treated and no longer a death sentence.

I am open to the idea that this is actually the best policy given a number of realistic political constraints. This does not move me to find it less galling that I'm stuck paying for people to live degenerate lifestyles. Avoiding HIV is absolutely trivial, but the "community" in question apparently insists on spreading HIV.

I also don't care for that lifestyle, but "engaging in risky behavior argument" as justification to deny care can be used for almost everything. Car accident while going too fast and not wearing a seatbelt? Snowboarding? Downhill skiing? Smoking? Football in high school? etcetera .

Wisdom involves judging and drawing up permissible and impermissible risks.

Playing football in high school is risky. Self-testing novel chemical amphetamines you bought online is also risky. But they're not the same kind of risk.

Having sex with a 17.9 year old or an 18.1 year old doesn't seem very different. But it doesn't then follow that 35 year old men should have ready access to 12 year old girls. At some point a line must be drawn on a qualitative, continuous and complicated scale. And people must fundamentally reason out a series of rules, guidelines and reasonable applications of flexibility in special cases to make this work.

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