Michigan is one state that has been host to repeated violations of HIV-positive persons’ rights, as has been frequently documented by The American Independent’s former sister site The Michigan Messenger. And a recent study into the application of Michigan’s HIV disclosure laws has uncovered policies in some local health jurisdictions that experts say are troubling in their implications to reproductive freedom and personal privacy.

Trevor Hoppe, a Ph.D. candidate in women’s studies and sociology at University of Michigan, has been conducting extensive interviews with local health department officials about how they have been applying state laws related to HIV. In the course of that study, Hoppe identified several health departments that are using pregnancy, partner-notification services, and sexually transmitted infection (STI) reports to initiate what’s known as “health threat to others” actions (HTTO). To ensure the anonymity of the respondents, Hoppe’s study did not identify specific health departments or counties where these policies were uncovered.

HTTO is a state law that allows health officials to intervene in the private lives of people who have serious infectious diseases. The initiation of an HTTO starts with a formal cease and desist letter with a demand for the person in question to appear at the local health department on a specific date. From there, health officials can do anything from prescribing counseling to seeking a court order to civilly confine a person for as long as six months.

Issuance of an HTTO order is also documented in a statewide database. That database is coded, but it is names-based and accessible to any health official in the state. A person remains in that database indefinitely – until the HTTO order is lifted by local and state health officials. And sometimes it’s never lifted.

Hoppe presented the results of his (currently unpublished) study in August at the 2011 National HIV Prevention Conference (PDF), held in Atlanta. Among the results, he found that two health departments were starting HTTO actions against HIV-positive women after knowing only two things about these women: They were pregnant; they were HIV-positive. The assumption underlying the HTTO actions against them was that the women engaged in behavior that would lead to a significant risk of HIV transmission in others.

What makes a human a ‘health threat’?

Joshua Moore, who runs Detroit Legal Services, a law firm focused on HIV issues and the law, told The American Independent that the policy of labeling people as ‘health threats’ with insufficient evidence is problematic for many reasons.

“The obvious concern is that the pregnant HIV-positive woman is not a ‘health threat to others’ based on the fact that she is simply HIV-positive,” Moore said. “This concept is just outrageous. Many HIV-positive women are choosing to have children safely and are not putting anyone at risk for contracting HIV. The fathers of these children are either HIV-positive themselves or are aware of their partners’ HIV status.”

These health departments have taken up this HTTO policy against pregnant HIV-positive women in spite of recent studies that have shown that in serodiscordant couples (where one partner is HIV-positive and the other is HIV-negative), the use of successful antiretroviral treatment reduces the risk of infection by 96 percent. In addition, the Centers for Disease Control and Prevention (CDC) in Atlanta reports the risk of HIV transmission to newborn babies is reduced to less than 2 percent for pregnant women who are on successful treatment during pregnancy, labor, and delivery and if babies are immediately treated with the medications. Even starting treatment only at labor and delivery reduces the risk of transmission to under 10 percent.

Nicole Seguin, of the Positive Women’s Network, told TAI that the kind of policy highlighted in Hoppe’s study is troubling. As an HIV-positive woman who chose to have a child while positive, Seguin said she worked very closely with her doctor and staff to ensure a safe pregnancy.

“The circumstance of a woman’s HIV status should not allow for an initiation of a ‘health threat to others’ action and diminish the responsibility doctors have to adequately explain medical choices to his patient so that she is comfortable and can consent to all procedures and interventions during pregnancy and birth,” Seguin said. “It erodes women’s reproductive rights by taking away the medical choices that every person is entitled to simply because the woman is living with HIV, and pregnant.”

Similar actions occurred in Mississippi until the U.S. Department of Justice intervened and ordered the state to stop directing people with HIV not to have children.

“Pregnancy in and of itself is not a sufficient reason to define an individual as a ‘health threat,’” said Angela Minicuci, spokesperson for the Michigan Department of Community Health (MDCH). “Local health departments carefully evaluate individual cases in order to determine whether they should be considered ‘health threats,’ as defined by statute, and if they are, appropriate action to be undertaken. We are not aware of action being taken against HIV-positive women for getting pregnant.”

Violation of privacy

In addition to the pregnant women being targeted, a more dangerous activity from public health officials was uncovered by Hoppe. Under Michigan law, the names of all people who test positive for HIV are reported to the MDCH. They are kept in a centralized, coded database. While the move to the names-based reporting was mandated by the CDC and fought by those living with HIV, the state assured the database would be used only as a list of those living with the virus.

What Hoppe discovered was that health officials were comparing the names of individuals named in partner services counseling with the state database. Partner-notification services are voluntary, and the state mandates only that the assistance to contact partners at risk be offered. The counseling session often happens at the same time a person is diagnosed with HIV or another STI. That period can be one of deep trauma, and many advocates have argued the counseling programs can turn coercive.

Hoppe found that when a person tests positive for HIV, health officials in at least three jurisdictions will solicit names as part of partner-notification services. With a list of names in hand, health officials will compare that list to the state database, and if any name on the partner-notification list pops up on the statewide list, health officials will initiate an HTTO action against that person.

“Anytime a government agency uses names inappropriately, it is a threat to the civil liberties of those with HIV, as well as those who are not infected with HIV,” said attorney Moore. “Often, partner notification laws are abused by individuals. Issuing an HTTO to a person simply because they were mentioned in a partner notification and are in the state database would not mean that individual is an automatic HTTO. To suggest that anyone would automatically be a HTTO under these circumstances is an extreme scenario.”

Perpetuating the criminalization of HIV-positives

The final stunning discovery from Hoppe’s study is that some local health departments have begun initiating HTTO actions against HIV-positive persons who test positive for other sexually transmitted infections.

Hoppe quoted “Fern,” an anonymous disease investigator from a local health department, in his PowerPoint presentation at the HIV conference earlier this year.

“Well, usually it’s all the sudden their name appears with another STD… So… if the [syphilis coordinator] has any syphilis cases where they’re also showing that they’re HIV-positive, then her and I work together and we – you know, if I’ve got a case report – then it goes to a ‘health threat to others,’ more or less. Because if they come up with syphilis, they’re having unprotected sex.”

But that’s false logic. What distinguishes syphilis from other STDs is that it can be spread by skin-to skin contact. Thus, contrary to Fern’s conclusions, a syphilis infection does not necessarily indicate unprotected sex.

Minicuci, of the state health department, said Hoppe’s findings in relation to STIs and partner-notification services are accurate.

“Under the Michigan Public Health Code and Administrative Rules, public health is permitted to use available disease reporting records to aid in disease investigation and to support prevention,” she told TAI. “Michigan’s Public Health Code grants public health the ability to prevent and control disease, including collecting information, case investigation, and action to prevent the spread of disease. Confidentiality of all reports, records and data pertaining to testing, care, treatment, reporting, research, and information pertaining to partner notification activities is, however, protected by law (MCL 333.5131 (7)).”

This news comes as some states are seeking permission to use results of viral load tests and immune function tests to track down people with HIV who may not be on medications or who have developed resistance to their HIV medications. Such a proposal in New York state has activists there rattled. The Obama administration’s National HIV/AIDS Strategy called for the monitoring and collection of these test results with the theory that reduction in community viral load will lead to reduced new infections.

Though Michigan has collected these results for years, Minicuci said the results are not used to track down individuals.

“Currently MDCH collects HIV viral load, western blot, and CD4 results for epidemiological surveillance of HIV disease in Michigan,” she said. “Physicians will follow up with their patients on any positive HIV test results (such as a detectable viral load and reactive western blot) and will then report that case to the MDCH for the epidemiological surveillance. Additionally, viral load (detectable and undetectable) and CD4 results are aggregated and used to identify areas of the state where there may be gaps in service for persons living with HIV. This helps us to make well-informed funding decisions.”

Mark Peterson, a director of the Michigan Positive Action Coalition (MI-POZ), said the study’s discoveries are “disturbing” in how they malign people with HIV but not people who regularly contract other STDs.

“How often does public health in Michigan apply health threat measures against someone who has repeated STIs that don’t include HIV?” Peterson said. “Conversely, how often are the same measures applied when HIV in present?

“Our public health messages have stated that people with HIV can live long and happy lives, that HIV is no more of a health consequence than diabetes, yet continued stigma related policies show that this is not actually the real case,” he continued. “If presence of HIV is the main reason that health threat cases are begun, then what we’re doing is criminalizing HIV and those living with it. We can’t say something is ‘chronic and manageable’ and then go to the extremes in health threat cases. People with HIV need comprehensive and compassionate care that includes individualized education, counseling and skills building on how to keep themselves from getting another STD because it is bad for their health. They don’t deserve to be labeled as imminent public threats simply because they have a virus, while the individuals who continually get other STIs are held harmless.”

Peterson was not alone in raising concerns about the local health departments’ actions.

Catherine Hanssens, executive director of the Center for HIV Law & Policy in New York, told TAI that the discoveries highlighted in Hoppe’s study have troubling implications.

“All women retain the constitutionally protected right to reproductive choice, including the right to bear a child, and this right is not affected by an HIV diagnosis,” she said. “Similarly, a policy that treats evidence that a person with HIV is sexually active as tantamount to positing a HTTO, without more [evidence], likely is a violation to the related right to sexual expression and intimacy. The fact that cooperation with partner-notification services can lead to intrusive government actions against a partner raises serious public health and privacy issues.”

Sean Strub, founding publisher of POZ Magazine and a board member of the Global Network of People with HIV North America, echoed Hanssens’ concerns.

“This is about punishing people with HIV for being sexual – that’s the real agenda here,” Strub said. “These are horrible, but increasingly typical, examples of how people with HIV are increasingly treated as a problem population to be tagged, regulated, controlled and criminalized. … Using the excuse of public health to oppress people is not new. The Nazis were pioneers in this regard. It is unfortunate to see Michigan officials following their lead.”

Photo: Flickr/Monifoto.net

UPDATE: Oct. 6 Amended with a correction.

A new congressional proposal to funnel federal grant money from sex-education programs that instruct in pregnancy and STI-preventive measures into abstinence-only curriculum evokes memories of a similar federally-mandated initiative that emerged during the Bush administration.

The Bush-era Community Based Abstinence Education (CBAE) program received criticism for peddling medical inaccuracies (PDF) and faded upon the advent of the Obama administration. One beneficiary of grant funding was the Palmetto Family Council, whose abstinence-only education curriculum relied heavily on some of the same points criticized throughout the duration of the CBAE program.

In 2008, a government report (PDF) cited the ineffectiveness of CBAE abstinence-only sex-ed programs. At the end of 2009, the Obama administration reduced abstinence-only spending, boosted spending for prevention-oriented programs and totally wiped out the CBAE program, the most controversial of the bunch because funding largely went to anti-abortion-rights organizations and crisis pregnancy centers. Between 2005 and 2009, the federal government expended almost a half-billion dollars in non-matching CBAE grants, according to the federal 2010 budget (PDF).

South Carolina’s Focus on the Family affiliate the Palmetto Family Council (PFC) received $1.2 million in CBAE support in 2008-09 for their abstinence-education project, which went to great lengths in linking sex outside of marriage to depression, according to grant documents recently obtained by The American Independent through the Freedom of Information Act (FOIA).

‘Sex is fire’

Hitting all points of the Bush administration’s eight-point A-H definition of abstinence-only sex education, PFC’s BTrue Youth Leadership Project was designed to dissuade teenagers from having premarital sex by teaching sexual activity within the context of a monogamous marriage is the expected American standard and sex outside of marriage will likely lead to harmful psychological and physical effects.

PFC contracted Charleston, S.C.-based Heritage Community Services to develop the curriculum, which uses a risk-elimination rather than a risk-prevention model, employing the analogy that “sex is fire.” Essentially, the message is that sex, like fire, is safe within the right place but unsafe outside a protected place. In this analogy, the safe, protected place is marriage.

Illustrating this philosophy is a student video on the still-functioning BTrue social-media network (WhyBeTrue.com), in which a boy is shown armed with a helmet and layers of protective gear before he plunges into oncoming traffic; another scene shows the same boy wearing only regular clothes but walking on the shoulder of the highway, out of harm’s way.

To carry out the BTrue program, Palmetto solicited help from church organizations statewide for access to students and meeting spaces. Alex Morales signed a letter saying that his Lino, S.C.-based organization Same Page Ministries would provide access to between 50 and 100 students. Ultimately, Morales provided access to one student, his son, Danny, who serves as the face of the lecture series.

The first lesson of the curriculum begins with Danny explaining the project’s connection to religion:

The message of abstinence of sex until marriage is not a religious message per say. A decision to wait is a decision made every day, by teens of all faiths, and by those who profess no religious faith or belief in God at all. But BTrue is also consistent with the principles of the Christian faith and other religious beliefs. In the BTrue Tube videos, we do not reference the Bible or the teachings of Christ, but we believe that the BTrue cause is a Christian cause.

Organizations such as Washington, D.C.-based Advocates for Youth*, which works for adolescent reproductive and sexual health, and the Sexuality Information Education Council of the United States (SIECUS) have condemned the CBAE program and its biggest curriculum writer, Heritage Community Services, because they claim the program is ineffective at preventing teen pregnancy and STIs, and because it often wields a faith-based component. When asked for comment on Palmetto’s project, Advocates for Life’s Emily Bridges chose to comment on CBAE projects generally.

“We find a ‘one size fits all’ approach to morality to be really problematic,” Bridges said. “Waiting until marriage is a moral goal for many young people, but not ALL young people. Delaying sex until a time when the young person is prepared for safer sex and in a committed relationship is not only a goal that fits within many people’s ideology/moral beliefs, but is also a way the young person can protect themselves from pregnancy, HIV, and STIs. And to do that, they need education about all their options, not just one option.”

Sex outside of marriage = depression

The curriculum, along federal guidelines, focused on the harmful psychological effects of sexual activity outside of marriage.

In PFC’s grant application, curriculum plans were outlined to discuss the “sex related regret & emotional pain” and the “connection between teen sex and depression.” It was encouraged to discuss the importance of beginning the wedding day “regret-free.” The curriculum design also mentioned plans to address “risky behaviors that come with teen sexual activity: alcohol, drugs and violence” and that “marriage decreases such stresses.”

A December 2004 report (PDF) commissioned for Rep. Henry Waxman (D-Calif.) on the efficacy of sex-ed programs such as Palmetto’s outlines specific problems with CBAE, among them medical inaccuracy, such as baseless claims that sex outside of marriage leads to depression and/or mental illness.

Waxman’s report, which evaluated 13 sex-ed curricula, demonstrated that 11 of them included distorted information about the effectiveness of contraceptives and the risks of abortion. The report also found these curricula often blurred religion and science and stereotyped males and females.

In October 2006, the Government Accountability Office released a report (PDF) on the federal government’s efforts to assess the accuracy and effectiveness of federally-funded programs. The report found the U.S. Department of Health and Human Service’s Administration of Children and Families, which awards CBAE grants, did not review its grantees’ education materials for scientific accuracy. Following this revelation, grantees — including PFC — were forced to sign forms declaring their curricula were “medically accurate.”

In May 2008, both PFC President Oran P. Smith and Heritage Community Services CEO Anne Badgley signed a statement declaring: “I hereby attest and certify that all medical materials proposed in this application and funded during the project period of this grant are medically accurate.”

Stan Weed, director of the Institute for Research & Evaluation (IRE), was identified in grant documents as the “3rd party independent evaluator” tasked to review PFC’s project and curriculum. As TAI reported previously, IRE had a relationship with Heritage; specifically Weed developed the “predictors of adolescent sexual initiation,” which is taught to Heritage educators during their training. In the end Weed did not work on the project; Paul Birch, now a senior research associate at Evans Evaluation, whose name is not mentioned in the grant application, was the evaluator.

Abstinence and marriage

Abstinence and marriage are promoted at seemingly equal rates throughout Palmetto’s curriculum. At the end of the second lesson, there are three videos where participating adult staffers discuss what abstinence means to them. One woman, talking about how she rediscovered abstinence after she first started having sex, emphasized how much fun marriage is.

In another the video, a student says marriage between a man and woman is beautiful, which is in direct compliance with CBAE requirements that mandate a one-man, one-woman definition of marriage.

The only way to prevent STIs and unwanted pregnancy, Palmetto’s programs materials suggested, is through marriage. But as Bridges pointed out, that does not leave a lot of room for people who do not necessarily intend to get married, or for gay men and lesbians, for whom marriage in many states is illegal.

“Any program that asks young people to wait until marriage to have sex is inappropriate for gay and lesbian young people, who can’t get married in most states and at the federal level,” Bridges said in an email. “They are being at best ignored and made to feel invisible. They’re being given a choice to either stop being gay; never have sex in their life; or become shameful, emotionally harmed, etc. … They need sex education that helps them protect themselves, not lectures about abstinence until a marriage they can’t legally enter into.”

An excerpt from PFC’s grant proposal, describing how it will promote “healthy marriage,” reads:

A-H legislation is about healthy marriages. PYN [Palmetto Youth Network] will equip youth and adults with skills/knowledge to [1] abstain from sex until marriage, [2] develop healthy relationships and marriages and [3] remain faithful when married. Since 1994, Palmetto Family Council has worked to strengthen SC’s families. Its mission is to promote a positive marriage/family culture by utilizing media and existing community, business and faith networks to promote an understanding of marriage’s central role to the fabric of society and to provide the skills/knowledge needed to form and sustain healthy marriages. … [Heritage Keepers Abstinence Education] teaches students the differences between lust, infatuation and love and the differences in cohabitation and marriage. Why Marriage Matters: 26 Conclusions from the Social Sciences is basic to all curricula.

The “Why Marriage Matters” report (PDF) Palmetto referred to as being “basic to all curricula” in the project was produced by the Institute for American Values, and infused with research and editorial assistance by Maggie Gallagher, who recently stepped down as president of the nation’s leading group working against marriage for gay men and lesbians, the National Organization for Marriage. In 2007, PFC was involved in a campaign to amend South Carolina’s constitution to ban same-sex marriage. The amendment passed in 2007; it was listed as Palmetto Family’s “top priority” the year before.

*Correction: TAI previously mis-identified the organization Advocates for Youth as Advocates for Life. We regret the error.

Using data from the 2006-2008 California Women’s Health Survey, the researchers studied approximately 3,000 women ages 18 to 44 and discovered that African-American and foreign-born Asian women were at a higher risk than white women of becoming pregnant unintentionally because of the types of contraceptive methods they were using. To come to this conclusion, birth-control method choice was compared to the subjects’ racial, ethnic, demographic and socioeconomic characteristics.

The research team identified the following contraceptive methods, ranked in descending order of effectiveness: male sterilization, female sterilization, intrauterine devices (IUDs), implants, injectables, vaginal ring, patch, pill, male condoms, other regular methods (i.e., spermicide, natural family planning), emergency contraception only and none. IUDs and hormonal methods were classified as “high-efficacy” and all other methods as “low-efficacy.”

(The report notes that female and male sterilization methods and the IUD have failure rates of less than 1 percent; birth control methods such as the ring, patch and pill have failure rates of 5-9 percent; and condoms have typical failure rates of 17-18 percent. However, according to the Centers for Disease Control and Prevention (CDC), condoms can be 98 percent effective if used correctly.)

When controlling for demographic and socioeconomic characteristics, the study team found that:

• Blacks, foreign-born Hispanics and foreign-born Asians had lower odds than whites of using “high-efficacy” reversible methods.
• Of all the racial groups, white women were the least likely to report using no contraceptive method during sex (19 percent), while black women were the most likely to report using no method (28 percent).
• Whites were more likely to rely on male sterilization than were other sub-groups, especially foreign-born Asians (16 percent). U.S.-born and foreign-born Asians were less likely to use female sterilization (2 percent and 4 percent, respectively) than were others (8–17 percent).
• U.S.-born Asians were more likely to use the hormonal birth control pill than any other racial group (28 percent); pill use was least common among blacks and foreign-born Hispanics (16-17 percent).
• Condoms were used most among U.S.- and foreign-born Asians (25 percent and 36 percent, respectively) and least among whites (16 percent).
• Overall, 21 percent of women reported not using any contraceptive method. Women were most likely to use the pill (23 percent) or condoms (20 percent), followed by male or female sterilization (10 percent for both) and IUDs (8 percent), followed by injectables (3 percent), the ring (2 percent) and the patch (1 percent).

Ethnic disparities were not found, however, in the use of IUDs, the report found.

The data also revealed that differences in income level also accounted for contraceptive method choice.

• Women in the highest income category were more likely to rely on male sterilization (15 percent vs. 2–6 percent in lower income groups) or the pill (26 percent vs. 17–18 percent) and less likely to report not using any contraception (19 percent vs. 23–26 percent).
• High school graduates were more likely than non-high school graduates to report not using any birth control (21 percent vs. 25 percent).
• IUD and condom use differed little by income or educational level.

National studies, such as a recent Guttmacher Institute report, on unintended pregnancies among American women, have found disparities among socioeconomic group, but the California study suggests that other factors influence what type of woman uses (or does not use) a certain kind of birth control method.

Based on the findings, the researchers identified a need for further research of birth-control use among various minority groups, coupled with intervention programs that target minority groups at high risk for unintended pregnancy.

“Our study underscores the need for improved understanding of contraceptive behavior among minority women,” the researchers write. “Other potential influences on differences in contraceptive use by racial, ethnic and income characteristics include client knowledge of contraceptives and values regarding method choice. … Asian women are of particular interest because of the relative lack of reproductive health information on this population and their relatively low rates of use of high-efficacy methods.”

The Papacy’s official newspaper, L’Osservatore Romano, this week published an editorial decrying the “failed utopia of sexual revolution” and suggested the policy will likely achieve the opposite of the desired effect, which is to reduce rates of unintended pregnancy and sexually transmitted diseases (STD) throughout the city, especially in Latino and African-American communities. The Vatican called the initiative “useless and even harmful.”

The new policy goes into effect this school year, which officially begins for students on Sept. 8, and requires schools to teach students in sixth grade and up sex education that includes instruction on abstinence, the risks of unprotected sex, puberty and pregnancy. The new rules also mandate the teaching of healthy eating and the importance of regular exercise and gives parents the option of opting-out their children from discussions of birth control methods.

The Vatican’s stance on the issue, as voiced by L’Osservatore Romano’s Lucetta Scaraffia, is that while unintended pregnancy, STDs and abortion are existing problems worldwide, sex education is not the answer, and, in fact, decreases their rates. Scaraffia compared New York to Italy, which she said is “better off” because there is no compulsory sex education in schools.

[H]ere young people have a lower risk of disease and early pregnancy. This is thanks to the family, to the loving vigilance of parents over their children, to the fact that kids are not left to themselves with a box of contraceptives as the only defense against their passions and mistakes.

[...]

It is not clear why public institutions in the West continue to have such magical trust in the effectiveness of sex education. After years of courses, focused, of course, on contraceptive methods, we see that – for example in the UK – boys and girls continue to have early sexual intercourse without any kind of protection, and the number of pregnancies and abortions among adolescents has multiplied. By now, it is clear that to avoid these tragedies it is not enough to explain to them how they can use contraceptives, and where to easily find them, but that the problem is further upstream, in education and in the family.

The Archdiocese of New York has also openly criticized the initiative, calling the citywide sex-ed mandate “troubling.”

New York’s new law standardizes public-school sex education curriculum, which has been taught in most schools in various forms. The new curriculum will be taught in sixth and seventh grades and again in ninth and 10th grades.

In the U.S., 21 states and the District of Columbia mandate some type of sex education, and 33 states and the District of Columbia mandate HIV education, according to the Guttmacher Institute (PDF). Thirty-seven states require that where sex education is provided, information on abstinence must be given: Of those states, 26 require that abstinence be stressed, and 11 states require that abstinence be covered.

Ultimately, Scaraffia notes, the Catholic Church will continue to teach and promote public policies promoting the idea that “sexual relations are much more than some kind of pleasurable exercise to be practiced in an unbridled and risk-free way.”

Seniors and people with disabilities who receive health care through Medicare* might have an additional service covered in the near future: testing for sexually transmitted diseases such syphilis, gonorrhea and hepatitis B, according to a Reuters report. Centers for Medicare and Medicaid Services (CMS) is due to decide on the measure within the next nine to 12 months.

Government-funded health insurance already covers HIV testing, but now CMS is looking into paying for additional STD exams, in an effort to promote preventative care and reduce the amount spent on costly treatments for people who do become infected.

CMS spokesperson Don McLeod said that under the Affordable Care Act, Medicare has to cover what other private insurers cover if the government deems these procedures appropriate and necessary. Cost of the increased coverage is never factored into CMS’ determination, he said.

“Somebody else has to worry about how to pay for it.”

The tests up for consideration -– chlamydia, gonorrhea, hepatitis B and syphilis -– target people considered to be high risk for these diseases: women, pregnant women and people with disabilities.

The Centers for Disease Control and Prevention estimates:

• Approximately 1.2 million chlamydial infections were reported in 2008, though the disease is frequently under-reported because many people don’t know they have chlamydia and do not seek testing. In women, untreated infections can increase the risk of HIV, cause pelvic inflammatory disease, and lead to infertility or pregnancies outside the uterus.
• More than 700,000 Americans contract new gonorrheal infections each year, but only about half of these infections are reported to the CDC. A pregnant women with gonorrhea can give birth to a baby who is blind or has a life-threatening blood infection.
• In 2007, there were an estimated 43,000 new hepatitis B virus infections in the U.S., and an estimated 800,000 to 1.4 million Americans have chronic hepatitis B.
• More than 36,000 cases of syphilis were reported in 2006. Reported cases of congenital syphilis in newborns increased from 339 in 2005 to 349 in 2006. Pregnant women with syphilis are at greater risk at giving birth to stillborns. Rates have increased in men every year between 2000 and 2006 from 2.6 to 5.7 percent. In 2006, 64 percent of reported syphilis cases were among men who have sex with men.

According to Reuters, since 2009 CMS has had the power to add coverage for preventive services; currently Medicare covers pap smears and pelvic exams and tests for colorectal cancer and diabetes.

Furthering preventative care, the Department of Health and Human Services announced Thursday that it will allocate $100 million to states that offer incentives to Medicaid beneficiaries who adopt healthy habits, as part of the Affordable Care Act. For instance, a state could establish a set of goals -– such as quitting smoking or losing weight -– and people who meet those goals could be offered direct cash incentives, gift cards, reduced Medicaid program fees or even services not normally available through Medicaid.

“With the right incentives, we believe that people can change their behaviors and stop smoking or lose weight,” said CMS Administrator Dr. Donald Berwick, in a press release. “Not only can preventive programs help to improve individuals’ health, by keeping people healthy we can also lower the nation’s overall health care costs.”

The Centers for Medicare & Medicaid Services is now inviting proposals from states to compete for grant awards for this legislatively mandated Medicaid Incentives for Prevention of Chronic Diseases Program. The program will target behaviors that cause some of the most critical chronic conditions Americans face: smoking (kills 430,000 people a year, according to HHS), obesity, heart disease, and diabetes. States’ notices of intent are due April 4; applications are due May 2.

Seniors and people with disabilities who receive health care through Medicare* might have an additional service covered in the near future: testing for sexually transmitted diseases such syphilis, gonorrhea and hepatitis B, according to a Reuters report. Centers for Medicare and Medicaid Services (CMS) is due to decide on the measure within the next nine to 12 months.

*Earlier we stated that additional STD coverage could be extended to Medicare and Medicaid beneficiaries, but only Medicare beneficiaries would be affected.

From Bloomberg:

The pledges, made orally or in writing, are viewed by advocates as buttressing federally funded education programs that say avoiding pre-marital sex rather than using protection will curb pregnancy and sexually transmitted diseases. President George W. Bush’s administration more than doubled the budget for abstinence-only education programs since 1999 to $204 million this fiscal year. More than a dozen states have rejected federal money rather than limit what is taught.

“The results suggest that the virginity pledge does not change sexual behavior,” wrote author Janet Rosenbaum, a postdoctoral fellow in the department of population, family and reproductive health at Johns Hopkins University in Baltimore. “Clinicians should provide birth control information to all adolescents, especially abstinence-only sex education participants.”

A 2007 congressional study (PDF) found that abstinence-only programs have “no impacts on rates of sexual abstinence,” and students who participate in them become sexually active at the same age and have as many partners as students who participate in more comprehensive sex-ed programs. With Democrats set to control the presidency and both houses of Congress, these studies should spell the end for abstinence-only education.

Ironically, that could be good news for conservatives who are honest about their desire to decrease the number of abortions and curb the spread of sexually-transmitted diseases.