Science
STDs have been on the rise. Who should pick up the tab for testing?
Inside the glassy waiting room of a Hollywood clinic, a 33-year-old man sat and listened for his number to be called over the beats of a Mariah Carey song.
“It’s just really easy. You don’t have to make an appointment,” said the man, who comes to the AIDS Healthcare Foundation clinic every two or three months to get tested for sexually transmitted diseases.
Nor does he get asked about his health insurance, which has sometimes been a frustration elsewhere. “And I like the discretion,” added the man, who declined to give his name. “You don’t want people in your business.”
For months, the AIDS Healthcare Foundation has been resisting a push from Los Angeles County for such providers to ask people if they have insurance that can cover costs related to STD tests, a step that the Department of Public Health says is needed in order to spare public dollars for more services.
The Health Department has long contracted with community organizations to test people for sexually transmitted diseases. In the past, the county shouldered all the costs of processing those tests at a county lab.
County officials said that for several years, their contracts have included a requirement for groups to check if clients have a “third-party payer” that could foot the bill for testing, such as public or private insurance.
Many groups had already started doing so before the county stopped routinely covering the costs of laboratory testing in January, the department said.
If someone has no insurance to cover such testing costs, the organizations can have the county pay for it, although they cannot exceed the overall amount of money allotted to them under their contracts.
Getting insurers to pay for testing has been a strategy for strapped public health departments around the country, seen as a crucial way to offset the costs of providing free care to the uninsured and other needed services as federal funding to combat sexually transmitted diseases has fallen short of the need. L.A. County Public Health said it was hunting for “as many revenue streams as possible” to ramp up STD efforts.
“This type of work cannot just be exclusively publicly funded,” said Dr. Rita Singhal, the department’s chief medical officer and director of the disease control bureau. “The more revenue for this effort, the better.” In the past, the department said it spent between $1.1 million and $2.3 million annually on testing for STDs.
But some local groups focused on sexual health argue that the change undermines their push to make STD testing easy and routine. Across the country, syphilis and gonorrhea have been on the rise — a longtime trend exacerbated by the interruption of preventative services as health agencies grappled with COVID-19. L.A. County has seen a persistent rise in STDs over the last decade, although there are some early signs of progress.
“If you’re trying to control a disease that’s spiking, you have to take away any deterrents, any obstacles” to routine screening, said Michael Weinstein, president of the AIDS Healthcare Foundation.
Dr. Ward Carpenter, chief health officer for the Los Angeles LGBT Center, said health providers want people to get tested regularly even if they have no symptoms, and “the harder that is, the more barriers that are in place, the less likely people are to do that.”
Among the concerns: Young adults who are on the health plans of their parents may not want to hand over insurance information, fearing their tests could show up in paperwork seen by their families. Such privacy concerns could also affect people who are insured through a spouse, Carpenter said. And clients who are “underinsured” may get stuck with a bill later, he said, and decide to stop getting regularly tested.
California lawmakers are considering legislation, Assembly Bill 1645, that would prohibit insurance plans from imposing out-of-pocket costs for recommended screenings for sexually transmitted diseases. L.A. County Public Health said it was backing that bill and “exploring as many models as possible to reduce the impact of health insurance screening,” including the use of technology to smooth the process.
Dr. Jeffrey Klausner, a USC Keck School of Medicine professor and formerly an STD prevention director in San Francisco, was nonetheless concerned by the county’s move, calling it “a penny saved, a pound foolish.”
“It’s going to come back and bite them,” Klausner said. “There will be a decrease in testing … particularly among the most vulnerable groups and young people.”
So far, L.A. County Public Health said its early data suggest STD testing has not fallen this year compared with last. Nearly 12,000 tests were reported to the county between January and March — a similar volume to the past — and the department believes the total amount of testing by community groups is likely higher because some are not being reported to the county.
The county agency said it was too early to tell whether it is spending less on testing, but it expects insurers to pick up more costs over time.
The move was welcomed by Dr. Tony Mills, chief executive of the Men’s Health Foundation, which also contracts with the county. Most people in California are eligible for some kind of health coverage, Mills said, and asking about it provides an opportunity to connect patients to coverage and other care.
If people are uneasy about a test showing up on paperwork for a shared plan, “we can easily get around” that issue by tapping other funds, he said. But L.A. County needs to be “the payer of last resort. … That’s going to save more money for the county to use on other things that are integrally important.”
“It’s just asking the providers to do a little bit more work,” Mills said.
The Health Department said that to boost the number of people screened and treated for STDs, it needs to support a range of screening models, including home testing and street medicine teams. Mario Pérez, director of its division of HIV and STD programs, said that to make a dent in the STD crisis, the department wants most community groups to screen 10,000 to 20,000 people each annually.
“If you want to support that level of volume, having multiple revenue streams at your disposal becomes very important,” he said.
One survey of more than 4,000 patients at STD clinics found that more than half had some kind of health insurance coverage, and 57% of those who were insured were willing to use it for their visit.
Among those waiting at the AIDS Healthcare Foundation clinic on a recent afternoon was Walter, a 32-year-old who said he liked going to the Hollywood site because his visits usually took less than a half hour.
He used to get routinely tested at an urgent care facility, but stopped when it no longer accepted his insurance. Still, he wasn’t fazed by the idea of being asked for insurance information in the future.
“For me, it’s not a deterrent or a big deal,” he said.
Another patient named Joe sought out the Hollywood clinic after getting results back from a test he had taken in the U.K. Even asking people about insurance will discourage people from STD testing and treatment, said the 26-year-old, who had been worried about obstacles he might face to getting treatment as a foreign tourist.
“It will put fear in people, and as soon as you start doing that, people stop doing it,” he said.
Federal funding for preventing STDs has barely budged in the last decade, resulting in STD programs losing about 40% of their buying power and forcing them to rely more heavily on other funds, said Stephanie Arnold Pang, senior director of policy and government relations for the National Coalition of STD Directors.
A survey of public health departments found the vast majority were billing Medicaid for STD services and more than two thirds billed private third-party payers. San Francisco City Clinic, a public clinic focused on sexual health, will bill Medi-Cal — the California Medicaid program — if a patient has it, but doesn’t bill private insurance or charge patients, according to the San Francisco Department of Public Health.
“It makes a lot of sense that jurisdictions are looking to have folks use insurance because it is another payer source in a system that’s very challenged,” Pang said.
But doing so has on-the-ground impacts: Carpenter, at the LGBT Center, said the organization had to hire more staff to collect billing information and testing takes longer as a result.
The AIDS Healthcare Foundation advertises free testing without an appointment and wants to get people in and out within an hour, Weinstein said. That speedy, walk-in model “will go out the window” if it has to screen everyone for insurance, he said.
Weinstein, an outspoken figure whose group has clashed with the county and other government agencies in court, said in late August that his group would not ask clients for information about third-party payers.
The Public Health Department, however, said the AHF had indicated to the county that it would begin screening clients for insurance. In response, the AHF said it would screen existing clients — people who are already AHF patients — when they come in for testing, but not “all individuals who walk in to our testing sites.”
Under the county contracts, groups can turn to the county to cover lab costs for such testing only after they have checked that patients don’t have insurance they could bill instead. The AHF said it expects an increase of at least $1 million annually in lab costs as a result of the county rule.
The Public Health Department said it was continuing to work with the AHF on adjusting to the change, as well as with any other groups “to review and resolve any unintended consequences tied to this approach.” It has been hammering out a spending plan for an added $10 million allocated by the county for STD services, including efforts to “cover critical program elements not covered by” other payers.
Science
There's a reason you can't stop doomscrolling through L.A.'s fire disaster
Even for those lucky enough to get out in time, or to live outside the evacuation zones, there has been no escape from the fires in the Los Angeles area this week.
There is hardly a vantage point in the city from which flames or plumes of smoke are not visible, nowhere the scent of burning memories can’t reach.
And on our screens — on seemingly every channel and social media feed and text thread and WhatsApp group — an endless carousel of images documents a level of fear, loss and grief that felt unimaginable here as recently as Tuesday morning.
Even in places of physical safety, many in Los Angeles are finding it difficult to look away from the worst of the destruction online.
“To me it’s more comfortable to doomscroll than to sit and wait,” said Clara Sterling, who evacuated from her home Wednesday. “I would rather know exactly where the fire is going and where it’s headed than not know anything at all.”
A writer and comedian, Sterling is — by her own admission — extremely online. But the nature of this week’s fires make it particularly hard to disengage from news coverage and social media, experts said.
For one, there’s a material difference between scrolling through images of a far-off crisis and staying informed about an active disaster unfolding in your neighborhood, said Casey Fiesler, an associate professor specializing in tech ethics at the University of Colorado Boulder.
“It’s weird to even think of it as ‘doomscrolling,’ ” she said. “When you’re in it, you’re also looking for important information that can be really hard to get.”
When you share an identity with the victims of a traumatic event, you’re more likely both to seek out media coverage of the experience and to feel more distressed by the media you see, said Roxane Cohen Silver, distinguished professor of psychological science at UC Irvine.
For Los Angeles residents, this week’s fires are affecting the people we identify with most intimately: family, friends and community members. They have consumed places and landmarks that feature prominently in fond memories and regular routines.
The ubiquitous images have also fueled painful memories for those who have lived through similar disasters — a group whose numbers have increased as wildfires have grown more frequent in California, Silver said.
This she knows personally: She evacuated from the Laguna Beach fires in 1993, and began a long-term study of that fire’s survivors days after returning to her home.
“Throughout California, throughout the West, throughout communities that have had wildfire experience, we are particularly primed and sensitized to that news,” she said. “And the more we immerse ourselves in that news, the more likely we are to experience distress.”
Absorption in these images of fire and ash can cause trauma of its own, said Jyoti Mishra, an associate professor of psychiatry at UC San Diego who studied the long-term psychological health of survivors of the 2018 Camp fire.
The team identified lingering symptoms of post-traumatic stress disorder, depression and anxiety both among survivors who personally experienced fire-related trauma such as injury or property loss, and — to a smaller but still significant degree — among those who indirectly experienced the trauma as witnesses.
“If you’re witnessing [trauma] in the media, happening on the streets that you’ve lived on and walked on, and you can really put yourself in that place, then it can definitely be impactful,” said Mishra, who’s also co-director of the UC Climate Change and Mental Health Council. “Psychology and neuroscience research has shown that images and videos that generate a sense of personal meaning can have deep emotional impacts.”
The emotional pull of the videos and images on social media make it hard to look away, even as many find the information there much harder to trust.
Like many others, Sterling spent a lot of time online during the early days of the COVID-19 pandemic. Back then, Sterling said, the social media environment felt decidedly different.
“This time around I think I feel less informed about what’s going on because there’s been such a big push toward not fact-checking and getting rid of verified accounts,” she said.
The rise of AI-generated images and photos has added another troubling kink, as Sterling highlighted in a video posted to TikTok early Thursday.
“The Hollywood sign was not on fire last night. Any video or photos that you saw of the Hollywood sign on fire were fake. They were AI generated,” she said, posting from a hotel in San Diego after evacuating.
Hunter Ditch, a producer and voice actor in Lake Balboa, raised similar concerns about the lack of accurate information. Some social media content she’s encountered seemed “very polarizing” or political, and some exaggerated the scope of the disaster or featured complete fabrications, such as that flaming Hollywood sign.
The spread of false information has added another layer of stress, she said. This week, she started turning to other types of app — like the disaster mapping app, Watch Duty — to track the spreading fires and changing evacuation zones.
But that made her wonder: “If I have to check a whole other app for accurate information, then what am I even doing on social media at all?”
Science
Pink Fire Retardant, a Dramatic Wildfire Weapon, Poses Its Own Dangers
From above the raging flames, these planes can unleash immense tankfuls of bright pink fire retardant in just 20 seconds. They have long been considered vital in the battle against wildfires.
But emerging research has shown that the millions of gallons of retardant sprayed on the landscape to tame wildfires each year come with a toxic burden, because they contain heavy metals and other chemicals that are harmful to human health and the environment.
The toxicity presents a stark dilemma. These tankers and their cargo are a powerful tool for taming deadly blazes. Yet as wildfires intensify and become more frequent in an era of climate change, firefighters are using them more often, and in the process releasing more harmful chemicals into the environment.
Some environmental groups have questioned the retardants’ effectiveness and potential for harm. The efficiency of fire retardant has been hard to measure, because it’s one of a barrage of firefighting tactics deployed in a major fire. After the flames are doused, it’s difficult to assign credit.
The frequency and severity of wildfires has grown in recent years, particularly in the western United States. Scientists have also found that fires across the region have become faster moving in recent decades.
There are also the longer-term health effects of exposure to wildfire smoke, which can penetrate the lungs and heart, causing disease. A recent global survey of the health effects of air pollution caused by wildfires found that in the United States, exposure to wildfire smoke had increased by 77 percent since 2002. Globally, wildfire smoke has been estimated to be responsible for up to 675,000 premature deaths per year.
Fire retardants add to those health and environmental burdens because they present “a really, really thorny trade-off,” said Daniel McCurry, an assistant professor of civil and environmental engineering at the University of Southern California, who led the recent research on their heavy-metal content.
The United States Forest Service said on Thursday that nine large retardant-spraying planes, as well as 20 water-dropping helicopters, were being deployed to fight the Southern California fires, which have displaced tens of thousands of people. Several “water scooper” amphibious planes, capable of skimming the surface of the sea or other body of water to fill their tanks, are also being used.
Two large DC-10 aircraft, dubbed “Very Large Airtankers” and capable of delivering up to 9,400 gallons of retardant, were also set to join the fleet imminently, said Stanton Florea, a spokesman for the National Interagency Fire Center in Boise, Idaho, which coordinates national wildland firefighting efforts across the West.
Sprayed ahead of the fire, the retardants coat vegetation and prevent oxygen from allowing it to burn, Mr. Florea said. (Red dye is added so firefighters can see the retardant against the landscape.) And the retardant, typically made of salts like ammonium polyphosphate, “lasts longer. It doesn’t evaporate, like dropping water,” he said.
The new research from Dr. McCurry and his colleagues found, however, that at least four different types of heavy metals in a common type of retardant used by firefighters exceeded California’s requirements for hazardous waste.
Federal data shows that more than 440 million gallons of retardant were applied to federal, state, and private land between 2009 and 2021. Using that figure, the researchers estimated that between 2009 and 2021, more than 400 tons of heavy metals were released into the environment from fire suppression, a third of that in Southern California.
Both the federal government and the retardant’s manufacturer, Perimeter Solutions, have disputed that analysis, saying the researchers had evaluated a different version of the retardant. Dan Green, a spokesman for Perimeter, said retardants used for aerial firefighting had passed “extensive testing to confirm they meet strict standards for aquatic and mammalian safety.”
Still, the findings help explain why concentrations of heavy metals tend to surge in rivers and streams after wildfires, sometimes by hundreds of times. And as scrutiny of fire suppressants has grown, the Forestry Service has set buffer zones surrounding lakes and rivers, though its own data shows retardant still inadvertently drifts into those waters.
In 2022, the environmental nonprofit Forest Service Employees for Environmental Ethics sued the government in federal court in Montana, demanding that the Forest Service obtain a permit under the Clean Water Act to cover accidental spraying into waterways.
The judge ruled that the agency did indeed need to obtain a permit. But it allowed retardant use to continue to protect lives and property.
Science
2024 Brought the World to a Dangerous Warming Threshold. Now What?
At the stroke of midnight on Dec. 31, Earth finished up its hottest year in recorded history, scientists said on Friday. The previous hottest year was 2023. And the next one will be upon us before long: By continuing to burn huge amounts of coal, oil and gas, humankind has all but guaranteed it.
The planet’s record-high average temperature last year reflected the weekslong, 104-degree-Fahrenheit spring heat waves that shuttered schools in Bangladesh and India. It reflected the effects of the bathtub-warm ocean waters that supercharged hurricanes in the Gulf of Mexico and cyclones in the Philippines. And it reflected the roasting summer and fall conditions that primed Los Angeles this week for the most destructive wildfires in its history.
“We are facing a very new climate and new challenges, challenges that our society is not prepared for,” said Carlo Buontempo, director of the Copernicus Climate Change Service, the European Union monitoring agency.
But even within this progression of warmer years and ever-intensifying risks to homes, communities and the environment, 2024 stood out in another unwelcome way. According to Copernicus, it was the first year in which global temperatures averaged more than 1.5 degrees Celsius, or 2.7 degrees Fahrenheit, above those the planet experienced at the start of the industrial age.
For the past decade, the world has sought to avoid crossing this dangerous threshold. Nations enshrined the goal in the 2015 Paris agreement to fight climate change. “Keep 1.5 alive” was the mantra at United Nations summits.
Yet here we are. Global temperatures will fluctuate somewhat, as they always do, which is why scientists often look at warming averaged over longer periods, not just a single year.
But even by that standard, staying below 1.5 degrees looks increasingly unattainable, according to researchers who have run the numbers. Globally, despite hundreds of billions of dollars invested in clean-energy technologies, carbon dioxide emissions hit a record in 2024 and show no signs of dropping.
One recent study published in the journal Nature concluded that the absolute best humanity can now hope for is around 1.6 degrees of warming. To achieve it, nations would need to start slashing emissions at a pace that would strain political, social and economic feasibility.
But what if we’d started earlier?
“It was guaranteed we’d get to this point where the gap between reality and the trajectory we needed for 1.5 degrees was so big it was ridiculous,” said David Victor, a professor of public policy at the University of California, San Diego.
The question now is what, if anything, should replace 1.5 as a lodestar for nations’ climate aspirations.
“These top-level goals are at best a compass,” Dr. Victor said. “They’re a reminder that if we don’t do more, we’re in for significant climate impacts.”
The 1.5-degree threshold was never the difference between safety and ruin, between hope and despair. It was a number negotiated by governments trying to answer a big question: What’s the highest global temperature increase — and the associated level of dangers, whether heat waves or wildfires or melting glaciers — that our societies should strive to avoid?
The result, as codified in the Paris agreement, was that nations would aspire to hold warming to “well below” 2 degrees Celsius while “pursuing efforts” to limit it to 1.5 degrees.
Even at the time, some experts called the latter goal unrealistic, because it required such deep and rapid emissions cuts. Still, the United States, the European Union and other governments adopted it as a guidepost for climate policy.
Christoph Bertram, an associate research professor at the University of Maryland’s Center for Global Sustainability, said the urgency of the 1.5 target spurred companies of all kinds — automakers, cement manufacturers, electric utilities — to start thinking hard about what it would mean to zero out their emissions by midcentury. “I do think that has led to some serious action,” Dr. Bertram said.
But the high aspiration of the 1.5 target also exposed deep fault lines among nations.
China and India never backed the goal, since it required them to curb their use of coal, gas and oil at a pace they said would hamstring their development. Rich countries that were struggling to cut their own emissions began choking off funding in the developing world for fossil-fuel projects that were economically beneficial. Some low-income countries felt it was deeply unfair to ask them to sacrifice for the climate given that it was wealthy nations — and not them — that had produced most of the greenhouse gases now warming the world.
“The 1.5-degree target has created a lot of tension between rich and poor countries,” said Vijaya Ramachandran, director for energy and development at the Breakthrough Institute, an environmental research organization.
Costa Samaras, an environmental-engineering professor at Carnegie Mellon University, compared the warming goals to health officials’ guidelines on, say, cholesterol. “We don’t set health targets on what’s realistic or what’s possible,” Dr. Samaras said. “We say, ‘This is what’s good for you. This is how you’re going to not get sick.’”
“If we were going to say, ‘Well, 1.5 is likely out of the question, let’s put it to 1.75,’ it gives people a false sense of assurance that 1.5 was not that important,” said Dr. Samaras, who helped shape U.S. climate policy from 2021 to 2024 in the White House Office of Science and Technology Policy. “It’s hugely important.”
Scientists convened by the United Nations have concluded that restricting warming to 1.5 degrees instead of 2 would spare tens of millions of people from being exposed to life-threatening heat waves, water shortages and coastal flooding. It might mean the difference between a world that has coral reefs and Arctic sea ice in the summer, and one that doesn’t.
Each tiny increment of additional warming, whether it’s 1.6 degrees versus 1.5, or 1.7 versus 1.6, increases the risks. “Even if the world overshoots 1.5 degrees, and the chances of this happening are increasing every day, we must keep striving” to bring emissions to zero as soon as possible, said Inger Anderson, the executive director of the United Nations Environment Program.
Officially, the sun has not yet set on the 1.5 target. The Paris agreement remains in force, even as President-elect Donald J. Trump vows to withdraw the United States from it for a second time. At U.N. climate negotiations, talk of 1.5 has become more muted compared with years past. But it has hardly gone away.
“With appropriate measures, 1.5 Celsius is still achievable,” Cedric Schuster, the minister of natural resources and environment for the Pacific island nation of Samoa, said at last year’s summit in Azerbaijan. Countries should “rise to the occasion with new, highly ambitious” policies, he said.
To Dr. Victor of U.C. San Diego, it is strange but all too predictable that governments keep speaking this way about what appears to be an unachievable aim. “No major political leader who wants to be taken seriously on climate wants to stick their neck out and say, ‘1.5 degrees isn’t feasible. Let’s talk about more realistic goals,’” he said.
Still, the world will eventually need to have that discussion, Dr. Victor said. And it’s unclear how it will go.
“It could be constructive, where we start asking, ‘How much warming are we really in for? And how do we deal with that?’” he said. “Or it could look very toxic, with a bunch of political finger pointing.”
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