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Imagine Being Kicked off Your Health Insurance Two Months After Giving Birth

When Madavia Johnson gave birth to Donald Ray Dowless III last year, she was hit by a case of severe postpartum anxiety. She was scared to carry her son downstairs or drive him in a car. She couldn’t manage to continue law school―and could hardly leave the house―because she didn’t trust anyone to watch him.…

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Imagine Being Kicked off Your Health Insurance Two Months After Giving Birth

When Madavia Johnson gave birth to Donald Ray Dowless III last year, she was hit by a case of severe postpartum anxiety.

She was scared to carry her son downstairs or drive him in a car. She couldn’t manage to continue law school―and could hardly leave the house―because she didn’t trust anyone to watch him. Her weight dropped from 140 to 115 pounds.

“It was very stressful for me mentally,” said Johnson, now 29, who lives in Clayton, North Carolina. And she found it hard to secure medical assistance because her Medicaid coverage ran out just two months after her son’s birth. Public health advocates are pushing to change that.

The difficulties Johnson faced contribute to the United States’ dismal record on maternal and child health. The U.S. is one of only three countries where maternal deaths are on the rise, joining Sudan and Afghanistan, according to the Alliance for Innovation on Maternal Health, a program of the Council on Patient Safety in Women’s Health. And data from the Centers for Disease Control and Prevention indicates that about 700 women die in the U.S. every year from pregnancy complications. Sixty percent of those deaths are deemed preventable.

Democratic presidential candidates such as Senator Cory Booker of New Jersey and Senator Kamala Harris of California have talked about those problems on the campaign trail, offering sweeping proposals to address disparities that lead to poor health for many new mothers.

Though maternal and child health experts appreciate the attention to the issue, they also point to what they say is a fairly minor policy option that could make a major difference: increasing access to Medicaid for postpartum women.

“Given that we know that this crisis disproportionately falls on low-income people … Medicaid is a very smart starting place to make sure these people are getting access to needed care,” said Valarie Blake, an associate professor of law at West Virginia University who focuses on health care law.

Take Johnson, for instance. At the time of her pregnancy, she was eligible for Medicaid based on a rule that provides women who otherwise might not qualify under strict income restrictions with coverage during pregnancy and for 60 days after. She gave birth August 14, 2018.

But North Carolina has tight eligibility requirements. It is also one of the 14 states that have not chosen to expand Medicaid under the Affordable Care Act. So, by mid-October, Johnson was no longer “Medicaid eligible.” Because her physician was backed up on appointments, she lost her coverage before she had a “six-week” checkup.

Eventually, she reapplied for Medicaid and was able to qualify because her status changed since she had a child. But Donald was 8 months old before she was able to see a doctor.

Experts point to the 60-day timeline as a sort of clock ticking on some severe postpartum medical issues: bleeding, infections, breastfeeding issues, and mental health screening, among others.

“If you’re on postpartum Medicaid, you need to get those issues solved right away,” Blake said.

And that 60-day countdown? It is arbitrary, said Alison Stuebe, a professor of obstetrics and gynecology at the University of North Carolina School of Medicine. It has roots in a general idea across cultures that women need special care after giving birth, but the 60-day mark isn’t based on medicine.

“It comes from the same place as the six-week postpartum visit,” Stuebe said. “We don’t know where it comes from either.”

Stuebe chaired a task force for the American College of Obstetricians and Gynecologists that recommended a different approach. Providers should check women two weeks after giving birth, and then continue holistic care for 12 weeks, eventually transitioning the patient to primary care.

That prolonged contact is essential, she said. ”Postpartum depression, if untreated, can begin to spiral,” Stuebe said. “Even if you’re in treatment, after 60 days, you’re not better.”

Johnson, though, was left to wrestle with severe postpartum anxiety on her own.

She sought support from other new moms on Facebook who were coping with anxiety. Since her son had Medicaid for the first year of his life, his pediatrician was a source of help. She also got care through her local health department’s free clinics.

At the federal level, the idea of extending postpartum Medicaid is getting more attention. At a September House hearing, representatives from the American Medical Association, the Icahn School of Medicine, and the Kaiser Family Foundation called for expanding postpartum Medicaid to 12 months as a possible solution to the maternal mortality crisis. The American College of Obstetricians and Gynecologists has also recommended it. Booker’s bill would extend Medicaid coverage from 60 days to 12 months alongside other far-reaching proposals. (Kaiser Health News is an editorially independent program of the foundation.)

Beyond protecting women during the medically vulnerable time after they deliver, experts think increasing Medicaid could go a long way toward addressing the racial disparities that exist in maternal mortality rates. Black women are two to three times more likely to die from pregnancy-related causes than white women.

“It’s not a silver bullet,” said Jamila Taylor, the director of health care reform at The Century Foundation, a nonpartisan think tank. “There’s racism in the health care system. Coverage is a piece of that, but we need to transform the system.”

Kaiser Health News (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

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The Hidden Mental Health Costs of Climate Change

“People don’t really understand—until you actually see it coming at you in a wall of flame,” says a woman in the Rural Fire Service of New South Wales, in startling footage of fighting Australia’s raging bushfires last month. Extreme weather events like these are becoming more frequent and more severe: in the U.S. just this…

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The Hidden Mental Health Costs of Climate Change

“People don’t really understand—until you actually see it coming at you in a wall of flame,” says a woman in the Rural Fire Service of New South Wales, in startling footage of fighting Australia’s raging bushfires last month. Extreme weather events like these are becoming more frequent and more severe: in the U.S. just this year, five states have set wildfire records. But it’s not just unlucky homeowners who are affected—fine particulate matter is an increasing concern for epidemiologists, who’ve found that public exposure can cause both acute and chronic disease.

Though these types of environmental catastrophes are often still talked about in terms of future consequences, climate change is already having a massive impact on public health. The World Health Organization (WHO) just released a report, which draws on data from 101 countries, highlighting these climate-related health risks—and the world’s lack of preparedness.

Impacts include increased risk of childhood diarrheal disease caused by a food supply that’s potentially more vulnerable to pathogens, heatwaves creating dangerous labor conditions, and increased disease risk from chronic exposures to things like air pollution later in life.

Mental health can be affected by climate change too, and depression, anxiety, and other mental health issues are identified in the report as climate-sensitive conditions. But only six countries emphasized that it was a priority for them. Katie Hayes, a climate change and mental health researcher, has recently published on the current and projected mental health consequences of the climate crisis in the International Journal of Mental Health Systems. She said that while attributing direct causes in the mental-health sphere can be challenging, it’s clear that the impacts of climate change are accelerating.

“Extreme weather events, like flooding, hurricanes, and wildfires have been linked to depression, anxiety, post-traumatic stress disorder (PTSD), suicidal ideation,” Hayes wrote in the International Journal of Environmental Research and Public Health. Further, “Vector-borne diseases like West Nile Virus and Lyme disease may compound mental health issues for people with pre-existing mental health illness.” Which is why, she said, “It’s important to link [mental health issues] to climate change,” because “these events, they’re no longer one-off—it’s not a one-in-100-year flood anymore.” Though it was only raised as a significant concern by six countries, Tara Neville, a lead author on the WHO report, said it’s important that “we are now seeing countries specifically identifying mental health issues as a health risk of climate change.”

Hayes notes that existing social injustices are amplified by climate change, and that it’s the most marginalized who are especially vulnerable, including people who have had to flee their homes because of climate change, or groups like indigenous communities who already struggle with access to healthcare. “Our physical health, our mental health, and our community health are all connected,” said Hayes.

The conclusions of the WHO report are buoyed by a litany of other recent research. In November, the Lancet Countdown, a project dedicated to monitoring health and climate change, released its 2019 report. “We’re able to say that for a child born today, their life is going to be affected by climate change at every single point,” said Nick Watts, executive director at the Lancet Countdown .

Nearly half of the countries WHO surveyed had conducted “a vulnerability and adaptation assessment for health,” but only 20 of the 48 countries said their findings led directly to funding policies to address public health impacts of climate change. Although there’s increasing concern and awareness of climate-related risks associated with extreme weather—like food- and water-borne diseases, or diseases carried by insects like mosquitoes—few countries have implemented significant policy changes.

“The concern is that governments simply aren’t moving fast enough,” Watts said.

It’s difficult to overstate the broad-reaching impacts. When we talk about disease, as emerging viruses like Zika demonstrate, “It’s important to say that no country, no population is immune,” Watts said. “The world’s very, very connected.”

As healthcare professionals scramble to deal with the fallout from a warming planet, they will have to deal with a new level of uncertainty. Whether in Australia, the U.S., or the U.K., healthcare systems have been built on an “assumption that the climate was going to be stable,” Watts said. “That’s no longer a safe assumption—whether we’re talking about the floods in Venice or the wildfires in California.”

Sean McDermott is a freelance journalist and photographer.

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I’m HIV-Positive. My Partner Is Negative. This Is How We Have Sex

For many, HIV is the ultimate boogeyman of the modern sex-scape. Years of horror stories have led some to fear contracting the virus so much that it becomes a constant phobia. It has also led to the stigmatization of HIV-positive individuals as toxic or wicked—and desexualized. Who, this line of thought goes, once struck with…

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I’m HIV-Positive. My Partner Is Negative. This Is How We Have Sex

For many, HIV is the ultimate boogeyman of the modern sex-scape. Years of horror stories have led some to fear contracting the virus so much that it becomes a constant phobia. It has also led to the stigmatization of HIV-positive individuals as toxic or wicked—and desexualized. Who, this line of thought goes, once struck with HIV could think of themself as a viable sexual object ever again? And who would view them as viable partners for any form of physical intimacy?

It is absurd that this even needs to be said, but people living with HIV are humans living full, long lives with a chronic but manageable condition, like so many others. They desire, and are deserving of, love and intimacy like anyone. Being in a relationship can actually be a vital motivator for some people to seek and keep up with treatment.

One might assume that HIV-positive people choose to date those who share their status, so as not to worry about transmitting the virus. And sure, this happens. But many HIV-positive and -negative people still pursue sex and intimacy together, in what are known as “serodiscordant” or mixed-status relationships. In the U.S. alone, there are at least 140,000 mixed-status couples, possibly many more, as that estimate was extrapolated from 23-year-old data. In countries where HIV is especially prevalent, more than 3 percent of all relationships are serodiscordant, and up to two-thirds of HIV-positive individuals are in such relationships.

Not all these couples know from the start that they are serodiscordant, thanks to a positive partner not knowing their status or contracting the virus while already in an established relationship. But many partners know they are mixed status when they get together and make it work.

There is no single strategy for HIV-positive and -negative people to pursue sex and intimacy. Some agree to pursue only emotional intimacy, perhaps consenting to forms of non-monogamy as well. Some only engage in non-penetrative sex. Some use condoms at all times. Increasingly, though, there’s recognition that effective treatment can lower one’s viral load to untransmissible levels. This makes the risk of an HIV-negative partner contracting the virus functionally nonexistent during unprotected sex with a HIV-positive partner who has had such a low load for at least six months and is maintaining their treatment regimen. The spread of PrEP—a preventive drug regimen used by an HIV-negative partner that reduces the risk of transmission by up to 99 percent—in recent years has also opened up new possibilities for a sense of security and less restrained intimacy. Some couples mix and match strategies as needed.

VICE recently caught up with Vasilios Papapitsios and Elijah McKinnon, a queer, non-monogamous, serodiscordant couple, to hear about how they manage sex and intimacy.

Vasilios Papapitsios: I became positive when I was 19. I’m 28 now. I’d just come out of the closet. I was living in a very hateful state [North Carolina] that had just defunded the AIDS drug assistance program, and I was going to school at UNC-Chapel Hill. As much as it thinks it is a progressive community, I was already feeling outed by a lot of my community members.

At that time, it was definitely easier to conceive of a relationship—or just casual sex—with another HIV-positive person because of the stigma I’d internalized and the fear of passing it along.

Elijah McKinnon: I’m from the San Francisco Bay area. I grew up in a pretty liberal household. I talked about sex and various STIs, including HIV, with my parents, who were in an open relationship and very open sexually. I had various relatives die from AIDS.

I had a lot of friends who were young and positive, but not out. It was more hidden than I think a lot of people are now about their status. So the first thing I learned is that I need to take ownership of my own status. What are the ways I can best protect myself? I mean not only from STIs, but a more holistic approach—like my mental sanity, my emotional sanity.

I never thought about serodiscordant relationships from this taboo perspective. One of my first…let’s just call him a boyfriend, was HIV positive. That’s when I discovered PrEP. I had to be 19, 20. This is right when the FDA approved it. I was super skeptical like, you want me to take what? Then after being involved with the study that changed the entire landscape of PrEP a couple years ago by testing a lot of people [using it] and seeing the significant decrease in [transmission of HIV], it was sort of a no-brainer for me. Leading into this relationship, I don’t think I had any barriers.

Vasilios: [Just before I met Eli in late 2016,] I’d been in New York for about half a year. It was suddenly an environment where people just didn’t care about my status. It was: That’s okay, the same way it’s okay for you to be gay. I felt more liberated and free to just be myself.

[Then I moved to Chicago.] It was the first time I was very open about my status to the public. I witnessed communities of people who were all on PrEP, or they know about it. I had been undetectable for a year or two. That was a major factor in terms of my internal stigma and fear.

My world blossomed. I was allowing myself to have intimacy and love and sex in ways that I couldn’t before…I realized I just deserved that and wasn’t this scourge of society.


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Elijah: I met Vas during a performance where they were doing a blood ritual [that involved taking a bath in fake blood] that centers on queer people living with chronic illnesses. So I was very much aware of their status.

Vasilios: I knew she was the PrEP girl. [Eli helped develop PrEP4Love, a campaign raising awareness of PrEP among black gay men, straight black women, and black trans women, and was a model in campaign ads all over Chicago.] She knew I was the poz artist and advocate.

Elijah: I’m black and queer and non-binary. We live on opposite ends of the country. We have different interests and passions. We’re constantly approaching things from the perspectives of our past traumas. There are constantly tensions between our other identities that we are processing. Our status is, I don’t want to say low on the totem pole, but there are other things we are processing.

Vasilios: We have an open relationship. Usually it’s separate. Sometimes it’s not.

I have to be aware that there are other STIs when you do not use a prophylactic. Even if people I’m having sex with are on PrEP, that doesn’t mean other things are thrown out the window. For me, PrEP is like a mental prophylactic. It gives us the opportunity to get into it and not have to think, oh my goodness, this little act of intimacy or sex is so wonderful but there’s still a lingering fear. That doesn’t really exist for me anymore. And that is an amazing gift. But any sex interaction, I have to think about, huh, I don’t know this person or whatever, I’m taking a risk.

How do I put this… We use condoms [together] if we need to. But we don’t really want to.

Elijah: There are a lot of tools that people don’t know about when navigating sex. Like the number of partners, or knowing how to have communicative conversations with those partners as just number one. That allows you to navigate sexually through an experience however you want to.

There are obviously condoms and PrEP, but also positioning [in terms of who is the recipient of penetrative sex; the receiving partner is at more risk]. There are ways of being intimate that are non-penetrative. There’re so many different things we discuss. Everything on our relationship is on the table. When it’s not, things begin to spiral because we’re not being communicative.

One thing that really has been intimate about our respective statuses is that I feel, versus a lot of other relationships, we’re more actively involved with each other’s holistic health. Not just okay, what’s your CD4 count? But how’s your mind doing? Let’s check in. How are you eating?

Vasilios: I think we have learned from our past experiences. And we complement each other in our different healing journeys.

Elijah: Up until about a year ago, I got a lot of questions, like: Aren’t you scared? Don’t you just think it would be easier with a negative person? I don’t even know what any of those questions mean!

There are still a lot of people who are very unaware due to fear and stigma around how to not only be in a serodiscordant relationship but be in a gay, queer, alternative relationship in general. Because they don’t have any models and the models that we do have are very monolithic. If it weren’t status, it’d be something else, like: How is it being in a mixed-race relationship?

That is just one facet of our multi-faceted relationship. It’s a topic that’s up for discussion, not so much negotiation. And it isn’t a barrier to accessing our most intimate depths of pleasure and joy.

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More People Than Ever Are Trying to Lose Weight, to No Avail

Despite reportedly trying lots of different weight loss methods, adults in the United States have seen overall increases in weight and actual measured BMI, according to a new study published this week in JAMA Network Open. The research basically paints a picture of people spinning their diet and activity wheels, reportedly restricting their food intake,…

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More People Than Ever Are Trying to Lose Weight, to No Avail

Despite reportedly trying lots of different weight loss methods, adults in the United States have seen overall increases in weight and actual measured BMI, according to a new study published this week in JAMA Network Open. The research basically paints a picture of people spinning their diet and activity wheels, reportedly restricting their food intake, increasing exercise, and drinking a ton of water, all to no avail.

The most interesting data within the study is the table of things people say they’ve done to try and lose weight, and how those tactics have changed over the 17 years of the research period. The number of people who say they “ate less food,” for instance, increased by 11 percent, and there was a more than 26 percent increase in “drinking more water” as a weight-management strategy (a questionable method); while only seven people say they drank water as a weight loss tactic in 1999–2000, 1,370 said the same in 2015–2016. Steady increases can be seen each year, which is a nice way to trace the celebrity diet cliché to just “drink a lot of water!!!” through time.

Researchers don’t offer much in the line of why this is happening (or maybe more fair to say, not happening). The study hypothesizes people are over-reporting the efforts they’re making to lose weight (the study data comes from a nationally representative survey). Or the gap in weight loss efforts and weight gained could come from a previously observed trend that people who perceive themselves to be overweight are more likely to increase their weight over time. This would also make sense, given that the number of people who think of themselves as overweight also increased in the study’s timeframe.

Researchers ultimately conclude that even though more people say they were trying to lose weight, across the board, weights and BMI increased. Of course, higher weights and higher BMI doesn’t necessarily speak to poor health: It’s extremely possible to gain mass in a healthy way; having more weight doesn’t necessarily mean being less healthy. But the overall picture of how healthy the country is isn’t what’s on display in this study. If anything, this study shows that people are certainly more stressed out about their weight, which can have a loose connection to health. But they’re not getting the tools they need to feel equipped to live healthily, or accept their healthy bodies.

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