Last year there were 1.2 million new cases of chlamydia, a sometimes symptomless infection that can lead to infertility in women. It was the most ever reported, up from the old record of 1.1 million cases in 2007.

Better screening is the most likely reason, said Dr. John M. Douglas Jr. of the U.S. Centers for Disease Control and Prevention.

Syphilis, on the verge of being eliminated in the United States about 10 years ago, also has been increasing lately. About 13,500 cases of the most contagious form of the disease were reported in 2008, up from about 11,500 the year before.

Unlike chlamydia, health officials think syphilis cases actually are increasing. Syphilis rates are up among both gay men and heterosexuals, said Douglas, director of the CDC’s Division of STD Prevention.

Syphilis can kill if untreated, but chlamydia is not life-threatening. Neither is gonorrhea, which seams to have plateaued in recent years. Gonorrhea cases dropped to about 337,000 cases in 2008, down from about 356,000 cases.

Girls, ages 15 through 19, had the largest reported number of chlamydia and gonorrhea cases, accounting for more than one in four of those cases. But they’re often screened more than other people, since 1993 federal recommendations that emphasize testing for sexually active women age 25 and under.

The government estimates there are roughly 19 million new cases of sexually transmitted disease annually. Experts say the most common is HPV, human papillomavirus, which can cause genital warts, cervical cancer and other cancers.

The government doesn’t ask doctors to report every HPV case, but estimates the virus causes 6.2 million new cases each year. That is an old estimate, based on data from 2000, before a vaccine against some types of HPV came on the market in 2006.

The CDC estimates there are 1.6 million new cases of genital herpes each year, but that too is an old estimate for a non-reportable disease.

The agency also estimates there about 56,000 new cases of HIV each year.

Mississippi is just one of several mostly rural states across the South with a dearth of resources for HIV and AIDS patients.

“Here, there’s no support group, no case management. There’s no daily reinforcement,” said Webb, 52, who has been HIV-positive for two decades.

Activists and the health care providers cite a need for more federal and state funding for outreach and drug assistance programs, as well as transportation for patients who have to travel from small towns to get care. That’s the message they’ll deliver when a top White House aide holds a rare community discussion Monday in Jackson.

Jeffrey S. Crowley, director of the White House’s Office of National AIDS Policy, said the meeting will highlight two realities of the national epidemic – the significant number of cases in the South, and how the disease disproportionately affects minorities.

The spread of the disease in the South has been attributed to numerous factors, including poverty and a social stigma that discourages many from getting tested or seeking treatment.

Patrick Packer, executive director of the Southern AIDS Coalition and a moderator for the discussion, wants to pose this question: “Why is it that the South is not getting its fair share of federal money based on the epidemic?”

The South leads the nation in the percentage of AIDS-related deaths. Yet, the region ranks last when it comes to overall federal dollars spent on an HIV-infected person at $6,565 a year, according to the coalition.

Forty-six percent of new AIDS cases in 2007 were in the South, according to the latest figures from the U.S. Centers for Disease Control and Prevention. Twenty-five percent of the new cases were in the Northeast, and 17 percent in the West, two regions with the nation’s largest metropolitan areas that have for many years received most of the federal money.

However, the South stands to get more funding.

President Barack Obama signed the $2.2 billion Ryan White HIV/AIDS extension act last month, which continued funding for rural areas, putting the South second in federal money behind the northern region. Activists said it’s still not enough to keep pace with the new cases.

Debbie Konkle-Parker, a nurse practitioner in Jackson, said the act also added federal money to the South in 2006, but didn’t put rural areas on the same level as big cities.

“The inequities were pretty huge,” she said. “People were spending (Ryan White) money in New York City to do journal writing conferences, and in Mississippi, we couldn’t even get people to the clinics.”

Konkle-Parker said Mississippi has about eight public clinics to treat the majority of the 9,000 HIV patients in the state.

The current economic crunch has exacerbated the situation. Some states, like Kentucky, have cut funding for HIV/AIDS programs. The state had been contributing $250,000 a year prior to 2007, but now almost no state money is set aside for the AIDS Drug Assistance program, said Sigga Jagne, a program manager for the Kentucky Department of Health.

There are 1,277 enrolled in Kentucky’s program with 100 more on a waiting list, she said. Arkansas and Tennessee also now have waiting lists for the program, which is mostly federally funded but receives some state money. Packer said funding cuts have led to the waiting lists.

“We’re already disproportionately impacted by poverty and high rates of umemployment. It’s important for people who are HIV positive to be provided with life-sustaining drugs,” Jagne said.

Landry is an exception. Unlike most Americans, she made her end-of-life decisions years ago: no heroic measures to save her and even instructions on the bar where mourners should gather.

The health overhaul bill that narrowly passed the House on Saturday includes a provision to nudge more people to confront such choices: It would pay for end-of-life counseling for Medicare patients.

Supporters say counseling would give patients more control and free families from tortuous decisions. Critics have warned it could lead to government “death panels.” What few on either side note is that counseling could lead more people to choose less intensive care when they’re dying, and ultimately trim government-funded health bills.

Hospice care has grown from about 25,000 patients in 1982, when Congress approved coverage under Medicare, to 1.45 million people in 2008. It’s for patients who have a prognosis of no more than six months – and it ranges from in-home care to stand-alone centers to special wings in hospitals. It does nothing to artificially lengthen or shorten life, focusing mostly on a patient’s comfort.

People on Medicare account for the vast majority of U.S. deaths, and care in the last year of life accounts for roughly a quarter of Medicare’s budget. So increased use of hospice could mean sizable savings for the government, particularly if patients enter it sooner.

A 2007 study published in the journal Social Science and Medicine found that among Medicare patient deaths, those who used hospice saved taxpayers an average $2,309 over their last year. In some cases, the savings were as much as $7,000, depending on the illness and length of hospice stay.

Still, only about 39 percent of Americans who died last year were in hospice. The average patient spent a little more than two months under that care; about a third moved to hospice only in the last week of life.

“It’s significantly underutilized. People are referred very late,” said Dr. Richard Payne, a Duke University professor who heads the school’s Institute on Care at the End of Life.

“Our culture just doesn’t tolerate talking about death and dying. And the minute you even start talking about having conversations with a doctor, it’s immediately pejoratively labeled as ‘You’re trying to kill me.’”

That perception is precisely what got affixed to the counseling measure in the House bill. Even though the legislation specifies counseling wouldn’t force patients to limit efforts to keep them alive, and even with the support of the American Medical Association, AARP and others, suspicion has lingered, encouraged by conservative voices including Sarah Palin.

Dr. Jim Small, a Denver pathologist who belongs to the Christian Medical and Dental Associations, said he feared the provision would be twisted into something more intrusive if bureaucrats lay out the details.

“It’s incredible micromanagement,” Small said. “End-of-life discussions are part of normal, good patient care, but there’s no reason for it to be in the bill.”

Even when patients do opt for less invasive, potentially cheaper care, there are limitations. Predicting when someone will die is notoriously inexact. Terminal patients can live for years. So deciding on less intensive treatment isn’t always an easy choice.

“The concept of the last year of life is entirely retrospective,” said Donald Taylor, a public policy professor at Duke who was the lead author of the study looking at hospice’s cost savings. “It’s just not that clear when people are dying.”

Among those for whom death is clearly imminent, though, advocates argue hospice offers a more compassionate approach.

Dr. Joel Policzer is medical director for VITAS Innovative Hospice Care, which runs the hospice wing at Florida Medical Center where Landry spent her final days. Many of the patients have been hospitalized repeatedly, often getting arguably unnecessary tests before finally succumbing. He characterizes the American medical perspective as “Do something! Do something! Do something!”

Often, Policzer says, a dying elderly patient may have wanted less invasive care. But it doesn’t happen.

“It doesn’t happen because people are never asked. If they were, people would tell you they want to die at home in bed, surrounded by their family, their friends and their pets,” he said. “People who are dying do not need to have needles shoved in them two or three times a day. It’s not going to make a difference.”

On a recent morning, Policzer stopped to check on 76-year-old Walter Norton, who lay frail and silent in his hospice bed. He had made numerous trips to the emergency room before his family turned to hospice. He had dementia and was suffering from pneumonia and dehydration.

No one’s sure exactly what Norton would have wanted. “He wasn’t asked, ‘What do you want to have done?’” Policzer said.

Five days later, Norton was dead.

Landry, on the other hand, had thought about life’s ending years ago.

Four days before she died, her closest friend, Joe Takach, was sitting in a recliner beside her. Her head was tilted, her mouth open and her left hand lay across her waist atop a crisp white sheet.

End-stage heart disease brought hospice care to Landry’s home in July; she entered the inpatient unit in late October. Until then, she had continued her routine, going to church every week, making coffee in the morning, sitting for hours in a swivel chair watching birds and squirrels from her bedroom window. She’d make four-course dinners and sometimes stay up talking with Takach until 2 a.m.

Landry had moved in with Takach after Hurricane Wilma destroyed her home four years ago; the 49-year-old retired police dispatcher said it was like having a grandmother again.

He called her the Energizer Bunny. She called herself a tough New Englander.

“You OK?” Takach asked her in one of their final meetings. “I’m OK,” she said in a soft, garbled voice, her eyes opened just a slit.

“You don’t have any pain?” he asked. “No,” she said.

Had Landry not made her wishes known, she likely would have been subjected to CT scans, blood tests, IVs and a feeding tube.

“She would not want that,” Takach said. “She would say, ‘Enough!’”

The American Medical Association also voted to declare that gay marriage bans contribute to health disparities for gay couples and their children.

Both gay-rights policies were adopted Tuesday at the AMA’s interim policy meeting in Houston.

The AMA says the ‘don’t ask, don’t-tell’ law creates an ethical dilemma for gay service members and the doctors who treat them.

The other measure declares that marriage bans leave gays vulnerable to being excluded from health care benefits, including health insurance and family and medical leave rights. The new AMA policy stops short of opposing the bans.

The House bill –HB 3962– includes a provision to direct the Department of Health and Human Services to address “health disparities” of a number of specific population groups, including those based on sexual orientation and gender identity. It makes people with HIV infection and low income eligible for Medicare coverage earlier in their illness. And it prohibits discrimination in health care based on “personal characteristics extraneous to the provision of high quality health care or related services.”

Jerilyn Goodman, a spokesperson for Rep. Tammy Baldwin (D-Wisc.) who led the effort to include the provisions, said the phrase “personal characteristics” is intended to include “sexual orientation” and “gender identity.” But there was virtually no attention given to the LGBT-related provisions in debate over the bill.

The Human Rights Campaign praised the legislation for being “a tremendous advance for the health needs of LGBT people.” It said the bill also “ends unfair taxation” of gay employees who have their partners or spouses covered on their health insurance at work. The tax provision originated as a freestanding bill introduced by Rep. Jim McDermott (D-Wash.) Senator Charles Schumer (D-NY) introduced a similar measure in the Senate but that has not been rolled into the Senate’s version of health care reform.

Instead, the House’s attention focused squarely on abortion. An amendment, offered by Rep. Bart Stupak (D-Mich.), prohibits the proposed government-funded insurance option –the so-called “public option” – in the bill from providing coverage for an abortion. The House approved the amendment on a 240 to 194 Saturday; all three openly gay representatives voted against it.

The House then passed the overall reform bill on a 220 to 215 vote; all three openly gay representatives voted for it. The bill needed 218 votes to pass.

H.B. 3962, also known as the Affordable Health Care for America Act, aimed at ensuring that all citizens have access to some level of health care. It attempts to offer various health insurance options –including a government-run option—to enable people to choose what level they need and/or can afford. And it attempts to make some option available to even the poorest.

But the House plan must now await a Senate vote on its version of health care reform –a version that does not include any of the pro-gay provisions. Once the Senate passes its bill, a House-Senate conference committee will have to hammer out one compromise version of the legislation.

Despite pressure from the White House, the fate of a health care reform bill in the Senate is far from certain. In recent days, Senator Joe Lieberman (I-Conn.) has threatened to provide his vote to stage a Republican filibuster against consideration of a bill if the Senate version contains a government-run health insurance option. Without Lieberman’s vote, the Democratic majority would not have the 60 votes necessary to break any filibuster.

© 2009 Keen News Service

The legislation provides care, treatment and support services to nearly half a million people, most of whom are low-income.

Obama also announced that the Department of Health and Human services has finally crafted a new regulation spelling the  end to the HIV Travel and Immigration Ban. The regulation goes into effect in January.

“We often speak as if AIDS is going on somewhere else. Often overlooked is that we face a serious HIV/AIDS epidemic of our own,” Obama said prior to the signing. He noted that early on, AIDS was considered a “gay disease, and those who had it were viewed with suspicion.”

This is the fourth re-authorization of the Ryan White bill, and Obama said it was the first time that the bill was not controversial or divisive, and passed with bi-partisian support.

There are 1.1 million living with HIV/AIDs in the United States; more than 56,000 cases are added each year. Obama noted that gay men, though they comprise 2 to 3 percent of the population, make up about half of all new cases, and that African-Americans make up almost half.

Obama said he hoped the lifting of the travel ban would help end the stigma attached to HIV/AIDS. He also said that he and his wife Michelle would be getting a second AIDS test soon.

For 22 years, United States had one of the most restrictive policies on the immigration and travel of HIV-positive people in the world. According to a historian writing for SHAFR.org:

“It compelled all non-citizens to attest that they were HIV-negative before being admitted to the United States for any reason – despite the obvious impossibility of enforcing this provision. At the same time, non-citizens living long-term in the United States were denied permanent resident categorization solely on basis of their HIV-positive status. While invoking its sovereign rights to control immigration and tourism, the U.S. government clung to policies suffused with the ignorance and bias toward HIV-positive people illustrated at the earliest stages of the AIDS pandemic.

“It disregarded the fact that for almost 25 years, it has been common medical knowledge that one cannot contract or transmit HIV casually. AIDS activists asserted that the HIV bar dissuaded immigrants unsure of their HIV status from getting tested; prompted HIV-positive immigrants not to seek to medical treatment until they had full-blown AIDS; and caused HIV-positive people seeking visas to lie on their applications and then enter the U.S. without their medications – situations posing exactly the threats to public health the 1987 ban aimed to prevent.”

In July 2008 as part of an AIDS bill,  Congress voted to restore the authority of the Secretary of Health and Human Services to remove HIV from the immigration and visitor ban list. George W. Bush signed it into law – but HHS had not yet issued a revised rule until today, which meant that those with HIV and AIDS were still banned from the country.