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In an email to employees sent out on July 31, the head of Wisconsin’s Department of Natural Resources not only reminded employees of Gov. Tony Evers’ mask order going into effect on Aug. 1, he also said that every DNR employee must wear a mask … even while on a teleconference.
“Also, wear your mask, even if you are home, to participate in a virtual meeting that involves being seen — such as on Zoom or another video-conferencing platform — by non-DNR staff,” Preston Cole said, according to the Milwaukee Journal Sentinel. “Set the safety example which shows you as a DNR public service employee care about the safety and health of others.”
DNR spokeswoman Megan Sheridan spoke with McClatchy News and said that employees wearing masks while video conferencing with external partners sets a good example during the pandemic.
“By wearing a mask while video conferencing with the general public, we visually remind folks that masking is an important part of navigating the business of natural resources during this tumultuous time,” Sheridan said.
“We ask staff to wear masks when on externally facing calls is that, taken out of context, a screenshot of a staff person or high ranking department official, if not properly attributed, could be misinterpreted to suggest that state employees are not properly following the Governor’s directive,” DNR spox Megan Sheridan said to McClatchy.
Rachel Maddow warned on Monday that as the country falls further into crisis, Donald Trump will only become more desperate and dangerous – particularly with the presidential election less than 90 days away.
During her program, the MSNBC host said the worsening pandemic, the economic disaster, and Trump’s sinking poll numbers will motivate him to use authoritarian tactics to hold onto the presidency.
“There are now real worries about the means by which he’s going to try to hold onto power in less than 90 days when the election happens – in the lead up to that election, during that election and after,” Maddow said.
With school reopening efforts going bust all over the country, simply because the spread of the virus is not under control and schools cannot safely open until the spread of the virus is under control. With realistic economic prospects remaining bleak, again, because the spread of the virus is not under control, and that not only affects schools, it affects work and travel and everything with unemployment still above 10 percent, the highest level since the Great Depression. With the positivity rate in terms of test results in Mississippi up near 21% as of now, this far into it, which is astonishing. With Texas’ positivity rate above 19 percent today. I mean, even though it seemed like maybe Texas was getting better there for a while, Texas’ positivity rate is over 19 percent right now. For contrast, New York is well under 1 percent now. With current polls, even with many grains of salt about polling, with current polls showing the president losing to his Democratic challenger, Joe Biden, in nearly every swing state in the country. With all of that, and with what we have come to learn about this president and what he is not only interested in doing but what he is able to do to the government when he puts his mind to it, there are now real worries about the means by which he’s going to try to hold onto power in less than 90 days when the election happens – in the lead up to that election, during that election and after.
Trump will stop at nothing to keep the White House
On Donald Trump’s watch, the country is on fire with nearly 170,000 Americans dead and millions more out of work as a result of his bungled response to the pandemic.
He is coming to the realization that he has nothing to run on, so he’s doing everything in his power to rig the election in his favor, whether it’s welcoming foreign interference, limiting access to voting, or slowing down the United States Postal Service.
Donald Trump knows he can’t win a free and fair election, so he will spend the next three months trying to make sure the election is neither free nor fair.
Sean Colarossi currently resides in Cleveland, Ohio. He earned his Bachelor of Arts degree in Journalism from the University of Massachusetts Amherst and was an organizing fellow for both of President Obama’s presidential campaigns. He also worked with Planned Parenthood as an Affordable Care Act Outreach Organizer in 2014, helping northeast Ohio residents obtain health insurance coverage.
Six states hold primaries and runoffs on Tuesday, but the spotlight will be on Representative Ilhan Omar, Democrat of Minnesota. In her primary race for re-election on Tuesday, she hopes to continue a string of victories by progressive candidates nationwide, but she faces a well-financed challenge from Antone Melton-Meaux, a lawyer who has raised more than $4 million.
In Georgia, a Republican QAnon supporter has a good chance of winning her party’s nomination in the 14th Congressional District. But the attention in Georgia will be on the election system there as much as on the candidates; ditto Wisconsin, which also votes on Tuesday. These two battleground states struggled to hold earlier primary elections amid the coronavirus pandemic; though Tuesday’s elections will probably be lower turnout, any test of the voting apparatus in Wisconsin and in Georgia will be closely monitored.
Polls are open from 8 a.m. to 9 p.m. Eastern time in Minnesota; 7 a.m. to 7 p.m. Eastern time in Georgia; and 8 a.m. to 9 p.m. Eastern time in Wisconsin.
Is Ilhan Omar in trouble?
It was long thought that Representative Rashida Tlaib, Democrat of Michigan, was the only member of the so-called squad who would face a difficult re-election. But by the time Ms. Tlaib cruised to victory last week, Ms. Omar’s challenge might have eclipsed Ms. Tlaib’s. That’s because Ms. Omar is facing a well-funded opponent.
Ms. Omar, an unabashed progressive who has at times run afoul of some party leaders, got the support of House Democrats like Speaker Nancy Pelosi in her re-election efforts. Her opponent, Mr. Melton-Meaux, has tried to cast her as a national lightning rod too controversial for the district, however.
Mr. Melton-Meaux, who has secured more than $4 million for his campaign, nearly matched Ms. Omar over all and outraised her in the most recent cycle, sending alarm bells that the race could be closer than expected.
The race has also been upended by the killing of George Floyd, the Black man whose death in the custody of the Minneapolis police ignited protests across the country. Ms. Omar has been a leading voice in advocating systemic changes such as restructuring the police department, while her opponents have focused efforts on more incremental reforms.
More than a referendum on Ms. Omar, the election could signal the electorate’s embrace of a path forward after a tumultuous summer.
Progressives have had a good month. Can it continue?
Ms. Omar’s re-election is one of the final down-ballot contests that will decide the overall success or failure of progressives in 2020. Progressive groups like Justice Democrats and Sunrise Movement rebounded from the heartbreak of Senator Bernie Sanders’s defeat in the presidential primary and secured key wins in races in New York, Illinois and Missouri.
Last week, when Cori Bush defeated the House Democrat William Lacy Clay and Ms. Tlaib won re-election on the same day, many on the left said a tumultuous year that began with a raging pandemic was finally turning into a good one. For that to remain true for the left, Ms. Omar would need to be sent back to Congress.
Beyond beating incumbents, progressives are seeking to show they can deliver for constituents, and winning a second term bolsters the argument that pushing back against challenges to Democratic norms coming from the White House is popular at home.
If she loses, it will be a win for a rare alliance: center-left Democrats and right wingers who love President Trump. Together, their mutual dislike of Ms. Omar has fueled donations for her challenger, and placed pressure on her in a tough primary in a deep-blue district. Her critics point to a record of controversy including the charges of anti-Semitism she has faced, and for which she has apologized. It is up to her district if they agree.
The squad goes for a sweep.
Ms. Omar is one of the few Muslim voices in Congress, and groups on the left believe that her representation has changed the scope of international debates. While both Ms. Omar and Mr. Melton-Meaux refer to themselves as progressives, one dividing line between them is their stance on Israel. Ms. Omar supports an effort to divest from Israel over its treatment of Palestinians, while Mr. Melton-Meaux has the backing of several pro-Israel groups.
Should Ms. Omar prevail, it would mean a clean sweep of victories for the squad, the group of four progressive Congresswomen of color who have been at the vanguard of the Democratic Party, helping to push it leftward.
Representative Alexandria Ocasio-Cortez of New York, the best-known member of the group, cruised to a dominant primary victory in June. Representative Ayanna S. Pressley of Massachusetts is unopposed. And last week, Ms. Tlaib easily dispatched an opponent she had edged out two years ago.
While members of the squad initially clashed with centrists and Ms. Pelosi, they have more recently found ways to build their strength within the ranks of the party.
Ms. Omar has raised more than $4 million for her re-election effort. And Ms. Pelosi endorsed her last month, calling her a “valued and important member of our caucus.”
In Georgia, Republicans have a QAnon problem.
The Republican Party is going to find out just how big a QAnon problem it has on Tuesday when a primary runoff is decided in a backwater district of Georgia.
The favorite in the race in the state’s 14th Congressional District is Marjorie Taylor Greene, a gun-rights activist who is an unabashed supporter of QAnon, a fringe group that has been pushing a convoluted pro-Trump conspiracy theory. Lined up against her is John Cowan, a physician who is no less conservative or pro-Trump, but who does not believe QAnon’s theory that there is a “deep state” of child-molesting Satanist traitors plotting against the president. The winner is a near lock to be elected to Congress in the overwhelmingly Republican district.
The F.B.I. has labeled QAnon a potential domestic terrorism threat and the conspiracy theory has already inspired real-world violence. Yet its supporters are slowly becoming a political force with more than a dozen candidates, who have expressed some degree of support for the theory, running for Congress as Republicans.
Most of them are expected to lose. Yet they all present a fresh headache for Republican leaders.
The party, while already struggling to distance itself from conspiracy theories steeped in racist and anti-Semitic messaging, also cannot afford to turn off voters who share those conspiratorial views if it hopes to retain the Senate and retake the House.
A victory for Ms. Greene is going to make that balancing act far harder. She has been caught in Facebook videos making a series of offensive remarks about Black people, Jews and Muslims. And unlike some other QAnon-linked candidates, she has made no effort to soft-pedal her support for the conspiracy theory. She recently called it “a once-in-a-lifetime opportunity to take this global cabal of Satan-worshiping pedophiles out.”
Yet she nonetheless won 40 percent of the vote in the district’s Republican primary in June. Mr. Cowan won 21 percent, and the remainder of the votes were split between seven other candidates.
Will Wisconsin and Georgia avoid a repeat of their last elections?
In Wisconsin, which was the first state to hold a large, statewide election as the number of coronavirus cases was surging in the U.S. in early April, the virus is still nearing peak levels but the elections apparatus appears to be on more solid footing. One of the central causes of the long, mask-clad lines in Milwaukee in April was a drastic shortage of poll workers, which led to the city consolidating its polling locations to five from 180.
On Tuesday, about 170 voting sites will be open in Milwaukee, or roughly 95 percent of the regular sites. The state also activated the National Guard, which will be dressed in plain clothes, to be on standby should there be any emergency shortages on Tuesday.
Though the complaints of missing or late arriving absentee ballots in Wisconsin are fewer this year, the Wisconsin Election Commission still had about 9,000 absentee ballot requests to fulfill as of Friday, and the return rate of ballots was still somewhat low. Officials are also wondering whether the state will be able to count all of the absentee ballots in time for reporting results by Tuesday night.
In Georgia, where about 60 percent of the state’s counties are holding elections, the turnout isn’t expected to reach levels where long lines would be a problem like during the primary. The state’s most populous county — Fulton — also opened an early voting location at State Farm Arena to help alleviate Election Day surges.
The absentee ballot deadlines, which required a ballot to arrive by close of business on Friday, remain unchanged from the primary election in June.
Video has begun to spread around the internets purportedly showing LA County, California law enforcement training their guns (including what appears to be an assault rifle) on three Black teenagers while bystanders plead with police, telling them that they are threatening the wrong people. In the video, which takes place in Santa Clarita, about 30 miles outside of Los Angeles, a law enforcement officer can be seen telling the crowd gathered to back up while he holds his rifle trained on teens standing at a bus stop. The teens have their hands up, and one teen has been moved to his knees in front of the police car.
Most striking is that more than a handful of onlookers plead with law enforcement to put down their guns, telling them they have the whole thing mixed up. TMZ reports that a mother of one of the teens told the outlet that the kids were sitting at a bus stop when an unhoused individual came up to them asking for drugs and then getting very aggressive, pulling off his shirt and attacking them with a knife. The kids reportedly fended their attacker off with their skateboards. The LA County Sheriff’s Dept. told TMZ that the reason the police were treating the teens this way was because they were responding to a call of “2 adult males hitting another man with a skateboard.” The deadly weapon that the police were training multiple guns on the kids for was their skateboard.
Just when you think 2020 can’t get any worse, bam, it does.
A New York dentist now says wearing a face mask for hours can be harmful to your dental health by giving you “mask mouth.”
“We’re seeing inflammation in people’s gums that have been healthy forever, and cavities in people who have never had them before,” Dr. Rob Ramondi, co-founder of One Manhattan Dental, told the New York Post
“About 50% of our patients are being impacted by this, [so] we decided to name it ‘mask mouth’ — after ‘meth mouth.”
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“The term ‘meth mouth’ is widely used by dentists to describe the dental problems that arise among methamphetamine users. Addicts often end up with cracked, black- and brown-stained teeth because the stimulant causes sugar cravings, teeth grinding and jaw clenching. They also often neglect their oral hygiene,” The Post wrote.
Constant mask wearing can lead to all kinds of mouth maladies, including cavities, decaying teeth, and dangerous halitosis.
Dr. Mark Sclafani, Ramondi’s business partner, said oral problems can sometimes lead to far worse conditions.
“Gum disease — or periodontal disease — will eventually lead to strokes and an increased risk of heart attacks. People tend to breathe through their mouth instead of through their nose while wearing a mask,” he said.
But Sclafani said that constant mask-wearing has prompted some people to visit the dentist.
“Patients are coming into us like, ‘Wow, my breath smells, I need a cleaning.’ [But] when you smell the bad breath, you either already have periodontal disease or you have a lot of bacteria that’s sitting on your tongue because of dry mouth,” he said.
The Attorney General of the United States, Bill Barr, claimed that Trump always makes well-vetted decisions, has tons of energy, and is always working.
Barr said, “He’s an excellent executive and president. There’s robust conversation. He calls on people for their ideas and so forth. I feel that the decisions that we make are well-vetted in the White House and my colleagues in the cabinet are I think high caliber individuals so that part of it has been good….I’ve never seen such energy. He’s always working.”
Video of Barr:
Bill Barr says that Trump “is an excellent executive” whose White House makes “well-vetted” decisions. He adds that that “I’ve never seen such energy. He’s always working.” pic.twitter.com/Hd8x4VQURt
Barr is the second member of the Trump administration in a day to point out how “hard-working” Trump is. Trump trade adviser Peter Navarro called Trump the hardest working president in history. Never has an attorney general gushed over a president the way that William Barr did. It is humiliating for the Department of Justice and the nation as a whole to have an attorney general who so openly grovels at the feet of a failed president.
The Trump administration is clearly worried about Trump’s constant golfing and his refusal to his job as president.
The Barr interview was disgraceful because it reveals how the Executive Branch of the federal government has been warped to fit Trump’s cult of personality.
Mr. Easley is the founder/managing editor and Senior White House and Congressional correspondent for PoliticusUSA. Jason has a Bachelor’s Degree in Political Science. His graduate work focused on public policy, with a specialization in social reform movements.
Awards and Professional Memberships
Member of the Society of Professional Journalists and The American Political Science Association
“It’s textbook in a lot of ways,” Professor Grant said. “If you are a Black woman, and you show up in a space with new ideas, asking people to be different than they have before, then you are subject to this criticism about not knowing your place, being too ambitious, wanting too much.”
There has long been a refrain among those who study women’s leadership that women who seek power must do it nicely. Research has shown that women can temper their ambitions by conveying warmth — because women are expected to be “warm,” so it offsets the bias — and that self-promotion is possible, but carefully, because people tend not to like immodest women.
There is an entire self-help industry devoted to this kind of bias hacking, with tips and tools for how to rise in a largely white and male-dominated corporate world where to be successful, a woman must be liked, but to be liked, she must not be too successful, her likability eroded by her professional status. “It’s a classic double bind,” said Marianne Cooper, a sociologist at Stanford who studies gender and leadership.
Joan C. Williams, who runs the Center for WorkLife Law at the University of California, Hastings College of the Law, and is an author of “What Works for Women at Work,” has called this “gender judo”: The idea that women can counter the bias to those stereotypically “masculine” behaviors, like ambition, by exhibiting stereotypically “feminine” behaviors, like warmth or friendliness.
In other words, negotiate, but do it with a smile. (Research from the Carnegie Mellon professor Linda Babcock has found that in a negotiation, smiling can help offset the tendency for a woman to be labeled aggressive.) Win the debate, but apologize for it later. And definitely, definitely don’t laugh.
And yet those temperament modifications have never been available in the same way to Black women — who must navigate what Francis M. Beal, the co-founder of the Black Women’s Liberation Committee of S.N.C.C., labeled “double jeopardy” long ago.
The California Department of Public Health estimates that up to 238,628 Californians would meet the criteria for PrEP – that is, they have unprotected sex or are IV drug users. But waiting several days for a doctor’s visit, another few days for HIV test results and maybe another day for insurance preauthorization can make PEP unusable and can make potential users of PrEP think twice about whether they really want the meds.
The CDPH estimates that up to 238,628 Californians would meet the criteria for the HIV prevention regimen PrEP.
To help boost the sale and use of PrEP and PEP, the California Legislature last year passed SB 159, a first-in-the-nation law allowing pharmacists to write prescriptions for it (and for PEP) and, in theory, to let the patient get the medication on the same day. The hope is that the law will significantly increase PrEP/PEP use for populations most vulnerable to HIV: Latino and Black gay and bisexual men whose doctors are less likely to prescribe the medication. But a question remains whether this well-meaning law could ultimately be hampered by systemic issues of a for-profit health care system, a system where disparities of care can be intractable.
In the first part of this series, I explored the disparities in PrEP access throughout California, and which regions might benefit from the law. Sprawling San Bernardino County, with its lack of LGBT support services and few public clinics, I speculated, could benefit the most—while San Francisco, the least.
In part two, I dig deeper into whether the dispersion of retail pharmacies and financial disincentives for pharmacists might undermine the law.
The Theory: SB 159 makes it easier to get PrEP
Before SB 159’s passage, obtaining PrEP required a prescription from a doctor and an HIV test. (If you test positive you don’t need, and can’t get, a prescription for PrEP, though people with HIV can get Truvada or Descovy for treatment.) The law still requires an HIV test, and standard protocol for PrEP still includes ongoing kidney function tests, to be conducted every three months. Each of those steps creates a potential delay for people who want to get the medication. There’s a financial hurdle, too: Lab tests are often an out-of-pocket expense.
SB 159 eliminated insurance preauthorizations for PrEP and PEP, saving, at the very least, time. Another part of the law, allowing pharmacists to prescribe PrEP and PEP, was designed as an end run around doctors, by partially “de-medicalizing” these potentially lifesaving meds. This part is meant to equalize very unequal health care outcomes because providers in some areas are much less likely to prescribe medication to prevent a disease that is largely spread through sexual activity and IV drug use—if they even know about the medication.
One sexually active young man said his doctor asked why PrEP was needed and, “Why are you gay?”
Many young, sexually active LGBT participants in Los Angeles told me their primary care doctors were hostile to the idea of providing medication to prevent HIV from sex. One said his doctor asked why the medication was needed and, “Why are you gay?” Several participants agreed that many primary care physicians, especially in Latino communities, are from other countries, older and conservative, and that many doctors who serve Medi-Cal patients are generally not gay-friendly. Some doctors and nurses are also clueless about HIV and STD testing, especially if their practice gets few requests for them. “If they do an HIV test, they don’t do a full STD panel, and never a throat swab or anal swab, and they don’t know what billing code to use,” said one participant.
Dr. Clint Hopkins, owner and pharmacist at Pucci’s Pharmacy in Sacramento, testified before the legislature in favor of SB 159, because, as he told Capital & Main, “Pharmacists are the most accessible health care providers in the community.”
Hopkins claims that one HMO, Kaiser Permanente, makes it difficult to get PrEP, requiring referrals to an infectious disease doctor in the network who will order the HIV test. “It can take up to two months to get PrEP (through Kaiser),” Hopkins said. When asked to verify that the process could take up to two months, a Kaiser spokesperson declined to comment.
SB 159 set out to prevent resistance from physicians, insurers and HMOs. Obstacles from the health care industry would also, in theory, be reduced by simply obtaining both a prescription and meds from pharmacists. But there are three ways the law may fall far short of its goal, at least initially, of making PrEP access easier for the most vulnerable populations. Unless retail pharmacies, a., opt in to the law, b., provide the required HIV test on-site and c., make that HIV test free, customers who are younger, lower income, or in areas with few pharmacy options won’t find it easier to get PrEP.
“If we want to end HIV then people should be able to walk into any pharmacy and get a test for free.”
— Dr. Clint Hopkins, Pucci’s Pharmacy
But Hopkins is concerned that the resulting law doesn’t go far enough. “Nothing in the law says insurers have to pay for the meds or the lab tests. Patients may have an undue burden to pay for testing out of pocket. And there is a lack of testing sites even in Sacramento. If we want to end HIV then people should be able to walk into any pharmacy and get a test for free.”
PrEP deserts might remain deserts
As reported in part one of this series, most urban areas in California have an extensive network of PrEP providers, some of which offer one-stop shopping for PrEP. Large swaths of the state have fewer physicians who have written or are willing to write a prescription, according to CDC data. Any doctor could prescribe PrEP or PEP, but not all know what the medication does, and more conservative doctors stigmatize and “slut-shame” patients who ask for it. Doing an end run around doctors, thus streamlining the process of getting PrEP/PEP, is one goal of SB 159. But the effectiveness of the law depends in part on where the pharmacies are and whether they choose to participate.
I have identified San Bernardino County as one of the counties that could be helped most by SB 159. It has one of the lowest overall rates of PrEP use—35 out of 100,000 people—and among the lowest rates of use of PrEP based on the estimated number of people who could benefit from it (PrEP-to-need ratio, or PnR), and the lowest PnR in California for people under 24 years old. There are currently only eight locations where prescriptions are being written for PrEP, for a population of 2 million—making much of the county a PrEP desert. (A 2019 study classified PrEP deserts in the United States as areas where the one way driving time was 30 minutes or more.) SB 159 could help shrink some of those deserts, provided that pharmacies in those areas agree to participate in the law.
However, overlaying a map of California pharmacies on a county map of PnR shows that even if the majority of pharmacies participate in SB 159—again, not a sure thing—there will still be PrEP deserts in California. Hayfork, in Northern California, is in a PrEP desert. The options for its residents for getting a PrEP prescription are Planned Parenthood in Redding and Redwoods Health Center in Redway, 43 and 45 miles away respectively. But even with SB 159, Hayfork would still be a desert: The nearest pharmacy is a CVS in Weaverville, 29 miles away and about 40 minutes of driving time.
Even under SB 159 the process for obtaining PrEP and PEP is a little more complicated than procuring birth control, which is covered by another opt-in law. SB 159 spells out requirements for HIV testing before a pharmacist can furnish PrEP, stating that a patient must be “HIV negative, as documented by a negative HIV test result obtained within the previous seven days from an HIV antigen/antibody test or antibody-only test or from a rapid, point-of-care fingerstick blood test approved by the federal Food and Drug Administration.”
In theory, a patient could get a test at a free clinic, if there’s one nearby, a day or so before heading to the pharmacy for a prescription. But when I contacted a CVS Minute Clinic in West Hollywood, which has been providing PrEP under an arrangement to work with one or more physicians called a collective practice agreement (CPA), I discovered several obstacles:
A nurse practitioner first performs an evaluation by appointment only (there are no walk-ins due to the COVID-19 crisis).
The NP then sends the patient to a lab for an HIV test.
After a wait that can last 72 hours, patients receive the results and may return to the Minute Clinic for the medication.
Additionally, patients must call their health insurance company to see if labs are covered, and these insurers might not be open on the weekends. This practice would make getting PEP, which must be taken within 72 hours of risky sexual contact, futile, and could make those who want PrEP give up. And this is at a pharmacy/clinic in a city known for decades as a mecca for LGBT people.
As mandated by the Affordable Care Act, HIV testing is free for those with insurance, but it may not always be easy to find a place offering HIV tests. According to CDC data, there are 20 places to get an HIV test, free or not, within three miles of ZIP code 90069, West Hollywood. But a search of Hayfork (in the middle of a PrEP desert) turns up no testing locations nearby. ZIP code 92363, Needles, shows one testing location seven miles away. Needles, in San Bernardino County, abutting the Arizona border, has only one pharmacy, a Rite Aid. If this pharmacy doesn’t offer HIV testing, residents there wanting PrEP will have to make a significant trek to get one. If the store doesn’t participate in SB 159, it will be a moot point, and residents wanting PrEP will have to travel at least 22 miles to get an HIV test and prescription. Then they’ll have to take that prescription back to their pharmacy.
A lack of incentives for pharmacists
One nagging concern about the rollout of SB 159 is that pharmacies will not opt in, either because of financial or moral objections. In those cases, the current PrEP deserts in California will remain deserts. In other words, for the law to work, pharmacists must buy in. To ensure that buy-in, it helps to have a financial incentive beyond the small Medi-Cal payment for each prescription.
The key for successful implementation of SB 159 is widespread pharmacy buy-in, according to Maria Lopez of Mission Wellness Pharmacy in San Francisco. “If they’re paid adequately they might [buy in], she says. “They have to invest in infrastructure and training staff, and that costs money.” Lopez is also developing a training module to instruct pharmacists on the law.
Hopkins hopes that more pharmacies like his will offer free, on-the-spot HIV testing to help reduce the number of steps people need to take to obtain PrEP. “There is no way to do (free testing) without the pharmacists losing money. If patients don’t pay for it, who will? Also, there is time involved. There’s OSHA, training requirements for the staff.”
A precursor to SB 159 was a 2013 law expanding the ability of pharmacists to act more like doctors, to order lab tests and interpret and modify prescriptions. But Hopkins, who did register for the 2013 law, SB 493, says that as with testing services, the lack of financial reimbursement from the state has prevented most pharmacists from registering.
“We’re not trying to get rich,” Hopkins said. “But the equipment and supplies are not free. We are paid pennies on prescriptions. Many opted not to get registered on SB 493 because it will cost them money.” And if they don’t get registered on SB 493, they won’t be able to offer testing, meaning more time and money will be spent by a potential PrEP customer before the medication is sold.
Hopkins and Lopez, whose practices for years have had certified physician assistants with doctors who prescribe PrEP and PEP, say CPAs can help pharmacists to provide these meds more easily. But Hopkins believes only a small percentage of pharmacies will do this because there’s no financial incentive. “Insurance providers typically will not recognize a pharmacist for the services that they provide outside of dispensing prescriptions. If there were a financial incentive, I’m certain that many more pharmacies across the state, both independent and chain alike, would seek out these relationships and provide more services.”
If few pharmacists, or, more important, pharmacies and their parent companies, decide to participate in SB 159, the current PrEP deserts in California will remain PrEP deserts.
Outreach and education needed, but who will provide?
Just as some doctors are unaware that Truvada and Descovy can be used to prevent HIV, it’s news to many pharmacists as well. A 2018 study showed that nearly three quarters of pharmacists nationwide didn’t know the CDC protocols for PrEP, and nearly half didn’t even know what PrEP is.
A 2018 study showed that nearly half of pharmacists nationwide didn’t know what PrEP was.
In California, there may be greater knowledge of PrEP, but very little awareness of SB 159, and without any money in the state budget for education and outreach in the California FY 2021 budget, that outreach is up to the California Pharmacists Association and LGBT social services organizations.
I randomly called seven San Bernardino County pharmacies in mid-June, nearly six months after the law went into effect, to see, first, whether they already provided PrEP with a doctor’s prescription, and whether their pharmacists were going to take the training to prescribe it themselves. For those pharmacies that sold PrEP with a doctor’s prescription, not only was pharmacist training not in the cards, none of them had heard about SB 159. An assistant at the CVS Minute Clinic in Rancho Cucamonga said that he wasn’t sure whether the pharmacy carried Truvada or Descovy, but that I should make an appointment on the website to meet with a nurse practitioner to learn more. But on the website, neither PrEP nor PEP nor anything related to HIV was given as an option.
The Planned Parenthood of Victorville was very helpful, though they don’t have meds on site: If I wanted PrEP they would set up an in-person visit to give an HIV rapid response test with same-day results. Planned Parenthood would submit a prescription for Truvada at the pharmacy of my choice. Calling on a Friday afternoon I found available appointments for Monday, but not over the weekend.
This brings up another potential benefit of SB 159. Many pharmacies are open on weekends and after 6 p.m.; most doctors’ offices and clinics are not. That might be a boon to people who need PEP, which has to be taken within 72 hours after sexual activity—right now an ER, if it carries it, is the only option for obtaining PEP on a Sunday afternoon. Again, the law only works as intended if pharmacies opt in.
The California Board of Pharmacists said that a 90-minute training module is close to being complete and that pharmacists must complete that or other state-approved training in order to prescribe PrEP or PEP. But as of mid-July no pharmacists had completed any training, and there was a statewide campaign to inform Californians about SB 159. I contacted two of the largest chains in the U.S., Walgreens and CVS, to see whether they would launch awareness campaigns. CVS responded by reiterating its support for HIV-related meds but said nothing about SB-159 awareness in California. A Walgreens spokesperson, in an email, said the chain was “considering a pilot program in the state to gather key learnings and insights that will help to determine any future steps in how our pharmacists can more broadly offer PrEP and PEP.”
Dr. Maria Lopez of Mission Wellness said that it has taken some effort in getting San Franciscans to know that her pharmacy provides PrEP without a doctor’s prescription. She said in addition to referrals from partners, people learn about her pharmacy through a city ad campaign, social media, word of mouth, and PleasePrepMe. She has also reached out to Latino and Black residents through an ad campaign for PrEP and drawn a higher percentage of these populations than in the city as a whole.
It’s unclear whether pharmacies in other parts of the state, including PrEP deserts, will go to such lengths to inform the public that they provide PrEP through SB 159. It’s possible that larger chains might advertise on gay hookup apps, like Grindr and Scruff. Those platforms feature ads from telemedicine apps, like Plushcare, NURX and the gay-focused Mistr, which provide on-demand doctor’s “visits,” PrEP by mail and, in some cases, home self-tests. These telehealth apps are gaining in popularity and may be an even more important link to PrEP for people in PrEP deserts, both in California and the rest of the U.S.
All advocates for SB 159 have admitted that it has some kinks to be worked out, and Hopkins said it’s a good “foot in the door” toward greater use of potentially lifesaving HIV prevention meds. But with all the ways the law might not work as expected, a question looms: Why is it so hard to provide access to meds to prevent a disease that’s a public health crisis? The answer, says Hopkins, is the for-profit health care system, which incites “turf wars” on the part of some doctors and the California Medical Association—who, he says, oppose laws expanding the role of pharmacists because it infringes on their ability to get paid. The CMA initially opposed the bill, because it disrupted the “patient-physician relationship,” but the final version of the bill required pharmacists to refer a PrEP customer to a doctor after providing up to a 60-day supply.
“The only way to end HIV is to make access to testing and PrEP universal,” Hopkins says. “insurance co-pays and a lack of free public HIV testing services not only make it harder to prevent HIV, they make the case for socialized medicine.
“I did some of my education in England, where you can walk in with a prescription for anything, and it is covered,” Hopkins says. “Everyone is treated the same. It is hard to bring HIV to zero with the health care system we have now.
This article was produced as a project for the USC Annenberg Center for Health Journalism 2019 Data Fellowship.
Peter Navarro referred to Trump, who has spent more time golfing than any other president in the last 50 years as the hardest working president in history.
Transcript of Navarro on NBC’s Meet The Press:
Why isn’t he involved?
Look, you have to understand this is the hardest working president in history. He works 24/7. He can be in Bedminster, Mar-a-Lago, the Oval Office, or anywhere in between. He can be at the Whirlpool factory, like we were on Thursday, celebrating working men and women benefiting from tariffs. He’s working 24/7. The problem here, the problem here is Capitol Hill, the swamp, two houses that are too far apart. I mean, the Lord and the founding fathers created executive orders because of partisan bickering and divided government. That’s what we have here. But the president’s taken action. His constituency — let’s be clear. His constituency is mainstream Republicans, blue collar Democrats, and independents who are sick and tired of the swamp. And he reached out and he took action. You know, he didn’t have to —
According to the Presidential Golf Tracker, Trump has played twice as much golf as Obama and more than five times more golf than George W. Bush, who preferred visiting his ranch, over hitting the links. Trump only trails Eisenhower and Woodrow Wilson in the average number of days between rounds.
The American people know that Navarro is lying because Trump’s private schedule has been leaked numerous times. Trump doesn’t start his workday until roughly 11 AM. He is usually done by 4-6 PM depending on the day of the week, and throughout the day has time scheduled for watching TV and tweeting.
Trump is a do-nothing president, and no one outside of his supporters is fooled by the false claims of hard work.
Mr. Easley is the founder/managing editor and Senior White House and Congressional correspondent for PoliticusUSA. Jason has a Bachelor’s Degree in Political Science. His graduate work focused on public policy, with a specialization in social reform movements.
Awards and Professional Memberships
Member of the Society of Professional Journalists and The American Political Science Association