Listen: More than 2 million Americans could benefit from PrEP, but only about a quarter of them are getting the HIV prevention medication. On Feb. 4, during WAMU’s “Health Hub,” ºÚÁϳԹÏÍø News reporter Zach Dyer shared tips for overcoming common hurdles to care.

Billing mistakes. Stigma. Doctors who aren’t keeping up with the latest research. Those are just some of the hurdles that for many Americans.

The Centers for Disease Control and Prevention estimates more than 2 million Americans could benefit from a treatment known as PrEP, but only a quarter of them are getting a form of the drug. Zach Dyer appeared on WAMU’s “Health Hub” on Feb. 4 to share tips patients can use to avoid those pitfalls and find a doctor who knows more about PrEP.

This <a target="_blank" href="/insurance/wamu-health-hub-prep-hiv-treatment-access-workarounds-february-4-2026/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

When Matthew Hurley was looking to take PrEP to prevent HIV, the doctor hadn’t heard of the medicine, and when he finally did prescribe PrEP, the bills sent to Hurley were expensive … and wrong. “I decided to write in because the process was really super frustrating.” At one point, Hurley asked, “Am I just going to stop this medication to stop having to deal with these coding issues and these scary bills?”

— Matthew Hurley, 30, from Berkeley, California

A couple of years ago, Matthew Hurley got the kind of text people fear.

It said: “When was the last time you were STD tested?”

Someone Hurley had recently had unprotected sex with had just tested positive for HIV.

Hurley went to a clinic and got tested. “Luckily, I had not caught HIV, but it was a wake-up call,” they said.

That experience moved Hurley to seek out PrEP, shorthand for preexposure prophylaxis. The antiretroviral medication greatly reduces the chance of getting HIV, the virus that causes AIDS. The therapy is at protecting people against sexual transmission when taken as prescribed.

Hurley started PrEP and all was well for the first nine months — until their health insurance changed and they started seeing a new doctor: “When I brought PrEP up to him, he said, ‘What’s that?’ And I was like, oh boy.”

Hurley, who is a librarian, went into teaching mode. They explained that the PrEP regimen they’d been on required daily pills and lab work every three months to look out for breakthrough infections or other health issues.

Hurley was surprised they knew more about PrEP than the physician. The FDA approved the first drug, Truvada, , and Hurley lives in the San Francisco Bay Area, a place with one of the of LGBTQ+ people in the nation and a of HIV and health care activism. Hurley said older friends and acquaintances who survived the AIDS epidemic shared the horror of living through a time when there was no effective treatment or drugs for prevention. Deciding to take PrEP felt like an empowering way to protect their health and their community.

So Hurley pushed the doctor, and after the physician did his own research, he agreed to prescribe PrEP.

Hurley got the care they needed, but they had to be the expert in the exam room.

“That’s a big burden,” said Beth Oller, a family medicine physician and board member of GLMA, a national organization of LGBTQ+ and allied health care professionals focused on health equity. “You really want someone you can just go in and talk [to] about your health concerns without feeling like you are having to educate and advocate for yourself at every turn.”

Oller said many queer people have had during health care visits.

“I have a lot of patients who had not done preventive care for years because of the medical stigma,” she said.

Billing Headaches

Clearing the access hurdles to HIV prevention medicine was just the beginning. Hurley started receiving a string of bills for PrEP-related care. Blood test: $271.80. Office visit: $263.

Again, Hurley was surprised. They knew — even if the billing office didn’t — that under the most private insurance plans and Medicaid expansion programs are PrEP and ancillary services, , as preventive with no cost sharing.

The bills for doctor visits and blood draws piled up.

Hurley would appeal the bill and get a denial almost every time. Then, they would appeal again.

Hurley shared a series of appeal letters for one service, in which the billing office acknowledged that blood work had been initially incorrectly coded as diagnostic. Once that was corrected, Hurley said, the insurer paid for the service.

That might sound quick or easy to resolve, but Hurley said it took “forever to get through the process.” They dealt with at least six incorrect bills over several months. Hurley estimated they spent more than 60 hours contesting the bills.

During that time, Hurley said, the billing department “is continuing to send me emails and bills that are saying, You’re overdue. You’re overdue. You’re overdue.”

Fed up with the hassles, Hurley decided to find a health provider (and billing office) better informed about PrEP. They settled on the AIDS Healthcare Foundation. The care team there was able to discuss the pros and cons of different PrEP regimens and knew how to navigate the formulary for Hurley’s insurance.

Hurley hasn’t gotten an unexpected bill since.

But siloing sexual health care and PrEP off from primary care hasn’t been ideal.

“I have multiple organizations that I have to deal with to get my holistic health dealt with,” Hurley said.

A provider doesn’t need to be an HIV specialist, an infectious disease expert, or a physician to prescribe PrEP. The Centers for Disease Control and Prevention encourages primary care providers to treat PrEP like .

To avoid some of the headaches Hurley faced, try these tips:

1. Find out if PrEP is right for you.

The CDC estimates Americans could benefit from HIV prevention drugs, but just over a quarter of that group have been prescribed them.

“Not enough people know about PrEP, and there are a number of people who know about PrEP but do not realize it’s for them,” said Jeremiah Johnson, executive director of PrEP4All, an organization dedicated to universal access to HIV prevention and medication.

According to the CDC’s clinical guidelines, PrEP can be prescribed as part of a preventive health plan to . It’s especially recommended for people who don’t use condoms consistently, intravenous drug users who share needles, men who have sex with men, and people in relationships with partners living with HIV or whose HIV status is unclear.

The vast majority of PrEP users are men. There are big race, gender, and geographical of HIV and the populations taking the prevention medicine. For example, based on the patterns of new infection in the U.S., a group that would benefit from PrEP is cisgender Black women, whose gender identity aligns with their sex assigned at birth.

2. Don’t assume your provider knows about PrEP.

If your doctors aren’t well informed, start by . There are also clinical guidelines and information you can share with your provider. Check your state or local health department for a how-to guide for prescribing PrEP. For example, the New York State Department of Health AIDS Institute has information .

The , but many of the agency’s websites dealing with LGBTQ+ health are in flux. Under the Trump administration, some HIV/AIDS resources have been taken down from federal websites. Others now have : “This page does not reflect biological reality and therefore the Administration and this Department rejects it.”

3. Get lab work in-network.

Johnson said Hurley’s experience with billing mistakes is common. “The lab expenses in particular end up being very tricky,” Johnson said.

For example, a doctor’s office may mistakenly code the lab work required for PrEP as a instead of preventive care. Patients like Hurley can end up with a bill they shouldn’t have to pay. If your doctor’s office is making mistakes, share the from NASTAD, an association of public health officials who administer HIV and hepatitis programs.

Try to get your lab work done in-network. If the lab is out-of-network, Johnson said, it can be difficult to appeal.

If the bills keep coming, appeal them. And if you can’t resolve the dispute, Johnson said, file a complaint with the agency that regulates your insurance plan.

4. Look for ways to save.

There are different kinds of PrEP. There are lower-cost, generic versions of Truvada, for example, sold as emtricitabine/tenofovir disoproxil fumarate, often shortened to FTC/TDF. Newer PrEP drugs have list prices in the thousands of dollars. Check your insurance formulary and ask your doctor to prescribe medicine your plan will cover.

With many health care premiums dramatically increasing and millions at risk of losing Medicaid coverage, many people may go without health insurance this year. Drug manufacturers such as and have assistance programs for qualifying patients. If you have to pay out-of-pocket, prescription price comparison websites, like GoodRx, can help you find the pharmacies with the cheapest price.

5. Consider telehealth.

Telehealth is an option if you don’t live near an affirming provider or are looking for a more private way to get PrEP. In 2024, roughly 1 in 5 people on PrEP used telemedicine. Online pharmacies like and offer PrEP without an in-person appointment, and lab work can be done at home. Some telehealth options have ways to if you’re uninsured.

Telehealth can also broaden the number of doctors who are ready to prescribe PrEP. And some patients say speaking with a remote provider feels like a safer setting to talk about sexual health. “They’re in the comfort of their own bedroom or living room but can interface virtually with a provider. It can open up a lot of doors for honesty and trust,” said Alex Sheldon, executive director of GLMA.

6. Seek out affirming care.

GLMA created the , a searchable database of health care providers across the nation who identify as queer-friendly. As Hurley discovered, living in a major metro area is no guarantee your doctor is up to date on LGBTQ+ health care.

Ask locals you trust for recommendations. You might be surprised to find good options nearby.

Health Care Helpline helps you navigate the health system hurdles between you and good care. Send us your tricky question and we may tap a policy sleuth to puzzle it out. Share your story. The crowdsourced project is a joint production of NPR and ºÚÁϳԹÏÍø News.

This <a target="_blank" href="/health-care-costs/health-care-helpline-prep-preexposure-prophylaxis-hiv-prevention-drug-lgbtq-tips/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Listen as senior producer Zach Dyer reports on the public health concerns over online sports betting and a fund in Missouri that might help with addiction treatment and prevention. 

The parking lot at the Super One Stop in Granite City, Illinois, is full. The convenience store just across the Mississippi River from Missouri sells liquor, cigarettes, and some groceries. But not all the cars belong to customers. It’s a Sunday morning in the middle of football season, and the people sitting in their vehicles are mostly looking down at their smartphones.

Nick Krumwiede is sure the people parked around him are betting on the day’s NFL games. That’s why he’s there. Krumwiede drove 15 minutes across the state line from his home in St. Louis to place three bets, including one on his beloved Chicago Bears.

Krumwiede could have driven to a casino in East St. Louis, Illinois, to bet on the games in person. But with apps like DraftKings and FanDuel on his smartphone, he doesn’t need to make the trip. He can place his bets in this parking lot.

“This is Sunday football, everybody,” Krumwiede said. “I guarantee you that’s what they’re doing.”

“You see them all sitting in there staring at their phones?” he said.

Public health experts say smartphone-based betting makes it easier for people to get into deep gambling trouble fast. But it takes effort to drive to a parking lot across state lines to bet on an NFL game. Soon, Missouri gamblers will be able to place those bets from their couches. Voters approved sports betting in Missouri in a November ballot initiative, and the state could start issuing sports betting licenses as soon as this summer.

The ballot measure requires the state to dedicate at least $5 million a year from its sports betting tax revenue to combat compulsive gambling. Supporters of the measure said that increase in resources could help the state address harms associated with gambling addiction. In other states, the introduction of online sports betting has been linked to increased calls to hotlines for problem gambling.

Estimates of the state’s revenue from sports betting range from $12.8 million to $20.5 million, according to a for a previous bill to legalize sports betting.

Carolyn Hawley is at Virginia Commonwealth University who researches problem-gambling addiction, treatment, and harm reduction. She has tracked Virginia’s experience since sports betting started there four years ago.

“ We don’t even have to leave our homes anymore,” she said. “We now have them on our smartphones. We can do it anytime, anyplace.”

In Virginia, some primary care providers have started asking their patients about their gambling habits, Hawley said. Doctors have shared reports of stress-related ailments, she said, especially in young men who had been betting on sports.

“They’re coming in with . They’re coming in with . They’re coming in with ,” she said.

Sports bettors tend to be younger and male. In a of registered voters, Fairleigh Dickinson University found that a quarter of men under 30 bet on sports online. Problem gamblers make up 10% of that group, compared with 3% of the overall U.S. population.

After the legalization of sports betting in Virginia, Hawley observed a spike in calls to her state’s gambling helpline: 1,000% more from 2019 to 2023.

Hawley, who is also the president of the Virginia Council on Problem Gambling, said 200% more people were looking for resources to quit gambling.  Other states have seen similar trends.

Dozens of states have legalized sports betting after a Supreme Court decision cleared the way in 2018, including every state that borders Missouri save one, Oklahoma.

Supporters who pushed for sports betting in Missouri say people already cross into other states to gamble. They argue that Missouri has missed out on valuable tax dollars that could, in part, help fund gambling treatment and prevention efforts in the state.

“The beautiful thing about being the 39th state to do something is you are able to take a look at what has worked and what hasn’t worked in other states,” said Jack Cardetti, spokesperson for , a group made up of Missouri and sports betting companies that supported the ballot initiative.  “If we’re going to have an expansion of gaming here in the state of Missouri,” he said, “we also need to expand the resources.”

Missouri spent just $100,000 on problem gambling in 2023 and zero dollars the year before that. The state is still developing a plan to spend the money earmarked from the ballot initiative.

In Illinois at the Super One Stop, store owner Himang Patel said he doesn’t mind sports bettors using his parking lot to gamble on their phones. Some people sit up to an hour, and Patel said that can be an opportunity to sell a pack of cigarettes or bag of chips. He guessed that the extra foot traffic will die off when sports betting becomes legal in Missouri.

Krumwiede said he’s looking forward to not having to make the drive across the state line, but he’s also mindful that easier access could come with risks. He knows gambling can be addictive.

“Sometimes I have bad days where I go out and put out a hundred bucks and I lose almost all of it,” he said. “It’s kind of like a sinking feeling. You don’t talk about it.”

Krumwiede tries to set rules for himself so he doesn’t lose too much money at any one time.

He said he is looking forward to not having to make the drive to Illinois after sports betting starts in Missouri. But he’s worried, too. He said there were periods in the past when he lost too much money.

“It’s a little scary, but I’m just going to have to make new rules,” Krumwiede said.

He has a few more months to figure it out.

This <a target="_blank" href="/mental-health/missouri-sports-betting-online-gambling-addiction-compulsive-illinois/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

ST. LOUIS — Shhhooo. Wee-uuu. Chick, chick, chick. That’s the sound of three different cicada species. For some people, those sounds are the song of the summer. Others wish the insects would turn it down. The cacophony can be especially irritating for people on the autism spectrum who have hearing sensitivity.

Warren Rickly, 14, lives in suburban south St. Louis County, Missouri. Warren, who has autism, was at the bus stop recently waiting for his younger brother when the sound of cicadas became too much to bear.

“He said it sounds like there’s always a train running next to him,” his mother, Jamie Reed, said.

Warren told her the noise hurt.

Starting this spring, trillions of the red-eyed insects out of the ground . It’s part of a rare simultaneous emergence of two broods — one that appears every 13 years, the other every 17.

The noisy insects can be stressful. People with autism can have a texture, brightness, and sound.

“I think the difference for individuals with autism is the level of intensity or how upsetting some of these sensory differences are,” said Rachel Follmer, a developmental and behavioral pediatrician at Lurie Children’s Hospital in Chicago.

“It can get to the extreme where it can cause physical discomfort,” she said.

When a large group of cicadas starts to sing, the chorus can be . Researchers at the University of Missouri-St. Louis this year crowdsourced cicada noise levels as high as , about as loud as a .

That can be stressful, not melodic, Follmer said.

To help children cope, she suggests giving them a primer before they encounter a noisy situation. For cicadas, that could mean explaining what they are, that they don’t bite or sting, and that they’ll be here for just a short time.

“When something is uncomfortable, not having power in that situation can be very scary for a lot of individuals, whether you’re on the spectrum or not,” Follmer said.

Jamie Reed’s family has been using this and other strategies to help her son. Warren wears noise-canceling headphones, listens to music, and has been teaching himself about cicadas.

“For him, researching it and looking into it I think grounds him a little bit,” Reed said.

Fatima Husain is a professor and neuroscientist at the University of Illinois Urbana-Champaign and studies how the brain processes sound. She said people with tinnitus may also struggle with cicada song.

Tinnitus, a ringing or other noise in the ears, is a person’s perception of sound without an external source.

“Some people say it sounds like buzzing, like wind blowing through trees, and ironically, quite a few people say it sounds like cicadas,” Husain said.

For most people with tinnitus the cicada’s song is harmless background noise, according to Husain, but for others the ringing can prevent easy conversation or sleep. Those with tinnitus are also more likely to have . A loud persistent sound, like singing cicadas, can make someone’s tinnitus worse, Husain said.

It’s not always bad, though. The cicada’s song can also be a relief.

For some, tinnitus gets worse in a quiet environment. Husain said she’s seen reports this year of patients saying the cicadas’ song has been like soothing white noise.

“The sound is loud enough that in some ways it’s drowning their internal tinnitus,” Husain said.

As loud as the cicadas can be, they anyone’s hearing, according to the Centers for Disease Control and Prevention. Hearing loss builds up over time from repeated exposure to loud sounds. Cicadas aren’t loud enough for long enough to do lasting damage, Husain said.

Everyday sources of noise come with a higher risk. Husain said constant exposure to loud highways, an airport, industrial sites, or household appliances like blenders and hair dryers can be a concern. And they can take a toll on someone’s emotional well-being.

“If you are being exposed to very loud sounds for a part of your school day or your working day, it may make you more stressed out; it may make you more angry about things,” she said.

Unlike the highway or an airport, cicadas won’t be around long. Most of the current brood will be gone in the next few weeks. Just in time for another noisy summer event: the Fourth of July.

This <a target="_blank" href="/mental-health/chorus-cacophony-cicada-song-noise-hearing-sensitivity-autism/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

“I didn’t have any teeth to smile with,” the 53-year-old of Independence, Missouri, said.

Thompson said he dealt with throbbing toothaches and painful swelling in his face from abscesses for years working as a cook at Burger King. He desperately needed to see a dentist but said he couldn’t afford to take time off without pay. Missouri is one of many states that employers to provide paid sick leave.

So, Thompson would and push through the pain as he worked over the hot grill.

“Either we go to work, have a paycheck,” Thompson said. “Or we take care of ourselves. We can’t take care of ourselves because, well, this vicious circle that we’re stuck in.”

In a nation that was sharply divided about government health mandates during the covid-19 pandemic, the public has been warming to the idea of government rules providing for paid sick leave.

Before the pandemic, and the District of Columbia had laws requiring employers to provide paid sick leave. Since then, , , , , and have passed laws offering some kind of paid time off for illness. and expanded previous paid leave laws. In , , and , advocates are pushing to put the issue on the ballot this fall.

The U.S. is that do not guarantee paid sick leave, according to data compiled by the World Policy Analysis Center.

In response to the pandemic, the Emergency Paid Sick Leave and Emergency Family and Medical Leave Expansion acts. These temporary measures allowed employees to take up to two weeks of paid sick leave for covid-related illness and caregiving. But the provisions .

“When the pandemic hit, we finally saw some real political will to solve the problem of not having federal paid sick leave,” said economist .

Wething co-authored a on the state of sick leave in the United States. It found that more than half, 61%, of the lowest-paid workers can’t get time off for an illness.

“I was really surprised by how quickly losing pay — because you’re sick — can translate into immediate and devastating cuts to a family’s household budget,” she said.

Wething noted that the lost wages of even a day or two can be equivalent to a month’s worth of gasoline a worker would need to get to their job, or the choice between paying an electric bill or buying food. Wething said showing up to work sick poses a risk to co-workers and customers alike. Low-paying jobs that often lack paid sick leave — like cashiers, nail technicians, home health aides, and fast-food workers — involve lots of face-to-face interactions.

“So paid sick leave is about both protecting the public health of a community and providing the workers the economic security that they desperately need when they need to take time away from work,” she said.

The National Federation of Independent Business has at the state level, arguing that workplaces should have the flexibility to work something out with their employees when they get sick. The group said the cost of , extra paperwork, and burdens small employers.

According to a report by the National Bureau of Economic Research, once these mandates go into effect, employees take, on average, than before a law took effect.

went into effect this year. Lauren Pattan is co-owner of the Old Bakery Beer Co. there. Before this year, the craft brewery did not offer paid time off for its hourly employees. Pattan said she supports Illinois’ new law but she has to figure out how to pay for it.

“We really try to be respectful of our employees and be a good place to work, and at the same time we get worried about not being able to afford things,” she said.

That could mean customers have to pay more to cover the cost, Pattan said.

As for Bill Thompson, he for the Kansas City Star newspaper about his dental struggles.

“Despite working nearly 40 hours a week, many of my co-workers are homeless,” he wrote. “Without health care, none of us can afford a doctor or a dentist.”

That op-ed generated attention locally and, in 2018, a dentist in his community donated his time and labor to remove Thompson’s remaining teeth and replace them with dentures. This allowed his mouth to recover from the infections he’d been dealing with for years. Today, Thompson has a new smile and a job — with paid sick leave — working in food service at a hotel.

In his free time, he’s been collecting signatures to put an initiative on the November ballot that would guarantee at least of earned paid sick leave a year for Missouri workers. Organizers behind the petition said they have to take it before the voters.

This <a target="_blank" href="/news/paid-sick-leave-post-pandemic-state-laws/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Listen: More than 2 million Americans could benefit from PrEP, but only about a quarter of them are getting the HIV prevention medication. On Feb. 4, during WAMU’s “Health Hub,” ºÚÁϳԹÏÍø News reporter Zach Dyer shared tips for overcoming common hurdles to care.

Billing mistakes. Stigma. Doctors who aren’t keeping up with the latest research. Those are just some of the hurdles that for many Americans.

The Centers for Disease Control and Prevention estimates more than 2 million Americans could benefit from a treatment known as PrEP, but only a quarter of them are getting a form of the drug. Zach Dyer appeared on WAMU’s “Health Hub” on Feb. 4 to share tips patients can use to avoid those pitfalls and find a doctor who knows more about PrEP.

This <a target="_blank" href="/insurance/wamu-health-hub-prep-hiv-treatment-access-workarounds-february-4-2026/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

When Matthew Hurley was looking to take PrEP to prevent HIV, the doctor hadn’t heard of the medicine, and when he finally did prescribe PrEP, the bills sent to Hurley were expensive … and wrong. “I decided to write in because the process was really super frustrating.” At one point, Hurley asked, “Am I just going to stop this medication to stop having to deal with these coding issues and these scary bills?”

— Matthew Hurley, 30, from Berkeley, California

A couple of years ago, Matthew Hurley got the kind of text people fear.

It said: “When was the last time you were STD tested?”

Someone Hurley had recently had unprotected sex with had just tested positive for HIV.

Hurley went to a clinic and got tested. “Luckily, I had not caught HIV, but it was a wake-up call,” they said.

That experience moved Hurley to seek out PrEP, shorthand for preexposure prophylaxis. The antiretroviral medication greatly reduces the chance of getting HIV, the virus that causes AIDS. The therapy is at protecting people against sexual transmission when taken as prescribed.

Hurley started PrEP and all was well for the first nine months — until their health insurance changed and they started seeing a new doctor: “When I brought PrEP up to him, he said, ‘What’s that?’ And I was like, oh boy.”

Hurley, who is a librarian, went into teaching mode. They explained that the PrEP regimen they’d been on required daily pills and lab work every three months to look out for breakthrough infections or other health issues.

Hurley was surprised they knew more about PrEP than the physician. The FDA approved the first drug, Truvada, , and Hurley lives in the San Francisco Bay Area, a place with one of the of LGBTQ+ people in the nation and a of HIV and health care activism. Hurley said older friends and acquaintances who survived the AIDS epidemic shared the horror of living through a time when there was no effective treatment or drugs for prevention. Deciding to take PrEP felt like an empowering way to protect their health and their community.

So Hurley pushed the doctor, and after the physician did his own research, he agreed to prescribe PrEP.

Hurley got the care they needed, but they had to be the expert in the exam room.

“That’s a big burden,” said Beth Oller, a family medicine physician and board member of GLMA, a national organization of LGBTQ+ and allied health care professionals focused on health equity. “You really want someone you can just go in and talk [to] about your health concerns without feeling like you are having to educate and advocate for yourself at every turn.”

Oller said many queer people have had during health care visits.

“I have a lot of patients who had not done preventive care for years because of the medical stigma,” she said.

Billing Headaches

Clearing the access hurdles to HIV prevention medicine was just the beginning. Hurley started receiving a string of bills for PrEP-related care. Blood test: $271.80. Office visit: $263.

Again, Hurley was surprised. They knew — even if the billing office didn’t — that under the most private insurance plans and Medicaid expansion programs are PrEP and ancillary services, , as preventive with no cost sharing.

The bills for doctor visits and blood draws piled up.

Hurley would appeal the bill and get a denial almost every time. Then, they would appeal again.

Hurley shared a series of appeal letters for one service, in which the billing office acknowledged that blood work had been initially incorrectly coded as diagnostic. Once that was corrected, Hurley said, the insurer paid for the service.

That might sound quick or easy to resolve, but Hurley said it took “forever to get through the process.” They dealt with at least six incorrect bills over several months. Hurley estimated they spent more than 60 hours contesting the bills.

During that time, Hurley said, the billing department “is continuing to send me emails and bills that are saying, You’re overdue. You’re overdue. You’re overdue.”

Fed up with the hassles, Hurley decided to find a health provider (and billing office) better informed about PrEP. They settled on the AIDS Healthcare Foundation. The care team there was able to discuss the pros and cons of different PrEP regimens and knew how to navigate the formulary for Hurley’s insurance.

Hurley hasn’t gotten an unexpected bill since.

But siloing sexual health care and PrEP off from primary care hasn’t been ideal.

“I have multiple organizations that I have to deal with to get my holistic health dealt with,” Hurley said.

A provider doesn’t need to be an HIV specialist, an infectious disease expert, or a physician to prescribe PrEP. The Centers for Disease Control and Prevention encourages primary care providers to treat PrEP like .

To avoid some of the headaches Hurley faced, try these tips:

1. Find out if PrEP is right for you.

The CDC estimates Americans could benefit from HIV prevention drugs, but just over a quarter of that group have been prescribed them.

“Not enough people know about PrEP, and there are a number of people who know about PrEP but do not realize it’s for them,” said Jeremiah Johnson, executive director of PrEP4All, an organization dedicated to universal access to HIV prevention and medication.

According to the CDC’s clinical guidelines, PrEP can be prescribed as part of a preventive health plan to . It’s especially recommended for people who don’t use condoms consistently, intravenous drug users who share needles, men who have sex with men, and people in relationships with partners living with HIV or whose HIV status is unclear.

The vast majority of PrEP users are men. There are big race, gender, and geographical of HIV and the populations taking the prevention medicine. For example, based on the patterns of new infection in the U.S., a group that would benefit from PrEP is cisgender Black women, whose gender identity aligns with their sex assigned at birth.

2. Don’t assume your provider knows about PrEP.

If your doctors aren’t well informed, start by . There are also clinical guidelines and information you can share with your provider. Check your state or local health department for a how-to guide for prescribing PrEP. For example, the New York State Department of Health AIDS Institute has information .

The , but many of the agency’s websites dealing with LGBTQ+ health are in flux. Under the Trump administration, some HIV/AIDS resources have been taken down from federal websites. Others now have : “This page does not reflect biological reality and therefore the Administration and this Department rejects it.”

3. Get lab work in-network.

Johnson said Hurley’s experience with billing mistakes is common. “The lab expenses in particular end up being very tricky,” Johnson said.

For example, a doctor’s office may mistakenly code the lab work required for PrEP as a instead of preventive care. Patients like Hurley can end up with a bill they shouldn’t have to pay. If your doctor’s office is making mistakes, share the from NASTAD, an association of public health officials who administer HIV and hepatitis programs.

Try to get your lab work done in-network. If the lab is out-of-network, Johnson said, it can be difficult to appeal.

If the bills keep coming, appeal them. And if you can’t resolve the dispute, Johnson said, file a complaint with the agency that regulates your insurance plan.

4. Look for ways to save.

There are different kinds of PrEP. There are lower-cost, generic versions of Truvada, for example, sold as emtricitabine/tenofovir disoproxil fumarate, often shortened to FTC/TDF. Newer PrEP drugs have list prices in the thousands of dollars. Check your insurance formulary and ask your doctor to prescribe medicine your plan will cover.

With many health care premiums dramatically increasing and millions at risk of losing Medicaid coverage, many people may go without health insurance this year. Drug manufacturers such as and have assistance programs for qualifying patients. If you have to pay out-of-pocket, prescription price comparison websites, like GoodRx, can help you find the pharmacies with the cheapest price.

5. Consider telehealth.

Telehealth is an option if you don’t live near an affirming provider or are looking for a more private way to get PrEP. In 2024, roughly 1 in 5 people on PrEP used telemedicine. Online pharmacies like and offer PrEP without an in-person appointment, and lab work can be done at home. Some telehealth options have ways to if you’re uninsured.

Telehealth can also broaden the number of doctors who are ready to prescribe PrEP. And some patients say speaking with a remote provider feels like a safer setting to talk about sexual health. “They’re in the comfort of their own bedroom or living room but can interface virtually with a provider. It can open up a lot of doors for honesty and trust,” said Alex Sheldon, executive director of GLMA.

6. Seek out affirming care.

GLMA created the , a searchable database of health care providers across the nation who identify as queer-friendly. As Hurley discovered, living in a major metro area is no guarantee your doctor is up to date on LGBTQ+ health care.

Ask locals you trust for recommendations. You might be surprised to find good options nearby.

Health Care Helpline helps you navigate the health system hurdles between you and good care. Send us your tricky question and we may tap a policy sleuth to puzzle it out. Share your story. The crowdsourced project is a joint production of NPR and ºÚÁϳԹÏÍø News.

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Listen as senior producer Zach Dyer reports on the public health concerns over online sports betting and a fund in Missouri that might help with addiction treatment and prevention. 

The parking lot at the Super One Stop in Granite City, Illinois, is full. The convenience store just across the Mississippi River from Missouri sells liquor, cigarettes, and some groceries. But not all the cars belong to customers. It’s a Sunday morning in the middle of football season, and the people sitting in their vehicles are mostly looking down at their smartphones.

Nick Krumwiede is sure the people parked around him are betting on the day’s NFL games. That’s why he’s there. Krumwiede drove 15 minutes across the state line from his home in St. Louis to place three bets, including one on his beloved Chicago Bears.

Krumwiede could have driven to a casino in East St. Louis, Illinois, to bet on the games in person. But with apps like DraftKings and FanDuel on his smartphone, he doesn’t need to make the trip. He can place his bets in this parking lot.

“This is Sunday football, everybody,” Krumwiede said. “I guarantee you that’s what they’re doing.”

“You see them all sitting in there staring at their phones?” he said.

Public health experts say smartphone-based betting makes it easier for people to get into deep gambling trouble fast. But it takes effort to drive to a parking lot across state lines to bet on an NFL game. Soon, Missouri gamblers will be able to place those bets from their couches. Voters approved sports betting in Missouri in a November ballot initiative, and the state could start issuing sports betting licenses as soon as this summer.

The ballot measure requires the state to dedicate at least $5 million a year from its sports betting tax revenue to combat compulsive gambling. Supporters of the measure said that increase in resources could help the state address harms associated with gambling addiction. In other states, the introduction of online sports betting has been linked to increased calls to hotlines for problem gambling.

Estimates of the state’s revenue from sports betting range from $12.8 million to $20.5 million, according to a for a previous bill to legalize sports betting.

Carolyn Hawley is at Virginia Commonwealth University who researches problem-gambling addiction, treatment, and harm reduction. She has tracked Virginia’s experience since sports betting started there four years ago.

“ We don’t even have to leave our homes anymore,” she said. “We now have them on our smartphones. We can do it anytime, anyplace.”

In Virginia, some primary care providers have started asking their patients about their gambling habits, Hawley said. Doctors have shared reports of stress-related ailments, she said, especially in young men who had been betting on sports.

“They’re coming in with . They’re coming in with . They’re coming in with ,” she said.

Sports bettors tend to be younger and male. In a of registered voters, Fairleigh Dickinson University found that a quarter of men under 30 bet on sports online. Problem gamblers make up 10% of that group, compared with 3% of the overall U.S. population.

After the legalization of sports betting in Virginia, Hawley observed a spike in calls to her state’s gambling helpline: 1,000% more from 2019 to 2023.

Hawley, who is also the president of the Virginia Council on Problem Gambling, said 200% more people were looking for resources to quit gambling.  Other states have seen similar trends.

Dozens of states have legalized sports betting after a Supreme Court decision cleared the way in 2018, including every state that borders Missouri save one, Oklahoma.

Supporters who pushed for sports betting in Missouri say people already cross into other states to gamble. They argue that Missouri has missed out on valuable tax dollars that could, in part, help fund gambling treatment and prevention efforts in the state.

“The beautiful thing about being the 39th state to do something is you are able to take a look at what has worked and what hasn’t worked in other states,” said Jack Cardetti, spokesperson for , a group made up of Missouri and sports betting companies that supported the ballot initiative.  “If we’re going to have an expansion of gaming here in the state of Missouri,” he said, “we also need to expand the resources.”

Missouri spent just $100,000 on problem gambling in 2023 and zero dollars the year before that. The state is still developing a plan to spend the money earmarked from the ballot initiative.

In Illinois at the Super One Stop, store owner Himang Patel said he doesn’t mind sports bettors using his parking lot to gamble on their phones. Some people sit up to an hour, and Patel said that can be an opportunity to sell a pack of cigarettes or bag of chips. He guessed that the extra foot traffic will die off when sports betting becomes legal in Missouri.

Krumwiede said he’s looking forward to not having to make the drive across the state line, but he’s also mindful that easier access could come with risks. He knows gambling can be addictive.

“Sometimes I have bad days where I go out and put out a hundred bucks and I lose almost all of it,” he said. “It’s kind of like a sinking feeling. You don’t talk about it.”

Krumwiede tries to set rules for himself so he doesn’t lose too much money at any one time.

He said he is looking forward to not having to make the drive to Illinois after sports betting starts in Missouri. But he’s worried, too. He said there were periods in the past when he lost too much money.

“It’s a little scary, but I’m just going to have to make new rules,” Krumwiede said.

He has a few more months to figure it out.

This <a target="_blank" href="/mental-health/missouri-sports-betting-online-gambling-addiction-compulsive-illinois/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

ST. LOUIS — Shhhooo. Wee-uuu. Chick, chick, chick. That’s the sound of three different cicada species. For some people, those sounds are the song of the summer. Others wish the insects would turn it down. The cacophony can be especially irritating for people on the autism spectrum who have hearing sensitivity.

Warren Rickly, 14, lives in suburban south St. Louis County, Missouri. Warren, who has autism, was at the bus stop recently waiting for his younger brother when the sound of cicadas became too much to bear.

“He said it sounds like there’s always a train running next to him,” his mother, Jamie Reed, said.

Warren told her the noise hurt.

Starting this spring, trillions of the red-eyed insects out of the ground . It’s part of a rare simultaneous emergence of two broods — one that appears every 13 years, the other every 17.

The noisy insects can be stressful. People with autism can have a texture, brightness, and sound.

“I think the difference for individuals with autism is the level of intensity or how upsetting some of these sensory differences are,” said Rachel Follmer, a developmental and behavioral pediatrician at Lurie Children’s Hospital in Chicago.

“It can get to the extreme where it can cause physical discomfort,” she said.

When a large group of cicadas starts to sing, the chorus can be . Researchers at the University of Missouri-St. Louis this year crowdsourced cicada noise levels as high as , about as loud as a .

That can be stressful, not melodic, Follmer said.

To help children cope, she suggests giving them a primer before they encounter a noisy situation. For cicadas, that could mean explaining what they are, that they don’t bite or sting, and that they’ll be here for just a short time.

“When something is uncomfortable, not having power in that situation can be very scary for a lot of individuals, whether you’re on the spectrum or not,” Follmer said.

Jamie Reed’s family has been using this and other strategies to help her son. Warren wears noise-canceling headphones, listens to music, and has been teaching himself about cicadas.

“For him, researching it and looking into it I think grounds him a little bit,” Reed said.

Fatima Husain is a professor and neuroscientist at the University of Illinois Urbana-Champaign and studies how the brain processes sound. She said people with tinnitus may also struggle with cicada song.

Tinnitus, a ringing or other noise in the ears, is a person’s perception of sound without an external source.

“Some people say it sounds like buzzing, like wind blowing through trees, and ironically, quite a few people say it sounds like cicadas,” Husain said.

For most people with tinnitus the cicada’s song is harmless background noise, according to Husain, but for others the ringing can prevent easy conversation or sleep. Those with tinnitus are also more likely to have . A loud persistent sound, like singing cicadas, can make someone’s tinnitus worse, Husain said.

It’s not always bad, though. The cicada’s song can also be a relief.

For some, tinnitus gets worse in a quiet environment. Husain said she’s seen reports this year of patients saying the cicadas’ song has been like soothing white noise.

“The sound is loud enough that in some ways it’s drowning their internal tinnitus,” Husain said.

As loud as the cicadas can be, they anyone’s hearing, according to the Centers for Disease Control and Prevention. Hearing loss builds up over time from repeated exposure to loud sounds. Cicadas aren’t loud enough for long enough to do lasting damage, Husain said.

Everyday sources of noise come with a higher risk. Husain said constant exposure to loud highways, an airport, industrial sites, or household appliances like blenders and hair dryers can be a concern. And they can take a toll on someone’s emotional well-being.

“If you are being exposed to very loud sounds for a part of your school day or your working day, it may make you more stressed out; it may make you more angry about things,” she said.

Unlike the highway or an airport, cicadas won’t be around long. Most of the current brood will be gone in the next few weeks. Just in time for another noisy summer event: the Fourth of July.

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“I didn’t have any teeth to smile with,” the 53-year-old of Independence, Missouri, said.

Thompson said he dealt with throbbing toothaches and painful swelling in his face from abscesses for years working as a cook at Burger King. He desperately needed to see a dentist but said he couldn’t afford to take time off without pay. Missouri is one of many states that employers to provide paid sick leave.

So, Thompson would and push through the pain as he worked over the hot grill.

“Either we go to work, have a paycheck,” Thompson said. “Or we take care of ourselves. We can’t take care of ourselves because, well, this vicious circle that we’re stuck in.”

In a nation that was sharply divided about government health mandates during the covid-19 pandemic, the public has been warming to the idea of government rules providing for paid sick leave.

Before the pandemic, and the District of Columbia had laws requiring employers to provide paid sick leave. Since then, , , , , and have passed laws offering some kind of paid time off for illness. and expanded previous paid leave laws. In , , and , advocates are pushing to put the issue on the ballot this fall.

The U.S. is that do not guarantee paid sick leave, according to data compiled by the World Policy Analysis Center.

In response to the pandemic, the Emergency Paid Sick Leave and Emergency Family and Medical Leave Expansion acts. These temporary measures allowed employees to take up to two weeks of paid sick leave for covid-related illness and caregiving. But the provisions .

“When the pandemic hit, we finally saw some real political will to solve the problem of not having federal paid sick leave,” said economist .

Wething co-authored a on the state of sick leave in the United States. It found that more than half, 61%, of the lowest-paid workers can’t get time off for an illness.

“I was really surprised by how quickly losing pay — because you’re sick — can translate into immediate and devastating cuts to a family’s household budget,” she said.

Wething noted that the lost wages of even a day or two can be equivalent to a month’s worth of gasoline a worker would need to get to their job, or the choice between paying an electric bill or buying food. Wething said showing up to work sick poses a risk to co-workers and customers alike. Low-paying jobs that often lack paid sick leave — like cashiers, nail technicians, home health aides, and fast-food workers — involve lots of face-to-face interactions.

“So paid sick leave is about both protecting the public health of a community and providing the workers the economic security that they desperately need when they need to take time away from work,” she said.

The National Federation of Independent Business has at the state level, arguing that workplaces should have the flexibility to work something out with their employees when they get sick. The group said the cost of , extra paperwork, and burdens small employers.

According to a report by the National Bureau of Economic Research, once these mandates go into effect, employees take, on average, than before a law took effect.

went into effect this year. Lauren Pattan is co-owner of the Old Bakery Beer Co. there. Before this year, the craft brewery did not offer paid time off for its hourly employees. Pattan said she supports Illinois’ new law but she has to figure out how to pay for it.

“We really try to be respectful of our employees and be a good place to work, and at the same time we get worried about not being able to afford things,” she said.

That could mean customers have to pay more to cover the cost, Pattan said.

As for Bill Thompson, he for the Kansas City Star newspaper about his dental struggles.

“Despite working nearly 40 hours a week, many of my co-workers are homeless,” he wrote. “Without health care, none of us can afford a doctor or a dentist.”

That op-ed generated attention locally and, in 2018, a dentist in his community donated his time and labor to remove Thompson’s remaining teeth and replace them with dentures. This allowed his mouth to recover from the infections he’d been dealing with for years. Today, Thompson has a new smile and a job — with paid sick leave — working in food service at a hotel.

In his free time, he’s been collecting signatures to put an initiative on the November ballot that would guarantee at least of earned paid sick leave a year for Missouri workers. Organizers behind the petition said they have to take it before the voters.

This <a target="_blank" href="/news/paid-sick-leave-post-pandemic-state-laws/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">