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US Supreme Court decides in favour of the Affordable Care Act

See World Report page 16

Independence Day, July 4, is a time for shared joy and pride within the USA; and elsewhere, for respectful admiration of that country’s founding principles. One of those principles is that the government’s power is balanced by three branches: executive, legislative, and judicial. Opponents to the Affordable Care Act 2010 have exploited both legislative and judicial methods to frustrate implementation of the Act, including the Supreme Court, which ruled on June 25. The legal argument questioned whether or not the entity that ran health insurance exchanges (either state or federal) determined the eligibility of users to receive federal tax subsidies. The justices noted the imprecise language of the Act that enabled such a challenge, but decided by six to three in favour of federal subsidies because the spirit of the Act was to improve health insurance markets, of which subsidies are a key component. Although the ruling represents a technical and symbolic victory that will protect the Act from major

legal challenges, it does not resolve deep and divisive opinions about where a government’s beneficence should end and individual responsibilities begin. As a result, more challenges are likely to follow, but in other forms, such as the upcoming Presidential election. The 2016 election campaign will take the Affordable Care Act from Washington, DC, to local voters. From abstract legal minutiae to the reality of the Act for citizens. In only 2 years, the number of uninsured Americans has fallen from 18% to 12%. The Affordable Care Act is providing what it promised: the expansion of affordable, quality health care. More than 16 million people have been covered so far. By embracing those citizens that the American dream had bypassed, the Affordable Care Act represents more than health care. It embodies a vision of the more generous and equitable country that President Barack Obama offered in his eulogy to Rev. Clementa Pinckney on June 26 in Charleston, SC. It is an Act of grace. „ The Lancet

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STIs climbing in men who have sex with men in England

For the Public Health England sexually transmitted infections report see https://www.gov.uk/ government/uploads/system/ uploads/attachment_data/ file/437433/hpr2215_STI_NCSP_ v6.pdf


Pride in London 2015, England’s biggest pride parade so far, took place last weekend, bringing together the lesbian, gay, bisexual, and transgender communities. Despite this celebration, a report from Public Health England on sexually transmitted infections (STIs) in England in 2014, published on June 23, 2015, uncovers alarming statistics in men who have sex with men (MSM). Although total STI diagnoses decreased by 0·3% in England from 2013 to 2014, diagnoses in MSM rose sharply, with syphilis increasing by 46%, gonorrhoea by 32%, chlamydia by 26%, and genital herpes and warts by 10% each. Gonorrhoea was the most commonly diagnosed, which is especially concerning because of the emergence of antimicrobial resistance and the depletion of effective treatment options, which put these diseases at risk of becoming untreatable. Such increases are thought to be caused by continuing high levels of unsafe sex, including serosorting, whereby MSM have condomless sex with other men believed to be of the same HIV status. This practice increases the risk of STIs because 16% of HIV-positive men were unaware of their infection in 2013. Acute bacterial STI transmission in

HIV-positive MSM was about four-times higher than that of HIV-negative or undiagnosed men in 2013, showing that rapid STI transmission in dense sexual networks of HIV-positive MSM is occurring. MSM are not the only group with a high number of STI diagnoses—heterosexuals aged 15–24 years are also greatly affected. 63% of heterosexuals diagnosed with chlamydia in 2014 were in this age group, as well as 55% with gonorrhoea, 52% with genital warts, and 42% with genital herpes. The report outlines obvious but important recommendations to reduce STI diagnoses. MSM should have an HIV and STI screen every year, or every 3 months if having condomless sex with new or casual partners, and sexually active individuals aged 25 years and younger should have a chlamydia screen every year and when changing sexual partner. Access to sexual health services, including STI screening, should be ensured. Individuals should also use condoms consistently and correctly, the number of sexual partners should be reduced, and simultaneous sexual relationships avoided. If these key, realistic, and achievable recommendations can be implemented, then these worrying trends could begin to be reversed. „ The Lancet www.thelancet.com Vol 386 July 4, 2015

US Supreme Court decides in favour of the Affordable Care Act.

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