Well, midway through the marathon that is the NFL season, it’s advantage Dolphins and advantage Tua.

The latter is more impressive than the former. It means in the quarterback-leaning NFL, and in the Dolphins’ quarterback-heavy offense, things are trending in the right direction for seasonlong and possibly postseason success.

So, as we acknowledge the Dolphins are the overwhelming favorites at midseason to win the AFC East, we must also acknowledge Dolphins quarterback Tua Tagovailoa is the overwhelming favorite at midseason to be the AFC East Quarterback of the Year (no, there is no such award).

It’s an impressive single-season path to be on, considering the competition was New York Jets quarterback Aaron Rodgers, Buffalo quarterback Josh Allen, the men who finished 1-2 in the 2020 NFL MVP voting, and New England quarterback Mac Jones.

This was shaping up to be a three-man Battle Royale among Rodgers, Allen and Tagovailoa. 

So far, it’s been nothing close to that. Tagovailoa is the clear leader, and you see that in the standings.

Disclaimer time: It’s important to note we’re only halfway through the season. Things can and will change in many areas. I’ve got to keep repeating that because we know Tua is injury-prone, and we know the Dolphins were 8-3 last year before finishing 9-8.

Having said that, here’s where we’re at right now:

— Rodgers, the future Hall of Famer, never got his season going. He sustained an Achilles injury in his first series as a Jets quarterback. Zach Wilson is the starter and he has five touchdowns, six interceptions and a cringe-worthy 74.6 passer rating, which ranks 30th in the NFL.

— Allen, the All Pro and Pro Bowl selection, is leading a struggling Buffalo team that has a 5-5 record, fired offensive coordinator Ken Dorsey on Monday and could have three or four more losses on its schedule among Dallas, Kansas City, Philadelphia and Miami. Allen has 19 touchdowns, which is tied for the league lead with Tagovailoa, a league-leading 11 interceptions, and a 96.6 passer rating, which ranks 12th in the league.

— Jones, who earned a Pro Bowl berth as a rookie in 2021 (he was originally a second alternate) and helped lead the Patriots to a wild-card berth that same year, was benched last week. Coach Bill Belichick has declined to name Jones as the starter this week. Jones has 10 touchdowns, 10 interceptions and a miserable 80.2 passer rating, which ranks 27th in the league;

— Tagovailoa, who has had well-documented injury concerns in the past, is trending in the right direction health-wise, team-wise and individually. He has 19 touchdowns, seven interceptions and a 106.4 passer rating, which is second in the league.

Most importantly, the Dolphins are 6-3 and leading the division, while Buffalo is 5-5 and in second place, followed by the Jets (4-5) and Patriots (2-8).

Again, it’s way too early to say for certain things will end the way they’re going right now.

But just as we hand out midseason awards, we can make other midseason observations.

Tagovailoa’s tenuous accomplishment is impressive for a variety of reasons. The top three reasons, in no particular order, being his competition, his injury history and his injury-riddled offensive line.

And, let’s be honest, Tagovailoa has the best supporting cast among AFC East quarterbacks.

He has the best coach (Mike McDaniel), the best running game, the best wide receivers, and soon he might have the best defense.

The offensive line, for all the doubts cast its way, has only allowed 15 sacks, third-fewest in the league. 

It takes a village, right?

It also takes a strong individual effort, and Tagovailoa has given that in many ways, including the offseason jiu-jitsu classes that taught him how to fall (tuck the chin to the chest) to help prevent the back of his head hitting the ground and getting concussions.

This is a dream scenario for the Dolphins. This is just the way they drew it up.

They’re the best team in the AFC East, and, so far, they have the season’s best-performing quarterback in the AFC East. 

What version did you grow up with? Maybe you turned up your nose or shook your head with the “no way” universal food language of “please remove that red concoction from the house.”

Let’s step back a little before we pass too much judgment on this traditional holiday side dish. We all agree that cranberries look pretty; they’re shiny, red and just the right size to pop in your mouth. But a raw cranberry can be bitterly tart eaten straight up. On the bright side, as a kid when you saw the bags of cranberries show up in the grocery store, you knew Thanksgiving was getting close and Christmas was not far behind.

First, the name. The internet says “cranberry” was originally called “craneberry,” in 1647, so named after the German word kraanebere by John Eliot, a Native American missionary from the Massachusetts Bay Colony. Seeing cranberries for the first time in their new country, Eliot, and perhaps other colonists, saw the resemblance of blooming cranberry flowers, petals and the stem growing on the shrub to the head, neck and bill of a crane.

Back in the day, Native Americans picked lots of cranberries. Algonquins called them sassamenesh, which translates to “sour berries.” They pounded cranberries into the first-ever energy bar, combined with dried deer meat and fat, and stored them in small animal skin sacks to last several months. Tasteeee!

Cranberries have excellent antibacterial properties and were historically used by Native Americans to make poultices for wounds, to treat stomach problems and fevers. Dyes from the red skin of the fruit were used for clothing and jewelry.

Later, when European colonists arrived, they figured out quickly that cranberries and all their vitamin C helped keep away scurvy, a disease caused by lack of vitamin C in a diet. Today, cranberry juice and tablets are often taken to prevent urinary tract infections. Cranberries are full of the chemical proanthocyanidins, which keeps bad bacteria from sticking to the surface of the tract.

(So much for passing on that dish of cranberries at Thanksgiving, right?)

The cranberry (Vaccinium macrocarpon) is native to the swamps of the Northeast. It belongs to the heather family (Ericaceae), which also includes huckleberries, blueberries and rhododendrons. The latter two and cranberries don’t grow well in the Western U.S. because of our dry, alkaline soils.

Cranberry shrubs are low-growing, woody perennials with small oval leaves on their vine-like shoots. They form dense mats from their runners, or horizontal stems that grow and root along the soil surface.

Cranberries flower dark pink from May to June, which then form berries in late September to October. The shrubs don’t constantly grow in a lake of water like the television commercials. Rather, fields are flooded for ease of harvest.

Today, five states grow the most cranberries: Wisconsin, Massachusetts, New Jersey, Oregon and Washington.

Now for the decision. Do you prefer molded jellied cranberry? Directly out of the can, slices of this wiggly gelatinous tube slide witih simple ease onto any plate no matter how highly piled with other Thanksgiving Day tasty eats.

Or, do you prefer the stove-top cooked version of whole cranberries with cups (the number is up to you) of added sugar? The end result looks more like pie filling.

I’ll take whatever you’re serving on Thanksgiving!

After Achane was designated to return Monday, marking his return to practice while on injured reserve for a knee ailment sustained more than a month ago, signs have pointed up for him as he was back at drills after the minimum four-game absence on IR.

“I do know that he really wants to play. He’s shown that,” McDaniel said ahead of Wednesday’s practice, Achane’s second since being injured Oct. 8 against the New York Giants. “We feel good about where he’s headed. If he’s ready to roll for this game, he’ll play.”

McDaniel noted that Achane “checked all the boxes” in a light Monday practice, which wasn’t padded with tackling involved and that the rookie phenom “looked like a pro.”

“He’s come a long way in a short amount of time,” McDaniel said. “It feels like he’s not a rookie within the locker room.”

Achane, in four games as a rookie, has 460 yards and five touchdowns on 38 rushing attempts for a whopping 12.1 yards-per-carry average. He also has two receiving touchdowns. In the Sept. 24 win over the Denver Broncos, Achane burst onto the NFL scene with four total touchdowns and 203 rushing yards.

The Dolphins have Raheem Mostert, Jeff Wilson Jr. and Salvon Ahmed at tailback, should Achane not make his return Sunday at home against the Raiders.

Hunt, who missed the loss to the Kansas City Chiefs on Nov. 5 in Germany with a hamstring injury, did not practice Wednesday after McDaniel said he and fellow offensive lineman Robert Jones (knee) are week to week.

McDaniel said Hunt is “like a cat being in water” with how unfamiliar the usually healthy guard is with dealing with injuries.

Hunt worked on the side of Wednesday drills with trainers.

“I could see him playing in this game, I could see him playing in the next game,” McDaniel said of Hunt.

Jones was not seen at Wednesday practice. Without either of them, the Dolphins would likely start some combination of Lester Cotton and Liam Eichenberg at left and right guard.

The Dolphins also worked out a number of offensive guards Tuesday, including veteran former All-Pro Andrew Norwell. McDaniel said that was about the organization getting ahead of different scenarios where they may reach out to a free agent. Miami also worked out fellow guards Colby Gossett and Wes Martin, along with defensive backs Bubba Bolden (a Miami Hurricanes alum), Dane Cruishank and A.J. Moore.

Along with Hunt and Jones, Dolphins not seen during a media viewing portion of Thursday’s practice were tight end Durham Smythe, wide receivers Braxton Berrios and Chase Claypool and fullback Alec Ingold.

The team will release its first injury report of the week later Wednesday.

This story will be updated

Cosmic Rewind, which opened this spring, is an indoor roller coaster with a storyline that swings through outer space and is set to a pop-music soundtrack. Bermuda Storm, a motion-simulator attraction at Chimelong Spaceship theme park in Zhuhai, China, also was recognized in the attraction division.

SeaWorld’s Yas Island in Abu Dhabi won in the indoor marine park category.

Other outstanding achievement winners were Disney Encanto x CAMP in New York (retail experience, limited budget), Mussikkfabrikken Hunderfossen at Hunderfossen Eventyrpark in Norway (attraction, limited budget), Geneva Journey of Switzerland (live spectacular), Deutschlandmuseum of Berlin (museum attraction, limited budget), “Le Mime et L’Etoile” at Puy De Fou in France (live show), Titanic Belfast of Northern Ireland (visitor experience re-envisioned, limited budget), Johnnie Walker Princes Street in  Edinburgh, Scotland (brand experience), Aura: The Forest at the Edge of the Sky in Haikou, China (immersive mall experience), Peaky Blinders: The Rise at Camden Stables Market of London (live interactive experience), Colored (Noire) of Centre Georges in Paris (extended reality exhibit) and Eatrenalin of Europa-Park in Germany (experiential dining attraction).

Individuals recognized include Su Zhigang, chairman and CEO of Chimelong Group, for the Buzz Price Award; Paul C. Hutton, principal and director of Regenerative Design at Cuningham for the Thea Catalyst Award, and David Green and Lisa Passamonte Green of Visual Terrain for the Peter Chernack Distinguished Service Award.

Liseberg, an amusement park in Gothenburg, Sweden, received the Thea Classic Award.

Winners will be honored at a gala in Hollywood, California, in March. IAAPA Expo at Orange County Convention Center continues through Friday.

dbevil@orlandosentinel.com

Republicans in Congress are “trying to wipe out federal funding to end the HIV epidemic.”

President Joe Biden on Oct. 14, 2023, in remarks at the 2023 Human Rights Campaign National Dinner.

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Are Republicans threatening to stop spending federal money to end one of the world’s most pressing public health epidemics? That’s what President Joe Biden said during a dinner hosted by an LGBTQ+ advocacy group.

“In the United States Congress, extreme MAGA Republicans are trying to undo virtually every bit of progress we’ve made,” Biden said Oct. 14 at the Human Rights Campaign event. “They’re trying to wipe out federal funding to end the HIV epidemic.”

Programs to treat HIV and fight its spread have enjoyed bipartisan funding support in recent years, experts said, so Biden’s portrayal signals a significant departure.

When we asked the White House what Biden was referring to, it pointed us to reports of budget recommendations from House Republicans that call for large cuts to the Ending the HIV Epidemic initiative, a Trump administration-era program designed to reduce new HIV infections in the U.S., as well as other programs.

The Senate Appropriations Committee passed a separate spending plan. The recommendations will be subject to negotiation as the House and Senate face a Nov. 17 deadline to pass another spending bill.

We found that although Republicans are recommending significant cuts to HIV prevention efforts across a number of public health agencies, the proposal keeps core funding intact. Meanwhile, political differences are eroding bipartisan support for global HIV-prevention funding.

Despite great strides in prevention and treatment since HIV was first reported in the U.S. in the 1980s, HIV remains at epidemic levels in the U.S. today, with approximately 1.2 million people living with HIV and around 30,000 to 35,000 new infections each year. Experts said cases are rising in the South and in rural areas, and new infection statistics show it is disproportionately affecting Black and Hispanic populations.

What Are the Proposed Cuts?

The AIDS Budget and Appropriations Coalition, a group of more than 100 public health advocacy organizations that track changes in HIV-related federal spending, said a majority of the proposed cuts to domestic HIV funding stem from House Republicans’ effort to eliminate the Ending the HIV Epidemic initiative.

The program started in 2019 with the goal of reducing new HIV infections in the U.S. by 75% by 2025 and 90% by 2030. The program so far worked regionally, targeting areas that have the highest rates of HIV cases for funding.

In 2023, about $573 million was allocated for the program across various agencies, according to KFF’s funding tracker.

• $220 million to the Centers for Disease Control and Prevention.
• $165 million to the Ryan White HIV/AIDS program. (It was named for a 13-year-old diagnosed with HIV in 1984 and is overseen by the Health Resources and Services Administration.)
• $5 million to the Indian Health Service.
• $26 million to the National Institutes of Health for research.
• $157.3 million to community health centers, which have treated around 200,000 HIV patients annually.

The program lags its goals as it approaches the 2025 benchmark. “It’s well designed, well planned, it has targets that makes sense,” said Jeffrey Sturchio, a lead researcher on a Center for Strategic and International Studies report.

Sturchio said the problem is not a fault of design, but funding, adding, “Congress has never fully funded the initiative.”

Sturchio pointed to a range of local and state “bureaucratic hurdles.” Jurisdictions that have pulled together sufficient resources have seen “tremendous progress,” he said, and overall indicators seem to be moving in the right direction.

But COVID-19 reduced HIV testing and may have diverted public health efforts, CDC administrators said. KFF Health News reported in April that stakeholders saw progress but worried that it won’t be enough to make the 2030 deadline.

Democrats appear to share this concern. The spending bill proposed by the Democratic-controlled Senate Appropriations Committee maintained or slightly increased funding levels to all HIV-related programs. The committee requested more data about the program, describing its “lack of quantifiable data showing outcomes.”

The House has not yet passed the bill out of committee. We know of some proposed cuts from the bill, which the Republican-led House Appropriations Subcommittee released in July.

It outlines a $1.6 billion cut to the CDC, including a $220 million reduction in “HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention” and a $238.5 million cut from the Ryan White HIV/AIDS program. The Ryan White program provides medical care and support services to low-income HIV patients and serves more than half of those diagnosed in the U.S.

The bill also proposes cutting funding to the Minority HIV/AIDS fund by more than half — from $60 million to $28 million. According to HIV.gov, the fund supports prevention and care projects targeting disparities that affect communities of color.

Additional details about how these cuts could affect programs are detailed in a committee report that has not been made public. PolitiFact and some advocacy organizations obtained copies of the report, but the House Appropriations Committee did not respond to questions about it. The report we saw recommended cutting all funding for the Ending the HIV Epidemic initiative.

And House Democrats, advocacy organizations, and KFF Health News have each reported that the Ryan White program and CDC cuts result from a plan to eliminate the Ending the HIV Epidemic initiative.

“If they cut funding, it’s going to have a dramatic and draconian impact on the ability of all of the people who are working in these jurisdictions to improve public health,” said Sturchio, the researcher.

Although the cuts would be dramatic, experts said, they would not eliminate all domestic HIV funding.

“There is certainly a demonstration and a commitment to some of the core HIV programs, but there are millions of dollars of proposed cuts in other areas,” said Lindsey Dawson, associate director for HIV policy at KFF. “These cuts would have a meaningful impact on the ability of programs to provide lifesaving interventions for both HIV care and treatment, as well as prevention.”

The cuts would mean a 16% cut to the CDC’s division of STD prevention, a 9% cut to the Ryan White HIV/AIDS program, and a 53% cut to the Minority HIV/AIDS Fund from fiscal year 2023 to 2024.

These funding cuts are only proposals. They require a vote from the full appropriations committee and would have to pass the House and be negotiated with a Democratic-controlled Senate.

“We’ve heard for a long time that HIV is a bipartisan issue. But what some people forget, is that that bipartisanship was hard fought for over the first decade of the HIV epidemic,” said Dawson.

Other Challenges to HIV/AIDS Spending

The U.S. commitment to global HIV prevention, meanwhile, is also under scrutiny. Rep. Chris Smith, R-N.J., challenged reauthorizing the President’s Emergency Plan for AIDS Relief, also known as PEPFAR, without first making some changes. Started in 2003 by President George W. Bush, the program distributes funds in more than 50 countries for HIV testing, prevention, treatment, and medications. It also strengthens health care systems to fight AIDS.

Funding for the program has grown over the past 20 years, totaling more than $110 billion. The program reported 25 million lives saved by medical intervention.

Smith, who chairs the House Foreign Affairs subcommittee on Global Health, has expressed concerns that money is being given to nongovernmental organizations that support abortion rights and access.

U.S. law prohibits the direct use of overseas funding to provide abortions or to lobby for access to abortions. This has been the case since 1973. However, organizations that receive U.S. funding can do so with their own non-U.S. funding.

An official from the State Department, which runs the program, confirmed to PolitiFact that PEPFAR is legally restricted from funding abortion or lobbying for abortion access; the official cited the training of staff and partners and the monitoring of procedures to ensure compliance.

Other anti-abortion groups have favored a“Mexico City Policy,’‘ which has required foreign nongovernmental organizations to certify that they would not perform or promote abortion with funds from any source to be eligible for U.S. government funding. Trump applied the policy to PEPFAR, but Biden rescinded it.

The failure to reauthorize PEPFAR would not eliminate the program, and Congress can continue to fund the program without reauthorization, but it could cause some provisions to lapse over the next few years.

The lack of a reauthorization would have significant symbolic impact, said Kellie Moss, KFF’s associate director of global health and HIV policy. “It could make the program more vulnerable during funding discussions without a clear signal of bipartisan support.”

Although reauthorization is being held up, funding has progressed. On Sept. 28, the House passed a State Department and Foreign Operations Appropriations bill, which would fund PEPFAR for another year but implement a Mexico City-like policy provision on all global health funding. This bill would also extend the lapsing provisions for another year.

Our Ruling

Biden said that Republicans in Congress are “trying to wipe out federal funding to end the HIV epidemic.”

A subcommittee of House Republicans has proposed cutting some HIV prevention programs anywhere from 53% to 9% in fiscal 2024, depending on the program.

A committee’s draft report cited by advocacy and policy groups shows these cuts stem from the elimination of the Trump-era Ending the HIV Epidemic initiative, although the committee did not respond to questions about that.

Taken together, these cuts would not eliminate — or “wipe out” — all federal domestic HIV spending, but they do represent a significant cut.

Meanwhile, the House has not moved ahead to reauthorize PEPFAR, which supplies U.S. dollars for global HIV prevention, over Republican concerns about where organizations that receive the money stand on abortion access. But the House has passed one year of PEPFAR funding with some conditions about how it is distributed, which it can do without reauthorizing the program.

Biden’s statement is partially accurate in that significant funding cuts have been proposed by House Republicans, but he exaggerates by saying these efforts would “wipe out” federal funding.

We rate this claim Half True.

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(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

A proposed federal policy aims to protect older Americans from contracting HIV by offering free preventive medication, the latest effort to catch up to much of Europe and Africa in stemming the spread of the virus.

Under the plan from the Biden administration, Medicare would cover patients’ full cost of preexposure prophylaxis drugs, which prevent HIV transmission. The drugs, known by the shorthand “PrEP,” would be free in pill form and — for the first time — as long-acting injectables through the government insurance program designed for those 65 and older. Those 50 and over make up half of all people in the U.S. already living with HIV.

The proposed policy change represents a big shift because it means that even new long-acting injectable versions of PrEP drugs, which can cost more than $20,000 a year in the U.S., would be covered fully, without requiring patients to kick in copayments. It is not yet clear what the plan would mean for taxpayers, though, either in paying for the medications or in offsetting the costs of caring for fewer Medicare patients with HIV in the future.

The final green light for the plan was expected Oct. 10, but the Centers for Medicare & Medicaid Services announced it is still working out details of how to transition coverage for patients already taking the drugs.

The U.S. is decades behind nations in Europe and Africa that are on track to end new HIV infections by 2030. But while the proposal should bring down infections in older Americans, it highlights remaining inequities: Many people under age 65 will still struggle to pay for PrEP. And, at the same time, Republican congressional leaders have threatened to cut funding for a federal HIV prevention effort championed by the Trump administration that is intended to help all at risk.

“We’ve done a very poor job in the U.S. of assuring that people who could most benefit from PrEP have access to it,” said Justin Smith, who directs the Campaign to End AIDS at Positive Impact Health Centers in the Atlanta area.

Though PrEP has been embraced by gay and trans Americans, it is prescribed less often to heterosexuals over 50 or women of any age. In the first three months of this year, just 8% of the more than 300,000 people receiving PrEP in the U.S. were women, according to the Centers for Disease Control and Prevention. The racial gap is large, too: While 66% of white people eligible for PrEP got prescriptions for it in that period, only 8% of eligible Black people and 17% of eligible Hispanic people did.

Broadening access for gay and bisexual men of color, as well as straight and cisgender women of color — particularly Black women, who represent the majority of women with HIV in the U.S. as well as the majority of new infections among women — is critical for the nation to catch up to the rest of the world, Smith said.

PrEP, a Key HIV Prevention Tool, Isn’t Reaching Black WomenNew HIV infections occur disproportionately among Black women, but exclusionary marketing, fewer treatment options, and provider wariness have limited uptake of preexposure prophylaxis, or PrEP, drugs, which reduce the risk of contracting the virus.

Leisha McKinley-Beach, a national HIV consultant and CEO of the Black Public Health Academy, which prepares Black health department employees for leadership positions, noted that the Medicare proposal to cover the cost of injectable PrEP could help many women because a shot given every two months can be easier to manage than a daily pill.

But it’s just a start. She and others are lobbying for a national PrEP plan that would build on momentum from the recent Medicare proposal to expand free access to other age groups, much as with covid-19 vaccinations. McKinley-Beach also wants the U.S. government to expand the message that anyone can get HIV, encourage drug companies to advertise more on TV to women of color, and fund outreach to dispel medical mistrust in communities of color.

“Gay white men have had a narrative of dignity and respect with regards to HIV treatment, and I would never want to change that narrative,” she said. “But the message needs to be broadened. Forty-two years into the HIV epidemic, the current HIV prevention model is detrimental to Black women who could benefit from PrEP.”

Though the U.S. was the first nation to approve PrEP, in 2012, it now trails the rest of the world in equitable access. That’s mostly due to the cost of laboratory tests and medical visits. While the cost of the generic form of Truvada, an oral form of PrEP, can be as low as about $30 a month in the U.S., a study by University of Virginia researchers reported the cost of starting PrEP is typically about $2,670 for uninsured patients, including about $1,000 for lab tests and medical visits. The new Medicare proposal would cover up to seven counseling visits every 12 months for HIV risk assessment and reduction.

Meanwhile, PrEP pills are free for people in the United Kingdom and European Union nations including France, Germany, Sweden, and Denmark. Those nations don’t yet cover the more expensive shots, although the U.K. is leading a small test on injectable PrEP in people who cannot take it in tablet form.

The U.S. also lags Western Europe and some nations in Africa in overall HIV treatment and prevention. For example, just 57% of HIV-positive Americans have attained viral suppression, according to the U.S. government website HIV.gov, meaning they regularly take medications to make them unable to transmit the virus. That makes PrEP, which is for people who don’t have the virus, all the more important for Americans to stay negative, according to HIV experts.

In Africa, by contrast, Botswana, Eswatini (formerly Swaziland), Rwanda, Tanzania, and Zimbabwe have already achieved the United Nations’ “95-95-95” targets set for 2025 — 95% of people with HIV know their HIV status, 95% of people with diagnosed HIV infection receive sustained antiretroviral therapy, and 95% of people receiving antiretroviral therapy have achieved viral suppression, or the virus is undetectable in their blood — according to the U.N.

In the U.K., 98% of HIV-positive people have achieved “undetectable” status via free antiretroviral medicines and treatment available through the country’s universal health care program, the National Health Service. Moreover, nearly anyone in the U.K. who is HIV-negative and wants to take PrEP can get it at no charge. The U.K. says it is now on a path to reduce new HIV infections by 80% by 2025.

The U.K. changed its PrEP approach after 2015, when Greg Owen founded “iwantprepnow.co.uk,” a website that ignited a PrEP movement by helping people in the U.K. and Europe self-source low-priced generic forms of Truvada, the first drug approved as PrEP, from pharmacies in Hong Kong and India.

“It became more affordable,” said Owen, now PrEP lead at one of the U.K.’s top HIV and sexual health charities, Terrence Higgins Trust. “Soon people demanded it for free on the NHS.”

In the U.S., Smith said, the lack of a national PrEP program that would make the drugs and associated bloodwork free and a heated political climate around health care have hindered HIV outreach.

“In rural areas of the South, especially in places like Georgia or Tennessee, there has been outright hostility toward accepting money from the CDC and expanding Medicaid to treat and prevent HIV,” Smith said. “People think it’s just politics, but this is having an impact on public health, on people’s lives.”

Anti-queer sentiment in many quarters also creates an environment of hostility around overall sexual health, said Richard Elion, director of clinical research at Washington Health Institute and a professor at George Washington University School of Medicine and Health Sciences. “There’s a chilling effect for everyone, not just queer Americans,” he said.

Elion said shame surrounding sex and the feeling of vulnerability that some people get from taking any medicine may also reduce PrEP uptake among older Americans. “Taking PrEP is actually very empowering, and that needs to be the message,” he said.

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(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

The year so far has given us a stock market filled with highs and lows, a flat bond market, high mortgage rates, rising interest rates and the global effects of wars in Europe and the Middle East.

Yet as with any year, a general financial review is necessary at year-end to stay focused on your financial goals and objectives. With that in mind, here are a few year-end topics that would be prudent to review:

Tax-loss harvesting

Tax-loss harvesting is an investing approach used for taxable accounts. Retirement accounts do not qualify.

To take advantage of tax-loss harvesting, consider selling select investments at a loss to help offset tax implications from other holdings that have generated taxable capital gains. Eligible investments aren’t limited to stocks or stock funds, which means losses from bonds and other asset classes can be used to offset gains as well.

Additionally, if losses are larger than gains, you can use the remaining losses to offset up to $3,000 of ordinary taxable income (for married couples filing separately, the limit is $1,500). Any amount over $3,000 can be carried forward to future tax years.

The impact of tax-loss harvesting can be significant for taxable account holders with high incomes. However, an investor selling securities as part of a tax-loss harvesting strategy should trade cautiously due to the Internal Revenue Service restriction known as the wash-sale rule. This states that if you sell a security at a loss and buy the same or a “substantially identical” security within 30 days before or after the sale, the loss is typically disallowed for current income tax purposes.

Required minimum distribution

Unless your retirement funds are in a Roth IRA, you may need to take the annual required minimum distribution from your individual retirement account by year-end. If your 70th birthday was before July 1, 2019, you began taking the RMD at age 70 ½. However, due to changes in federal law as part of the Setting Every Community Up for Retirement Enhancement (Secure 2.0) Act, which was signed into law in December of 2022, these rules changed for others.

In 2023, one change under Secure 2.0 was to delay RMDs from age 72 to begin at age 73 instead. This applies to people who were born between 1951 and 1959. People born in 1960 or later will not be required to take RMDs until age 75.

The distribution amount varies annually and is determined by an IRS table, the year-end balance of your account, and your age. If you miss the window to take your annual RMD, you will be subject to an IRS penalty of 25% of the RMD amount. Before Secure 2.0, this penalty was 50% of the amount of the RMD that was not withdrawn in the required year.

Roth IRA conversion

If your portfolio values are down this year, it may be a good time to convert some of your assets from an IRA to a Roth IRA.

Assets converted from an IRA to a Roth IRA are taxable as income in the year of the conversion. However, following the conversion, Roth IRAs are not subject to RMDs. Additionally, when the funds are distributed from a Roth IRA during retirement, the income is not taxable. Because IRA assets converted to a Roth IRA are taxable, discussing the tax ramifications with a tax adviser or CPA before the conversion would be best.

Inherited IRA RMD for non-spouse beneficiaries

An inherited IRA is an account that is opened when a person inherits an IRA after the original owner’s death. This may happen at the death of a spouse or when a child inherits their parent’s IRA. On Jan. 1, 2020, the IRS proposed changes for a non-spouse IRA beneficiary of a deceased owner who was subject to RMDs.

In 2022, the IRS proposed new guidance requiring the non-spouse beneficiary to take RMDs as well as empty the inherited IRA by the end of the 10th year. A final ruling was expected early this year. But in July, the IRS waived penalties on missed RMDs for 2023 and indicated that final guidance would not be available until 2024.

There are many rules for inherited IRAs and Roth IRAs. Don’t assume all rules for inheriting an IRA are the same for everyone. They are not. Your financial or tax adviser can help you manage your annual distributions.

Annual gifting

In 2023, an individual can give $17,000 to as many people as they want without reporting the gift on their tax return and paying additional tax. This is called the gift tax annual exclusion or exemption.

If the person is married, both individuals can give $17,000 for a total gift to any person of $34,000. This exemption applies to more than cash gifts. Forgiving debt and transferring stock are two other examples that would also qualify if the fair market value of the gift is under the annual limitation.

This amount is adjusted for inflation and can be given annually. Any amount over the annual gift tax exclusion limit is reportable to the IRS for the given tax year.

Cash donations to public charities

For individuals who can still itemize their deductions, this year you may deduct up to 60 percent of your adjusted gross income (AGI) for cash donations to public charities. One caveat is that the 60 percent deduction applies only to cash that is donated to qualified public charities. If you choose to donate non-cash assets to public charities, the deduction falls to a limit of 30 percent of your AGI.

Gifting appreciated securities to public charities

Donating long-term, highly appreciated taxable securities—that is, stocks, mutual funds, and exchange-traded funds (ETFs) that have realized significant appreciation over time—to nonprofit organizations is one of the most tax-efficient ways to give. You receive a tax deduction for the full value of the gift without having to pay the capital gains you would have paid if you sold the securities.

Also, you can significantly increase the amount of funds available for charitable giving because you are not paying capital gains taxes on the gift. In other words, you are giving the full value of the security, not the after-tax net value.

Assets held for one year before they are gifted reap the following benefits:

— Capital gains taxes are avoided on the future sale of the securities.

— A tax deduction is received for the full fair market value of the securities, up to 30 percent of your AGI.

Most banks and brokerage firms can assist you with this transaction but will require you to sign a letter of instruction to transfer the shares to a charity. Do not wait until the last week of December to begin this task, or it may not happen in 2023.

This tax deduction is only relevant if you itemize your deductions on your tax return. If the sum of your deductions falls below $13,850 for single filers or $27,700 for joint filers, this strategy will not help reduce your taxes.

Qualified charitable deductions

At the end of 2015, lawmakers approved a permanent measure allowing individuals who are 70 1/2 years old or older to make qualified charitable distributions (QCDs) directly from their IRAs to their favorite qualified charities.

In addition to the well-known benefits of giving to charity, a QCD offers this additional benefit: the donated amount is excluded from taxable income, unlike regular withdrawals from an IRA, which are taxed as ordinary income. A lower income may also help reduce your Medicare premiums, which are income based.

As year-end approaches, remember that markets will always be unpredictable, and the volatility experienced in the past few years will be no exception. Take the time to review your financial situation with your adviser and implement the strategies you can control before the year is over. When you actively manage your finances and plan for your future, the feeling of personal financial empowerment is justly earned.

Note: This column is intended to be informational only and does not constitute legal, accounting or tax advice.

Teri Parker is a vice president for CAPTRUST Financial Advisors. She has practiced in the field of financial planning and investment management since 2000. Reach her via email at Teri.parker@captrustadvisors.com.

Laughter seems plausible, particularly since we had no children yet when he casually worked its mention into our conversation. But my sense of home-schooling at that time was mostly that it was for families on the cultural fringe — that is, not us.

Yet, here I am years later, not only a home-schooler but finding that our decision to educate our children outselves isn’t fringy at all.

It’s actually increasingly mainstream, if not slightly cool.

According to a new analysis from the Washington Post, home-schooling is the fastest growing form of education in the U.S. — not just in conservative states like Texas.

And it’s not exclusive to conservative enclaves, either. In New York City and Washington — famously bastions of progressivism — home-school communities are growing and flourishing.

Indeed, home-schooling is now a less ideological practice with more diverse practitioners, attracting families across the political spectrum and across various racial and ethnic communities.

That’s probably because today’s home-school families are motivated by an assortment of factors, not just moral and religious education but also physical and emotional safety, social environment, curriculum, family flexibility and accommodating kids’ special needs and education goals.

For most families, like mine, it’s really a combination of reasons.

And alongside traditional home-schooling models, micro-schools, hybrids and co-ops have also exploded, providing families with a parent-lead learning environment that also provides social outlets as well as needed structure and support.

Indeed, home-schooling’s newfound social status should be seen as a challenge to the long-held notion that a quality education can only occur inside a traditional school environment.

It’s not exactly news that home-schooling ballooned during the pandemic.

Those were the days when COVID protocols (too strict for some and too lenient for others) and virtual learning provided a proverbial window into what was being taught in public schools and what wasn’t, much to the chagrin of parents who began seeking alternative options for their kids.

The Washington Post data shows, however, that while the number of children being home-schooled has declined slightly since its pandemic-peak, the growth of home-schooling remains stable and significant.

Before the pandemic, estimates suggested that about 1.5 million children in the U.S. were home-schooled.

The latest data suggests that number is now somewhere between 1.9 million and 2.7 million, although, because of the dearth of reporting requirements in many states, it’s likely that number is even higher.

This is not a blip but a fundamental shift in how our culture views education.

Unsurprisingly, not everyone is pleased.

Home-school critics argue that the loose or nonexistent regulation will inevitably result in substandard or parochial education.

But one only need look at standardized testing results in a district like Fort Worth ISD, where minority students in particular consistently cannot read or perform math at grade level, to recognize that attending school in no way guarantees that a student receives a quality education.

Then there are the detractors who deride home-schoolers for the same reasons they criticize private school participation — that it takes resources away from public schools.

Public schools do indeed serve an important role in our communities, but they have never been a panacea.

And with more and more families finding that public schools do not meet the needs of their individual students and circumstances, it behooves state governments to support alternative forms of education, like home-schooling.

Parents deserve choices in their children’s education.

Cynthia Allen is a columnist for the Fort Worth Star-Telegram.

The dominating narrative regarding higher energy bills is that they’re directly related to the higher outside temperatures, but this ignores the greed of investor-owned utilities (IOUs) and minimizes the intersection of climate change, energy and race.

Every Floridian deserves access to electricity, regardless of one’s racial or socioeconomic background. However, IOUs often prioritize profits over people, leading to higher utility bills, low-grade infrastructure and inadequate service in many communities of color.

Communities of color often experience higher utility rates, burdening them with a greater financial strain. Studies have shown that these disparities are not coincidental; they are a result of historical redlining and discriminatory practices that have left these communities with fewer resources to invest in infrastructure improvements.

IOUs have a history of prioritizing investments in more affluent, predominantly white neighborhoods while neglecting the upgrade and maintenance of systems in communities of color. This neglect leads to more frequent power outages, longer emergency response times and a lower overall quality of service. In some instances, it can even put lives at risk, as we’ve seen in the aftermath of natural disasters like Hurricane Katrina.

In Florida, IOUs operate as monopolies, meaning customers don’t get to pick their power provider. In exchange for their service territory, utilities are regulated by the Public Service Commission (PSC), a board of Gov. Ron DeSantis appointees who are responsible for ensuring that the utilities provide reliable and affordable electricity. IOUs’ continual dependence on nonrenewable resources not only raises bills for consumers but also contributes to rising temperatures, and further exacerbates climate inequalities across communities.

According to leading climate scientists, we must cut greenhouse gas by 50% by 2030 and significantly reduce carbon dioxide emissions to stabilize global temperatures and reduce extreme weather events. Unfortunately, in this past legislative session, Florida lawmakers voted to pass numerous bills (HB 1645, SB 250, HB 1281, SB 170 and HB 125) that set us back even further.

However, there is still hope. The United Nations’ Intergovernmental Panel on Climate Change asserts that we have options across all of our sectors in order to achieve these emissions goals, thus we must call on our colleagues in the Legislature and municipal governments to champion the following demands:

• We demand municipal authority of utilities. Municipal utilities are publicly owned with a community-elected board. They do not operate on a for-profit basis, which often means lower rates for residential customers. With Duke’s lease in St. Petersburg set to expire in 2026, we are presented with a timely opportunity to enact this change on a local level.
• We demand a publicly elected Public Service Commission. If the PSC’s mission is to provide reliable and affordable electricity for its customers, then we should have a say in who is defining “affordable” and “reliable” on our behalf.
• We demand renewable, clean energy that is backed by research. Carbon capture and storage, hydrogen power and biomass are not sustainable and efficient solutions, nor are they equitable. In the Sunshine State, we choose solar.
• We will not further marginalize the communities that have borne the brunt of environmental injustice. Latino and Black communities are exposed to 63% and 56% more environmental pollution than they produce, while non-Hispanic white Americans are exposed to 17% less pollution than they produce. As we build out the infrastructure for clean energy, we must do so in a way that is clean for all of our residents, not just the privileged few.

For more information about the Florida lawmakers that spent the 2023 legislative session fueling corporate greed and the ones who championed their communities’ best interests, visit “The Corporate Greed Report” at StopCorporateGreedFL.com.

Dr. Chelsea Rivera is a policy organizer at Central Florida Jobs with Justice, which is a coalition of labor unions, community-based organizations, faith-based and student groups coming together to build power for worker rights. State Rep. Michele Rayner is a Democrat from St. Petersburg representing House District 62, which includes parts of Pinellas and Hillsborough counties.

This opinion piece was distributed by The Invading Sea website (www.theinvadingsea.com), which posts news and commentary on climate change and other environmental issues affecting Florida.