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As Syphilis Invades Rural America, A Fraying Health Safety Net is Failing to Stop It

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When Karolyn Schrage first heard about the “dominoes gang” in the health clinic she runs in Joplin, Mo., she assumed it had to do with pizza.

Turns out it was a group of men in their 60s and 70s who held a standing game night — which included sex with one another. They showed up at her clinic infected with syphilis.

That has become Schrage’s new normal. Pregnant women, young men and teens are all part of the rapidly growing number of syphilis patients coming to the Choices Medical Services clinic in the rural southwestern corner of the state. She can barely keep the antibiotic treatment for syphilis, penicillin G benzathine, stocked on her shelves.

Public health officials say rural counties across the Midwest and West are becoming the new battleground. While syphilis is still concentrated in cities such as San Francisco, Atlanta and Las Vegas, its continued spread into places like Missouri, Iowa, Kansas and Oklahoma creates a new set of challenges.

Compared with urban hubs, rural populations tend to have less access to public health resources, less experience with syphilis and less willingness to address it because of socially conservative views toward homosexuality and nonmarital sex.

In Missouri, the total number of syphilis patients has more than quadrupled since 2012 — jumping from 425 to 1,896 cases last year — according to a Kaiser Health News analysis of new state health data. Almost half of those are outside the major population centers and typical STD hot spots of Kansas City, St. Louis and its adjacent county.

Syphilis cases surged at least eightfold during that period in the rest of the state.

At Choices Medical Services, Schrage has watched the caseload grow from five cases to 32 in the first quarter of 2019 alone compared with the same period last year. “I’ve not seen anything like it in my history of doing sexual health care,” she said.

Back in 1999, the Centers for Disease Control and Prevention had a plan to eradicate the sexually transmitted disease that totaled over 35,000 cases nationwide that year. While syphilis can cause permanent neurological damage, blindness or even death, it is both treatable and curable. By focusing on the epicenters clustered primarily throughout the South, California and in major urban areas, the plan seemed within reach.

Instead, U.S. cases topped 101,500 in 2017 and are continuing to rise along with other sexually transmitted diseases. Syphilis is back in part because of increasing drug use, but health officials are losing the fight because of a combination of cuts in national and state health funding and crumbling public health infrastructure.

“It really is astounding to me that in the modern Western world we are dealing with the epidemic that was almost eradicated,” said Schrage.

Craig Highfill, who directs Missouri’s field prevention efforts for the Bureau of HIV, STD and Hepatitis, has horror stories about how syphilis can be misunderstood.

“Oh, no, honey, only hookers get syphilis,” he said one rural doctor told a patient who asked if she had the STD after spotting a lesion.

In small towns, younger patients fear that their local doctor — who may also be their Sunday school teacher or basketball coach — may call their parents. Others don’t want to risk the receptionist at their doctor’s office gossiping about their diagnosis.

Some men haven’t told family members they’re having sex with other men. And still more have no idea their partner may have cheated on them — and their doctors don’t want to ask, according to Highfill.

It’s even hard to expect providers who haven’t seen a case of syphilis in their lifetime to automatically recognize the hallmarks of what is often called the “great imitator,” Highfill said. Syphilis can manifest differently among patients, but frequently shows up for a few weeks as lesions or rashes — often dismissed by doctors who aren’t expecting to see the disease.

Since 2000, the current syphilis epidemic was most prevalent among men having sex with men. Starting in 2013, public health officials began seeing an alarming jump in the number of women contracting syphilis, which is particularly disturbing considering the deadly effects of congenital syphilis — when the disease is passed from a pregnant woman to her fetus. That can cause miscarriage, stillbirth or birth deformities.

Lauren Weber, Kaiser Health News

Lauren Weber, Kaiser Health News

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Activism

As California Hits Aging Milestone, State Releases Its Fifth Master Plan for Aging

“California’s Master Plan for Aging started a powerful movement that is shaping the future of aging in our state for generations to come,” Gov. Gavin Newsom said in a statement, calling the initiative a “future-forward” model delivering real results for older adults, people with disabilities, and their families.

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By Bo Tefu, California Black Media  

On Jan. 27, California released its Fifth Master Plan for Aging Annual Report,titled “Focusing on What Matters Most,” outlining the state’s progress and priorities as its population rapidly grows older.

The report, issued by the California Health and Human Services Agency (CalHHS), provides updates on the Master Plan for Aging’s “Five Bold Goals”: housing, health, inclusion and equity, caregiving, and affordability.

The report comes as Californians aged 60 and older now outnumber those under 18 for the first time, a demographic shift expected to accelerate over the next decade.

“California’s Master Plan for Aging started a powerful movement that is shaping the future of aging in our state for generations to come,” Gov. Gavin Newsom said in a statement, calling the initiative a “future-forward” model delivering real results for older adults, people with disabilities, and their families.

Launched in 2021, the Master Plan for Aging takes a “whole-of- government” and “whole-of-society” approach, coordinating state agencies, local governments, community organizations, and private partners. The annual report highlights significant milestones, including more than 100 California communities joining AARP’s Age-Friendly Network and $4 million in state funding awarded to local organizations to develop aging and disability action plans in 30 communities statewide.

The report also underscores California’s leadership at the national level, noting that dozens of states have followed its example and that federal legislation inspired by the plan was reintroduced in the U.S. Senate in December 2025.

CalHHS Secretary Kim Johnson emphasized the plan’s focus on equity and resilience amid ongoing challenges.

“The Master Plan for Aging continues to provide a vision, a focus, and a platform for collaboration,” Johnson said. “Equity is at the center of all that we do.”

Looking ahead, the report notes that by 2030, one in four Californians will be age 60 or older, positioning the Master Plan for Aging as a central framework for meeting the state’s long-term social, economic, and health needs.

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Community

Candidates Vying for Governor’s Seat Debate at Ruth Williams–Bayview Opera House in San Francisco

The gubernatorial debate participants included Antonio Villaraigosa, former Los Angeles mayor; Matt Mahan, San Jose mayor; Betty Yee, former California state controller; Xavier Becerra, former U.S. Secretary of Health and Human Services, and attorney general of California; Steve Hilton, political commentator and political adviser; Tom Steyer, entrepreneur, and Tony Thurmond, California’s superintendent of public instruction.

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The gubernatorial debate was hosted by KTVU’s Greg Lee, KTTV’s Marla Tellez and KTVU’s Andre Senior. The candidates are (l.-r.): Xavier Becerra, Steve Hilton, Matt Mahan, Tom Steyer, Tony Thurmond, Antonio Villaraigosa, and Betty Yee.
The gubernatorial debate was hosted by KTVU’s Greg Lee, KTTV’s Marla Tellez and KTVU’s Andre Senior. The candidates are (l.-r.): Xavier Becerra, Steve Hilton, Matt Mahan, Tom Steyer, Tony Thurmond, Antonio Villaraigosa, and Betty Yee.

By Carla Thomas 

 

On Tuesday, Feb. 3, seven candidates took the stage at the historic Ruth Williams–Bayview Opera House in San Francisco for the gubernatorial debate, hosted by the Black Action Alliance (BAA) in partnership with KTVU and sister station KTTV Fox 11 in Los Angeles.

 

For many voters, it marked a first opportunity to hear directly from several candidates seeking to lead the nation’s most populous state.

 

The gubernatorial debate participants included Antonio Villaraigosa, former Los Angeles mayor; Matt Mahan, San Jose mayor; Betty Yee, former California state controller; Xavier Becerra, former U.S. Secretary of Health and Human Services, and attorney general of California; Steve Hilton, political commentator and political adviser; Tom Steyer, entrepreneur, and Tony Thurmond, California’s superintendent of public instruction.

 

Crucial topics and issues addressed throughout the debate included housing, crime, immigration, climate change, health care and homelessness.

 

The debate was moderated by KTVU political reporter Greg Lee alongside KTVU’s Andre Senior and KTTV Fox 11’s Marla Tellez.

 

Candidates also addressed inflation and the rising costs across the state, impacting everything from groceries to childcare and health care. 

 

Thurmond vowed to generate 2.3 million units of housing by placing 12 units on each parcel of available land in the 58 counties of California. Steyer agreed that billionaires should pay their fair share of taxes.

 

Hilton wanted to cut taxes, help working-class families, and end the Democrats “climate crusade and insane regulations.”

 

Yee offered a more transparent governmental approach with accountability, given the state’s debt.

 

Gonzalez said, “This debate was a great way to see who has great ideas and who has substance.”

 

“It’s important to have the debate within a community that requires the most,” said business leader Linda Fadekye.

 

Attendees included State Controller Malia Cohen, representatives of the National Coalition of 100 Black Women, the National Coalition of 100 Black Men, the San Francisco African American Chamber of Commerce, and Black Women Organized for Political Action, among others. 

 

Event host, the Black Action Alliance (BAA) was established to amplify the voices of the Bay Area’s Black community, whose perspectives have too often been overlooked in politics and public policy.  

 

Loren Taylor, CEO of BAA, said it was important to bring the event to the Bayview in San Francisco and shared his organization’s mission.

 

“The Black Action Alliance (BAA) stands for practical, community-driven solutions that strengthen public safety, address homelessness, support small businesses, expand affordable housing, and ensure access to quality education—issues at the heart of the Black experience in the Bay Area,” said Taylor. 

 

California’s primary election will take place on June 2 and the general election will take place on Nov. 3. 

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Activism

Medi-Cal Cares for You and Your Baby Every Step of the Way

Across California, including Alameda and San Francisco counties,  Medi-Cal is working to address those concerns by expanding and coordinating maternal health services so pregnant and postpartum people receive care that is respectful, comprehensive, and easier to navigate. From the first prenatal visit through a child’s first birthday, Medi-Cal provides coverage and support designed to protect both parent and baby.

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For many pregnant people, pregnancy brings a mix of both joy and uncertainty. Alongside excitement, there are questions about finding the right doctor, understanding what care is covered, and knowing where to turn for support after the baby arrives. For Black families in Alameda and San Francisco counties those questions are often compounded by long-standing disparities in maternal health outcomes.

Across California, including Alameda and San Francisco counties,  Medi-Cal is working to address those concerns by expanding and coordinating maternal health services so pregnant and postpartum people receive care that is respectful, comprehensive, and easier to navigate. From the first prenatal visit through a child’s first birthday, Medi-Cal provides coverage and support designed to protect both parent and baby.

These services are available to people who qualify for Medi-Cal. In California, eligibility is based primarily on income, household size, age, pregnancy status, disability, or other qualifying circumstances. Pregnant people qualify at higher income levels than non-pregnant adults and remain eligible through pregnancy and for 12 months after the pregnancy ends.

Importantly, pregnant people who qualify for Medi-Cal are eligible for full-scope coverage regardless of immigration status, including medical, behavioral health, dental, and vision services during pregnancy and the postpartum year.

A Clearer Path Through Pregnancy: The Birthing Care Pathway

The Birthing Care Pathway helps pregnant people understand what care they should receive and when, while supporting providers in delivering coordinated, culturally responsive services. It outlines key steps during pregnancy, including prenatal screenings, behavioral health check-ins, nutrition support, and preparation for labor and delivery.

For Black pregnant and postpartum people in Alameda and San Francisco counties the pathway emphasizes early prenatal care, shared decision-making, and connections to community-based programs that address medical needs and social drivers of health.

Doula Services: Support Before, During, and After Birth

Medi-Cal covers doula services for pregnant and postpartum members who qualify. Doulas provide non-medical emotional support, education, and advocacy during pregnancy, labor and delivery, and postpartum recovery. Research shows doula care is associated with reduced stress, improved birth outcomes, and increased breastfeeding success.

Covered doula services include prenatal visits, support during labor and delivery, and postpartum follow-up visits, in accordance with Medi-Cal benefit guidelines.

Care That Continues After Birth: The Postpartum Pathway

More than half of pregnancy-related deaths in California occur after childbirth, with Black families facing the greatest risks. The Postpartum Pathway defines the care pregnant and postpartum people who qualify for Medi-Cal should receive during the first year after birth.

The Pathway promotes a comprehensive postpartum visit within 12 weeks, ongoing primary care through 12 months postpartum, screening and treatment for postpartum depression and anxiety, breastfeeding support, chronic condition management, and referrals to community-based services.

Mental Health, Dental, and Vision Care Included

Medi-Cal covers perinatal behavioral health services for eligible members, including screening, therapy, counseling, and medication management when medically necessary. Services may be provided in person or through telehealth.

Pregnant and postpartum people who qualify for Medi-Cal also receive full dental benefits, including exams, cleanings, and medically necessary treatment, as well as vision care such as eye exams and eyeglasses.

Community Supports Through CalAIM

CalAIM (California Advancing and Innovating Medi-Cal) is a statewide initiative that strengthens Medi-Cal by improving care coordination and addressing health-related social needs.

Through CalAIM, eligible Medi-Cal members in Alameda and San Francisco counties may receive Community Supports such as transitional housing assistance, medically tailored meals, and help navigating social services.

How to Contact Medi-Cal in Alameda and San Francisco Counties

Pregnant and postpartum people who meet Medi-Cal eligibility requirements can get help enrolling, choosing a health plan, finding providers, or accessing doula and postpartum services by contacting the Alameda County Medi-Cal office at (510) 795-2428 or the San Francisco Medi-Cal office at (855) 355-5757 or calling the number on their Medi-Cal card.

Support at Every Step

Pregnancy and postpartum care should be clear, compassionate, and complete. Through the Birthing Care Pathway, Postpartum Pathway, doula services, behavioral health care, Black Infant Health, and Community Supports, Medi-Cal is working to ensure that eligible families in Alameda and San Francisco counties — especially Black Californians — receive the care and support they need to stay healthy and give their babies a strong start.

Ready to Learn More or Get Started?

Pregnant and postpartum people in Alameda and San Francisco counties can learn more about Medi-Cal benefits, enroll in coverage, or get help finding providers by contacting the Alameda County Medi-Cal office or San Francisco County Medi-Cal office or calling the number on their Medi-Cal card. Trained representatives can explain eligibility, available services, and next steps.

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