E6 Chimney swifts in decline On almost any summer day in the city, you can throw your head back, look up into the blue and watch the aerial acrobatics of the birds some call “flying cigars.”
The small, sooty-brown birds spend most of their daylight hours in the air. With short tails and long, slender wings they make speedy twists and turns to pick off flying insects.
A family of swifts can consume 12,000 insects per day.
Swifts that are raising a brood will make regular pit stops to refuel their chicks. Baby swifts sit in a half-saucer-shaped nest of sticks glued with their parents’ sticky saliva to the inside wall of a chimney, air shaft or unused smokestack.
In early autumn, huge flocks gather to make a 3,000-mile trip to wintering grounds in northwestern South America.
SOURCES: Committee on the Status of Endangered Wildlife in Canada; Driftwood Wildlife Association
Chaetura pelagica
Before European colonists razed the forests of eastern North America, the birds relied on large, hollow trees for nesting sites. As those disappeared, swifts gradually moved into the region’s increasing number of chimneys. Consequently, chimney swift population densities are now highest in cities.
Since 1966, the U.S. population of chimney swifts has fallen 53 percent, and continues to drop at an increasing rate.
Several factors may be contributing to the decline: logging and fires in the upper Amazon River watershed, reduction of insect numbers by pesticides, the cleaning of chimneys during breeding season and, most important, the capping or loss of traditional chimneys and air shafts.
People who want to attract swifts without using a chimney can build a chimney swift tower in their yard. For instructions, visit
www.chimneyswifts.org.
KLMNO
The changing natural world at our doorsteps. URBAN JUNGLE
TUESDAY, JUNE 15, 2010
A chimney may host several roosting swifts but can
accommodate only one nesting pair.
PATTERSON CLARK/THE WASHINGTON POST
clarkp@washpost.com
African women begin anti-HIV test
Silver Spring group makes vaginal ring intended to kill viruses
by David Brown The first test of a long-acting
vaginal ring loaded with an HIV- preventing drug has begun en- rolling women in southern Africa. With no prospects for an AIDS
vaccine in the next decade or lon- ger, the AIDS community has high hopes for “microbicides,” the general term for substances that kill viruses or bacteria on contact. None of the compounds tested to date, however, has worked, and one of them actually increased a woman’s risk of becoming infec- ted. The new study is the 15th un-
dertaken by the International Partnership for Microbicides, a nonprofit group in Silver Spring that has helped lead the search
for a discreet, woman-controlled means of protection. “This is the one that is most
likely to work,” Zeda Rosenberg, the head of the organization, said last week at Women Deliver 2010, an international conference on maternal and child health held in Washington. Elizabeth Mataka, the United
Nations special envoy for HIV/ AIDS in Africa, said she was “very excited about the prospect” of a long-acting microbicidal ring. She told reporters that its advan- tage is that “nobody needs to know, nobody needs to agree” when a woman uses it. Heterosexual intercourse is by far the main mode of HIV trans- mission in the world, with wom- en at somewhat greater risk than men. Of the 33 million people liv- ing with AIDS worldwide, 16 mil- lion are women age 15 and older. Two-thirds of HIV-infected peo- ple live in sub-Saharan Africa, and 60 percent of them there are women.
The product manufactured by the Silver Spring nonprofit is a sil- icone ring similar to one used in contraceptive devices such as Nu- vaRing. It is impregnated with dapivirine, an antiretroviral drug. The drug is released into the vagi- na over a month, after which it is replaced. The study is recruiting 280 women and will evaluate the ring’s safety through blood tests, pelvic exams and interviews with users. The first women were re- cruited in South Africa at the end of April; other volunteers will come from three nearby coun- tries.
Whether the ring successfully
prevents HIV infection will re- quire a much larger study that won’t begin until next year. It will recruit up to 8,000 women in sev- en countries, will cost about $90 million and is expected to have re- sults in 2015. Previous studies have shown
that a woman’s sexual partner is aware that she is using a vaginal
ring about half the time. Some ex- perts are worried that if a woman uses the ring without informing a partner, she might risk becoming the victim of violence if he finds out.
“I think women are incredibly resourceful and will figure out how to place this in the context of their relationship,” Rosenberg said.
An 889-woman study of a vagi-
nal gel containing the antiretrovi- ral drug tenofovir is underway in South Africa. Preliminary results on that microbicide will be re- vealed next month. A vaginal ring that contains both contraceptives and an anti- retroviral drug is also under de- velopment with support from the U.S. Agency for International De- velopment, said Régine Sitruk- Ware, an endocrinologist with the nonprofit Population Council. It would be removed once a month during the menstrual period and could be used for a year.
browndm@washpost.com
Star system for Medicare plans has few devoted fans
medicare continued from E1
three or fewer stars. But many don’t have much choice: Biles found that only 15 percent of Medicare Advantage members live in counties where four- or five-star plans are of- fered. In a new study, Avalere
Health, a consulting firm, found that only 5 percent of Medicare Advantage members in Virginia are in four-star plans. That compares with 33 percent in Maryland and 68 percent in the District. And no one in the Washington area is enrolled in a five-star plan, for a good reason: None of the plans offered here has earned the top grade.
Although the scores are up- HEALTH-CARE Q&A Insurer may allow graduate to stay on parent’s plan Gerard Anderson and Bradley
Herring of the Johns Hopkins Bloomberg School of Public Health answer questions about the new health-care law. Ander- son is director of the school’s Cen- ter for Hospital Finance and Management; Herring directs its PhD program in health eco- nomics and policy. Send ques- tions to them at health-science@
washpost.com. My 22-year-old daughter
graduated from college in May. She is currently on my health in- surance and has a part-time job that offers health insurance. Can she remain on my policy un- til she turns 26 even though health insurance is offered to her through her employer?
Herring: Your employer may decide to allow your daughter to remain on your policy, but is not required to do so because she has this alternative offer from her own employer. Generally speaking, parents will soon be able to cover their children on their policy until their child’s 26th birthday. While some insurers and employers are offering to do this already, they won’t actually be required to do so until the first open enrollment period after Sept. 23, which is most commonly Jan. 1, 2011. The best-case scenario for you
two is that your employer allows her to maintain her coverage now, despite graduating from col- lege, and keep it until she turns
26. The worst-case scenario is that your employer drops her from your policy now and doesn’t allow her to re-enroll this Janu- ary because of her other offer of insurance. If she loses that job, though, she could be added to your policy later.
I am planning to retire in Thai- land, in part because health- care costs in Thailand are very low compared with those in America. I have heard that everyone in the United States will be required to be covered by medical insurance. Does that include Americans living abroad? Anderson: The short answer is
that you will not be required to purchase insurance under the
health-reform law. The legisla- tion amended the Internal Rev- enue Code to state that expatri- ates shall be treated as having minimum essential coverage. As always with the IRS, there are de- tailed rules concerning who gets to claim that they are living over- seas. Medicare does not cover peo- ple living overseas, so you will need to weigh carefully the ben- efits that you will lose if you retire overseas. You might want to con- sider returning to the United States once you turn 65 in order to get the Medicare benefits. If you wait to enroll in Medicare un- til you are older than 65, penal- ties will make that coverage more expensive.
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dated every fall, some are based on information that is almost two years old. More than 40 percent of plans have no rating because they are too new or too small, according to studies by the Kaiser Family Foundation and Avalere. To fix some of the ratings’
shortcomings, CMS will pro- pose changes this summer, says Blum. “We will start off with the system we have,” he says. “But I fully expect that it will change over time.” The ratings’ flaws were underscored in April, when Medicare ordered Aetna, one of the nation’s top health insurers, to suspend enrollment in its Medicare Advantage and stand- alone Medicare prescription- drug plans. Medicare’s compli- ance officer told Aetna that a delay in the plans’ approval of the filling of prescriptions “po- tentially puts Aetna’s current and future enrollees’ heath at risk.” Yet when the decision was announced, Aetna’s most ex- pensive Medicare Advantage plan in Northern Virginia was rated at 31
⁄2 stars — between
“good” and “very good.” An Aet- na official said the rating makes sense because drug-coverage performance is only one of many criteria used to deter- mine rankings. Under the Medicare Advan-
tage program, the government pays the plans a set amount for each beneficiary — an average of 13 percent, or about $1,140 in 2009 — above what the original Medicare program spends on a similar individual. Some plans use the money to offer extra benefits such as dental care, eyeglasses and gym member- ships, often at no additional ex- pense to the beneficiary. The health-care law phases out these extra payments begin- ning in 2011. That change, which would probably force many Advantage plans to trim their extra benefits, may make the plans less attractive to many people. Medicare Advantage ratings
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“It’s so complex, it boggles the mind. Part of me says I should just keep working, and that’s the way I’m headed.”
are currently based on 33 cri- teria, including members’ satis- faction, customer service and how often members get screen- ings and tests. Plans that also offer drug coverage are graded in 19 additional areas. A sum- mary or average of the results for each plan appears on the “Medicare Options Compare” Web site (go to
www.medicare. gov and click on “health and drug plans”). Most beneficia- ries can enroll in a plan only during the last six weeks of the year, unless they move or have just become eligible for Medi- care. Under the new law, plans earning four or five stars will get a 1.5 percent bonus in Medi- care payments starting in 2012 , rising to 5 percent by 2014.
— Elaine Collins, describing her reaction to trying to find information about Medicare Advantage plans
Some of the top plans may get even bigger bonuses. Improving the rating system could help consumers such as Elaine Collins, a 69-year-old Arlington resident who works for a military contractor and is thinking of retiring and enroll- ing in a Medicare Advantage plan. When she checked the Medicare Web site recently, al- most half of the 26 plans in Northern Virginia lacked rat- ings. “It’s so complex, it boggles the mind,” she says. “Part of me says I should just keep working, and that’s the way I’m headed.” The ratings system and the
new bonuses draw complaints from both the industry and consumer advocates. Robert Zirkelbach, a spokes- man for America’s Health In- surance Plans, says that some plans may never get four or five stars even if they improve, be- cause he says much of the as- sessment is relative and “the plans are compared against each other and then graded on a curve.” Vicki Gottlich, a senior attor-
ney at the Center for Medicare Advocacy, a consumer group, says she dislikes the use of an average score because it can mask the fact that a plan might be good in one area but lousy in another. To get the complete view, seniors would need to look on the Medicare Web site for the plan’s complete score card.
But if seniors in the Washing- ton area search for a four-star plan, they’ll discover that only one insurer, Kaiser Perma- nente, now offers options with that rating. And if they want a five-star health plan, Avalere’s nationwide research shows, they’ll have to move to Florida, Maine or Texas.
health-science@washpost.com
Jaffe is a freelance writer. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente.
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