Tagged Insuring Your Health

If You’ve Got Hep C, Spitting Can Be A Felony

Last week, an Ohio man who has the hepatitis C virus was sentenced to 18 months in prison for spitting at Cleveland police and medics.

Matthew Wenzler, 27, was reportedly lying on a Cleveland street across from a downtown casino in January. When police and emergency medical technicians tried to put him on a stretcher to take him to a hospital, he spit saliva mixed with blood repeatedly at them, hitting an officer in the eye.

In Ohio, it’s a felony for people who know they have HIV, viral hepatitis or tuberculosis to intentionally expose another person to their blood, semen, urine, feces or other bodily substances such as saliva with the intent to harass or threaten the person.

Advocates for people living with diseases like hepatitis C and HIV say these laws add to the stigma that patients already face and studies suggest the laws are not effective at stopping the spread of disease.

“This person is now facing a year and a half of incarceration for something that didn’t harm anyone and didn’t pose a risk of harm to anyone,” said Kate Boulton, a staff attorney at the Center for HIV Law and Policy.

Roughly two-thirds of states, according to the Center for HIV Law and Policy, have laws that make it a crime to knowingly expose others to HIV, the virus that causes AIDS. Many of these laws were passed in the 1980s and 1990s when fear and stigma about HIV were high and contracting the disease was considered a death sentence.

In recent years, about a dozen states have added hepatitis C to the list of medical conditions for which people can face criminal prosecution if they knowingly expose others by engaging in certain activities like sex without disclosure, needle-sharing or organ donation.

Public health officials say these provisions, which are sometimes tacked on to existing HIV laws, are likely to be ineffective at stemming transmission of the disease. They may even exacerbate the problem.

“If you have to let people know that you are infected with HIV or hepatitis C before you have sex with them, why would anyone in their right mind get themselves tested and begin treatment?” said Dr. Anne Spaulding, an epidemiologist and associate professor at Emory University’s public health school. She has worked as a medical director in correction systems and published research on hepatitis C among prisoners.

Yet, among some lawmakers there is still interest in criminalizing actions they view as spreading the disease. The increasing awareness of the opioid epidemic, which is linked to the spread of hepatitis C through the use of dirty needles, may play a role, some experts say.

“We’re seeing this massive surge in opioid addiction,” said Boulton. “Whereas hepatitis maybe wasn’t on the radar in the past, now it is.”

An estimated 3.5 million people have hepatitis C, a viral infection that causes inflammation of the liver that can lead to scarring, liver cancer and death. It is typically passed from person to person through blood. Today that happens often through sharing needles to inject drugs, and, more rarely, through sex. But many older cases were caused by blood transfusions before testing for the virus existed.

The virus isn’t transmitted through urine, feces, semen or saliva, Spaulding said, noting that although there have been some cases of the disease being spread through blood hitting the eye, it is very rare and requires a great deal of blood.

In 2016, the most recent figures available, nearly 3,000 cases were reported to the federal Centers for Disease Control and Prevention, a 22 percent increase from the previous year. But many cases go unreported, in part because people don’t realize they carry the virus. The CDC estimates that the full number of new cases in 2016 was 41,200.

“Hepatitis C is still a very dangerous disease to contract,” said South Dakota Republican State Sen. Stace Nelson, who sponsored a bill this year that would have made it a felony for people who have been diagnosed with hepatitis C to expose someone else to the disease. “These circumstances where someone knows that they have it and intentionally or negligently infects someone else … it’s a threat to society.”

Advocates have been working to reform state laws that make it a crime to expose people to HIV. In the process, they are increasingly working to head off efforts to criminalize hepatitis C, including supporting local advocates to help stop a bill in Michigan in recent years, said Sean Strub, who in 1994 founded POZ magazine, which is dedicated to issues about HIV. He is also executive director of the Sero Project, an education and advocacy group that, among other things, is working to end criminal penalties for exposing others to HIV.

“Now we have this very robust and active movement combatting HIV criminalization,” Strub said. “But we’re really combatting a whole range of conditions.”

Sometimes, however, HIV reform has had negative consequences for people living with hepatitis C.

Take for example Iowa, which passed a law in 1998 that said people who were found guilty of knowingly exposing others to HIV faced up to 25 years in prison and had to register as sex offenders, even if they used a condom and didn’t infect anyone. The burden of proof was on the accused to show that they had disclosed their HIV status to their partner.

Advocates successfully pushed to replace that with a law reducing the penalties and eliminating the sex offender registration requirement. But one of their goals also was to reduce stigma by no longer singling out HIV.

So they added hepatitis, meningococcal disease and tuberculosis to the medical conditions that people could be prosecuted for if they exposed others to it.

People who worked for the replacement law say they realized from the start that it wasn’t an ideal solution.

But outright repeal wasn’t an option politically, said Tami Haught, a community organizer in Iowa who works as the training and organizing coordinator for the Sero Project.

“It was a tough decision that had to be made,” said Haught, who is HIV positive. She noted that in some states without disease-specific exposure laws, prosecutors have found a way to charge people under other general criminal laws in any case.

On balance, she said she believes it was the right way to go.

The ‘Perfect Storm’: Redirecting Family Planning Funds Could Undercut STD Fight

A Trump administration effort to shift family planning funding toward groups that may not provide comprehensive services and away from organizations that provide abortions could cripple other federal efforts to curb an explosion in sexually transmitted diseases (STDs), some public health officials fear.

“This is the perfect storm, and it comes at absolutely the worst time,” said Daniel Daltry, program chief of the HIV/AIDS, STD and Viral Hepatitis Program at the Vermont Department of Health.

In 2016, there were more than 2 million cases of chlamydia, gonorrhea and syphilis reported to the federal Centers for Disease Control and Prevention. It was the highest number of reported cases ever.

Now the Department of Health and Human Services has proposed changes to the rules for the federal family planning services program, known as Title X. Daltry and other public health officials fear the changes will make testing and treatment for STDs harder to get.

The new rules, if adopted in their current form, would require that Title X services be physically and financially separate from abortion services.

Many family planning clinics are committed to offering comprehensive services, including contraception and abortion referrals, said David C. Harvey, executive director of the National Coalition of STD Directors, a membership group of public health department STD directors and community organizations. “These principles are near and dear to them, and if the changes are enacted we fear many programs would decide not to take Title X funding.”

With less funds, they’d have fewer resources available for STD screening, treatment and outreach.

Title X funds have never been permitted to be used for abortions. But President Donald Trump and other Republicans have vowed to cut off all federal funding for Planned Parenthood and other organizations that provide abortions.

It’s too soon to know what will happen. The proposed rule was published June 1 and is available for public comment until the end of July.

Title X provides grants that fund family planning, STD screening and breast and cervical cancer screening at nearly 4,000 sites nationwide.

The program primarily serves low-income, young women, although a growing number of men receive services at Title X funded clinics as well.

The clinics are recognized primarily for providing contraceptive services, but the STD screening and treatment services they provide also are critical. Young people ages 15 through 24 accounted for half of all new STD cases in 2016 (the most recent figures available), according to the CDC. One in 4 four adolescent girls who were sexually active had a sexually transmitted disease.

People who are infected typically don’t have symptoms. The diseases are generally easy to cure with antibiotics but without treatment can cause serious health problems, such as pelvic inflammatory disease, and may lead to infertility.

Even if young people have coverage through their parents’ insurance, many avoid using it, concerned that the health plan may notify their parents that they’ve been tested or treated for a sexually transmitted disease. Instead, they may visit a clinic receiving Title X funding where they can receive confidential services that they pay for on a sliding scale based on their income.

Daltry and other public health experts are concerned that proposed changes to the Title X family planning program rules may result in the closing of some Planned Parenthood and other family planning clinics that also provide abortion services.

The number of STD clinics funded by local or state governments has dwindled over the past decade, and many states rely on other providers for testing and treatment, Harvey said.

With 12 sites in Vermont, “Planned Parenthood has operated as our STD clinic,” said Daltry. No one should live more than a 45-minute drive from a site. And while there are other providers throughout the state, “the same continuum of care might not be offered at all sites.”

However, advocates of the Trump administration’s plan point out that some new clinics may also now get Title X funding. Earlier this year, the administration made a point of encouraging providers that emphasize natural family planning methods, sometimes called fertility awareness, to apply for money.

The Catholic Medical Association, which on its website emphasizes the need for any national health care legislation to provide “respect for human life” and to not fund “or mandate abortion as a ‘health care benefit,’” applied for Title X funding this year. The organization also notes the importance of “conscience rights for health professionals.”

Some Catholic medical practices – like the one where she works — choose not to prescribe birth control pills or other Food and Drug Administration-approved methods of contraception, said Dr. Anne Nolte, a family physician at St. Peter’s Gianna Center, a gynecology and infertility practice in New York City. But “patients are welcome to come to us for STD screening and treatment,” she said.

The proposed regulation doesn’t focus on sexually transmitted disease testing and treatment, but it appears in one provision that some advocates find concerning.

The rule would require that teenagers who come to a Title X clinic with an STD or who are pregnant be screened to ensure they aren’t victims of sexual abuse.

“The idea that every single young person under the age of 18 who is there because they either have [a sexually transmitted infection] or because they need a pregnancy test has to be screened is troubling,” said Kinsey Hasstedt, a senior policy manager at the Guttmacher Institute, a reproductive health research and advocacy organization. “They’re there for health care support, and instead they get another level of screening.”

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