Analysis Sexual Health

Preventing Sexually Transmitted Infections: The Money Crisis

William Smith

If the family planning infrastructure of our nation is obliterated by the current strains of extremism, we’ll see not only more unintended pregnancies and abortions, but also a big rise in STDs.

April is STD Awareness month.  This article is one in a series  published by Rewire in partnership with the National Coalition of STD Directors, focused on aspects of STD prevention, treatment and funding and the public health implications of neglecting STDs.

Each April, National STD Awareness Month is observed in the United States. Led by our friends at the Centers for Disease Control and Prevention (CDC) in collaboration with many other partners, including my own organization, the National Coalition of STD Directors (NCSD), it is a time to try and inject discussions about sexually transmitted diseases (STDs) and sexual health in the nation’s discourse.

Throughout the month, NCSD and its members and partners will be contributing pieces to raise awareness of a number of important issues.

I wanted to take this opportunity to highlight what I think is the biggest obstacle to preventing the 19 million-plus STDs that occur in this country each year: MONEY. Or more aptly described, the threat that what money is being invested to prevent STDs will evaporate into thin air.

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The current battles over sexual health issues in Washington are no doubt well known to most readers. Unprecedented attempts to eliminate the Title X family planning program and prohibit any federal resources from going to Planned Parenthood health care providers are indicative of just how divisive the current state of play is. Make no mistake, if the family planning infrastructure of our nation is obliterated by extremists, we’ll see not only more unintended pregnancies and abortions, but also a big rise in STDs.

But beyond Washington, public funding for sexual health services as a core component of public health, such as screening and treatment for STDs, are under enormous threat.

NCSD represents the state Sexually Transmitted Disease programs in every state and our members know all too well that state budget crises are taking a tremendous toll. Services have been cut, staff are furloughed, critical positions to protect the public’s health remain unfilled due to across the board hiring freezes, and yes, clinics have been shuttered.

I was reminded of the severity of these crises this week as the state of New Hampshire attempts to pass its own budget. The Governor of New Hampshire is a Democrat, John Lynch, and he is in his fourth term. Back in February, Gov. Lynch presented his budget for the next two fiscal years (New Hampshire passes two years of appropriations at a time as opposed to just a single year). According to a recent analysis by the Center on Budget and Policy Priorities, 44 states and the District of Columbia are projecting Fiscal Year 2012 shortfalls totaling some $112 billion. New Hampshire is among this group and the Governor’s proposed budget made tough choices and cut about 3.3 percent in state spending from 2010-2011 levels.

But while Lynch was re-elected in 2010, many of his fellow Democrats succumbed to the national wave of Republican victories and the Republicans retook firm control of both the New Hampshire House and Senate. Many of these Republicans, like their GOP compatriots in Washington, are seeking deeper cuts in government spending that have the salutary effect of circumscribing the size and role of government itself.

And so it was last week that the House passed a budget that in Governor Lynch’s words, “goes far beyond what is necessary to live within our means, risking our state’s economic strategy and the health and safety of our citizens.”

You don’t need to delve too deeply into the House-passed budget to see why Governor Lynch used such strong words. On sexual health issues, for example, the picture is awful. The budget slashes state general funds for family planning by over $750,000 over the next two years and piles on anti-choice language that hamstrings providers. And the $344,000 per year in state general funds for STD prevention? Gone.

These STD funds in New Hampshire allow the state to support a network of 20 clinics that provide a wide array of integrated STD and HIV services, including counseling, testing, and treatment (and I should note that there are no state revenues that support the HIV-specific services). Further, this network of providers is arranged such that no person needs to travel more than 1 hour to reach a clinic, including those that live in the state’s rural “north country.”

The folly of dismantling this system was done with much evidence in hand, not the least of which, are concrete numbers showing an increase in STDs in the state. From 2009 to 2010, members of the House were informed that there were: 36 additional cases of gonorrhea for a 2010 total of 146 cases; 7 additional cases of syphilis for a 2010 total of 44; and reported cases of both Chlamydia and HIV were up markedly. The latter two instances may likely be the result of increased testing, but that deliberate scale up of testing underscores that infections are being found and treated and now is not the time to bail on the entire enterprise. In the “Live Free or Die State,” eyes now turn to the state Senate with a likely verdict coming from them sometime in May.

While the situation in New Hampshire is not unique, it is the most recent and profound example of politicians using the current budget crisis to abandon support for sexual health services within public health.

If this was happening, say, in 2017 and if health-care reform achieved its full promise, I might be singing a different tune. But this is 2011, and the road to 2014 and the implementation of health-care reform is long, full of pot holes, and speckled by eager and ideological bulldozers and backhoes ready to plow the whole thing under. And, even if we find great success in ensuring a broad range of covered services for the majority of our citizens, whether they access those services is another question entirely. Add the sensitivity of sexual health-care needs to that scenario, and it becomes clear that state-funded programs such as that in New Hampshire will remain essential in many places across the country.

Every state needs to ensure the sustainability of its safety net providers for sexual health services. This is not an ideological or a partisan position, nor is it free; but it is basic public health.

News Human Rights

What’s Driving Women’s Skyrocketing Incarceration Rates?

Michelle D. Anderson

Eighty-two percent of the women in jails nationwide find themselves there for nonviolent offenses, including property, drug, and public order offenses.

Local court and law enforcement systems in small counties throughout the United States are increasingly using jails to warehouse underserved Black and Latina women.

The Vera Institute of Justice, a national policy and research organization, and the John D. and Catherine T. MacArthur Foundation’s Safety and Justice Challenge initiative, released a study last week showing that the number of women in jails based in communities with 250,000 residents or fewer in 2014 had grown 31-fold since 1970, when most county jails lacked a single woman resident.

By comparison, the number of women in jails nationwide had jumped 14-fold since 1970. Historically, jails were designed to hold people not yet convicted of a crime or people serving terms of one year or less, but they are increasingly housing poor women who can’t afford bail.

Eighty-two percent of the women in jails nationwide find themselves there for nonviolent offenses, including property, drug, and public order offenses.

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Overlooked: Women and Jails in an Era of Reform,” calls attention to jail incarceration rates for women in small counties, where rates increased from 79 per 100,000 women to 140 per 100,000 women, compared to large counties, where rates dropped from 76 to 71 per 100,000 women.

The near 50-page report further highlights that families of color, who are already disproportionately affected by economic injustice, poor access to health care, and lack of access to affordable housing, were most negatively affected by the epidemic.

An overwhelming percentage of women in jail, the study showed, were more likely to be survivors of violence and trauma, and have alarming rates of mental illness and substance use problems.

“Overlooked” concluded that jails should be used a last resort to manage women deemed dangerous to others or considered a flight risk.

Elizabeth Swavola, a co-author of “Overlooked” and a senior program associate at the Vera Institute, told Rewire that smaller regions tend to lack resources to address underlying societal factors that often lead women into the jail system.

County officials often draft budgets mainly dedicated to running local jails and law enforcement and can’t or don’t allocate funds for behavioral, employment, and educational programs that could strengthen underserved women and their families.

“Smaller counties become dependent on the jail to deal with the issues,” Swavola said, adding that current trends among women deserves far more inquiry than it has received.

Fred Patrick, director of the Center on Sentencing and Corrections at the Vera Institute, said in “Overlooked” that the study underscored the need for more data that could contribute to “evidence-based analysis and policymaking.”

“Overlooked” relies on several studies and reports, including a previous Vera Institute study on jail misuse, FBI statistics, and Rewire’s investigation on incarcerated women, which examined addiction, parental rights, and reproductive issues.

“Overlooked” authors highlight the “unique” challenges and disadvantages women face in jails.

Women-specific issues include strained access to menstrual hygiene products, abortion care, and contraceptive care, postpartum separation, and shackling, which can harm the pregnant person and fetus by applying “dangerous levels of pressure, and restriction of circulation and fetal movement.”

And while women are more likely to fare better in pre-trail proceedings and receive low bail amounts, the study authors said they are more likely to leave the jail system in worse condition because they are more economically disadvantaged.

The report noted that 60 percent of women housed in jails lacked full-time employment prior to their arrest compared to 40 percent of men. Nearly half of all single Black and Latina women have zero or negative net wealth, “Overlooked” authors said.

This means that costs associated with their arrest and release—such as nonrefundable fees charged by bail bond companies and electronic monitoring fees incurred by women released on pretrial supervision—coupled with cash bail, can devastate women and their families, trapping them in jail or even leading them back to correctional institutions following their release.

For example, the authors noted that 36 percent of women detained in a pretrial unit in Massachusetts in 2012 were there because they could not afford bail amounts of less than $500.

The “Overlooked” report highlighted that women in jails are more likely to be mothers, usually leading single-parent households and ultimately facing serious threats to their parental rights.

“That stress affects the entire family and community,” Swavola said.

Citing a Corrections Today study focused on Cook County, Illinois, the authors said incarcerated women with children in foster care were less likely to be reunited with their children than non-incarcerated women with children in foster care.

The sexual abuse and mental health issues faced by women in jails often contribute to further trauma, the authors noted, because women are subjected to body searches and supervision from male prison employees.

“Their experience hurts their prospects of recovering from that,” Swavola said.

And the way survivors might respond to perceived sexual threats—by fighting or attempting to escape—can lead to punishment, especially when jail leaders cannot detect or properly respond to trauma, Swavola and her peers said.

The authors recommend jurisdictions develop gender-responsive policies and other solutions that can help keep women out of jails.

In New York City, police take people arrested for certain non-felony offenses to a precinct, where they receive a desk appearance ticket, or DAT, along with instructions “to appear in court at a later date rather than remaining in custody.”

Andrea James, founder of Families for Justice As Healing and a leader within the National Council For Incarcerated and Formerly Incarcerated Women and Girls, said in an interview with Rewire that solutions must go beyond allowing women to escape police custody and return home to communities that are often fragmented, unhealthy, and dangerous.

Underserved women, James said, need access to healing, transformative environments. She cited as an example the Brookview House, which helps women overcome addiction, untreated trauma, and homelessness.

James, who has advocated against the criminalization of drug use and prostitution, as well as the injustices faced by those in poverty, said the problem of jail misuse could benefit from the insight of real experts on the issue: women and girls who have been incarcerated.

These women and youth, she said, could help researchers better understand the “experiences that brought them to the bunk.”

News Abortion

Study: Telemedicine Abortion Care a Boon for Rural Patients

Nicole Knight

Despite the benefits of abortion care via telemedicine, 18 states have effectively banned the practice by requiring a doctor to be physically present.

Patients are seen sooner and closer to home in clinics where medication abortion is offered through a videoconferencing system, according to a new survey of Alaskan providers.

The results, which will be published in the Journal of Telemedicine and Telecare, suggest that the secure and private technology, known as telemedicine, gives patients—including those in rural areas with limited access—greater choices in abortion care.

The qualitative survey builds on research that found administering medication abortion via telemedicine was as safe and effective as when a doctor administers the abortion-inducing medicine in person, study researchers said.

“This study reinforces that medication abortion provided via telemedicine is an important option for women, particularly in rural areas,” said Dr. Daniel Grossman, one of the authors of the study and professor of obstetrics, gynecology, and reproductive sciences at the University of California San Francisco (UCSF). “In Iowa, its introduction was associated with a reduction in second-trimester abortion.”

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Maine and Minnesota also provide medication abortion via telemedicine. Clinics in four states—New York, Hawaii, Oregon, and Washington—are running pilot studies, as the Guardian reported. Despite the benefits of abortion care via telemedicine, 18 states have effectively banned the practice by requiring a doctor to be physically present.

The researchers noted that even “greater gains could be made by providing [medication abortion] directly to women in their homes,” which U.S. product labeling doesn’t allow.

In late 2013, researchers with Ibis Reproductive Health and Advancing New Standards in Reproductive Health interviewed providers, such as doctors, nurses, and counselors, in clinics run by Planned Parenthood of the Great Northwest and the Hawaiian Islands that were using telemedicine to provide medication abortion. Providers reported telemedicine’s greatest benefit was to pregnant people. Clinics could schedule more appointments and at better hours for patients, allowing more to be seen earlier in pregnancy.

Nearly twenty-one percent of patients nationwide end their pregnancies with medication abortion, a safe and effective two-pill regime, according to the most recent figures from the U.S. Centers for Disease Control and Prevention.

Alaska began offering the abortion-inducing drugs through telemedicine in 2011. Patients arrive at a clinic, where they go through a health screening, have an ultrasound, and undergo informed consent procedures. A doctor then remotely reviews the patients records and answers questions via a videoconferencing link, before instructing the patient on how to take the medication.

Before 2011, patients wanting abortion care had to fly to Anchorage or Seattle, or wait for a doctor who flew into Fairbanks twice a month, according to the study’s authors.

Beyond a shortage of doctors, patients in Alaska must contend with vast geography and extreme weather, as one physician told researchers:

“It’s negative seven outside right now. So in a setting like that, [telemedicine is] just absolutely the best possible thing that you could do for a patient. … Access to providers is just so limited. And … just because you’re in a state like that doesn’t mean that women aren’t still as much needing access to these services.”

“Our results were in line with other research that has shown that this service can be easily integrated into other health care offered at a clinic, can help women access the services they want and need closer to home, and allows providers to offer high-level care to women from a distance,” Kate Grindlay, lead author on the study and associate at Ibis Reproductive Health, said in a statement.


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