Commentary Sexual Health

AIDS 2012: Criminalized Groups Need Not Apply

Jonathan Cohen

Drug users and sex workers represent the majority of people living with HIV in many countries, and are among the most at-risk of infection everywhere. The irony of allowing people living with HIV to the conference while refusing those likeliest to be—or become—infected has not been lost on everyone.

Cross-posted in partnership from the HIV Human Rights blog and part of Rewire’s coverage of the International AIDS Conference, 2012.

When the International AIDS Society announced that the 19th International AIDS Conference would be held in Washington, DC, some advocates saw an instant opportunity: tens of thousands of scientists, activists, government officials, and journalists descending on Washington four months before a presidential election, all pressing President Obama and the U.S. administration to keep their promise on AIDS. The shift that made it possible to host the AIDS conference in the US for the first time in 22 years—U.S. repeal of an archaic law denying admission to people living with HIV—lent a spirit of optimism to the event, particularly after Secretary of State Hillary Rodham Clinton announced an “AIDS-Free Generation” as a U.S. policy priority.

Others felt their hearts sink when Washington was chosen for the conference. These were the millions of people who, by virtue of having a history of drug use or prostitution, remain inadmissible to the U.S. under current law. In order to apply for a U.S. nonimmigrant visa or a visa waiver, all persons must answer the following two questions, even if the sole purpose of their visit is to attend a conference:

  1. Are you or have you ever been a drug abuser or drug addict?
  2. Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been engaged in prostitution or procuring prostitutes within the past 10 years?

Answering “yes” to either of these questions renders an applicant ineligible for a U.S. visa, though the consulate may grant a waiver and let people in at its discretion.

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Drug users and sex workers represent the majority of people living with HIV in many countries, and are among the most at-risk of infection everywhere. The irony of allowing people living with HIV to the conference while refusing those likeliest to be—or become—infected has not been lost on everyone. Towards the end of the 2010 International AIDS Conference in Vienna, Indian activist Meena Seshu called for a boycott of AIDS 2012, making the self-evident point that it was unethical 31 years into the AIDS epidemic to discuss matters of AIDS policy in the absence of those most affected. But the response was muted.

Drug users and sex workers working to end AIDS find themselves in an untenable position. Aside from the usual barriers to conference attendance—expensive flights, prohibitive registration fees, limited scholarships—they now have to choose between lying on their visa application form (which is of course against the law) or risk getting rejected for a visa (and potentially having this recorded for any future attempt to visit the U.S. or countries with whom the U.S. may share immigration information). Many have understandably chosen to boycott the conference: starting in Kiev on July 9, drug users and people living with HIV from Eastern Europe will host their own conference to discuss issues of HIV policy that matter to them. Sex workers and their allies will follow with a side meeting in Kolkata the week of AIDS 2012. The International AIDS Society considers Kiev and Kolkata to be “hubs” of the main event, but they are as much a protest against the main meeting as a satellite of it.

The Obama Administration could have prevented this. They could have issued a blanket waiver of inadmissibility for meeting delegates, as they did for people living with HIV when that ban remained in effect during the 2008 UN High-Level Meeting on HIV/AIDS in New York. They could have issued a public statement promising to streamline individual waiver requests, including setting timelines and allowing automatic review of negative recommendations. They could have reassured participants that they would look favorably upon applicants seeking a waiver for the sole purpose of attending a conference. All they did, according to a letter issued on March 30 but not released by the International AIDS Society until June 21, was place the conference on a list of events provided to U.S. missions and notify those missions of the importance of the conference.

The conference, which has ironically chosen the theme “Turning the Tide Together,” will begin on July 22. In the days leading up to it, drug users, sex workers and their allies from around the world will not be silent. In Kiev, Kolkata, and via Twitter, Facebook, and the website www.hivhumanrightsnow.org, they will share their messages with conference delegates about what is needed to end AIDS. Hopefully the conference delegates in Washington—who have been denied their right to hear from these communities in person—will listen closely.

Analysis Law and Policy

State-Level Attacks on Sexual and Reproductive Health and Rights Continue, But There’s Also Some Good News

Rachel Benson Gold & Elizabeth Nash

Despite the ongoing attention to restricting abortion, legislators in several states are looking to expand access to sexual and reproductive health services and education.

State legislatures came into session in January and quickly focused on a range of sexual and reproductive health and rights issues. By the end of the first quarter, legislators in 45 states had introduced 1,021 provisions. Of the 411 abortion restrictions that have been introduced so far this year, 17 have passed at least one chamber, and 21 have been enacted in five states (Florida, Indiana, Kentucky, South Dakota, and Utah).

This year’s legislative sessions are playing out on a crowded stage. The U.S. Supreme Court is considering a case involving a package of abortion restrictions in Texas; that decision, when handed down in June, could reshape the legal landscape for abortion at the state level. Moreover, just as state legislatures were hitting their stride in late March, the U.S. Food and Drug Administration revised the labeling for mifepristone, one of the two drugs used for medication abortion. That decision immediately put the issue back on the front burner by effectively counteracting policies restricting access to medication abortion in a handful of states. (Notably, the Arizona legislature moved within days to enact a measure limiting the impact of the FDA decision in the state.)

Progress on Several Fronts 

Despite the ongoing attention to restricting abortion, legislators in several states are looking to expand access to sexual and reproductive health services and education. By the end of the first quarter, legislators in 32 states had introduced 214 proactive measures; of these, 16 passed at least one legislative body, and two have been enacted. (This is nearly the same amount introduced in the year 2015, when 233 provisions were introduced.)

Although the proactive measures introduced this year span a wide range of sexual and reproductive health and rights issues, three approaches have received particular legislative attention:

  • Allowing a 12-month contraceptive supply. Legislators in 16 states have introduced measures to allow pharmacists to dispense a year’s supply of contraceptives at one time; these bills would also require health plans to reimburse for a year’s supply provided at once. (In addition, a bill pending in Maryland would cover a six-month supply.) Legislative chambers in three states (Hawaii, New York, and Washington) have approved measures. Similar measures are in effect in Oregon and the District of Columbia.
  • Easing contraceptive access through pharmacies. Legislators in 12 states have introduced measures to allow pharmacists to prescribe and dispense hormonal contraceptives. As of March 31, bills have been approved by at least one legislative chamber in Hawaii and Iowa and enacted in Washington. The measures in Hawaii and Iowa would require pharmacist training, patient counseling, and coverage by insurance; the Hawaii measure would apply only to adults, while the Iowa measure would apply to both minors and adults. The new Washington law directs the state’s Pharmacy Quality Assurance Commission to develop a notice that will be displayed at a pharmacy that prescribes and dispenses self-administered hormonal contraception. Under current state law, a pharmacy may prescribe and dispense these contraceptives under a collaborative practice agreement with an authorized prescriber. Oregon has a similar measure in effect. (California, the only other state with such a law, issued regulations in early April.)
  • Expanding education on sexual coercion. Measures are pending in 17 states to incorporate education on dating violence or sexual assault into the sex or health education provided in the state. A bill has been approved by one legislative chamber in both New Hampshire and New York. The measure approved by the New Hampshire Senate would require age-appropriate education on child sexual abuse and healthy relationships for students from kindergarten through grade 12. The measure approved by the New York Senate would mandate education on child sexual abuse for students from kindergarten through grade 8. And finally, in March, Virginia enacted a comprehensive new law requiring medically accurate and age-appropriate education on dating violence, sexual assault, healthy relationships, and the importance of consensual sexual activity for students from kindergarten through grade 12. Virginia will join 21 other states that require instruction on healthy relationships.

Ongoing Assault on Access to Sexual and Reproductive Health Services

Even as many legislators are working to expand access to services, others are continuing their now years-long assault on sexual and reproductive health services and rights. Restricting access to abortion continues to garner significant attention. However, last year’s release of a series of deceptively edited sting videos targeting Planned Parenthood has swept both the family planning safety net and biomedical research involving fetal tissue into the fray.

  • Abortion bans. Legislative attempts to ban abortion fall along a broad continuum, from measures that seek to ban all or most abortions to those aimed at abortions performed after the first trimester of pregnancy or those performed for specific reasons.
    • Banning all or most abortions. Legislators in nine states have introduced measures to ban all or most abortions in the state, generally by either granting legal “personhood” to a fetus at the moment of conception or prohibiting abortions at or after six weeks of pregnancy. Only one of these measures, a bill in Oklahoma that would put performing an abortion outside the bounds of professional conduct by a physician, has been approved by a legislative chamber.
    • Banning D&E abortions. Legislators in 13 states have introduced measures to ban the most common technique used in second-trimester abortions. Of these, a bill in West Virginia was enacted in March over the veto of Gov. Earl Ray Tomblin (D). A similar measure was approved by both houses of the Mississippi legislature and is being considered by a conference committee. (Kansas and Oklahoma enacted similar laws last year, but enforcement of both has been blocked by court action.)
    • Banning abortion at 20 weeks post-fertilization. South Dakota and Utah both enacted measures seeking to block abortions at 20 weeks during the first quarter of the year. The new South Dakota law explicitly bans abortions at 20 weeks post-fertilization (which is equivalent to 22 weeks after the woman’s last menstrual period). The Utah measure requires the use of anesthesia for the fetus when an abortion is performed at or after that point, something that providers would be extremely unlikely to do because of the increased risk to the woman’s health. In addition to these new measures, 12 other states ban abortion at 20 weeks post-fertilization.
  • Banning abortion for specific reasons. In March, Indiana enacted a sweeping measure banning abortions performed because of gender, race, national origin, ancestry, or fetal anomaly; no other state has adopted such a broad measure. The Oklahoma House approved a measure to ban abortion in the case of a fetal genetic anomaly; the state already bans abortion for purposes of sex selection. Currently, seven states ban abortion for the purpose of gender selection, including one state that also bans abortion based on race selection and one that also bans abortion due to fetal genetic anomaly.
  • Family planning funding restrictions. In the wake of the Planned Parenthood videos, several states have sought to limit funding to family planning health centers that provide or refer for abortion or that are affiliated with abortion providers. These efforts are taking different forms across states.
    • Medicaid. Measures to exclude abortion providers (e.g., Planned Parenthood affiliates) from participating in Medicaid have been introduced in five states, despite the clear position of the federal Centers for Medicare and Medicaid Services that such exclusions are not permitted under federal law. In March, Florida Gov. Rick Scott (R) signed a Medicaid restriction into law. By the end of the first quarter, measures had passed one chamber of the legislature in Arizona, Mississippi, and Missouri; a measure introduced in Washington has not been considered. (A related measure enacted in Wisconsin in February limits reimbursement for contraceptive drugs for Medicaid recipients.)

Similar attempts by six other states have been blocked by court action since 2010. These measures include laws adopted by Indiana and Arizona as well as administrative actions taken in Alabama, Arkansas, Louisiana, and Texas.

  • Other family planning funds. Legislators in 13 states have introduced measures to prevent state or federal funds that flow through state agencies from being distributed to organizations that provide, counsel, or refer for abortions; the measures would also deny funds to any organization affiliated with an entity engaging in these activities. Measures in three of these states have received significant legislative attention. In February, Wisconsin enacted a measure directing the state to apply for Title X funds (the state is not currently a grantee under the program); if the state’s application were approved, the measure would ban this funding from going to organizations that engage in abortion care-related activity. A measure that would deny funds to organizations engaged in abortion care-related activity passed the Kentucky Senate in February. A similar measure in Virginia, which would both prohibit an abortion provider from receiving funding and give priority to public entities (such as health centers operated by health departments) in the allocation of state family planning funds was vetoed by Gov. Terry McAuliffe (D) in March.
  • Related funds. In February, Ohio Gov. John Kasich (R) signed a measure barring abortion providers or their affiliates from receiving federal funds passing through the state treasury to support breast and cervical cancer screening; sex education; and efforts to prevent infertility, HIV in minority communities, violence against women, and infant mortality.
  • Fetal tissue research. The Planned Parenthood videos have also led to legislation in 28 states aimed at research involving fetal tissue. Measures have passed one legislative chamber in four states (Alabama, Iowa, Idaho, and Kentucky), and new laws have been enacted in four states (Arizona, Florida, Indiana, and South Dakota) in the first quarter alone. All four laws ban the donation of fetal tissue for purposes of research. These new laws are the first to ever ban the donation of fetal tissue. The Arizona law also bans research using fetal tissue, and the new South Dakota law strengthens the state’s existing ban by now considering fetal tissue research as a felony; four other states (Indiana, North Dakota, Ohio and Oklahoma) have similar provisions in effect.

Zohra Ansari-Thomas, Olivia Cappello, and Lizamarie Mohammed all contributed to this analysis.

Commentary Politics

Punish Women for Abortion? Spare the Outrage: That IS the ‘Mainstream’ Anti-Choice Position

Jodi Jacobson

No matter how much the anti-choice movement dissembles, there is only one reality: The laws and policies pushed by the movement and the politicians it supports punish women both explicitly and implicitly.

In 2014, Jennifer Whalen, a nursing home aide, was sentenced to between 12 and 18 months in jail. Her crime? Trying to obtain medication abortion pills for her teenage daughter, who was facing an unwanted pregnancy. Whalen, who was charged with “performing an illegal abortion,” bought the pills online because the nearest clinic from her home was 75 miles away, and because Pennsylvania has a 24-hour mandated waiting period requiring patients to make two visits to a clinic to obtain an abortion. Without health insurance, and facing loss of income from time off, the costs—of two round-trips to the clinic, a possible overnight stay in Harrisburg, and the procedure itself—became insurmountable. Out of desperation, Whalen turned to the Internet.

Whalen was arrested for a simple reason: Her daughter was pregnant and did not want to be.

Earlier this week, GOP presidential candidate Donald Trump asserted that women who have abortions should face “some form of punishment.” He since “walked it back,” political parlance for being too honest or saying the wrong thing at the wrong time. In response to his initial statement, however, the GOP and leaders of anti-choice groups collectively fell all over themselves criticizing Trump for what they declared to be a position outside the “mainstream” of their movement. Their outcry was political theater at its most insidious: Anti-choice leaders know that their real intentions—to ban abortion and punish women who have them—is a deeply unpopular opinion. So they feign concern for women by talking about “safety,” and “caring,” and “life.” No matter how much they dissemble, however, there is only one reality: The laws and policies pushed by the anti-choice movement and the politicians it supports already punish women both explicitly and implicitly, including by sending them to prison.

The anti-choice movement seeks to punish women through a web of entrapment that, spun just a little bit at a time, harms women in ways that are less noticeable to the rest of us because they don’t make headlines until women start ending up in jail.

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First, anti-choice legislators pass laws to mandate medically unnecessary waiting periods, driving up the costs of abortion care and insulting the intelligence of women who don’t need to be told to wait to figure out how to deal with their own realities. Then, they pass laws to require clinics to mimic ambulatory surgical centers, though abortion is among the safest procedures a person can obtain and there is no reason not to do them in a clinic. This forces many clinics to close because providers can’t recoup the costs of medically unnecessary building renovations, and in turn it leaves women in large swaths of a state without access to care. Then, having cut off many avenues to legal safe abortion care, lawmakers pass laws to make medication abortion inaccessible, again on medically unnecessary grounds. They also pass laws mandating that only doctors can perform abortions, even though nurses and nurse practitioners are perfectly capable of being trained to perform early abortions safely and effectively, as well as to administer medication abortion. Finally, they pass laws making self-induced abortion a crime. Put these together and the anti-choice movement has made a safe, legal abortion virtually impossible to obtain. So when, in desperation, women go to any length to end an unintended pregnancy, legislators punish them further by making them criminals and putting them into jail.

It should not be surprising then that in many states, including Georgia, Louisiana, Mississippi, Texas, and Utah, where a raft of laws similar to those mentioned above have been passed, women are taking matters into their own hands and paying the price of anti-choice laws. For example, a recent study estimated that in Texas, where abortion access has been severely limited as a result of the omnibus legislation known as HB 2, between 100,000 and 240,000 women have attempted to self-induce. Many of these women, already vulnerable because they are poor or undocumented or are made subject to racial profiling, are policed every day at medical centers and at border crossings where they go to seek medication to terminate a pregnancy. Medication that, by the way, taken correctly is completely safe and could be used for self-induction were it legal.

Women who attempt to self-induce abortion are now routinely charged with crimes. In Georgia, Kenlissia Jones was arrested in 2015 for allegedly using misoprostol to self-induce her abortion. Jones was originally facing two charges: “malice murder” and “possession of a dangerous drug” (i.e. the misoprostol). The murder charge against Jones was dropped, but she still faces punishment for the drug charge. That same year in Arkansas a nurse, Karen Collins, was arrested and faced the charge of “performing an unlicensed abortion” (a class D felony in her state) for allegedly providing a drug to a woman that would allow her to terminate her pregnancy. And in Tennessee, Anna Yocca was charged with attempted murder for a failed self-induced abortion attempt with a coat hanger. Prosecutors later dropped the attempted murder charge but said they would still pursue criminal charges against Yocca, likely for aggravated assault.

These cases are the product of anti-choice laws promoted relentlessly by Americans United for Life, the Susan B. Anthony List, the National Right to Life Committee, the Family Research Council, and others. The fact that the use of these laws to harass, frighten, indict, and imprison women is never protested by anti-choice groups tells you everything you need to know about the movement’s intentions. Punishment.

Moreover, those who seek to outlaw abortion are forever finding new and creative ways to punish women. Feticide laws, for example, were ostensibly created to allow for the prosecution of third-party actors who were violent toward pregnant women and, in turn, harmed a fetus. According to the National Conference of State Legislatures, 38 states now have feticide or “fetal homicide” laws on the books, and in 23 of these states, these laws can be applied at any stage of pregnancy. While these laws were not originally created with the intent of criminalizing pregnant women for actions they took during their own pregnancy, they are now widely used to do just that. “Pro-life” prosecutors are arresting and indicting women under such laws when they deem that either an action or lack of action by a pregnant woman causes harm to a fetus or leads to pregnancy loss. In fact, these are de facto fetal “personhood” laws of the kind promoted by anti-choice organizations such as Susan B. Anthony List.

There is Bei Bei Shuai, who was charged with murder and attempted feticide for attempting suicide while pregnant. Shuai sat in jail for 435 days until she was released on bail (where she remained under surveillance by an electronic ankle monitor). In August 2013, nearly two and a half years after her prosecution began, she accepted a plea deal to the misdemeanor charge of “criminal recklessness.”

There is Purvi Patel, who was charged with neglect of a dependent and feticide after having a pregnancy loss that the state deemed was a self-induced abortion. She is currently serving a 41-year sentence while her case is on appeal. In three states—Wisconsin, Minnesota, and South Dakota—laws on the books allow for the involuntary civil commitment of pregnant women for “not following doctors’ orders.” Recent cases in which these laws were applied include those of Alicia Beltran and Tamara Loertscher in Wisconsin. As ProPublica has noted in “How States Handle Drug Use During Pregnancy,” hundreds and potentially thousands of women in three states—Alabama, South Carolina, and Tennessee—have faced criminal prosecution under “chemical endangerment laws” that allow for the criminal prosecution of drug use during pregnancy. The anti-choice movement has pushed for and supported these laws.

This is not punishment?

And then consider AJ, a woman on whose case we reported earlier this week. AJ’s teenage daughter became pregnant. Her teacher somehow insinuated herself into the daughter’s decision-making process. Unbenownst to her mother, the teacher called another person, a stranger to this teen, who took her to a so-called crisis pregnancy center, at which the young woman was pressured under threat of “hell and damnation” to sign a document stating she did not want an abortion. These anti-choicers sent the document, containing a raft of personal information including address and social security number, to clinics and police stations in the surrounding area. When AJ’s daughter later decided, after confiding in her mother, that she did in fact want to terminate the pregnancy, they went to a clinic in Memphis, Tennessee. There, AJ found herself threatened with arrest for feticide for “coercing” her daughter to have an abortion. While there was no substance to this charge, the whole episode frightened a teen and her mom and further delayed her abortion. There are several layers of “punishment” here, including frightening a young woman with lies, tricking her into signing a bogus legal document, seeking to get her to delay the abortion until it was too late, and then threatening to arrest her mother.

There are innumerable other ways in which the anti-choice movement is actively punishing women, by, for example, supporting monitoring and harassment of women outside clinics and hospitals, making immigrant women fear arrest, and denying women access to abortion for severe fetal and developmental anomalies while slashing state funding of support for children who are severely disabled.

I could go on. The fact that these laws and policies are passed and employed throughout the country, that they  infantalize, criminalize, and otherwise treat women as children without agency is part of an overall agenda aimed at punishing women and is becoming deeply entrenched in the U.S. legal system as a direct result of the advocacy of anti-choice groups.

The anti-choice movement is built on lies. And those lies continue to be perpetuated both by its leaders, and by a media unable, unwilling, or too self-absorbed and preoccuppied with access to politicians to actually understand and report on what is happening throughout the country.

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