Commentary Law and Policy

“Would It Be Easier If I Lied?”

Alexandra Volgina

For the past 10 years I’ve been open about my HIV status and my drug use history. I can’t lie about these things anymore. I just don’t do that. Now, it’s quite possible that my honesty will cost me a US visa.

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

Tomorrow I go to the US consulate to find out whether I got my US visa. If I’d lied on my visa application, I wouldn’t have to worry. But I said the truth, and now I’m worried I won’t get the visa. I admitted that I used drugs in the past. For the past 10 years I’ve been open about my HIV status and my drug use history. I can’t lie about these things anymore. I just don’t do that. In 2004 I was given an MTV award for being honest about my status. Now, it’s quite possible that my honesty will cost me a US visa.

I have to get to this AIDS conference. Our patient movement for access to HIV treatment in Russia, “Patients in Control,” has won the Red Ribbon award this year and I really want to be there to accept it. I also have to be there for “EVA”–a network that advocates for the rights of women living with HIV in Russia. Our network is at the beginning stages of its development and I need to learn from other countries with similar initiatives. Perhaps, other conference participants could learn something from me as well. During the many sessions I am scheduled to participate in I want to talk about doing advocacy work in countries with limited political freedoms and supporting human rights movements under these conditions. I think that would be interesting for activists from China or other countries in which the political situation is similar. But right now all I can think about is that this conference is taking place in the US and I might not get a visa because I’ve used drugs in the past.

The previous conference was in Vienna. I opened that conference. In front of thousands of people I talked about our region, about Russia, about people who use drugs and are living with HIV, and are dying. I was really nervous, but I think I did well. That conference was unique–it had a strong emphasis on our region, Eastern Europe and Central Asia. Because there were a lot of Russian participants, we staged a protest and a press-conference and succeeded at getting the Global Fund to extend its grant. More than 10,000 Russian prisoners and migrants were able to receive their ARVs for another year. We also broke the silence on the ARV stock-out crisis in Russia—finally, people outside our country were talking about our problems! All this was possible because the Austrian consulate didn’t ask us questions about past drug use or sex work. There was a general understanding that this was an AIDS conference and that our participation mattered.

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I’m used to thinking that the US is a country that promotes tolerance. It would be sad to find out that this extends to everyone but people who have used drugs. To be fair, I have to admit that my own country isn’t very tolerant towards people who use drugs either. A considerable part of our population, including some human rights activists, believes that forcible detention, beatings, starvation, humiliation and handcuffs constitute legitimate and effective drug treatment. Those who advocate for evidence-based drug treatment methods are in the minority. Russia’s drug laws are becoming more and more severe, and yet there are almost no free drug treatment centers in the country. There are no such centers for women with children. The only thing available is detoxification, which could hardly qualify as drug treatment and is not available to pregnant women. Our doctors have nothing to offer to pregnant women who use drugs. Some progressive doctors may tell them to continue using street drugs to avoid going into withdrawal and suffering a miscarriage. But more often the advice is to either get an abortion or to quit using drugs.

Not only does my country not have drug treatment, we also have regular interruptions of HIV treatment and diagnostics. According to our latest study on HIV treatment access and ARV pricing policy in Russia, the amount of HIV medications procured by the government in 2012 will not be sufficient to cover all those in need of treatment (200,000 people according to the official sources.) There are currently about 100,000 Russians with HIV and a CD4 count of less than 350 who are not receiving treatment. And yet, according to the same sources, only 5,000 new patients will be able to start treatment in 2012. When our clinics run out of treatment, they tell their patients to buy their medications. Needless to say, that’s difficult or impossible for most patients, and particularly problematic for people who use drugs. What’s worse is that more often than not, people who use drugs are discouraged from seeking HIV treatment in the first place. As one of the doctors at an HIV clinic put it: “Thank God, we’ve managed to set up our treatment programs in such a way that drug users don’t come here anymore.” At the same time there are only a handful of low-threshold drop-in centers operating in Russia where people who use drugs can start treatment, receive counseling on adherence issues and other support they need.

What we have in Russia as a result of state policy denying access to harm reduction measures and opioid substitution treatment is an epidemic that continues to grow, particularly among people who use drugs. Then again, my country has never declared itself to be tolerant or democratic–there are no conversations about equality and no promises being made here. It’s tragic, but at least they’re honest.

The US is a different story. Tolerance and equal opportunity mean something here. In the past, there used to be another question on the visa application–about people’s HIV status. Now that the question is gone, the ban on holding International AIDS Conferences in the US could be lifted, and many people living with HIV are finally able to come to the US. But people who use drugs, sex workers and former prisoners are still treated unfairly. It would be great if our rights could matter, too.

P.S. Today I received my visa. This means that I can attend the conference and do all the things I was hoping to do. The staff at the consulate asked me why I was going to the conference, when was the last time I used drugs and whether I had any prior convictions. I told them the truth.

I know I am lucky, because many of my friends and colleagues simply aren’t able to go. But I can’t help but wonder: wouldn’t it be better not to be in a situation where you have to ask yourself, even for just one second: “Would it be easier if I lied?”

Commentary Contraception

Hillary Clinton Played a Critical Role in Making Emergency Contraception More Accessible

Susan Wood

Today, women are able to access emergency contraception, a safe, second-chance option for preventing unintended pregnancy in a timely manner without a prescription. Clinton helped make this happen, and I can tell the story from having watched it unfold.

In the midst of election-year talk and debates about political controversies, we often forget examples of candidates’ past leadership. But we must not overlook the ways in which Hillary Clinton demonstrated her commitment to women’s health before she became the Democratic presidential nominee. In early 2008, I wrote the following article for Rewirewhich has been lightly edited—from my perspective as a former official at the U.S. Food and Drug Administration (FDA) about the critical role that Clinton, then a senator, had played in making the emergency contraception method Plan B available over the counter. She demanded that reproductive health benefits and the best available science drive decisions at the FDA, not politics. She challenged the Bush administration and pushed the Democratic-controlled Senate to protect the FDA’s decision making from political interference in order to help women get access to EC.

Since that time, Plan B and other emergency contraception pills have become fully over the counter with no age or ID requirements. Despite all the controversy, women at risk of unintended pregnancy finally can get timely access to another method of contraception if they need it—such as in cases of condom failure or sexual assault. By 2010, according to National Center for Health Statistics data, 11 percent of all sexually experienced women ages 15 to 44 had ever used EC, compared with only 4 percent in 2002. Indeed, nearly one-quarter of all women ages 20 to 24 had used emergency contraception by 2010.

As I stated in 2008, “All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.”

Now, there are new emergency contraceptive pills (Ella) available by prescription, women have access to insurance coverage of contraception without cost-sharing, and there is progress in making some regular contraceptive pills available over the counter, without prescription. Yet extreme calls for defunding Planned Parenthood, the costs and lack of coverage of over-the-counter EC, and refusals by some pharmacies to stock emergency contraception clearly demonstrate that politicization of science and limits to our access to contraception remain a serious problem.

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Today, women are able to access emergency contraception, a safe, second chance option for preventing unintended pregnancy in a timely manner without a prescription. Sen. Hillary Clinton (D-NY) helped make this happen, and I can tell the story from having watched it unfold.

Although stories about reproductive health and politicization of science have made headlines recently, stories of how these problems are solved are less often told. On August 31, 2005 I resigned my position as assistant commissioner for women’s health at the Food and Drug Administration (FDA) because the agency was not allowed to make its decisions based on the science or in the best interests of the public’s health. While my resignation was widely covered by the media, it would have been a hollow gesture were there not leaders in Congress who stepped in and demanded more accountability from the FDA.

I have been working to improve health care for women and families in the United States for nearly 20 years. In 2000, I became the director of women’s health for the FDA. I was rather quietly doing my job when the debate began in 2003 over whether or not emergency contraception should be provided over the counter (OTC). As a scientist, I knew the facts showed that this medication, which can be used after a rape or other emergency situations, prevents an unwanted pregnancy. It does not cause an abortion, but can help prevent the need for one. But it only works if used within 72 hours, and sooner is even better. Since it is completely safe, and many women find it impossible to get a doctor’s appointment within two to three days, making emergency contraception available to women without a prescription was simply the right thing to do. As an FDA employee, I knew it should have been a routine approval within the agency.

Plan B emergency contraception is just like birth control pills—it is not the “abortion pill,” RU-486, and most people in the United States don’t think access to safe and effective contraception is controversial. Sadly, in Congress and in the White House, there are many people who do oppose birth control. And although this may surprise you, this false “controversy” not only has affected emergency contraception, but also caused the recent dramatic increase in the cost of birth control pills on college campuses, and limited family planning services across the country.  The reality is that having more options for contraception helps each of us make our own decisions in planning our families and preventing unwanted pregnancies. This is something we can all agree on.

Meanwhile, inside the walls of the FDA in 2003 and 2004, the Bush administration continued to throw roadblocks at efforts to approve emergency contraception over the counter. When this struggle became public, I was struck by the leadership that Hillary Clinton displayed. She used the tools of a U.S. senator and fought ardently to preserve the FDA’s independent scientific decision-making authority. Many other senators and congressmen agreed, but she was the one who took the lead, saying she simply wanted the FDA to be able to make decisions based on its public health mission and on the medical evidence.

When it became clear that FDA scientists would continue to be overruled for non-scientific reasons, I resigned in protest in late 2005. I was interviewed by news media for months and traveled around the country hoping that many would stand up and demand that FDA do its job properly. But, although it can help, all the media in the world can’t make Congress or a president do the right thing.

Sen. Clinton made the difference. The FDA suddenly announced it would approve emergency contraception for use without a prescription for women ages 18 and older—one day before FDA officials were to face a determined Sen. Clinton and her colleague Sen. Murray (D-WA) at a Senate hearing in 2006. No one was more surprised than I was. All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.

Sometimes these success stories get lost in the “horse-race stories” about political campaigns and the exposes of taxpayer-funded bridges to nowhere, and who said what to whom. This story of emergency contraception at the FDA is just one story of many. Sen. Clinton saw a problem that affected people’s lives. She then stood up to the challenge and worked to solve it.

The challenges we face in health care, our economy, global climate change, and issues of war and peace, need to be tackled with experience, skills and the commitment to using the best available science and evidence to make the best possible policy.  This will benefit us all.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

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