Commentary Sexual Health

What Is the Role of Disease Intervention Specialists in Preventing STDs?

Stacy Shiver

When our clients are vulnerable and coping with the range of emotions that accompany news of their infection, DIS offer confidence, understanding, trust, and assurance. They are the humanity of STD awareness.

Published in partnership with the National Coalition of STD Directors (NCSD).

See all of our coverage of STD Awareness Month 2013 here.

Each year, STD Awareness Month is used to increase awareness and understanding of sexually transmitted diseases (STDs), in an attempt to influence behaviors that contribute to the number of reported cases of STDs in the United States. While we use April to communicate the social, economic, and emotional costs of STDs to individuals and communities, we cannot escape the fact that true change begins with decisions made at the individual level. To get desired change at the population level, we must influence positive changes at the individual level.

There is no role more associated with individual clients, their sexual partners, or others at risk of infection than that of the disease intervention specialist (DIS). DIS personnel conduct voluntary interviews with patients to obtain the names and contact information of their sexual partner(s) and then use that information to contact a patient’s sexual partner(s) and inform them of their potential exposure to an STD or HIV. This work breaks the chain of disease transmission and protects the community’s health.

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What then, is the role of the DIS as it relates to STD Awareness Month? The answer to this question is both deeply profound and rooted in the most fundamental aspect of being human.

In Florida, we have working DIS who started their careers during the Kennedy administration as well as new DIS who have never known a world without smartphones. The bridge and bond between these generations is the foundation that makes the DIS unique in public health.

What they share are the unique qualities that build essential trust between strangers, which enable them to educate, mentor, and improve individual behaviors. They share a common desire to help their fellow citizens, to become trusted parts of the communities they love, and a hope that they affect lives in a positive way. Seeking to influence positive choices and reduce the risk of any future infection, they perform their art at the most fundamental human level. When our clients are vulnerable and coping with the range of emotions that accompany news of their infection, DIS offer confidence, understanding, trust, and assurance. They are the humanity of STD awareness.

Over the course of a single day, they will interact with residents of gated communities and communities with gated windows; educate and inform the most highly educated individuals and people without formal education; gain the confidence of those who drive up in luxury cars and those whose belongings are in a grocery cart; and seek to locate and treat not just those on the street, but those who remain unseen by most of society. While we discuss the social determinants of health in publications and at conferences, our DIS stand face to face with the ultimate realities of these factors and their effects on individual health.

The role of DIS in STD Awareness Month is to be the instrument of change at the individual level, to be the role model at the community level, and to touch lives in ways that bring opportunities for a better future.

Analysis Human Rights

ICE Releases Reports for 18 Migrants Who Died in Detention, Medical Neglect Is Suspected

Tina Vasquez

Though the death reviews released by ICE provide further insight into the conditions inside detention centers, the bigger concern among researchers and advocates is what they don't know.

A new report from Human Rights Watch (HRW) documents the deaths of 18 migrants in Immigration and Customs Enforcement custody from mid-2012 to mid-2015. In some cases, the deaths were likely preventable and the result of “substandard medical care and violations of applicable detention standards.”

These are not the only deaths that occurred, however. ICE acknowledges on its website that 31 deaths have occurred between May 2012 and mid-June of this year. It is unclear whether ICE intends to release information about the additional 13 deaths that have occurred.

Even so, these new findings add to a growing body of evidence showing what HRW calls “egregious violations” of medical care standards in detention centers. A February report found such violations contributed to at least eight in-custody deaths over a two-year period.

The public is just beginning to learn more about the deeply rooted problem, Clara Long, a researcher with Human Rights Watch and the lead researcher on the report, explained to Rewire. Long referenced an ongoing investigation by reporter Seth Freed Wessler at the Nation, which explores the numerous deaths that have occurred inside immigrant-only prisons.

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Though the death reviews released by ICE provide further insight into the conditions inside detention centers, the bigger concern among researchers and advocates is what they don’t know. For example, HRW worked with two independent medical experts to review the 18 death reviews released by ICE. The experts concluded that substandard medical care “probably contributed to the deaths of seven of the 18 detainees, while potentially putting many other detainees in danger as well.” Long told Rewire that the information provided by ICE simply wasn’t enough for their independent medical experts to determine that all 18 deaths were related to inadequate medical care, but that it was “likely.”

So there is the larger, systemic issue of inadequate medical care. Researchers at HRW also don’t know exactly how ICE collects information or why the agency releases information when it does. There’s also the core of the issue, as Long noted to Rewire: that the United States “unnecessarily” detains undocumented immigrants in “disturbing conditions” for prolonged periods of time.

Major Failures Lead to Death

The new HRW report identified two of the most dangerous ways ICE is failing migrants in detention: not following up on symptoms that require assistance and not responding quickly to emergencies. Both failures are illustrated by the case of 34-year-old Manuel Cota-Domingo, who died of heart disease, untreated diabetes, and pneumonia after being detained at the Eloy Detention Center in Eloy, Arizona.

ICE’s death review for Cota-Domingo suggests there was a language barrier and that Cota-Domingo was worried about having to pay for health care, which isn’t surprising given that detention centers make migrants pay for things like phone calls to their attorneys and family members. HRW asked Corrections Corporation of America, the company that runs the Eloy Detention Center, about potential fees for medical care, and it said there are no fees for such services at Eloy. For whatever reason, Cota-Domingo was not aware he had a legal right to access the medical care he needed.

When it became clear to his cellmate that Cota-Domingo was in serious need of medical attention and was having trouble breathing, the cellmate “banged on a wall to get a guard’s attention. His cellmate said he did that for three hours before anyone came to help,” Long said. The researcher told Rewire the death report outlines how investigators checked to see if the banging would have been audible to correctional officers.  It was. “Once [the cellmate] got their attention, our medical experts said this was something that should have been followed up on immediately, but the nurse decided to wait several hours before doing anything. All of these sluggish responses went on for eight hours. This is not how you treat an emergency,” Long said.

As Human Rights Watch noted in the report, “When officers finally notified medical providers of his condition, they delayed evaluating him and finally sent him to the hospital in a van instead of an ambulance. Both medical experts concluded that the combination of these delays likely contributed to a potentially treatable condition becoming fatal.”

In other death reviews by ICE, the agency’s own records show “evidence of the misuse of isolation for people with mental disabilities, inadequate mental health evaluation and treatment, and broader medical care failures.” Tiombe Kimana Carlos, Clemente Mponda, and Jose de Jesus Deniz-Sahagun all committed suicide in ICE detention after showing signs of “serious mental health conditions.” HRW’s independent experts determined that “inadequate mental health care or the misuse of isolation may have significantly exacerbated their mental health problems.”

It’s important to note that none of the death reviews released by ICE admit any wrongdoing, and that’s primarily because they don’t seek to examine whether medical negligence was at play. The reports simply present information about the deaths.

“There is no conclusion drawn, really,” Long told Rewire. “There’s one [report] in particular that even goes beyond that; it doesn’t even take into account the quality of care that led to the death, even though it’s clearly an issue of quality of care. That raises the question: What is the report for? ICE doesn’t conclude the cause. If you read [the death reviews], you can see there’s a lot of detailed information included in them that allows someone with expertise in correctional health care and who is familiar with how these systems should work, to make an assessment about whether care contributed to death, but that’s not something ICE doesat least not in the information we are able to access.”

ICE’s Murky Death-Review Process 

In a statement to Rewire, ICE explained that when a person dies while in the agency’s custody, their “death triggers an immediate internal inquiry into the circumstances.” The summary document ICE releases to the public is “the result of exhaustive case reviews conducted by ICE’s own Office of Detention Oversight (ODO), which was established in 2009 as part of the agency’s comprehensive detention reforms,” Lori K. Haley, a spokesperson with ICE, told Rewire in a prepared statement.

In fact, the ODO was created as a direct result of a series of reforms from the Obama administration after reports of human rights abuses and deaths in detention centers. The death review it produces includes a mix of findings from ICE’s own investigators and from a Beaumont, Texas-based company called Creative Corrections.

According to its website, Creative Corrections serves “local, state and federal government agencies,” offering “training, advising, professional management and consulting services” in “correctional, law enforcement, rule of law, and judicial systems.” The company contracts include the Department of Homeland Security (DHS).

“From what we can see from the documents, both ICE and Creative Corrections interview various people involved, check records, do what seems to be a pretty robust investigation for the death review,” Long said. “Unfortunately, in the set of death reviews that we used for this investigation, [the public doesn’t] have access to the Creative Corrections reports or any of the exhibits that go along with them.”

As the ICE spokesperson noted, the summary documents are typically written by ICE staff. The documents released to the public do not include medical records, full reports from Creative Corrections, or any exhibits that would provide more insight into the apparent medical neglect resulting in an estimated 161 people dying in ICE custody since October 2003. Six migrants have died in ICE custody since March 2016, two of whom died at two different detention centers in the same week. The causes of these most recent deathsand whether they can be attributed to medical neglect—is still unknown.

“If we had access to all of the information gathered during these investigations, including the reports from Creative Corrections, they would be very rich sources of information,” Long said.

Long and other researchers are also hoping for more information regarding the deaths that happen just after migrants are released from ICE custody. Teka Gulema, an Ethiopian asylum seeker detained at Etowah County Detention Center in Gadsden, Alabama, was released from ICE custody in November 2015 while in the hospital after becoming paralyzed from a bacterial infection acquired in detention. He died in January.

“One concern we have, and it’s a very big fear, is that there are multiple reports of folks who are released from ICE custody while in critical condition,” Long said. “When they die, they are no longer counted as in-custody deaths [by ICE]. We’re worried that’s a loophole being exploitedand for obvious reasons, we don’t have a number in terms of how often this is happening.”

The researcher said she has “no idea” when or why ICE decides to release information, including death reviews.

ICE did not respond to Rewire‘s request for information about its schedule or process for releasing such information.

“Maybe they released the 18 reports because they were cleared for release. Maybe a congressional office asked for them. Maybe they decided to be transparent. It could have been a [Freedom of Information Act] request from the ACLU. I wish I knew, but we really have no idea who decides—or why they decide—to release information, especially without making anyone aware that it’s been released,” the researcher told Rewire.

In April, ICE posted a series of spreadsheets about the inner workings of the detention system on their website that Long said provided a lot of information about how detention operates. The spreadsheets were removed from the site in a matter of days, too soon for many researchers—including HRW—to download them all.

“It’s a big system. We still don’t totally know how it works, which in itself is a major problem,” Long said. “One of the biggest lessons we’ve learned is to always check the ICE website. You never know what you’ll find.”

Rethinking Detention

DHS secretary Jeh Johnson is engaging in what some advocates are calling an “enforcement overdrive,” by funneling more undocumented immigrants into an already overcrowded detention system thanks to the detention bed quota established in 2009. This quota requires 34,000 undocumented migrants be locked up each day. It is in place to ensure more people get deported, though it’s costing taxpayers $2 billion a year while also creating “a profitable market for both private prison corporations and local governments,” the National Immigration Forum has said.

Reporting for the Nation, Michelle Chen recently noted that “migrants are warehoused under convoluted partnerships involving private vendors and state, local, and federal agencies. Homeland Security may contract out security duties to, or use facilities owned by, private vendors—dominated by Corrections Corporation of America (CCA) and GEO Group—with preordained headcount distributions ranging from 285 in Newark to more than 2,000 in San Antonio.”

Long told Rewire that 80 percent of migrants currently in detention are in what is considered “mandatory detention,” which, according to the Immigrant Legal Resource Center, means that “non-citizens with certain criminal convictions must be detained by ICE. People who are subject to mandatory detention are not entitled to a bond hearing and must remain in detention while removal proceedings are pending against them.” This also means that those in mandatory detention aren’t allowed to have an individual assessment by ICE of their case, “so they just sit in immigration detention indefinitely,” Long said.

“This system doesn’t work. We’re detaining far too many people for far too long and not determining on an individual level if they should be detained in the first place, taking into account all of the options available,” Long said. Options include being monitored by ICE using telephonic and in-person reporting, curfews, and home visits.

Long joins a long list of undocumented community members, researchers, organizers, activists, and other advocates pushing for the Obama administration—and whoever comes after it—to see detention as a last resort, rather than the only resort.

“We spend a lot of time talking about the disturbing conditions in detention centersthat’s what our report is about. But step one requires taking a step back and rethinking this system and how it’s unnecessary and also abuses vulnerable peoples’ rights,” Long said. “In terms of the legality of treating people this way, under U.S. and international law, people who are detained are entitled to medical treatment. The state has an obligation to provide care to this population. They are failing, and people are dying.”

Commentary Human Rights

Love, Respect, Accountability: What We Need in This Time of Tragedy and Crisis

Jodi Jacobson

Speaking up, speaking out, changing systems... This is not disrespect or lack of love and support. It is the essence of the struggle for the rights of all people. It is democracy.

In a time of great strife, in which those who seek to divide us have a very large platform, I remember that these things are all true:

You can oppose an illegitimate or unnecessary war, and still individually and collectively honor and love the troops that serve.

You can honor and love the troops that serve, but protest the ways in which war is waged and abhor the behavior of individual soldiers who abuse human rights and dehumanize the civilians in a population. You can honor and love and support the troops that serve but still work to change the systems, and hold politicians and individuals responsible for crimes they perpetrate.

You can honor and love any and all public servants—as I do deeply—but still abhor systemic problems in civil services that lead to racist behaviors and outcomes (or those based on class, immigrant status, gender, ability, or any other basis for discrimination).

You can honor, love, and respect police, but abhor the militarization of our police forces; racial and ethnic profiling; abuses of fines, fees, and arrests that both target and most adversely affect the poorest individuals; and the growing dependency of the budgets for police forces based on fines drawn from those who can least afford it. You can honor, love, and respect the police, but still understand why there is a great level of distrust of policing in some communities. You can honor, love, and respect the police, but still recognize real abuses of power by individuals or groups among them, and seek to hold those responsible accountable for their actions.

You can honor and love police for putting their lives on the line for public safety, but recognize the very deeply legitimate concerns of movements—like Black Lives Matter, immigrants’ rights groups, women’s rights groups, LGBTQ rights groups, and others for whom policing often is not about public safety, but is itself a source of fear—because law enforcement is and has been too often used against these groups in ways that are disrespectful, demeaning, and sometimes deadly.

You can honor, respect, and love the police, but support the work of Black Lives Matter, immigrants’ rights groups, women’s rights groups, and LGBTQ rights groups, and defend them against blame for the behavior of someone acting in their name who is not actually acting in their name at all.

You can honor and respect the work of prosecutors, judges, and other law enforcement officials, but recognize when the systems in which they are working are not working for the people or to promote justice, or when individuals within those systems operate more on bias than on integrity.

You can protest and advocate for change in any and all of these systems without dishonoring the individuals within them. Indeed, by protesting and seeking to make them better, you make the world better for those within and outside of law enforcement and, hopefully, promote a more universal justice.

You can and we all must honor and treasure the freedoms of speech and of assembly, and abhor violence, while also recognizing that sometimes it is perpetrated by people, like veterans, whose own needs for health care, love, and honor have not been met by the country that sent them to war, or by people who feel so alienated that they—wrongly but nonetheless—resort to violence.

You can be confused by or even irritated by something you don’t understand, but it is on you, not others, to try to understand it. As Proverbs 4:7 says, “The beginning of wisdom is this: Get wisdom. Though it cost all you have, get understanding.” Read, discuss, challenge yourself. Try to open yourself up to what may seem like radical ideas. Make yourself vulnerable to learning. If you don’t understand the movement for Black lives, women’s rights, LGBTQ rights, immigrant rights, then listen to the very people fighting for their rights in order to better understand them. You may have started from a very different place than they do; you may stand in a very different place today. The issues may seem alien at first. But just because you don’t have cancer does not mean cancer does not exist. Try hard to understand why there is distance, what you don’t understand, and what you can—what we all must—do to narrow that distance in understanding each other.

We can love, honor, and respect each other and still recognize and raise awareness of our collective weaknesses. Indeed, that is the essence of progress and of democracy. Don’t fight it. Try to help it along.

People are human and therefore flawed. The systems we create also are therefore often flawed. We need mutual love and respect, along with vigorous debate and sometimes protest, to right the wrongs that are the inevitable result of our flawed selves and our flawed systems.

Love, honor, respect, and accountability: We need them all. Accountability, along with freedom, is the essence of a functioning democracy and part of the struggle for justice. The right to speak, the right to protest, the right to agitate for changes in systems that are flawed because we are all flawed in some way. The right to make things better.

Speaking up, speaking out, changing systems… This is not disrespect or lack of love and support. It is the essence of the struggle for the rights of all people. It is democracy. Some will tell you that in speaking out you are being disrespectful, but the opposite is true. You are respecting the many who have fought and given their lives—and who continue to be placed in harm’s way—on behalf of all of us so that we may all exercise our basic freedoms.

Let’s embrace the struggle. We can love, honor, respect police and other public servants, politicians, soldiers, and ourselves, and still work to hold them and ourselves accountable. These things are all true. I can hold these true simultaneously.

Can we all hold these things true simultaneously? I hope so, because I fear our failure to do so will only result in more violence and hatred.