Analysis Health Systems

At Long Last, D.C. Legalizes Care for Partners of Patients With Some STIs

Jonathan Neeley

Expedited partner therapy is now legal in Washington, D.C., thanks to the passage of Bill 20-343. It's a progressive step for a medical practice whose day is long overdue.

When patients in California are diagnosed with chlamydia or gonorrhea, doctors can send them home with medication not only for themselves, but also for their partners. It’s a practice called expedited partner therapy, and it’s legal in 35 states as well as the city of Baltimore.

And now, thanks to Bill 20-343, the Expedited Partner Therapy Act of 2013, you can add Washington, D.C., to that list. Introduced by D.C. city council members David Grosso, Anita Bonds, and Tommy Wells and co-sponsored by six others, the bill passed its final reading last Tuesday. It is now awaiting Mayor Vincent Gray’s expected signature and the completion of a 30-day Congressional review process. The city council expects the bill to become law in April or May.

“It’s an important issue,” said Grosso, a former board member at Planned Parenthood Metro Washington. “We have to get control over our STD issues in the District.”

The reality of those issues, according to the D.C. Committee on Health’s report on the bill, is dire. From 2010 to 2011, chlamydia and gonorrhea diagnoses rose 18 and 22 percent, respectively. Seventy-one percent of chlamydia cases and 62 percent of gonorrhea cases occur in people between ages 15 and 24. Executive witness Michael Kharfen, an interim senior deputy director for the D.C. Department of Health’s HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA), noted two points in his testimony: that prescribing medication without first examining patients is acceptable in cases of emergencies and epidemics, and that the rate of sexually transmitted infections (STIs) in D.C. is reason to approve the use of expedited partner therapy (EPT).

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The Centers for Disease Control and Prevention’s (CDC) 2013 “Threat Report” lists chlamydia and gonorrhea as the two most common bacterial infections in the United States. Both can cause complications with pregnancy, increase the chance of infertility, and make those who are infected more susceptible to HIV infection. Yet their treatment often requires only a single dose of medication or, at most, a week-long cycle. “These diseases are very easy to cure,” said Stephanie Arnold Pang, director of policy and communications at the National Coalition of STD Directors (NCSD). “The drugs come with very low side effects. This is just another tool in the toolbox.”

It would be optimal if everyone with chlamydia or gonorrhea saw a health-care provider first-hand (this is referred to as an index patient) and received treatment from that visit (called a provider-assisted referral). But the reality is that this isn’t always possible. The CDC started recommending the use of EPT in 2005 because many individuals, particularly those from low-income communities, which are most affected by chlamydia and gonorrhea, face limited resources that keep them out of doctors’ offices; jobs with inflexible hours, lack of access to transportation, and insufficient or no insurance are common barriers to doctor visits. While EPT is not the best way to treat chlamydia and gonorrhea, the alternative—those who cannot or will not go to a health-care provider remaining untreated—is far worse.

EPT is also beneficial for index patients because treating infected partners is crucial to preventing reinfection. Put more plainly, if two people have sex and one has an STI, treating only one of the two partners makes for a job half-finished. The D.C. bill painted a clear picture of the reinfection problem, noting thatthe 12-month reinfection rate of chlamydia among adolescents and young women [in D.C.] is as high as 26%, often due to untreated male sexual partners.” In addition, “nearly one in five [D.C.] teens diagnosed with chlamydia or gonorrhea had a prior diagnosis within 12 months and nearly one third had a prior diagnosis in the preceding two years.”

“The evidence is utterly clear that [EPT] is effective in preventing reinfection,” NCSD Executive Director Bill Smith told Rewire. “If we have a patient come in, and they test positive for chlamydia and go home and have sex with the same partner, they’re going to get reinfected. We can drive those infection rates down significantly by providing EPT.”

In 2001, California became the first state to authorize EPT. An NCSD fact sheet notes that nearly half of California’s doctors and nurse practitioners report using EPT. It also shows that the state has an 80 percent partner treatment rate with EPT—“the same partner treatment rate for those who agreed to bring their partners with them to the clinic”—and that EPT can reduce the estimated $850 million that is spent annually to fight chlamydia and gonorrhea by curbing infection rates and, in turn, reliance on public services to treat STIs.

“EPT is highly effective,” said Heidi Bauer, chief of the California Department of Public Health’s Center for Infectious Diseases STD Control Branch. “Several research studies, including randomized clinical trials, have demonstrated that [it] is safe and as effective as other partner management strategies in facilitating partner notification and reducing recurrent infection among index cases. We have had no calls regarding adverse reactions.”

Despite EPT’s success, its ease of use among the states where it is legal varies. In Georgia, for example, prescriptions that are faxed or emailed have to include a patient’s name and address—a requirement that can be difficult to meet for patients with no direct contact with doctors. And in Massachusetts, dispensing prescription medications requires “the physical act of delivery of a drug to an ultimate user.” In some states, doctors send patients home with doses of medication for their partners, while in others they send prescriptions. (This also varies based on whether the provider is a public health center or a private practice.)

Of the remaining 15 states, the CDC lists nine where EPT is “potentially allowable,” which often means that there is conflicting regulation information. On one hand, prescriptions might not require a name, which would allow a doctor to practice EPT. But on the other hand, they may be limited to one per patient, which would prevent it. The D.C. report cites testimony from doctors who “candidly explained they have bypassed the District’s lack of EPT laws by writing prescriptions to patients that contained two doses and prepared to justify it as a preventative measure ‘just in case the patient got sick and vomited’ while taking the first dose.” But without explicit permission—the CDC’s benchmark for listing a state as having permissible EPT—doctors who use EPT are at risk.

“Physicians’ hands are tied without this legislation,” said Annette Mercatante, a board-certified family practice physician and the medical director at Michigan’s St. Claire County Health Department. “A lot of physicians opt to do EPT rather than treat the same patient four or five times in a row. I think most physicians do the right thing, but it’d be nice to have the legal health code back us up on it.”

Kentucky, Michigan, and West Virginia, three of the six states where EPT is outright prohibited, are on the verge of making progress: In Kentucky and Michigan, EPT bills have passed in the house and are awaiting votes in the senate, and in West Virginia a bill is in the House Judiciary Committee. Each faces the slow but steady process of illuminating the EPT issue and clarifying misinformation.

“I realized [what EPT was] because I started going to conferences where the NCSD spoke about it,” said Rep. Mary Lou Marzian (D-Louisville), the sponsor of Kentucky’s EPT bill. “It was something I had been unaware of, and I’ve been here 20 years.” Marzian went on to acknowledge the political struggle characteristic of any issue relating to sex or prescription drugs—let alone both at once. “Sometimes legislators are so backward,” she said, “that anything that has to do with sex they sort of giggle like it’s kindergarten.”

In Michigan, Sen. Jim Marleau (R-Lake Orion), chair of the senate’s Health Policy Committee, has not brought the EPT bill to a vote because the health department in his home county—Oakland, an influential Detroit suburb—has raised concerns that treating gonorrhea with EPT could lead to the bacteria becoming drug-resistant. But in its 2013 “Threat Report,” the CDC stated that the best way to stave off such a scenario is to keep gonorrhea infection rates low; EPT, the report said, is a key means of doing so.

Mercatante is optimistic that Michigan’s bill will pass. “Most health departments are solidly in favor of this because they realize the benefit of treatment outweighs the risk of gonorrhea resistance,” she said. “Our job is to treat diseases, so whatever we could do to improve treatment compliance, we’d be supportive of a policy like that.”

Before the D.C. bill passed, Yvette Alexander, a council member and chair of the health committee, was wary that once the District started using EPT, authorities would be unable to track the number of positive STI diagnoses in D.C. According to health committee Director Rayna Smith, Alexander’s concerns were quelled with an addition requiring providers to report prescriptions for both index patients and partners to the D.C. Department of Health.

Its recent passage is not all that puts D.C.’s bill in the EPT legislative forefront. Bill 20-343 allows EPT for not only chlamydia and gonorrhea, but also trichomoniasis, an STI with a rising infection rate and dangerous symptoms that is, like chlamydia and gonorrhea, easily cured. While the CDC has not yet approved EPT for treating trichomoniasis, states like Vermont and Wisconsin have added similar provisions that allow it.

D.C.’s legalization of EPT is a progressive step for a medical practice whose day is long overdue. The bill received overwhelming support and no opposition throughout its vetting process, and once Alexander’s concerns were addressed it passed through council vote easily. With wheels turning in West Virginia, and EPT being potentially allowable in Maryland and Virginia, D.C.’s new law could be a step in the right direction for not only the District but also the region.

“It was more than time for the District to take this important step,” said Christina Henderson, Grosso’s deputy chief of staff, “and join these other states in what has been proven to be a good thing for the public health of residents.”

Commentary Politics

On Immigration, Major Political Parties Can’t Seem to Agree on What’s ‘Un-American’

Tina Vasquez

As far as immigration is concerned, neither the Democrats nor Republicans are without their faults, though positions taken at the conventions were clearly more extreme in one case than the other.

Read more of our coverage of the Democratic National Convention here.

Immigration has been one of the country’s most contentious political topics and, not surprisingly, is now a primary focus of this election. But no matter how you feel about the subject, this is a nation of immigrants in search of “el sueño Americano,” as Karla Ortiz reminded us on the first night of the Democratic National Convention (DNC). Ortiz, the 11-year-old daughter of two undocumented parents, appeared in a Hillary Clinton campaign ad earlier this year expressing fear that her parents would be deported. Standing next to her mother on the DNC stage, the young girl told the crowd that she is an American who wants to become a lawyer to help families like hers.

It was a powerful way to kick-start the week, suggesting to viewers Democrats were taking a radically different approach to immigration than the Republican National Convention (RNC). While the RNC made undocumented immigrants the scapegoats for a variety of social ills, from U.S. unemployment to terrorism, the DNC chose to highlight the contributions of immigrants: the U.S. citizen daughter of undocumented parents, the undocumented college graduate, the children of immigrants who went into politics. Yet, even the stories shared at the DNC were too tidy and palatable, focusing on “acceptable” immigrant narratives. There were no mixed-status families discussing their deported parents, for example.

As far as immigration is concerned, neither the Democrats nor Republicans are without their faults, though positions taken at the conventions were clearly more extreme in one case than the other. By the end of two weeks, viewers may not have known whether to blame immigrants for taking their jobs or to befriend their hardworking immigrant neighbors. For the undocumented immigrants watching the conventions, the message, however, was clear: Both parties have a lot of work to do when it comes to humanizing their communities.  

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“No Business Being in This Country”

For context, Republican presidential nominee Donald Trump and his running mate Mike Pence are the decidedly anti-immigrant ticket. From the beginning, Trump’s campaign has been overrun by anti-immigrant rhetoric, from calling Mexicans “rapists” and “killers” to calling for a ban on Muslim immigration. And as of July 24, Trump’s proposed ban now includes people from countries “compromised by terrorism” who will not be allowed to enter the United States, including anyone from France.

So, it should come as no surprise that the first night of the RNC, which had the theme of “Make America Safe Again,” preyed on American fears of the “other.” In this case: undocumented immigrants who, as Julianne Hing wrote for the Nation, “aren’t just drug dealers and rapists anymorenow they’re murderers, too.”

Night one of the RNC featured not one but three speakers whose children were killed by undocumented immigrants. “They’re just three brave representatives of many thousands who have suffered so gravely,” Trump said at the convention. “Of all my travels in this country, nothing has affected me more, nothing even close I have to tell you, than the time I have spent with the mothers and fathers who have lost their children to violence spilling across our borders, which we can solve. We have to solve it.”

Billed as “immigration reform advocates,” grieving parents like Mary Ann Mendoza called her son’s killer, who had resided in the United States for 20 years before the drunk driving accident that ended her police officer son’s life, an “illegal immigrant” who “had no business being in this country.”

It seemed exploitative and felt all too common. Drunk driving deaths are tragically common and have nothing to do with immigration, but it is easier to demonize undocumented immigrants than it is to address the nation’s broken immigration system and the conditions that are separating people from their countries of originconditions to which the United States has contributed. Trump has spent months intentionally and disingenuously pushing narratives that undocumented immigrants are hurting and exploiting the United States, rather than attempting to get to the root of these issues. This was hammered home by Mendoza, who finished her speech saying that we have a system that cares more about “illegals” than Americans, and that a vote for Hillary “puts all of our children’s lives at risk.”

There was also Maricopa County Sheriff Joe Arpaio, a notorious racist whose department made a practice of racially profiling Latinos and was recently found to be in civil contempt of court for “repeatedly and knowingly” disobeying orders to cease policing tactics against Latinos, NPR reported.

Like Mendoza, Arpaio told the RNC crowd that the immigration system “puts the needs of other nations ahead of ours” and that “we are more concerned with the rights of ‘illegal aliens’ and criminals than we are with protecting our own country.” The sheriff asserted that he was at the RNC because he was distinctly qualified to discuss the “dangers of illegal immigration,” as someone who has lived on both sides of the border.

“We have terrorists coming in over our border, infiltrating our communities, and causing massive destruction and mayhem,” Arpaio said. “We have criminals penetrating our weak border security systems and committing serious crimes.”

Broadly, the takeaway from the RNC and the GOP nominee himself is that undocumented immigrants are terrorists who are taking American jobs and lives. “Trump leaned on a tragic story of a young woman’s murder to prop up a generalized depiction of immigrants as menacing, homicidal animals ‘roaming freely to threaten peaceful citizens,’” Hing wrote for the Nation.

When accepting the nomination, Trump highlighted the story of Sarah Root of Nebraska, a 21-year-old who was killed in a drunk-driving accident by a 19-year-old undocumented immigrant.

“To this administration, [the Root family’s] amazing daughter was just one more American life that wasn’t worth protecting,” Trump said. “One more child to sacrifice on the altar of open borders.”

It should be noted that the information related to immigration that Trump provided in his RNC speech, which included the assertion that the federal government enables crime by not deporting more undocumented immigrants (despite deporting more undocumented immigrants than ever before in recent years), came from groups founded by John Tanton, a well-known nativist whom the Southern Poverty Law center referred to as “the racist architect of the modern anti-immigrant movement.”

“The Border Crossed Us”

From the get-go, it seemed the DNC set out to counter the dangerous, anti-immigrant rhetoric pushed at the RNC. Over and over again, Democrats like Congressional Hispanic Caucus Chair Rep. Linda Sánchez (D-CA) hit back hard against Trump, citing him by name and quoting him directly.

“Donald Trump believes that Mexican immigrants are murderers and rapists. But what about my parents, Donald?” Sánchez asked the crowd, standing next to her sister, Rep. Loretta Sánchez (D-CA). “They are the only parents in our nation’s 265-year history to send not one but two daughters to the United States Congress!”

Each speech from a Latino touched on immigration, glossing over the fact that immigration is not just a Latino issue. While the sentiments were positiveillustrating a community that is thriving, and providing a much-needed break from the RNC’s anti-immigrant rhetoricat the core of every speech were messages of assimilation and respectability politics.

Even in gutsier speeches from people like actress Eva Longoria, there was the need to assert that her family is American and that her father is a veteran. The actress said, “My family never crossed a border. The border crossed us.”

Whether intentional or not, the DNC divided immigrants into those who are acceptable, respectable, and worthy of citizenship, and those—invisible at the convention—who are not. “Border crossers” who do not identify as American, who do not learn English, who do not aspire to go to college or become an entrepreneur because basic survival is overwhelming enough, what about them? Do they deserve to be in detention? Do their families deserve to be ripped apart by deportation?

At the convention, Rep. Luis Gutiérrez (D-IL), a champion of immigration reform, said something seemingly innocuous that snapped into focus the problem with the Democrats’ immigration narrative.

“In her heart, Hillary Clinton’s dream for America is one where immigrants are allowed to come out of the shadows, get right with the law, pay their taxes, and not feel fear that their families are going to be ripped apart,” Gutiérrez said.

The Democratic Party is participating in an all-too-convenient erasure of the progress undocumented people have made through sheer force of will. Immigration has become a leading topic not because there are more people crossing the border (there aren’t) or because nativist Donald Trump decided to run for president, but because a segment of the population has been denied basic rights and has been fighting tooth and nail to save themselves, their families, and their communities.

Immigrants have been coming out of the shadows and as a result, are largely responsible for the few forms of relief undocumented communities now have, like Deferred Action for Childhood Arrivals, which allows certain undocumented immigrants who meet specific qualifications to receive a renewable two-year work permit and exemption from deportation. And “getting right with the law” is a joke at this point. The problem isn’t that immigrants are failing to adhere to immigration laws; the problem is immigration laws that are notoriously complicated and convoluted, and the system, which is so backlogged with cases that a judge sometimes has just seven minutes to determine an immigrant’s fate.

Becoming a U.S. citizen is also really expensive. There is a cap on how many people can immigrate from any given country in a year, and as Janell Ross explained at the Washington Post:

There are some countries, including Mexico, from where a worker with no special skills or a relative in the United States can apply and wait 23 years, according to the U.S. government’s own data. That’s right: There are people receiving visas right now in Mexico to immigrate to the United States who applied in 1993.

But getting back to Gutierrez’s quote: Undocumented immigrants do pay taxes, though their ability to contribute to our economy should not be the one point on which Democrats hang their hats in order to attract voters. And actually, undocumented people pay a lot of taxes—some $11.6 billion in state and local taxes last year, according to the Institute on Taxation and Economic Policy—while rarely benefiting from a majority of federal assistance programs since the administration of President Bill Clinton ended “welfare as we know it” in 1996.

If Democrats were being honest at their convention, we would have heard about their failure to end family detention, and they would have addressed that they too have a history of criminalizing undocumented immigrants.

The 1996 Antiterrorism and Effective Death Penalty Act and the 1996 Illegal Immigration Reform and Immigrant Responsibility Act, enacted under former President Clinton, have had the combined effect of dramatically increasing the number of immigrants in detention and expanding mandatory or indefinite detention of noncitizens ordered to be removed to countries that will not accept them, as the American Civil Liberties Union notes on its site. Clinton also passed the North American Free Trade Agreement, which economically devastated Mexican farmers, leading to their mass migration to the United States in search of work.

In 1990, then-Sen. Joe Biden introduced the Violence Against Women Act, which passed in 1994 and specifically excluded undocumented women for the first 19 of the law’s 22 years, and even now is only helpful if the victim of intimate partner abuse is a child, parent, or current/former spouse of a U.S. citizen or a permanent resident.

In addition, President Obama is called by immigrant rights advocates “deporter in chief,” having put into place a “deportation machine” that has sent more than two million migrants back to their country of origin, more than any president in history. New arrivals to the United States, such as the Central American asylum seekers coming to our border escaping gender-based violence, are treated with the same level of prioritization for removal as threats to our national security. The country’s approach to this humanitarian crisis has been raiding homes in the middle of the night and placing migrants in detention centers, which despite being rife with allegations of human rights abuses, are making private prison corporations millions in revenue.

How Are We Defining “Un-American”?

When writing about the Democratic Party, community organizer Rosa Clemente, the 2008 Green Party vice president candidate, said that she is afraid of Trump, “but not enough to be distracted from what we must do, which is to break the two-party system for good.”

This is an election like we’ve never seen before, and it would be disingenuous to imply that the party advocating for the demise of the undocumented population is on equal footing with the party advocating for the rights of certain immigrants whose narratives it finds acceptable. But this is a country where Republicans loudly—and with no consequence—espouse racist, xenophobic, and nativist beliefs while Democrats publicly voice support of migrants while quietly standing by policies that criminalize undocumented communities and lead to record numbers of deportations.

During two weeks of conventions, both sides declared theirs was the party that encapsulated what America was supposed to be, adhering to morals and values handed down from our forefathers. But ours is a country comprised of stolen land and built by slave labor where today, undocumented immigrants, the population most affected by unjust immigration laws and violent anti-immigrant rhetoric, don’t have the right to vote. It is becoming increasingly hard to tell if that is indeed “un-American” or deeply American.

Analysis Economic Justice

New Pennsylvania Bill Is Just One Step Toward Helping Survivors of Economic Abuse

Annamarya Scaccia

The legislation would allow victims of domestic violence, sexual assault, and stalking to terminate their lease early or request locks be changed if they have "a reasonable fear" that they will continue to be harmed while living in their unit.

Domestic violence survivors often face a number of barriers that prevent them from leaving abusive situations. But a new bill awaiting action in the Pennsylvania legislature would let survivors in the state break their rental lease without financial repercussions—potentially allowing them to avoid penalties to their credit and rental history that could make getting back on their feet more challenging. Still, the bill is just one of several policy improvements necessary to help survivors escape abusive situations.

Right now in Pennsylvania, landlords can take action against survivors who break their lease as a means of escape. That could mean a lien against the survivor or an eviction on their credit report. The legislation, HB 1051, introduced by Rep. Madeleine Dean (D-Montgomery County), would allow victims of domestic violence, sexual assault, and stalking to terminate their lease early or request locks be changed if they have “a reasonable fear” that they will continue to be harmed while living in their unit. The bipartisan bill, which would amend the state’s Landlord and Tenant Act, requires survivors to give at least 30 days’ notice of their intent to be released from the lease.

Research shows survivors often return to or delay leaving abusive relationships because they either can’t afford to live independently or have little to no access to financial resources. In fact, a significant portion of homeless women have cited domestic violence as the leading cause of homelessness.

“As a society, we get mad at survivors when they don’t leave,” Kim Pentico, economic justice program director of the National Network to End Domestic Violence (NNEDV), told Rewire. “You know what, her name’s on this lease … That’s going to impact her ability to get and stay safe elsewhere.”

“This is one less thing that’s going to follow her in a negative way,” she added.

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Pennsylvania landlords have raised concerns about the law over liability and rights of other tenants, said Ellen Kramer, deputy director of program services at the Pennsylvania Coalition Against Domestic Violence, which submitted a letter in support of the bill to the state House of Representatives. Lawmakers have considered amendments to the bill—like requiring “proof of abuse” from the courts or a victim’s advocate—that would heed landlord demands while still attempting to protect survivors.

But when you ask a survivor to go to the police or hospital to obtain proof of abuse, “it may put her in a more dangerous position,” Kramer told Rewire, noting that concessions that benefit landlords shift the bill from being victim-centered.

“It’s a delicate balancing act,” she said.

The Urban Affairs Committee voted HB 1051 out of committee on May 17. The legislation was laid on the table on June 23, but has yet to come up for a floor vote. Whether the bill will move forward is uncertain, but proponents say that they have support at the highest levels of government in Pennsylvania.

“We have a strong advocate in Governor Wolf,” Kramer told Rewire.

Financial Abuse in Its Many Forms

Economic violence is a significant characteristic of domestic violence, advocates say. An abuser will often control finances in the home, forcing their victim to hand over their paycheck and not allow them access to bank accounts, credit cards, and other pecuniary resources. Many abusers will also forbid their partner from going to school or having a job. If the victim does work or is a student, the abuser may then harass them on campus or at their place of employment until they withdraw or quit—if they’re not fired.

Abusers may also rack up debt, ruin their partner’s credit score, and cancel lines of credit and insurance policies in order to exact power and control over their victim. Most offenders will also take money or property away from their partner without permission.

“Financial abuse is so multifaceted,” Pentico told Rewire.

Pentico relayed the story of one survivor whose abuser smashed her cell phone because it would put her in financial dire straits. As Pentico told it, the abuser stole her mobile phone, which was under a two-year contract, and broke it knowing that the victim could not afford a new handset. The survivor was then left with a choice of paying for a bill on a phone she could no longer use or not paying the bill at all and being turned into collections, which would jeopardize her ability to rent her own apartment or switch to a new carrier. “Things she can’t do because he smashed her smartphone,” Pentico said.

“Now the general public [could] see that as, ‘It’s a phone, get over it,'” she told Rewire. “Smashing that phone in a two-year contract has such ripple effects on her financial world and on her ability to get and stay safe.”

In fact, members of the public who have not experienced domestic abuse may overlook financial abuse or minimize it. A 2009 national poll from the Allstate Foundation—the philanthropic arm of the Illinois-based insurance company—revealed that nearly 70 percent of Americans do not associate financial abuse with domestic violence, even though it’s an all-too-common tactic among abusers: Economic violence happens in 98 percent of abusive relationships, according to the NNEDV.

Why people fail to make this connection can be attributed, in part, to the lack of legal remedy for financial abuse, said Carol Tracy, executive director of the Women’s Law Project, a public interest law center in Pennsylvania. A survivor can press criminal charges or seek a civil protection order when there’s physical abuse, but the country’s legal justice system has no equivalent for economic or emotional violence, whether the victim is married to their abuser or not, she said.

Some advocates, in lieu of recourse through the courts, have teamed up with foundations to give survivors individual tools to use in economically abusive situations. In 2005, the NNEDV partnered with the Allstate Foundation to develop a curriculum that would teach survivors about financial abuse and financial safety. Through the program, survivors are taught about financial safety planning including individual development accounts, IRA, microlending credit repair, and credit building services.

State coalitions can receive grant funding to develop or improve economic justice programs for survivors, as well as conduct economic empowerment and curriculum trainings with local domestic violence groups. In 2013—the most recent year for which data is available—the foundation awarded $1 million to state domestic violence coalitions in grants that ranged from $50,000 to $100,000 to help support their economic justice work.

So far, according to Pentico, the curriculum has performed “really great” among domestic violence coalitions and its clients. Survivors say they are better informed about economic justice and feel more empowered about their own skills and abilities, which has allowed them to make sounder financial decisions.

This, in turn, has allowed them to escape abuse and stay safe, she said.

“We for a long time chose to see money and finances as sort of this frivolous piece of the safety puzzle,” Pentico told Rewire. “It really is, for many, the piece of the puzzle.”

Public Policy as a Means of Economic Justice

Still, advocates say that public policy, particularly disparate workplace conditions, plays an enormous role in furthering financial abuse. The populations who are more likely to be victims of domestic violence—women, especially trans women and those of color—are also the groups more likely to be underemployed or unemployed. A 2015 LGBT Health & Human Services Network survey, for example, found that 28 percent of working-age transgender women were unemployed and out of school.

“That’s where [economic abuse] gets complicated,” Tracy told Rewire. “Some of it is the fault of the abuser, and some of it is the public policy failures that just don’t value women’s participation in the workforce.”

Victims working low-wage jobs often cannot save enough to leave an abusive situation, advocates say. What they do make goes toward paying bills, basic living needs, and their share of housing expenses—plus child-care costs if they have kids. In the end, they’re not left with much to live on—that is, if their abuser hasn’t taken away access to their own earnings.

“The ability to plan your future, the ability to get away from [abuse], that takes financial resources,” Tracy told Rewire. “It’s just so much harder when you don’t have them and when you’re frightened, and you’re frightened for yourself and your kids.”

Public labor policy can also inhibit a survivor’s ability to escape. This year, five states, Washington, D.C., and 24 jurisdictions will have passed or enacted paid sick leave legislation, according to A Better Balance, a family and work legal center in New York City. As of April, only one of those states—California—also passed a state paid family leave insurance law, which guarantees employees receive pay while on leave due to pregnancy, disability, or serious health issues. (New Jersey, Rhode Island, Washington, and New York have passed similar laws.) Without access to paid leave, Tracy said, survivors often cannot “exercise one’s rights” to file a civil protection order, attend court hearings, or access housing services or any other resource needed to escape violence.

Furthermore, only a handful of state laws protect workers from discrimination based on sex, sexual orientation, gender identity, and pregnancy or familial status (North Carolina, on the other hand, recently passed a draconian state law that permits wide-sweeping bias in public and the workplace). There is no specific federal law that protects LGBTQ workers, but the U.S. Employment Opportunity Commission has clarified that the Civil Rights Act of 1964 does prohibit discrimination based on gender identity and sexual orientation.

Still, that doesn’t necessarily translate into practice. For example, the National Center for Transgender Equality found that 26 percent of transgender people were let go or fired because of anti-trans bias, while 50 percent of transgender workers reported on-the-job harassment. Research shows transgender people are at a higher risk of being fired because of their trans identity, which would make it harder for them to leave an abusive relationship.

“When issues like that intersect with domestic violence, it’s devastating,” Tracy told Rewire. “Frequently it makes it harder, if not impossible, for [victims] to leave battering situations.”

For many survivors, their freedom from abuse also depends on access to public benefits. Programs like Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), the child and dependent care credit, and earned income tax credit give low-income survivors access to the money and resources needed to be on stable economic ground. One example: According to the Center on Budget and Policy Priorities, where a family of three has one full-time nonsalary worker earning $10 an hour, SNAP can increase their take-home income by up to 20 percent.

These programs are “hugely important” in helping lift survivors and their families out of poverty and offset the financial inequality they face, Pentico said.

“When we can put cash in their pocket, then they may have the ability to then put a deposit someplace or to buy a bus ticket to get to family,” she told Rewire.

But these programs are under constant attack by conservative lawmakers. In March, the House Republicans approved a 2017 budget plan that would all but gut SNAP by more than $150 million over the next ten years. (Steep cuts already imposed on the food assistance program have led to as many as one million unemployed adults losing their benefits over the course of this year.) The House GOP budget would also strip nearly $500 billion from other social safety net programs including TANF, child-care assistance, and the earned income tax credit.

By slashing spending and imposing severe restrictions on public benefits, politicians are guaranteeing domestic violence survivors will remain stuck in a cycle of poverty, advocates say. They will stay tethered to their abuser because they will be unable to have enough money to live independently.

“When women leave in the middle of the night with the clothes on their back, kids tucked under their arms, come into shelter, and have no access to finances or resources, I can almost guarantee you she’s going to return,” Pentico told Rewire. “She has to return because she can’t afford not to.”

By contrast, advocates say that improving a survivor’s economic security largely depends on a state’s willingness to remedy what they see as public policy failures. Raising the minimum wage, mandating equal pay, enacting paid leave laws, and prohibiting employment discrimination—laws that benefit the entire working class—will make it much less likely that a survivor will have to choose between homelessness and abuse.

States can also pass proactive policies like the bill proposed in Pennsylvania, to make it easier for survivors to leave abusive situations in the first place. Last year, California enacted a law that similarly allows abuse survivors to terminate their lease without getting a restraining order or filing a police report permanent. Virginia also put in place an early lease-termination law for domestic violence survivors in 2013.

A “more equitable distribution of wealth is what we need, what we’re talking about,” Tracy told Rewire.

As Pentico put it, “When we can give [a survivor] access to finances that help her get and stay safe for longer, her ability to protect herself and her children significantly increases.”