HB 2474: De-felonizing MJ possession reduces harm, but doesn't go far enough.

Marijuana needs to be legalized altogether, before more lives and communities are destroyed by these laws. I think most Arizonans would be astonished to know how many people we have locked up in prison today just for smoking pot on probation - often the probation they were put on for smoking pot so they wouldn't go to prison in the first lace, because Arizonans have long felt prison was inappropriate for MJ possession or use.  With this campaign to legalize, there should be a chance next election for people to fight back against vicious laws and penalities altogether.

Thank you, Represenative Cardenas, for having the courage to do this much, however.

----------from ABC15.com-----------

Lawmaker: Remove felony charge for simple marijuana possession

Posted: 02/11/2014

ABC15.com

• By: Moriah Costa, Cronkite News Service

PHOENIX - Saying harsh penalties for marijuana use do more harm than good, a state lawmaker wants to remove felony charges for possession without the intent to sell.

“I don’t believe they should go away to prison and face hefty fines and possibly have their civil rights taken away,” said Rep. Mark A. Cardenas, D-Phoenix. “We shouldn’t have people that are being sentenced to long prison terms for simple possession of marijuana.”

Cardenas authored HB 2474, which would subject those carrying less than 1 ounce of marijuana without intent to sell to a civil penalty of no more than $100. Possession of less than 2 pounds without intent to sell would be a petty offense, while possession of greater amounts would be a misdemeanor.

Currently, possession of up to two pounds is a class six felony, punishable by up to two years in prison and a $750 fine.

The bill would reduce the charge for growing marijuana from a felony to a misdemeanor if the amount is less than 2 pounds.

Cardenas said he was against legalization when he served in the Army and National Guard but that his views changed after taking an Arizona State University class on drugs and justice.

“It took being willing to learn from facts and figures to say, I was wrong,” he said. “Let’s change that. Let’s try to change my corner of the world.”

His bill was assigned to the House Judiciary Committee but hadn’t been scheduled for a hearing.

Cardenas also signed onto a bill that would legalize the recreational use of marijuana. HB 2558, authored by Rep. Ruben Gallego,D-Phoenix, had yet to be assigned to a committee.

While Cardenas is for marijuana legalization, he said “the next best option would be to decriminalize small amounts.”

Maricopa County Attorney Bill Montgomery said reducing marijuana possession penalties would undermine efforts by counties to rehabilitate first- and second-time offenders who aren’t facing other charges. Those successfully completing the diversion program avoid criminal records.

“The irony is that if you try to reduce those penalties, you are going to wind up with people who are going to have maybe an ostensibly lower level offense, but they’re going to have more of a conviction record than people who could initially be charged with a felony and be offered diversion and have no record,” he said.
Montgomery said that in 2013, 63 percent of the diversion cases in Maricopa County were for marijuana possession, and 85 percent of those in the program successfully completed it.

Nine other counties have similar diversion prosecution programs, according to the Arizona Prosecuting Attorneys’ Advisory Council.

Montgomery said the idea that Arizona’s prisons are full of marijuana-possession offenders. According to the 2011 Arizona Sentencing Report from the Arizona Prosecuting Attorneys’ Advisory Council, about 95 percent of inmates in Arizona’s prison system have committed multiple or violent felonies.

“If that’s the motivation of this bill, it’s a solution in search of a problem,” he said.

Carolyn Short, chairwoman for Keep AZ Drug Free, a committee that opposed the 2010 medical marijuana ballot initiative, said the idea of reduce sentences for marijuana possession isn’t rational and ignores scientific fact.

“It’s just another way of communicating to kids that its not that big of a deal and it really is a big deal,” she said. “We already have two substances now that are legal, alcohol and tobacco, that are creating damage economically and socially to our society.”

STAND WITH MONICA JONES: Project Rose is Violence!

(Edited November 10, 2013) 

When I first put up this blog post, I didn't realize how toxic the environment was in which the debate between sex worker rights activists and anti-traffickers has been taking place these past several years. It was not my intent to polarize local parties even further by focusing so much on the person who developed and implemented Project Rose, as opposed to simply critiquing the methods the program employs to rescue people. The edits made in this post account for that concern.

I also didn't intend to diminish the reality that there are many lives torn apart by human trafficking, whether or not the labor exploited and stolen is sexual in nature. There are enough in the business who would choose a diferent line of work, given the option, that I don't want to minimize that reality, either. In a truly healthy economy, people would have more choice and mobility.

Sex work really isn't for everyone - but those who do work in the field deserve respect, safety and protection from exploitation and violence. I don't see how Project Rose does anything for them but expose them to even more state violence than they otherwise would be...and it seems as if Social Work should be very much concerned with the principle of "first do no harm" when professional interventions are designed for public policy and private lives. I was a social work student for many years myself, and Project Rose runs counter to so much I learned about social work ethics.

I still adamantly object to a program design which casts a large net to round everyone up in handcuffs and sorts through who gets to be free and who goes to jail later. It "liberates" some at the expense of others, and does immeasurable harm to those arrested in the end.  That said, I hope readers who take issue with Project Rose - particularly those of you who are ASU students, will still raise your concerns with Professor Roe, but please do so in a respectful  way which allows the dialogue to continue. I don't think her ultimate objective is to hurt anyone, by any means, and I hope there is at least some common ground we can agree on...like the principle that consensual sex workers and their allies also deserve to be free of violence, and thus Project Rose should offer everyone assistance, regardless of priors or other factors, and arrest no one (especially not those of us protesting it). If the people behind Project Rose could at least agree to that much, we will have made progress.


Peggy Plews

 SWOP-Phoenix Activist Monica Jones

 

SUPPORT MONICA HERE!!!!

  

Last May I joined the  Phoenix Sex Workers Outreach Project (SWOP-Phoenix) in a protest of Project Rose, a Phoenix Police prostitution sting operation that purports to rescue victims of sex trafficking, and claimed not to arrest those voluntary sex workers swept up in its net (See: Cracking down on sex trafficking by not arresting prostitutes). My friends and I were not terribly well-received, and the day after our protest - which was the second day Project Rose was operating - one of our transgender friends who was out there with us, Monica Jones, was even arrested for "manifestation" of the intent to commit prostitution for accepting a ride to the bar in her own neighborhood.


Specifically, the Phoenix Police say that under the Phoenix Municipal Code, she is guilty of this:

23-52 Prostitution, soliciting an act of prostitution and related offenses.

A.    A person is guilty of a misdemeanor who: 


3. Is in a public place, a place open to public view or in a motor vehicle on a public roadway and manifests an intent to commit or solicit an act of prostitution. Among the circumstances that may be considered in determining whether such an intent is manifested are: that the person repeatedly beckons to, stops or attempts to stop or engage passersby in conversation or repeatedly, stops or attempts to stop, motor vehicle operators by hailing, waiving of arms or any other bodily gesture; that the person inquires whether a potential patron, procurer or prostitute is a police officer or searches for articles that would identify a police officer; or that the person requests the touching or exposure of genitals or female breast;  


The first time I put this post up, I did some speculating about the mindset of the Phoenix Police when they decided to arrest Monica. My comments were kind of inflammatory and probably unfair to the arresting officer, so I've taken them down. The truth is, I don't know what the PPD was thinking - maybe they weren't thinking at all. I can't believe they thought we would all quietly go away after this. 

It's possible the cop who did the dirty work is the one who made the call to target her while he was driving through her neighborhood, and thought she was really out hooking. I'm skeptical of the arresting officer's veracity and his bias about transgender people, though, having read the report. For one thing, even though Monica's driver's license identifies her as female, the cop identified her using male pronouns throughout the entire police report - he really felt she should be clearly identified as a man, not a woman. And there are a few variations between his version (or interpretation of events) and hers.


I'm more inclined to think that the commander made the decision the day before after they identified her at the protest and saw that she had a prior - which is what makes her so vulnerable to that "manifestation" charge: they apparently use a prior offense as evidence that you intended to commit that crime again. I guess it's possible that her neighborhood was on their map of areas to target, but it seems awfully coincidental that the Project Rose officers were lurking around there.


  In any case, here's pretty much what went down: The day after our protest, Monica got dressed up and decided to go to the bar.  She's on her way, by foot (through her own neighborhood, mind you), when this guy pulls up in front of her, literally blocking her path, and offers her a ride. She has a mile yet to walk to the bar and was bothered by another dude in the area, so she figures "either this guy is a cop and I've got a safe ride, or he's someone who might buy me a drink when we get there", and she gets in.


Almost immediately the guy starts propositioning her, asking how much she wants for a sex act. Monica wasn't working, though - besides, she knew full well what was going down with Project Rose; he must have been disappointed that she wouldn't take his bait. This guy kept being really pushy, too, so she asked him "look are you a cop? Because there's this sting going down and you really need to be more careful about asking those kinds of things..." He was obviously a cop.

The guy insists several times that he's not a cop, though, as he passes by Monica's bar, and keeps going when she says "turn here!" "stop!" "I want to get out!". So what was she supposed to think? If he wasn't a cop, then he was in the process of abducting her, so she grabs his..umm..male organ,  having every reason to be concerned for her safety now (what would you do if you thought you were being kidnapped? That's better than going for the jugular...). Of course, in his report Officer John made that moment sound like a sex act. At that point he gave his buddies the signal to pull him over, and they arrested her for trying to solicit him.

The cops took Monica (in cuffs) to Project Rose's HQ at the Bethany Home Bible Church, where she asked for an attorney, and was introduced to the prosecutor, who threatened to send her to jail that night if she didn't agree to participate in their program. She was not entitled to consult an attorney before deciding whether or not to sign away her rights and enter the diversion program (which is an implied admission of guilt). 



Monica had already been through a diversion program, though, which they soon discovered - that disqualifies you from ever being diverted from the criminal system again (that's how they sort out the "victims" from the "repeat offenders"  - the  "real prostitutes" who they apparently do feel belong in jail). She also would have been disqualified from the program if she had so much as a baggie they thought once held pot in it. After detaining and processing Monica that night, though, they released her without charges...that is, until this fall, when they sent her a summons to answer the charge of "manifestation".

This is no small thing. Monica is facing up to 6 months in jail and a $2,500 fine - with a minimum mandatory of 30 days in jail.  Even if the judge doesn't think imprisonment is appropriate, with a conviction she would lose not only her freedom, but also her student loans and class standing, as well as her safe, affordable housing. Now, I ask the perpetrators of Project Rose: just how are you "saving" trafficking victims with this program again? Are you sure it isn't inadvertently hurting anyone?

As a transgender woman who would be locked up in a male facility, Monica faces infinitely higher levels of violence, abuse and exploitation from both prisoners and officers than cisgender people are when incarcerated. She would be forced to remain in solitary confinement for her own safety through the course of her imprisonment - which still doesn't protect prisoners from lecherous guards and the jail trustees. She would have to endure the special "care" of Joe Arpaio's gracious deputies, who are known for beating up some of thier mentally ill prisoners in restraints, and killing others through overt violence or deliberate indifference, among other things.

The law that Monica is being prosecuted under assumes that certain things she did that day: walking in a "high-vice area", accepting a ride from a stranger, asking the man who was propositioning her repeatedly for sex if he was a cop, and making physical contact with his, um, sex organ - were motivated by the intent to trade sex for money. Now, how do they prove criminal intent? They'll point to her prior conviction for a prostitution charge as evidence of that intent: after all, "Once a whore always a whore". They may even use her statement from the protest the day before - she, like myself - believes sex work should be legalized. Does that mean she was out hooking the next day herself? C'mon, guys - you know she wasn't.

If anything, the fact that this arrest went down during Project Rose - the day after she publicly criticized the sting - should have been evidence enough to the cops that Monica WASN'T attempting to solicit anyone  - she knew full well what they were up to. They should have been wary that SHE might be stinging them when they went after her - none of us would be so stupid, though, as to deliberately bait a Vice operation.

Even if the cops who picked Monica up were totally oblivious to her role in the protest the day before, Daniel Garcia, the Chief of Police and Aarón J. Carreón-Aínsa, the Phoenix City Prosecutor, are well aware of the back-story to this arrest now - and yet these charges still stand. What does that tell you about the overall "intent" and integrity of  Project Rose?

 Can't miss Monica standing tall, even in this one...

(May 2013: Protesting Project Rose)

Interestingly, given that some of these Project Rose arrests are being based on assumptions about the target's "intent" behind non-criminal behaviors and their response to having someone aggressively proposition them for a sex act, the Phoenix Police department apparently decided not to record any of their cops in the act of setting these people up - or any of these people actually committing their crime. I guess they know that in court their testimony alone always wins against some streetwalker's version of events - and a recording might contradict the good officer's word, so they made sure not to have any way for these women to defend themselves if they alleged the officers version ws inaccurate. That alone brings the validity and credibility of Project Rose arrests into question.

I recently wrote to the professor at the Arizona State University School of Social Work who is supervising the academic/research side of Project Rose about my concerns for Monica and the charges she's facing. She never responded to it, though. ASU insists that Project Rose first does no harm...of course, we can see from Monica's prosecution that this assertion isn't true at all - they appear to be going out of their way at the Phx PD to do my friend as much harm as possible for challenging them.

Project Rose is also embraced by a host of non-profit organizations in the valley, most of which serve populations at high risk of victimization by state violence. They're all collaborating with the cops in the worst kind of way, encouraging violence against sex workers by lining up to have the police deliver their prospective clients to them in a church basement in handcuffs and tears, so they're more receptive to the great services those kind people have to offer them. I think those agencies are being paid from anti-trafficking funds for the time they give to Project Rose, by the way, but don't quote me on that.


Shame on all of those organizations (including ASU, Catholic Charities, EMPACT, Community Bridges, and HealthCare for the Homeless , StreetlightUSA, and ALERT) - beginning with the biggest provider of services to homeless youth in the valley, Tumbleweed. Most of these agencies appear to have a bunch of cops, prosecutors, and big business CEOs on their boards of directors - no wonder they don't know what they're doing. And they all seem to be quite happy to be in bed with the Phoenix Police - how can they really be serving the vulnerable populations that are most violated by the police, then? Word must be out on the street that these places can't be trusted by now.


Anyway, if you're hungry and homeless and you call Tumbleweed for a crisis outreach team to take you to a homeless shelter, you better make sure you don't have a warrant out for your arrest: before they come to your aid those nice people at Tumbleweed are going to call the cops to see where you stand with them - and to tell them where to grab you if you're wanted. I was floored. I had to drag it out of them, but they really told me that when I called them about a homeless 18 year old kid getting out of prison the other day.  They said "well, we can't have people up in here who have warrants out for them." That doesn't mean you have to call the cops on them yourself, though! What a violation of trust.


Now, why should homeless and runaway youth ever ask these people for help?  They seem far more interested in their corporate image than the safety and survival of their clientele, and clearly lack a meaningful, critical analysis of how state violence plays out against the youth they serve.  They certainly don't seem to understand the basics of street outreach and harm-reduction, with these kinds of policies and their cozy "partnerships" with the police. Far too often the people who are there to help those kids only do them harm by involving the police. Good intentions can even kill.

Project Rose has already been roundly criticized in a well-respected professional journal, AFFILIA - and I expect more to hit the presses soon. Please read that article if you still believe programs like this "help" more people than they hurt, or that the harm they do to some is worth the good they do for others. There are far more effective outreach programs to help people who are really being trafficked against their will, and the best jail "diversion" program for sex workers would be to simply legalize prostitution altogether. It would certainly undermine those who are trafficking others by bringing the entire sex work industry out of the shadows, making it safer for victims to ask for help.


The City of Phoenix needs to drop these charges against Monica now, before it takes any more of a toll on her. The intent of prosecuting her seems not only to punish her, but to silence anyone who would publicly call this project what it is - a conspiracy between cops and social workers to lock up people they think are "willing whores". They had to charge Monica for "manifesting" her "intent" because she wasn't actually doing anything criminal - they know full well she wasn't out there prostituting during their sting, and that she had every reason to think their buddy was indeed a cop.  This prosecution is malicious - and when she beats it, she's going to have one hell of a good wrongful arrest suit on her hands.

Monica's next court date (we thought it would be her trial, but it's a pre-trial) is November 27, 2013 at the Phoenix Municipal Court. Tune into SWOP-PHX to keep up on what's happening, and visit our INDIEGOGO page to support Monica's defense - though I'm going to be really pissed off if the city makes us spend all that money on a lawyer just to motion to dismiss this garbage...


(note: I made prior reference to Monica being Dr. Roe-Sepowitz' student - she never was. She's an ASU student planning to major in social work, and had simply spoken to Professor Roe before about Project Rose).

CURING HCV in prison: The new Community Standard of Care.

"Q: Will we be able to wipe out hepatitis C entirely?

A: In contrast to HIV, we do have the capability of doing that - essentially curing everyone who got infected. While we have made tremendous progress against HIV, we still don't have a cure, we still don't have a vaccine. The situation for HCV is dramatically different. A cure is achievable. Someday soon, the cure using an interferon-free cocktail is going to be routine...."

 ----------

Until now, I thought it was likely that this disease would kill not only my imprisoned friend Davon, sick as a dog on interferon right now, but also my big brother, who hasn't been able to get treatment - both I feared would die very painfully, at an early age. 

This news gives me hope, though. We have the capability to wipe out this disease and cure those who are ill right now - the question remains: do we have the collective will? That much, I still don't know.


Nearly 6,000 AZ state prisoners have tested positive for the Hepatitis C virus, but only a fraction are deemed eligible for a miserable course of interferon treatment because it costs so much and takes such a toll on body and mind. Many drop out from the side effects, having to face debilitating and fatal liver disease instead. Most public health estimates put the jail/prison population at being over 50% HCV+. Imagine how hard it is already to see loved one do time and maybe even make amends for their crimes in prison, and come home only to find that they were sentenced to die from an infectious disease, as well. 

For those who don't care about prisoners, though, think about this: since 95% of then return to the free world eventually, that means there's already an epidemic in communities with high rates of poverty, unemployment, homelessness, felonization, incarceration, uninsured persons, IV drug addiction, HIV/AIDS, and other compromised populations. It also disproportionately affects people of color, the LGBTQ communities, and Baby Boomers. That's a huge public health problem that no one in Arizona likes talking about - why are they so silent now, I wonder? Surely they've heard this by now.

It sounds like it's time for the AZ DOC and Wexford to re-write their Hep C treatment protocols, in any case, in order to assure that the standard of care they provide to prisoners with the virus (HCV) is consistent with the community's new standard. Otherwise, they can both expect to be named in a new class action lawsuit soon, I'm sure. I'd think the public at large could even sue the state for having an infected population unleashed on us - uneducated, untreated, unsupported, uninsured, and unwell.

remembering those we have already lost...

  

we must accelerate the fight for the living.

Fight the spread of HEP C today: 

support PHRO (Phoenix Harm Reduction Organization)

Phoenix Art Museum: Art of Resistance

Prisoners' Justice Day Guerilla Installation

August 10, 2012

--------from the San Francisco Chronicle----------

Hepatitis C fight - 'watershed moment'

Erin Allday / San Francisco Chronicle

Tuesday, September 11, 2012

Earlier this year, an editorial in the New England Journal of Medicine declared that the world was in a "watershed moment" in the history of treatment for hepatitis C, a virus that is believed to infect roughly 180 million people globally. Dr. Warner Greene, director of the Gladstone Institute of Virology and Immunology in San Francisco, agrees wholeheartedly - and believes that with recent advances in treatments and a cure, the world could be on the cusp of nearly wiping out the virus.

Q: What does the hepatitis C virus do to the body?

A: This is an RNA virus that infects hepatocytes, cells in the liver. That's why you ultimately get hepatitis, or inflammation in the liver, and that can progress on to cirrhosis. About 20 percent of people spontaneously clear the hepatitis C virus, and of the rest, about 20 to 25 percent will progress to cirrhosis, and eventually end-stage liver disease. Hepatitis C is the leading reason behind liver transplants in the United States.

Q: For many years, hepatitis C has been treated with interferon. What is interferon?

A: Interferon is a type of protein called cytokine. It normally triggers an antiviral response in the body. It inhibits key steps in the (hepatitis C) virus life cycle that allow it to replicate. But it's doing it at a cost. Cytokine is pretty toxic. It makes patients very sick.

Q: Last year the Food and Drug Administration approved new drugs to treat hepatitis C. How do they work?

A: It's just like with HIV - you're attacking multiple, key proteins needed for the hepatitis C virus lifecycle. Now you have these small molecules that are attacking the virus itself, as opposed to trying to induce an antiviral response, like with interferon.

These drugs are proving to be just dynamite. We're very close to being able to cure everybody of hepatitis C. The natural history of hepatitis C virus infection has been fundamentally changed.

Q: Why has hepatitis C been so hard to treat historically?

A: One thing that limited progress was the lack of an infectious molecular clone to use in the laboratory to test drugs. It was only in the last few years that an infectious molecular clone came out of Japan. Before that, none of them fully replicated (in the lab). When the molecular clones came along progress just took off at light speed.

Then the blueprint for working on HIV became very informative - protease inhibitors, polymerase inhibitors, they were all targeted very quickly, by multiple pharmaceuticals. Many of the pharmaceuticals just moved their HIV discovery teams into HCV. Progress has been made so rapidly here because the trail had been blazed by all of the HIV drugs.

Q: Will we be able to wipe out hepatitis C entirely?

A: In contrast to HIV, we do have the capability of doing that - essentially curing everyone who got infected. While we have made tremendous progress against HIV, we still don't have a cure, we still don't have a vaccine. The situation for HCV is dramatically different. A cure is achievable. Someday soon, the cure using an interferon-free cocktail is going to be routine.

Then it becomes more of an implementation issue - how you distribute these drugs, what you charge for them. There are 180 million people infected worldwide, five to six times the size of the HIV epidemic, and many are living in resource-poor settings. We're going to have to figure out how to deal with the developing world.

Hepatitis C drugs offer hope for cure

Erin Allday / San Francisco Chronicle

Updated 4:09 p.m., Wednesday, September 12, 2012

Scientific breakthroughs, one piled on top of another at breakneck speed over the past few years, have put medical researchers on the cusp of curing almost everyone who suffers from hepatitis C, if not wiping out the disease entirely.With 180 million people in the world thought to be infected with the virus - 12,000 of them in San Francisco alone - that's potentially a huge public health coup, doctors and scientists say.

In a little more than a decade, a virus that was once almost untreatable could be made nearly extinct.
"It is just a remarkable moment in the history of hepatitis C," said Dr. Warner Greene, director of the virology and immunology division at the Gladstone Institute in San Francisco. "I think hepatitis C and its sequela - liver cancer, cirrhosis, liver transplants - can largely be gone in the future. We just won't have to worry about it."

In the past year, new treatments have come out that already have doubled the number of people who can be cured of hepatitis C. Now the race is on among drug developers to market the first medical cocktails that would cure almost everyone on the planet, and do it safer and faster than the best treatments currently available.

New treatments - both those already available and those expected to be approved in the next five or so years - were a large part of the reason the U.S. Centers for Disease Control and Prevention recommended this summer that all Baby Boomers get screened for hepatitis C.

That generation is thought to have the largest number of undiagnosed cases of the disease, with so many of them potentially exposed to the virus in the wild, drug-friendly hippie years of the '60s and '70s. Until recently it wasn't practical to screen millions of people for possible cases of hepatitis C because few good treatments were available.

Hepatitis C's spread

Hepatitis C is a virus transmitted through the blood, similar to HIV. It's often spread through shared needles used by intravenous drug abusers. Decades ago, and even still in some developing parts of the world, people were exposed to hepatitis C through unsterilized equipment used for tattoos or surgical procedures. Also, the U.S. blood supply wasn't screened for hepatitis C until the early 1990s, so people sometimes became infected from a blood transfusion or organ transplant.

In roughly 20 percent of hepatitis C cases, the body's immune system fights off the virus without any medical intervention and probably without the individual ever being aware of having it. The remaining cases develop into chronic hepatitis C.

In some of those cases, the virus may lie dormant for decades, or even a lifetime, but in about 1 in 5 chronic cases, the virus will attack the liver, scarring it and causing cirrhosis, and potentially leading to liver cancer and liver failure. The infection causes about 10,000 deaths a year in the United States, and it's the leading reason for liver transplants. Hepatitis C is especially prevalent in people who also have HIV infections; in fact, HIV-positive patients are more likely to die of hepatitis-caused liver disease than of AIDS or HIV.

Antiviral drugs

It's only in the past seven years or so that doctors and scientists discovered the first antiviral drugs that can stop the virus, giving the body's natural immune system a chance to fight it off. The cure rate with those drugs is 75 to 80 percent, but they require that patients also take interferon, a toxic medication that can cause disabling side effects for a year.

In the next five years, researchers expect to develop even more potent antiviral medications - drugs that will cure more than 90 percent of patients, and do it in half the time and without the interferon.

"There's no question that with these new treatments, cure is going to be the rule and not the exception," said Dr. Brad Hare, medical director of the HIV/AIDS ward at San Francisco General Hospital, who studies HIV and hepatitis C co-infections. "It's more important than ever to identify people with hepatitis C, because we have something even better to offer them."

That said, Hare added, it's unlikely that the virus will ever be eradicated. There will always remain a pocket of people who don't respond to drug therapy or aren't able to take it for some reason. Those who have been cured can be reinfected.

And getting new medications to the tens of millions of people affected by hepatitis C won't be easy, especially because the drugs will almost definitely be expensive.

Strains on the system

Just screening the millions of Baby Boomers in the United States, and getting those who test positive for hepatitis C into treatment, could be an overwhelming strain on the health care system, public health experts say. Drugs in development could ease some of that burden if they're easier to take and more effective than the current treatments.

Hepatitis C was discovered in the late 1980s, although scientists had known for years that a virus existed that was causing inflammation in the liver and that wasn't the hepatitis A or B viruses.

The U.S. Food and Drug Administration approved the first treatment for hepatitis C - the chemotherapy drug interferon - in 1991, and added a second drug, ribavirin, in 1998. Those two medications were considered a breakthrough therapy for a virus that had previously been untreatable, but the treatment itself was rough and not all that effective.

The ribavirin comes in pill form, but the interferon has to be given intravenously three times a week for 48 weeks. Both drugs, especially the interferon, often come with awful side effects - major depression and, sometimes, suicidal thoughts, plus fatigue, nausea and flu-like symptoms.

And the worst of it is that the treatments lead to a cure only roughly half the time - less than half for patients with the most common strain of hepatitis C.

"A lot of us didn't have bad symptoms before we went on treatment," said Daniel Berrner, a San Francisco resident who was diagnosed with both HIV and hepatitis C in 2005, and underwent successful treatment for the latter in 2009. "People maybe feel some fatigue, but that's it. So to convince them to feel awful for a year when they're not feeling that bad to begin with is a really hard thing to do."

Because treatment was, for many people, tougher to endure than the virus itself, many doctors over the years have "triaged" patients by performing liver biopsies or blood tests to determine if hepatitis C was causing severe enough damage to treat even at the risk of failure. If patients weren't experiencing acute symptoms and their livers seemed relatively healthy, they'd often postpone treatment.

More seek treatment

Whether to get treatment for hepatitis C is still a personal decision and best made after a thoughtful conversation with a primary care doctor or a liver expert, doctors said. But increasingly patients are being encouraged to get treatment, even if their infection isn't particularly virulent.

"I still try to triage based on the risk of end-stage liver disease. But now more patients are willing to be treated," said Dr. Natalie Bzowej, a liver disease specialist at California Pacific Medical Center.

Bzowej helped lead national research into one of the first antiviral treatments that targeted hepatitis C, a protease inhibitor called telaprevir made by Vertex Pharmaceuticals, which was approved by the FDA in June 2011. A similar drug, boceprevir from Merck, also won FDA approval last year.

Remarkable success

In clinical trials, about 80 percent of patients with the most common strain of hepatitis C who took one of those drugs, plus the usual interferon and ribavirin combination, were cured. That was a remarkable improvement over the previous 40 to 50 percent cure rate.

Also encouraging: Most of the patients who were cured were able to stop taking the medications after just 24 weeks, cutting the treatment time in half.

The reason for the difference is that the new drugs single out the hepatitis C virus specifically, whereas the interferon and the ribavirin essentially just give a boost to the body's natural immune system. For many people, the immune system is not strong or fast enough on its own to fight off the virus.

Protease inhibitors are best known as a class of drugs used to treat HIV infection. They work by attacking specific enzymes, or proteases, in a virus that are a key part of the replication process. By inhibiting those enzymes, the virus is unable to reproduce and eventually dies off.

Now, scientists are looking for the next line of drugs to attack other points of the hepatitis life cycle. The pharmaceutical industry is racing toward clinical trials - companies battling to be the first to get new drugs, especially those that would make interferon obsolete, to the market.

Multidrug attack

Doctors and scientists alike expect the first of the new wave of drugs to be available in four or five years. Part of the reason not everyone can be cured of hepatitis C is that, like many viruses, it mutates so quickly and becomes immune to drugs. So ideally, doctors will have at their disposal several drugs - maybe dozens - that will attack the virus on several fronts at once.

If those drugs are strong and fast enough, they could cure patients without the need for interferon. Protease inhibitors and other antiviral drugs aren't without side effects, but the symptoms are much less severe than those from interferon, and the newest classes of drugs may work in as little as 12 weeks, or about half the time it takes telaprevir, the protease inhibitor, to do the job.

"I feel like we are glimpsing the beginning of the end for hepatitis C," said Dr. Cami Graham, vice president of global medical affairs at Vertex. "We really are beginning to see what that path to eradication is going to look like."

Long incubation period

Both drug developers and doctors alike said they are advising patients not to raise their hopes too high. Almost all of the clinical trials are in their earliest stages, and for the Baby Boomers especially, patients with decades-old infections may not have even a few years to wait for new treatments.

"What we have now is better than anything we've had in a long time," said Dr. Joanna Ready, chief of gastroenterology at Kaiser Santa Clara. "What will be even better is interferon-free therapies, and the early studies have been very, very, very promising. But the disease has such a long incubation period and damages the liver over decades, so we really need to be following people over time.
Still, Ready said, she's hopeful.

"If we don't wipe out hepatitis C entirely, we can probably make it go away like polio, where you haven't gotten rid of it but you've really beaten it down," she said. "The science behind these treatments is improving every day. And the more we know, the better we are at treating it."

Erin Allday is a San Francisco Chronicle staff writer. E-mail: eallday@sfchronicle.com 

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FIGHT THE SPREAD OF HEP C TODAY. 

 Phoenix Harm Reduction Organization (PHRO)

Harm-Reduction = Crime-Reduction: Zimring on NYC.

Franklin Zimring is a great researcher, and has done some excellent work on juvenile justice and the death penalty. Note that NYC brought crime down through harm-reduction strategies, not mass incarceration, as Arizona prosecuting attorneys argue the solution is (the Fischer Report is nonsense)...We really need someone like this guy to check out the integrity of our own crime reporting stats more often.

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‘Cheerful News’ on Crime Data and the Integrity Thereof

By AL BAKER

New York Times Blogs
February 3, 2011, 3:40 pm

The three panelists Police Commissioner Raymond W. Kelly tapped to evaluate the integrity of his department’s crime-recording system will be visited on Friday by a longtime academic, author and criminologist: Prof. Franklin E. Zimring of the University of California, Berkeley.

Why — some right-leaning law and order types might wonder — would a trio of Kelly appointees, former federal prosecutors all, seek out the wisdom of an academic from the West Coast? Simple: The professor has already carried out what one police official called “a pretty remarkable” analysis of the city’s historic crime decline. A draft of his findings (see also below) will be published in Scientific American in the fall, with a book to follow.

(The 38-page draft of the article was distributed by the New York Police Department’s public relations arm, which tickled the professor, who voted in 1972 for Senator George S. McGovern for president.)

The book — working title: “The City That Became Safe: What New York Can Teach America About Crime Control” (Oxford University Press) — has been years in the works. Professor Zimring relied on police statistics, and he had cooperation from the department’s hierarchy. He studied crime in three categories: homicides, robberies and automobile thefts. And he compared data from across the last two decades.

In a nutshell, his findings are that the crime drops depicted in the police statistics are, as Professor Zimring put it, “real.”

“The crime trends you get off the official data are trustworthy in the three cases where we could check them,” he said. “What that does not mean is that the number of thefts the New York City Police Department reports is the number of thefts that citizens have experienced in the city. There is not a ‘CompStat-effect’ that makes the problem much worse than 1994.”

He added: “The degree of underreporting, which I regard as a chronic condition in all police-generated data, is no greater now than it was 20 years ago, and probably, if you look at the robbery indicators, a little better now than it was then — and not measurably greater in this city than in other cities.”

Translation of Professor Zimring’s findings: Police data are always a bit loose, but no more so in New York than elsewhere or at other times; the department’s CompStat program, a computerized mapping system that tracks crime patterns, created tensions right from its inception, with police commanders ridiculing underlings at the twice-weekly sessions at the department’s 1 Police Plaza headquarters in Lower Manhattan. The overall news about crime being down is “not only big news,” Professor Zimring said, “but enormously cheerful news.”

The professor also concluded from his research that large numbers of criminals have stopped committing serious crimes. And he looked deeply at how the police in New York have successfully fought the war on drugs — essentially, by going into the “harm-reduction business,” where a principal aim was to make the streets safer and increase people’s confidence in using agencies.

So successful has the effort been, Professor Zimring said, that the narcotics squads in the city that were beefed up through the 1990s now have smaller staffs than in 1990.

As his paper says, one surprise from the city’s experience is that “the city made giant strides toward solving its crime problem without either winning its war on illicit drug use or massive increases in incarceration.”

“So,” it continues, “the great success in this city is a challenge to the two dominant assumptions of crime control policy in modern America.”

With regard to numbers, Professor Zimring truth-tested the police statistics with independent data. He compared the Police Department’s murder rates with municipal health records. He compared the department’s reporting of a “spectacular drop” in auto theft over the last two decades with theft loss reports from insurance-industry data bureaus.

“So the biggest decrease (auto theft) and the most important decrease (homicide) are both confirmed by independent sources,” Professor Zimring wrote. “And, there is confirmation as well for the big drop in robbery, because the number of killings from robberies dropped more than the 84 percent decline in non-fatal robberies.”

In an interview, Mr. Zimring expanded on his methodology of using independent sources — data the police could “not have fudged” — to confirm police crime statistics. “In all three cases, on the size of the decline and when it happened, I confirmed it,” he said. “I was a little bit surprised with that.”

He added: “That does not say there is no fudging; of course, there is fudging. There is fudging everywhere.” However, he added, the statistical measures of the declines in the three areas he studied seem clearly to survive an audit.

So, what does Professor Zimring plan to tell Mr. Kelly’s panel?

“First of all, I am going to tell them what I am not an expert on is the mechanics of the crime-reporting phenomenon,” he said. “I will then take them through what I did to assess trends and talk about what that does say and what it does not say.” And then, talk to them about what some of the dilemmas in crime reporting are.

That includes a discussion of what he called a “completely garbage category” — larceny — and “a second junk category,” assault.

“I think that police accountability is a very good thing,” Professor Zimring said. “And I don’t think the police should be in a ‘Love us or leave us’ position: ‘If anything we do works, then you have to approve of everything we do.’ That is not the way we run democracies and not the way we should run police departments. But what concerns me is, people should focus on the enormously important changes that have taken place.”...

Zimring Journal Article

Prison Health is Public Health: UN

Got this from the UNSHACKLE list-serve - join it if you haven't already and are serious about these issues. This argument also applies to Hepatitis C - only it's even more infectious and prevalent than HIV/AIDS...

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UN warning on AIDS in prisons

By VERONIKA OLEKSYN

Associated Press Writer

VIENNA (AP) -- The U.N.'s top investigator on torture and punishment warned Friday that overcrowded prisons are breeding grounds for AIDS.

Often, inmates are held in inhumane conditions in which the HIV virus is spread through the use of non-sterile drug injection equipment, sexual contacts, tattooing and sharing of razors, Manfred Nowak said.

"There is a global prison crisis," he told an international AIDS conference.

Nowak, who has visited detention facilities around the world, urged authorities to inform prisoners of the risk of HIV transmission and to offer them free condoms, HIV testing and counseling. He also pressed prisons to offer needle and syringe programs, opiate substitution therapies and methadone treatments.

"Science tells us exactly what we have to do, it's just a question of political will to implement it," Nowak said.

In addition, prison guards should live up to their obligation to prevent rape and other forms of coercion that thrive in packed environments.

"One of the most important measures to prevent HIV transmission would be the reduction of overcrowding," since it leads to violence and conditions that are conducive to the spread of the virus, he added.

Nowak said that, although reliable figures are hard to come by, the prevalence of HIV in prisons is generally much higher than in a country's wider population.

In Ukraine, for example, the prevalence of HIV in prison is at least 10 times that of the overall population, he said.

Dmytro Shermebey of the All-Ukrainian Network of People Living with HIV/AIDS - who was diagnosed with HIV, tuberculosis and hepatitis after spending nine years in a Ukrainian jail - stressed that inmates have a right to both treatment and protection from the disease.

"They have the right because they are human," Shermebey said.

While about 10 million people are incarcerated every year, some 30 million enter and leave prisons annually - making it a public health problem for society, according to Nowak.

"Prison health is public health," he said.

Harm Reduction in Prison: Under the Skin.

We need to be organizing more programs like this here, too. Pretty cool that they went around interviewing the prisoners instead of letting all the "experts" speak for them...

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Under the Skin: A People’s Case for Prison Needle and Syringe Programs

What do people in prison have to say about the Canadian government’s unwillingness to permit the distribution of clean needles in prison?

Between 2008 and 2009, interviews were conducted in person and over the phone in British Columbia, Alberta, Manitoba, Ontario, Quebec, New Brunswick and Nova Scotia, resulting in sworn affidavits or testimonials from 50 individuals who have used drugs or shared needles in a federal prison. The hope is that their stories will strengthen the case for change, which governments continue to ignore even as a growing body of evidence highlights the need.

The Legal Network is not alone in calling on the federal government to implement needle and syringe programs in Canada’s prison. Our position is supported by the Canadian Medical Association, the Ontario Medical Associations, the World Health Organization, UNAIDS, the UN Office on Drugs and Crime, the Correctional Investigator of Canada and the Canadian Human Rights Commission. Furthermore, a 2006 review of the scientific evidence by the Public Health Agency of Canada concluded that prison-based needle and syringe programs have largely positive outcomes for the health of people in prison.

www.aidslaw.ca/
undertheskin

Published On	2010-02-02
Author	Canadian HIV/AIDS Legal Network
Topics	Prisons, Drug Policy and Harm Reduction
Document Type	Reports
Language	English
Doc Id	1594

Harm Reduction Strategies: Condoms in Prison.

From the National Commission on Correctional Health Care:

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Prevention in Practice: Access to Condoms in California
By Mary Sylla, JD, MPH

Fall 2007

Providing inmates with access to condoms is controversial. To some it seems hypocritical—why would we give inmates condoms when it’s illegal to have sex in jail and prison?—and to others it seems like common sense, unless we pretend to ignore the fact that some sexual activity takes place in jails and prisons. There are clearly pros and cons and unusual challenges to adopting a harm reduction strategy in a law-and-order environment.

On Oct. 15, 2007, California Gov. Arnold Schwarzenegger vetoed the latest “prison condom bill” to hit his desk. But this time he directed the California Department of Corrections and Rehabilitation to determine the “risk and viability of such a program” by establishing a pilot program.

What follows is a review of the inmate condom access programs in two jails—one in Los Angeles and one in San Francisco—administered by the Center for Health Justice, a community-based nonprofit organization focused on HIV and incarceration, and ongoing research on those programs.

Condom Access: Pros and Cons
There are serious concerns about providing inmates with condoms. Introducing anything new into the security environment provides an additional potential tool for conducting illegal activities, including secreting contraband and assaulting staff with bodily fluids or excrement (called “gassing” in California).

Furthermore, in a rule-based environment it can be considered hypocritical to tell inmates it’s illegal to engage in sexual activity and then provide the means to “safely” engage in that activity. From this viewpoint it sends the wrong message. Condoms also could be used by assailants to prevent evidence of sexual assault from remaining.

But there are also reasons why provision of condoms to inmates might be a good idea. Even though it is illegal to have sex in jail or prison, that rule cannot be perfectly enforced in the many overcrowded and understaffed institutions in this country.

Both scientific evidence and popular media point to the fact that sexual activity takes place behind bars. Last year the CDC published in the Morbidity and Mortality Weekly Report a study that documented seroconversion during incarceration. Those who became HIV-infected were 8 to 10 times as likely as likely to report engaging in male-to-male sexual activity while in prison than those who did not.

The prevalence of known HIV among prisoners is extremely high, 5 to 7 times that of the general population. The very behaviors that put people at risk for HIV infection—injection drug use and sex work—are also behaviors that can lead to incarceration. In the United States, approximately one in four persons with HIV infection passes through a jail or prison each year, and many of those do not know they are infected. Therefore, a considerable number of HIV-infected inmates may unwittingly transmit their infection to others.

Where Are Condoms Provided?
Condoms are provided to inmates in county jails in Los Angeles, San Francisco, Washington, D.C., Philadelphia and New York, and in the state prisons in Vermont and Mississippi. The manner in which condoms are made available varies widely, and most reach only a small subset of the inmate population.

In Los Angeles, the Center for Health Justice distributes free condoms to a segregated gay male population only, one condom per week per inmate, a limit imposed by the Los Angeles Sheriff’s Department.

San Francisco’s Forensic AIDS Project (part of the Department of Public Health) distributes condoms upon request through its public health nurses in one-on-one health counseling sessions, one per person, per request, and upon release. Earlier this year the Center for Health Justice in San Francisco installed a condom dispensing machine—a vending machine set to require no payment—in a gym to which 800 inmates have access. About 70 condoms per week are taken from the machine.

In Washington, D.C., inmates in the D.C. jail system have access to free condoms during health education classes, voluntary HIV pretest or posttest counseling, or upon request to members of the health care staff. The jail’s health educator and staff of a community-based AIDS service provider distribute about 200 condoms to inmates each month.

In Philadelphia, inmates can get condoms from the medical services department or through the commissary.

Two Pilot Programs in California

The Los Angeles County Jail Model
The Los Angeles condom access program was the result of a unique set of circumstances: A new custody chief—who had just been promoted from medical services—approached the Center for Health Justice about the possibility of designing a program that could provide gay male inmates in dormitory-style housing units with access to condoms without involving custody staff or time.

The program today exists as it did when implemented: Once a week a health educator from the Center for Health Justice goes into each dorm, provides a brief, interactive HIV education session, explains the rules of the program (including that sex is still illegal in jail under California law and that the condoms are not to leave the dorm or they will be considered contraband) and hands one condom to each inmate who lines up to receive one.

Although the average has changed over time, the Center for Health Justice currently distributes about 120 condoms per week to the 300+ inmates in this unit.

To evaluate this program, 101 of the approximately 300 inmates who live in the unit for segregated gay males were asked a series of questions through a computer-assisted self-interview program. Although the formal data analysis has not been completed, interesting statistics compiled so far include that 93% of respondents were aware of the condom program and 82% had received at least one condom from the program. Fifty-three percent of respondents reported anal sex during the past 30 days—but despite access to condoms, 75% of those individuals said it was unprotected. The three top reasons for not using condoms were (1) my partner and I are both HIV negative (or positive), (2) I ran out of condoms and (3) I don’t like the way condoms feel.

Information was gathered about other methods of condom access: 66% preferred the current method of distribution; other methods of distribution cited were medical (41%), vending (10%) or canteen (8%).

Charles R. Drew University’s Nina Harawa, PhD, MPH, and the Center for Health Justice (with funding from the Institute for Community Health Research, itself funded by the California HIV/AIDS Research Program) are evaluating the pilot program to determine whether it is reducing sexual risk activity. The results of this evaluation will be finalized and published during the coming year, but they support the assertion that some risk-reduction is achieved in this population through access to condoms.

The San Francisco County Jail Model
In San Francisco, the Center for AIDS Prevention Studies and Olga Grinstead, PhD, MPH, are conducting research on a novel way to provide inmates with access to condoms that has been successful in other countries.

As mentioned above, in San Francisco, inmates have had access to condoms since 1987 through the Forensic AIDS Project. In the fall of 2006, the Center for Health Justice, Dr. Grinstead and the Forensic AIDS Project approached the sheriff of San Francisco about installing a condom dispensing machine, in part because of reports from Forensic AIDS Project staff that the demographic characteristics of the health educator seemed to influence whether a inmate being counseled took a condom. The Center for Health Justice sought to evaluate a method of providing access to condoms that is more anonymous as well as less staff-intensive.

The dispensing machine program and its pilot feasibility are being conducted by the Center for Health Justice in collaboration with the Forensic AIDS Project. The machine was installed in April 2007 in a gym to which 800 inmates have access every week for their three hours of recreation. Sheriff Michael Hennessey himself, to provide a large number of inmates with access to the machine, suggested the precise location.

Before the machine was installed, brief written surveys were conducted with inmates to elicit baseline information about their HIV status, knowledge of the existing condom program and risk behavior. Interviews were conducted with sheriff’s department staff to assess attitudes about condom access for inmates and to determine potential security concerns. Center for Health Justice staff also made presentations to all deputy staff and inmates affected by the program before the machine was installed. The same written survey and similar interviews were conducted after the machine was operational for four months.

The machine itself is a low-profile, tamper-resistant unit, designed to withstand break-in attempts. It dispenses condoms in a cellophane-wrapped paper box. Inside the box the condoms are enclosed in another cellophane wrapper. The “Condom Machine Rules” posted next to the machine indicate that condoms are to be removed from the box and carried only in the clear wrapper, with the condom inside visible.

During the study period the Center for Health Justice has successfully installed, stocked and maintained the condom machine. Data analyses of the pre- and post-surveys and interviews are currently underway. Preliminary data analyses indicate that inmate self-report of sexual activity did not increase during the study period. In addition, the custody staff have reported no increase in reported sexual activity or any other security problems related to increased condom access.

We have encountered few operational problems, the most notable falling on the staff restocking the machine: The machine was difficult to open and close for restocking and sometimes jammed. A new model of machine has been purchased to address these problems.

Condoms Coming Soon to a Facility Near You?
While controversial, there is a trend toward increased inmate access to condoms. The CDC now recommends that prison systems with existing condom distribution programs evaluate those programs, and those without such programs consider the feasibility of implementing them.

Gov. Schwarzenegger’s “friendly” veto of legislation requiring inmate access to condoms may result in a pilot project across the state. At the federal level, California Rep. Barbara Lee’s JUSTICE Act of 2007 (H.R. 178), modeled on the California bill, requires federal prisoners to have access to condoms. Even where legislation is not pending, jails and prisons are considering the issue.

Regardless, programs that involve corrections cannot be successful without the support of the administration of corrections systems. The best circumstances for risk reduction involve input at the development stage, and any success these programs have is a credit to the professionalism of the corrections staff in the facilities where they exist.

— About the author: Mary Sylla, JD, MPH, is the director of policy and advocacy at the Center for Health Justice, based in West Hollywood and Larkspur, CA; http://healthjustice.net. This article is a written version of a presentation given at the National Conference on Correctional Health Care in Nashville on Oct. 17, 2007. It is a slightly abridged version of an article that appeared in the October-November issue of IDCR.

[This article first appeared in the Fall 2007 issue of CorrectCare.]