'How did we get here?' (The Washington Blade) 03/20/09
City Aims To Step Up HIV Battle (WaPo) 03/20/09
Condom Sense (Editorial, WaPo) 03/19/09
Tax Dollars for Tyrants (Metro Weekly) 03/19/09
City Says HIV Count Is Likely Too Low (WaPo) 03/17/09
HIV/AIDS Rate in D.C. Hits 3% (WaPo) 03/15/09
Dr. Phil (MW) 02/05/09
Early Testing Is Vital (WaPo) 12/09/08
Test Obstacles (Editorial, WaPo) 12/06/08
Guideline Urges HIV Tests for All Patients 13 and Older (WaPo) 12/01/08
Many People Disregard Advice to Get HIV Tests, Studies Show (WaPo) 11/21/08
HIV tests not yet as routine as cholesterol checks (AP) 11/20/08
Summersgill: mandatory HIV testing bill "seriously flawed"Testimony submitted for the record by Bob Summersgill on the
"Mandatory HIV Testing and Educational Services for Inmates and
Committed Youth Amendment Act of 2009," Bill 18-75
To the Committee on Public Safety and the Judiciary, July 1, 2009
The “Mandatory HIV Testing and Educational Services for Inmates and Committed Youth Amendment Act of 2009,” Bill 18-75, is seriously flawed in that it relies on the HIV Testing of Certain Criminal Offenders Act of 1995, (D.C. Law 11-74, D.C. Official Code § 22-3901), which fails to help the victims of sexual assault and adds to the stigma of HIV and AIDS. The bill would be improved by repealing § 22-3901; establishing a comprehensive medical care for inmates with appropriate treatment, care, and counseling.
Comprehensive Medical Care for Inmates
As the District takes on responsibility for the health and welfare of inmates, we must also provide all of their medical care. The District has recently moved to universal health care coverage, and that must include inmates. HIV testing should be a part of a standard intake medical examination for people who are incarcerated in the District. It should be included with cholesterol, hepatitis, hyper-tension testing, and depression testing and screening to name a few.
Missing from the Code is what medical care will be made available to inmates. While alcohol and drug addiction are specifically addressed in Title 24, there is a general lack of requirements for the care and treatment of inmates.
§ 7-131, “Regulations to prevent spread of communicable diseases” provides the guidance on preventing the spread of HIV as well as the confidentiality that should be maintained. § 7-1605, “Confidentiality of medical records and information,” makes it explicit that the confidentiality rules in § 7-131 apply to HIV and AIDS.
Medical privacy is just as important to maintain for inmates as it is for the rest of the population, as the inmates will not be in jail forever. Violating medical confidentiality as this bill and § 22-3901 do is neither useful nor beneficial for anyone.
Helping the victim
The original HIV Testing of Certain Criminal Offenders Act of 1995 legislation was designed to let a sexual assault victim know as early as possible if his or her assailant is infected with HIV, so that the victim could get treatment sooner or be relieved of that particular worry.
Bill 18-75 fails to recognize the medical advances of the past decade. In the early 1990s, there was no effective treatment for HIV. Testing was expensive, took weeks to get results, and because it looked for anti-bodies, was unreliable for the first 3 to 6 months after infection.
Today, we have effective treatments which make HIV a long-term, manageable disease. Importantly, we also have post-exposure prophylactic drug regimens that can prevent HIV disease if taken within days after infection.
HIV-antibody tests are now cheap and quick—results are available in 20 minutes. There is also a test for the virus itself, not just the antibodies. The viral load test is a standard test to monitor disease progression. The viral load test doesn’t need 3 to 6 months to be reliable because HIV replicates rapidly after initial infection and before the body can develop antibodies.
We now have the technology to determine if a person has been infected and treatment to prevent HIV from taking hold. If intervention is too late, there is effective treatment to hold the virus in check for decades and decades with few side effects.
The bill also makes an unstated and misguided presumption that the victim was HIV negative before the assault. It is estimated that 1 in 4 people in the U.S. with HIV are unaware that they have HIV and 5% of people in D..C. are infected with HIV. The victim needs information on what is going on in his or her own body, not what is in the assailant’s body.
To help the victims, the appropriate response is to provide free post-exposure prophylactic drugs, counseling, and viral-load testing until it is clear that the patient either has not been infected, or if he or she has been infected, started on a regular treatment program. Morning-after pregnancy prevention drugs and other appropriate interventions should also be available in addition to counseling and follow up that the victims may need. Most, if not all of this is already provided under D.C. Code Title 7, Chapter 21A, “Victims of Sexual Assault Emergency Care.”
Unnecessarily stigmatizes HIV
The original 1995 legislation and today’s bill both make the same error in singling out HIV disease for special consideration. Both treat HIV as something unique and sufficiently onerous that it be handled unlike any other communicable disease.
Hepatitis C is transmitted in the same ways, has less effective treatments, and is quite deadly but, because there is not a widespread panic about it, we treat it as a normal medical problem. HIV needs to be handled as a normal and routine public health problem, not singled out for added scrutiny and stigma.
HIV testing needs to become routine as is cholesterol testing if we are going to reduce the number of people infected with HIV but don’t know it. Both bill 18-75 and the 1995 law (DC Code Title 22, Chapter 39) exacerbate the problem by treating HIV as something different requiring different laws and different medical interventions. This is not a medically sound policy. Rather it is just AIDS panic.
Addressing Needs without Panic
The Council should take advantage of the opportunity that this bill presents to write new law to provide for the health of inmates and subsequently their families and communities when they return.
This bill does little to address the health of inmates or the community. If the intent is to address prisoners and their treatment, then it should be in Title 24, “Prisoners and Their Treatment,” and not as it is in Title 22, “Criminal Offenses and Penalties.” HIV testing should simply be routine and standard. It should not be punitive or mandatory.
A new section on medical care for prisoners would be consistent with the District’s goal of universal health care. It could provide vaccinations that have been missed. It could provide routine depression and other mental illness screening. It could provide information on preventative care that many people in our city overlook. And of course it could provide HIV testing, treatment, and counseling as needed.
To help sexual assault victims, we need to offer a range of testing and post-exposure prophylactics in addition to the other counseling and follow up that the victims may need. To fight the spread of HIV, we need—in part—to reduce stigma and promote routine testing. To help inmates, their families, and their community we need comprehensive health care in our jails.
I recommend that the Committee amend the bill to delete Title 22 Chapter 39 from the Code and adopt new health care law for inmates in Title 24.
Thank you for your consideration of my comments and the opportunity to testify on this bill.