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Sex workers across the world are a vulnerable population. Because of poverty, abuse and discrimination, sex work is often critical to survival for many cisgender and transgender women and LGBT young people, especially those who are homeless. In the United States, transgender women engage in sex work at ten times the rate of cisgender women.

Sex workers bear a disproportionate burden of HIV. The difficulty in reducing HIV disparities among sex workers further heightened by the interact of multiple afflictions including incarceration, mental health problems, substance use, trauma, poverty, and stigma and discrimination rooted in sexism, transphobia, and/or homophobia. These afflictions interact with each other and potentiate the HIV epidemic among sex workers. The complex nature of interacting afflictions requires going beyond behavioral and biomedical approaches that focus on individual-level risk factors and necessitates addressing the syndemic effects of social and structural factors among sex worker. A syndemic is “two or more afflictions, interacting synergistically, contributing to excess burden of disease in a population.”

Among the multiple afflictions that sex workers face, encounters with the criminal justice   system from arrest to incarceration present one of the greatest structural barriers that limit access health service access and undermine effective HIV responses for sex workers. Recent research suggest that decriminalization of sex work could have the largest impact on the HIV epidemic among sex workers. One study found that decriminalization of sex work could reduce HIV infections by 33 to 46 percent over the next decade.

While I have previously written about the reasons for decriminalization of all aspects of adult consensual sex work, it is also important to recognize important criminal reforms that have the potential to protect sex workers and promote their health and well-being short of full decriminalization. Assessing and understanding the impact incremental reforms will be important for educating practitioners, policymakers, and advocates.

An example of a recent criminal reform is an Alaska immunity statute for sex workers. On July 11, 2016, Alaska Governor Bill Walker signed into law Senate Bill 91, a major criminal law intended to reduce the state’s prison population and its associated costs. The reforms introduced by SB 91 addressed a number of important issues, including expansion of diversion programs, capping prison stays for parole and probation violations, and making drug possession a misdemeanor offense. SB 91 also altered Alaska’s prostitution statute to offer immunity from prosecution if a sex worker is a victim or witnesses of certain, mostly violent, crimes and reports the crime to law enforcement.

SB 91 bars prosecution if a person witnessed or was a victim of covered crime, reported the crime to law enforcement in good faith and cooperates with law enforcement, and the evidence for a prostitution charge was obtained as a result of reporting. This provides a mechanism for sex workers to report criminal activity to law enforcement without them having to risk being prosecuted for prostitution. The immunity that SB 91 provides to sex workers is aimed at creating pathways for sex workers to report crimes and encouraging cooperation between sex workers and law enforcement.

The Alaska immunity for sex workers is limited in a number of ways. First, the SB 91 only provides immunity from prosecution for the offense of prostitution. Sex workers can still be prosecuted for other offenses and parole or probation violations. It is important to note that sex workers are regularly charged with many other offenses other than prostitution, including resisting arrest, disorderly conduct, failure to obey a police officer, and loitering. A 2015 study by the Williams Institute suggest that law enforcement target sex workers with HIV criminal laws in California, where 95% of all HIV-specific criminal incidents impacted people engaged in sex work or individuals suspected of engaging in sex work.

Second, SB91 further leaves open the door for law enforcement to arrest and charge sex workers with the offense of prostitution as immunity only applies to prosecution. Immunity also does not prevent prosecution for future acts of prostitution. Finally, in order to bar prosecution, the person needs to cooperate with law enforcement, a term that is not defined. This requirement has the potential to put sex workers in a difficult position if they are reluctant to cooperate or law enforcement perceives them as being uncooperative.

O’Neill Institute is committed to advancing the policy dialogue around the health and rights of sex workers. With support from the Elton John AIDS Foundation, we recently have established a collaborative project with Whitman-Walker Health and HIPS to explore how sex workers in DC access health care, how they interact with law enforcement, and how laws, policies, and practices designed to disrupt commercial sexual activity impede access to HIV prevention and care services. Through this project, we will investigate the impact of laws and policies on sex workers’ access to clinical care and social services and recommend potential criminal law and policy reforms to better support sex workers in Washington DC. For more information about the O’Neill Institute project, check out our webpage.

Posted in Global Health, Human Rights, National Healthcare; Tagged: , , .


Genetically Modified Mosquitoes: The Key to Eliminating Zika?

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This post was written by Laura Malavé-Seda and Rebecca Reingold.

Image courtesy of SynBioBeta

Since 2015, the U.S. and U.S. territories have reported 5,074 and 38,306 cases of Zika, respectively. The Zika virus is spread to people primarily through the bite of an infected Aedes aegypti mosquito. Most people never know that they have been infected with the virus – it is estimated that four out of five people with Zika virus infections have no symptoms at all.  Even in those who develop symptoms, the illness is usually mild and, as a result, may never be diagnosed.

There is no vaccine for Zika so prevention is key. Prevention efforts have included advising people in Zika-affected areas to eliminate mosquito breeding sites, use insect repellent, wear clothes (preferably light-colored) that cover as much of the body as possible, sleep under mosquito nets, etc. However, many countries affected by Zika have struggled to control its spread, particularly during the summer months, and are exploring new prevention methods.

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Posted in Global Health; Tagged: , , , , .


Let’s Get Physical: WHO’s Renewed Focus on Promoting Physical Activity

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In January this year, the World Health Organization (WHO) renewed its focus on physical inactivity, a key risk factor for the worldwide epidemic of non-communicable diseases (NCDs). Encouraging and creating universal opportunities for physical activity is a complex, potentially costly exercise for governments, involving a wide range of public and private actors. Fresh global attention presents both opportunities and challenges for all stakeholders, and an opportunity for WHO to provide leadership on this often-neglected NCD risk factor.

Physical inactivity is a leading risk factor for premature death

Physical inactivity is one of the leading risk factors for premature death worldwide. Lack of physical activity increases the risk of NCDs including heart disease, cancer, and type 2 diabetes. Lee et al. estimate that by reducing rates of physical inactivity by 25%, more than 1.3 million deaths could be avoided each year.  Additional benefits of physical activity include improved mental health, better cognitive function, and enhanced bone health.

High rates of physical inactivity

Globally, 23% of adults do not meet WHO’s recommended levels of physical activity. Of even greater concern, more that 80% of adolescents (11-17 years) are not sufficiently physically active.

Economic growth and urbanization, manifesting in sedentary jobs, leisure activities, and modes of transportation, often correspond with decreases in levels of physical activity. Other factors contributing to high rates of physical inactivity include air pollution and lack of safe, accessible places for recreation.

A lack of global attention (and progress) on physical inactivity

As compared to other key modifiable risk factors for NCDs (tobacco, alcohol, and unhealthy diets), physical inactivity has tended to receive less dedicated attention from the WHO, governments, and civil society.

During the first decade of the 21st century, WHO developed a range of strategies and recommendations to promote physical activity, including the Global Strategy on Diet, Physical Activity and Health (2004), a Guide for Population-Based Approaches to Increasing Levels of Physical Activity (2007), and the Global Recommendations on Physical Activity for Health (2010). More recently, global action on physical activity has been in the context of NCDs more broadly, including as part of the United Nations Political Declaration on the Prevention and Control of NCDs (2012), the Global Action Plan for the Prevention and Control of NCDs (2013), and the Sustainable Development Goals (2015).

For the most part, these global efforts to address physical inactivity have not translated into impactful national action or reductions in persistently high or increasing rates. For example, although around 80% of WHO Member States have polices and plans to address physical inactivity, only 56% of these plans are operational. The International Congress on Physical Activity and Public Health’s 2016 Bangkok Declaration on Physical Activity for Global Health and Sustainable Development identifies the “urgent need to strengthen… the development, prioritisation, financing and implementation of evidence-informed national plans to enable all countries to achieve the WHO global target for reducing physical inactivity… by 10% by 2025.” Read More

Posted in Non-communicable diseases; Tagged: , , , .


Don’t Forget the Forgotten Children

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In our turbulent and oft troubled world, with new threats to people’s rights and health coming at us quickly, whether a new epidemic or a policy against immigrants or refugees that comes with great health costs, it is too easy to forget some of the long persisting health and human rights crises, particularly those that have always seemed forgotten, hidden away. Few such crises are more horrific than the institutionalization of children.

Worldwide, up to 8 million children live (often, if barely) in orphanages, which have been dubbed “dumping grounds for poor children and those with disabilities.” Almost all of these children, more than 90%, have at least one living parent. In these orphanages, the children are often neglected, abused, and denied medical care. Even when they are treated well, children housed in these institutions experience lasting psychological damage and developmental delays. They are simply no place for children. Yet, once placed in an institution, they will often never know life outside of its cold confines.

In Ukraine, for example, where “orphanages are a gateway to lifelong institutionalization in abusive adult facilities” – still more the rule rather than an exception around the world – abuse is rife. As Disability Rights International reported in 2015, “Children with disabilities are…often relegated to the most barren and filthy sections of institutions, left without activities, stimulation or human contact. Many children are left in physical restraints or kept in beds and cribs where their arms and legs atrophy from disuse….children are subject to beatings, rape, and other forms of routine violence.”

The complete loss of liberty, the total control over their lives by the institution (and at times legal guardianship by the state or institution), and the abuse of these children, make their institutionalization akin to slavery, effectively the property of the institution. Even if not legally owned by state or institution, for these children, that is a distinction without a difference. And sometimes, as with slavery, the children are forced into labor. In Ukraine, forced labor among institutionalized children is common, including of the most exploitive sort: sex trafficking, pornography, and sale of bodily organs. One former orphanage resident related: “In Andrey-Ivanovo institution the children were forced to work in the field from 6 am to 6 pm. Sometimes staff members took children home to help in the house and in the fields.” Read More

Posted in Global Health, Human Rights; Tagged: , , , , , , , , .


O’Neill Institute Event this Thursday February 23rd on Georgetown University’s Main Campus

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This post was written by Anita Alvin Nilert, Art Dialogues Curator, please direct any questions or comments to an435@georgetown.edu.

DIALOGUES ON BEING HUMAN: Intersections of Art, Health and Dignity with artist Jesse Krimes in dialogue with Marc Howard of the Prison and Justice Initiative moderated by Alicia Ely Yamin, Director of the Health and Human Rights Initiative.

Jesse Krimes with his work Apokaluptein 1638067 (The title combines the Greek root of the word “apocalypse,” or “redemption,” and Krimes’ Federal Bureau of Prisons ID number) a 15 foot high x 40 foot wide, 39-panel mural on prison bed sheets, created over 3 years, smuggled out, and pieced together when he was released.

Artist Jesse Krimes conveys the dehumanizing experience of incarceration through his compelling body of artwork clandestinely produced over 6 years on the inside while doing time for a non-violent drug offense. Saying that he only survived his odyssey through the criminal justice system by producing art every day, the work embodies themes of alienation, purification, redemption, social stratification and power. Awaiting sentencing in a 23 hour maximum security lock down for one year, he created 292 separate portraits, mostly of offenders, on slivers of prison-issued bars of soap. Then while serving a 70 month sentence, he created a 39-panel mural illustrating heaven, hell and purgatory using contraband prison sheets, hair gel, plastic spoons, and newspaper clippings, that he smuggled out in the mail. Mr. Krimes jail-made art work and compelling story embody issues of prison reform, sentencing and social justice.

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Posted in Human Rights; Tagged: , , , , , .


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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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