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Saturday, December 16, 2017

BEYOND AIDS LEADERS FOR 2018, 2019

In its biennial election on November 19, 2017, Beyond AIDS selected the following officers and directors to serve during 2018 and 2019:

President:  Ronald P. Hattis, MD, MPH (California)
Vice-Pres:  Jeffrey Klausner, MD, MPH (California)
Secretary
Gary A. Richwald (California)
Treasurer:  Richel Strydom, MD, MPH (California)
Directors
Franklyn N. Judson, MD (Colorado)
                   Elizabeth Kidder, MD, MPH (Washington, DC)
                   Deanna C. Stover, PhD, FNP (California)
                   Monica M. Sweeney, MD, MPH (New York)

Past-Pres.: Cary Savitch, MD (California)


The Advisory Council will consist of:

Denise Bleak, MSN, PHN (California)
I. Jean Davis, PA, DC (California)

Josileide Gaio, MPH (California)
Peter Kerndt, MD, MPH (California)
Marsha Martin, DSW (Washington, DC)
Cesar Reis, MD, fellow (California)                             

The subsidiary Beyond AIDS Foundation, a 501(c)3 charitable corporation, will be governed by the following Board (elected by the membership of Beyond AIDS):

President:   Gary Richwald, MD, MPH (California)
Vice-Pres.:  Monica M. Sweeney, MD, MPH (New York)

Secretary:   Ronald P. Hattis, MD, MPH (California)
Treasurer:   Richel Strydom, MD, MPH (California)
Directors:   
Franklyn N. Judson, MD, MPH (Colorado)
                     Elizabeth Kidder, MD, PhD, MPH (Washington, DC)

                     Jeffrey Klausner, MD, MPH (California)
  Cary Savitch, MD (California)                                                                                                 Deanna C. Stover, PhD, FNP (California) 
                                   
The Scientific Committee is assigned by Beyond AIDS  to work with the Foundation. Members, as of November 2017:


Franklyn N. Judson, MD, MPH (Colorado) and
Monica M. Sweeney, MD, MPH (New York), Co-Chairs
I. Jean Davis-Hatcher, PhD, PA, DC (California)
Ronald P. Hattis, MD, MPH (California)
Elizabeth Kidder, MD, PhD, MPH (Washington, DC)
Peter Kerndt, MD, MPH (Mozambique)
Jeffrey Klausner, MD, MPH (California)
Gary A. Richwald, MD, MPH (California)
Cary Savitch, MD (California)
Colin Shepherd, MD (China)
Deanna C. Stover, PhD, FNP (California)

The memberships of this and other committees are subject to change and available on request.

BRIEF BIOGRAPHIES OF BOARD MEMBERS OF BEYOND AIDS, 2016/2017

RONALD P. HATTIS, MD, MPH, President

Ron Hattis is continuing as President of Beyond AIDS, and Secretary of our subsidiary tax-deductible Foundation.  When the organization was founded, he was the first Vice-President, and later but before his current offices served as Secretary, as well as President of the Foundation. He has been active in contacts with federal leaders, and in Beyond AIDS' legislative efforts in California, and has represented our organization in consultations with the California Office of AIDS. He developed the original Bylaws for both the membership organization and the foundation, and has mentored many of our past interns.  

He is a physician, board-certified in Public Health/Preventive Medicine, and lives in Redlands, California.  He was formerly the Chief of Medical Services at a large state hospital, where in addition to medical management, he was in charge of HIV testing and training HIV educators for 20 years, and he treated HIV/AIDS patients at the infectious disease clinic.  Since retiring from that position, he has worked part-time in clinical medicine, currently including student health and primary care. He has been an HIV clinician/specialist. 
Dr. Hattis is an Associate Professor of Preventive Medicine Loma Linda University School of Medicine, where he has lectured on HIV as a representative of our Foundation.  He spent 23 years with a disaster medical assistance team, serving at the World Trade Center, Hurricane Katrina, Hurricane Ike, and the Northridge earthquake.

Other past positions in reverse order have included teacher of family medicine, county health officer, country family physician (on Kauai in Hawaii), and Epidemic Intelligence Service Officer for the Centers for Disease Control and Prevention (assigned through field services to the Hawaii Department of Health).  

His goals for Beyond AIDS over the next two years include completing research and continuing to develop proposals for more effective implementation of the National HIV/AIDS Strategy; and continuing to be involved with legislation in California and important states, as well as at the federal level. In particular, he plans to continue to work to promote the HIV care continuum; to utilize HIV reporting to trigger outreach for referral of patients to treatment, partner services, and other services to prevent transmission; and to enhance HIV prevention science. 


JEFFREY D. KLAUSNER, MD, MPH, Vice-President
Jeffrey D. Klausner is a UCLA Professor of Medicine and Public Health. He is a physician, board certified in Internal Medicine and Infectious Diseases. He served as a CDC Epidemic Intelligence Service Officer 1995-1997, Deputy Health Officer and Director of STD Prevention and Control Services, San Francisco Department of Public Health, 1998-2009, and Branch Chief for HIV and TB, CDC South Africa, 2009-2011. 

Dr. Klausner has been a leader in implementing the public health approach to HIV prevention and control through policy and programmatic activites resulting in the streamlining and evaluation of routine HIV testing, early HIV case detection with HIV RNA screening, linkage-to-care and contact tracing and partner notification services.  In addition Dr. Klausner through his epidemiologic research, identified the role that bacterial STDs, the Internet, sex clubs, methamphetamine and Viagra played in augmenting the risk of HIV tranmission and implemented successful population-based programs to mitigate those risk factors. In collaboration with community leaders and organizations, he inititated sexual health campaigns and peer-led sexual health services for sex workers and gay men in San Francisco which have been replicated globally. 

Dr. Klausner has been conducting research in laboratory-based diagnostics for HIV infection and other STDs since the early 1990s and is considered an expert in infectious disease detection and management. He has a busy clinical HIV/AIDS practice in Los Angeles and regularly attends on the infectious diseases consultation service at UCLA Ronald Reagan Hospital.  Dr. Klausner brings nearly two decades of public health, clinical and research experience to the Board, much of it specific to HIV prevention. 


DEANNA STOVER, PHD, RN, FNP, CNS, COHN-S, Director

Deanna Stover is the Chief Executive Officer of the Community Health Association Inland Southern Region. She began her nursing career in 1979 as a medic serving in the United States Air Force. She earned her MSN/FNP degree in 1997 and a PhD in Nursing, Health Policy from Loma Linda University in 2011. She has held leadership positions in both hospital and ambulatory / outpatient health care environments.

She has actively worked in the medical arena for over 30 years with training and expertise in community-based health care, health policy, HIV/AIDS health care, occupational medicine and nursing, and advance practice nursing as a family nurse practitioner and clinical nurse specialist. She holds a certificate as an Advanced HIV Nurse Clinician from USC Medical Center, AIDS education training center (1995) and has provided HIV/AIDS training for healthcare providers. She is an adjunct professor for the Department of Nursing at California State University, San Bernardino.

She has served on organizational Board of Directors at the state, local, and national  levels, including immediate past-president of the Beyond AIDS Foundation, and Secretary of Beyond AIDS


GARY A. RICHWALD, MD, MPH, Secretary

Gary Richwald received his engineering degree from Cornell University, medical degree from the Mount Sinai School of Medicine in New York City, and Master's in Public Health (MPH) in health services research/epidemiology from UCLA. He completed his specialty/subspecialty training in internal medicine, geriatrics, and preventive medicine at the University of Michigan and UCLA. He was a Robert Wood Johnson Foundation Scholar at UCLA/RAND in health policy services research.

From 1981 to 1989, Dr. Richwald was a full-time faculty member at UCLA in the Schools of Public Health/Medicine, and subsequently served as Director and Chief Physician, L.A. County Sexually Transmitted Disease Program (1989-2000). He has been a consultant on STD policy and clinical care for the AME, American Sexual Health Association (ASHA), and CDC. He chaired the California STD Control Association for 3 terms, and was a founding member, National Coalition of STD Directors. He has worked with GSK, Novartis, Abbott, Merck, 3M Pharmaceuticals, and Focus Technologies/Quest Diagnostics in the development of STD-related health care technology.  
 
STRYDOM, MD, MPH, Treasurer

Richel Strydom, MD, MPH, the current Beyond AIDS, Inc. and Beyond AIDS Foundation Treasurer,  is presently a third year Loma Linda University (Loma Linda, CA) Preventive Medicine Resident Physician.  Prior to beginning her current Preventive Medicine Residency Training, Richel obtained a Masters degree in Public Health, with a Global Health Concentration, at the Loma Linda University School of Public Health.  Prior to her MPH studies, Richel completed a couple of years of Family Medicine Residency Training, in Tallahassee, FL.

Dr. Strydom was born and raised in the country of South Africa.  The HIV burden of the South African population, as well as the HIV burden within many African and other countries, including within the U.S.A., have contributed to a strong, persistent public health problem.  In July 2016, shortly following the June 2016 launch of   the “Test and Treat” HIV care approach in Lesotho, the first country in sub-Saharan Africa to formally adopt this strategy recommended by UNAIDS in 2015, Richel had the privilege of attending a briefing on the new program while doing a rotation in HIV and Tuberculosis care and prevention, at Maluti Adventist Hospital, in Lesotho. 

While a Family Medicine Resident in training, in Tallahassee, FL, Richel worked as a volunteer to provide education and comprehensive support to people who are living with HIV, within an eight-county area of Florida. Earlier, while attending medical school at the American University of the Caribbean School of Medicine, she worked with students and faculty members to actively promote knowledge about, and the prevention of, HIV and STIs. Prior to that, while attending North Carolina State University, she worked with the Alliance of AIDS Services – Carolinas (AASC) as a volunteer “care partner” for a young woman living with HIV. 

Richel feels compelled to work to improve HIV care and prevention policies and practices. Serving with Beyond AIDS furthers that aim.


FRANKLYN N. JUDSON, MD, MPH, Director 
 
Frank Judson received his BA from Wesleyan University in 1964, his MD from the University of Pennsylvania in 1968, and his house staff training from the University of Wisconsin Hospitals (internal medicine) and the University of Colorado (infectious diseases).  He was an Epidemic Intelligence Service officer with the Centers for Disease Control assigned to the Colorado Department of Public Health  (1970-72), and Scientific Liaison, Global Program on AIDS, Geneva (1990 -91).  He is board-certified in internal medicine, infectious diseases and preventive medicine. 

For over 41 years, his research interests have concentrated on the epidemiology and control of sexually transmitted infections including hepatitis B and HIV.  His public health policy interests have run the gamut from childhood and adolescent vaccine programs, to urban air pollution, bioterrorism preparedness, and tobacco, tuberculosis, influenza, and HIV prevention and control.  He has authored or co-authored more than 270 scientific publications.  

Dr. Judson has served as President of the American STD Association (ASTDA), President of the International Society for STD Research (ISSTDR), President of the International Union Against the Sexually Transmitted Infections (IUSTI), Chairman of the Board of the American Social Health Association (ASHA), Chief of Infectious Diseases for the Denver Health Medical Center (1983-2002), and Director of the Denver Public Health Department (1986-2004). He has been a member of the Presidential Advisory Council on HIV/AIDS (PACHA), the CDC/HHS Advisory Committee on Immunization Practices (ACIP), the Board of Regents of the American College of Preventive Medicine, and the Colorado State Board of Health. Currently, he is a member of the Colorado Governor’s Expert Emergency Epidemic Response Committee (GEEERC) and Professor, Department of Medicine (Infectious Diseases) and the Colorado School of Public Health, University of Colorado, Denver. 

ELIZABETH (BETSY) KIDDER, MD, PhD, MPH, Director
Elizabeth (Betsy) Kidder, MD, PhD, MPH received her Master's in Public Health, Medical Degree, and PhD in Public Policy and Health Policy from the George Washington University. She completed her residency in Internal Medicine and Primary Care program at the George Washington University Hospital.  Her career and research interests focus on access to quality health care by underserved communities, improving access to addiction treatment, and implementing innovative and patient-centered cancer screening options.  Her dissertation research investigated self-administered HPV testing as a cervical cancer screening option for underscreened women.

Betsy joined Beyond AIDS in 2001 as an intern, and has served as a Board member since 2003. She received her Master's in Public Health in 2004 and her Medical Degree in 2011, both from the George Washington University. She also completed a doctorate there in health policy.

As a public health professional, she has worked in Rome, Italy with the United Nations on the development team for the "Initiative to End Child Hunger" - a collaboration between the World Bank, the United Nations Children's Fund, and the World Food Program. Previous to that, she worked with the Global Health Council in Washington, DC on issues related to HIV/AIDS and child health, as a part of a national PBS media and outreach campaign in global health. She has also worked at the Department of Defense's HIV/AIDS Prevention Program as well as the Futures Group, where she assisted with the research and writing of a "What Works" program guide for developing country policymakers on evidence-based practices in HIV/AIDS/STI prevention. 

Her interest in issues related to HIV was initially sparked by the case of Nushawn Williams, a young man who knowingly spread HIV in her small hometown community and high school. After that incident, she traveled to South Africa, where she studied the epidemic in the Eastern Cape, taught an HIV/AIDS education class, and volunteered in a pediatric HIV clinic, all of which deepened her commitment to staying involved with HIV advocacy through her career.



MONICA SWEENEY, MD, MPH, Director

Monica Sweeney is Vice Dean for Global Engagement and Chair, Dept. Health Policy and Management, School of Public Health, State University of New York (SUNY) Downstate Medical Center.  Additionally, she is the chair of the SUNY Downstate Medical Center's Association of Council Members and College Trustees.
Before that, she was the Assistant Commissioner of Health for New York City. Previously, for six years, she was in charge of the NYC Bureau of HIV/AIDS Prevention and Control. Her responsibilities there included oversight of programs and budgets for prevention; care and treatment (Ryan White); Housing Opportunities for People With AIDS (HOPWA); and the epidemiology/Field Services Unit. 

Previously, she was the medical director and vice president for medical affairs in a Federally Qualified Health Center in Bedford Stuyvesant, Brooklyn NY.  The community served was medically and economically deprived and HIV/AIDS was one of many challenges she addressed daily during her 17 years in Bedford Stuyvesant.  During her tenure there, in addition to direct patient care, she became involved in policy and advocacy and had the opportunity to work with Assemblywoman Nettie Mayersohn to get her historic legislation (the Baby AIDS Bill, and Named-based Reporting) passed -- over almost insurmountable opposition.

Dr. Sweeney is a board-certified internist and geriatrician with a masters degree in public health.  She has always combined individual and public health in her practice, by working with the Medical Society for the State of New York (MSSNY), the National Association of Community Health Centers (NACHC), and the American College of Physicians (ACP) and by serving on the President’s Advisory Council on HIV/AIDS (PACHA).  Prior to election to the position of Vice-President, she was a Director on the Beyond AIDS Board, and before that she served on the Advisory Council. Her goals as Vice-President include working diligently to broaden the reach of the only AIDS organization that has always used sound public health policy to fight the epidemic.


CARY SAVITCH, MD, Immediate Past-President

Cary Savitch was one of the Founding Members of Beyond AIDS, organized its founding meetings, and was elected its first President. He has served on the Board of Directors since the founding of the organization.  He recruited many of the early members of the organization by speaking to friends, colleagues, and patients about the need for HIV reform, writing a book about the subject, and giving talks on HIV, especially in Ventura County and the surrounding area where the founding meetings were held. 
He is an infectious disease physician, and has taken care of AIDS patients for the past 33 years (starting even before the disease had a name). 

In 1997, he published a book, “The Nutcracker is Already Dancing,” which highlighted the lack of application to HIV of sound public health practices that had been successfully utilized for diseases such as syphilis and tuberculosis. He believes strongly that the mission of Beyond AIDS, to stop the transmission of HIV, is the direction we must take in order to save lives in this epidemic.

He expresses pride in the time he has already spent with Beyond AIDS, which he believes is the only organization willing to stand up and support the necessary public health policies needed to contain HIV. His goals are to continue these efforts in every and any capacity needed, and to encourage others to join our battle for HIV/AIDS prevention.

Wednesday, June 07, 2017

BEYOND AIDS POSITION, HIV EXPOSURE PENALTIES; CA SB 239

The following letter to California Governor Jerry Brown outlines the Beyond AIDS position on this controversial issue. Against the opposition of Beyond AIDS, the bill was signed into law.




September 15, 2017

Hon. Governor Edmund “Jerry” G. Brown
Office of the Governor, Suite 1173, California State Capitol
Sacramento, CA 95814
Fax: 916-558-3160 (5 pages)

RE: REQUEST VETO OF SB 239 (WIENER); COSTS AND RISKS TO STATE

Dear Governor Brown:

Beyond AIDS, an organization dedicated to reversing the course of the HIV epidemic through sound public health policy, urges that you veto SB 239 (Wiener). This bill will endanger public health and safety and risk excessive costs to the state. The AIDS groups in support, who like the repeal of penalties that only apply to HIV-infected individuals, have paid no heed to the public health implications and how they would endanger the state’s population. Beyond AIDS is unique among AIDS-related organizations in that it prioritizes public health.

SPONSORS REFUSED TO COMPROMISE WITH CONCERNED PUBLIC HEALTH OPPONENTS; BILL REPEALS ALL PENALTIES FOR WILLFUL EXPOSURE TO ANY COMMUNICABLE DISEASE

On Wednesday, August 16, a conference call was held with the sponsors of SB 239 and some of the opponents, including the California Academy of Preventive Medicine. Our organizations approached this meeting with a very reasonable compromise proposal, making many concessions, including agreeing to the repeal of all current felony penalties and of all current penalties specific to HIV. The sole thing we held out for, in the interests of protecting the public against not only HIV but also many other communicable diseases affecting public health, was to retain an existing misdemeanor penalty in the Health and Safety Code (Section 120290) for willful exposure to a communicable disease. SB 239 abolishes this, along with all lthe other penalties, in effect throwing out the baby with the bathwater. We offered to soften the wording of that section to make it more specific and scientific, exempting cases in which the exposed person was informed and consented, or where precautions against transmission were taken Alternatively, other wording was offered to accomplish essentially the same thing. The sponsors would not compromise even to change a single word, leaving no choice other than to oppose the bill.

HSC 120029 applies to any communicable disease, not just HIV. It is necessary to retain this in state law, to maintain clout to control the future spread of Ebola virus, deadly new strains of influenza, SARS, and future emerging contagious diseases.

FINANCIAL COSTS TO THE STATE AND COUNTIES

The wording in SB 239 substituting for existing law fails to provide a disincentive to irresponsible, willful or negligent behavior that endangers unknowingly exposed persons to any communicable disease. As a result, it subjects the state to significant financial liability.

Let us take HIV not as the sole infection, but as an example. The bill removes all deterrents to reckless and unsafe behavior exposing others to HIV.  Some additional cases of HIV infection are bound to result, and each one carries an estimated lifetime cost for persons who become HIV infected at age 35 is $326,500 (60% for antiretroviral medications, 15% for other medications, 25% non-drug costs). For individuals who remain uninfected but at high risk for infection, the discounted lifetime cost estimate is $96,700. (Reference: Med Care. 2015 Apr; 53(4): 293–301, full text readable online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4359630/.) For younger patients, the costs are greater because they live longer with the virus; for untreated patients who develop AIDS and require hospitalization, the cost can be millions.

For each patient on regular Medi-Cal, 50% of this cost will be borne by the state. For expanded Medi-Cal, state costs are currently less, but will greatly increase if any Republican health reform legislation is passed. In addition to direct state costs, the county hospitals will be taxed with huge expenses for HIV treatment of uninsured patients.

The state is also fully responsible for 100% of treatment costs for incarcerated persons in state prisons and in state hospitals, who are particularly likely to willfully expose others to HIV or another communicable disease, unless there is a deterrent penalty such as an extension of incarceration.

In addition, public health data show that each person infected by a person not deterred by the weakened law will, on average, spread the infection to others. The current transmission rate is 5%/year, with an average life expectancy of over 20 years, so the epidemic will tend to get worse and worse as a result of this bill. (Reference: Public Health Rep. 2010 May-Jun; 125(3): 372–376, full text readable online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848261/) Of course, each new case will incur the same treatment costs as above, multiplying the expense to the state and the danger to the public.

Additional potential state costs may result from this bill. It eliminates the requirement for HIV testing and education of two extremely high-risk groups, drug users in diversion programs, and persons convicted of prostitution. These programs are effective, and their elimination can be predicted to result in more new cases of HIV, as well as more transmission by those who are already infected but may not know it. We recommended retention of these programs, but the sponsors refused to do so.

THE FALLACY OF “HIV CRIMINALIZATION” AND STIGMA

In recent years, a virtual ideology has arisen in the name of “decriminalization of HIV.” We believe that this way of thinking is dangerously erroneous, and regret that it seems to have persuaded a number of well-intentioned organizations to support this bill as well as periodic initiatives in other states.
Thus, shooting blindly into a crowd is illegal, but this does not “criminalize” gun ownership or serve as a disincentive to it. Similarly, dangerous acts in a vehicle such as driving a car into a crowd of pedestrians, or negligently running someone over, are illegal, but that does not “criminalize” or serve as a disincentive to driving, car ownership, or obtaining a driver’s license. A similar analogy is that driving under the influence of alcohol is illegal, but that does not “criminalize or serve as a disincentive to drinking.

Similarly, behaving in a dangerous manner that exposes others to a significant risk of communicable diseases, including but not limited to HIV infection, should be illegal, and does not “criminalize” those diseases (including HIV) or serve as a disincentive to being tested. The same organizations now supporting SB 239 once fought against our campaign for reporting of HIV infections to public health. They claimed that this would reduce HIV testing, but in fact, testing increased after this, and today’s National HIV/AIDS Strategy relies on testing, reporting, and outreach to those testing positive to link them to treatment.

Another invalid argument against penalties for dangerous behavior exposing others to HIV is that they somehow add to the stigma of HIV, or of minorities that have higher HIV prevalence rates. The opposite is more likely and logical, i.e., people with HIV, gay men, etc. should be less subject to stigma as a source of danger, if it can be noted that they are unlikely to endanger others since there would be penalties for that.

THERE IS NO VALID SCIENTIFIC EVIDENCE TO SUPPORT THE SPONSORS’ CLAIMS

The sponsors claim that having criminal penalties for egregious behavior that threatens to spread HIV and other communicable diseases does not reduce the incidence of those diseases. However, there is no evidence for that claim. The most recent article cited by the sponsors is by Sweeney et al. in the journal AIDS in June of this year. (http://journals.lww.com/aidsonline/Citation/2017/06190/Association_of_HIV_diagnosis_rates_and_laws.15.aspx). It found that states that 30 states that have laws criminalizing HIV exposure do not have lower HIV diagnosis rates. However, we would expect that the states with higher rates would have been more prone to adopting such laws, and that states with high rates would do more testing and therefore find more cases. So the fact that these states do not have higher rates could in fact be cited as evidence of effectiveness, not ineffectiveness. Most other articles in the literature on this subject are just emotional and ideological essays, or scattered anecdotal examples of miscarriages of justice in places like Zimbabwe.

THE SPONSORS CONCEDE THAT SOME EXPOSURE SHOULD BE CRIMINAL BEHAVIOR, BUT ARBITRARILY EXCLUDE WILLFUL/RECKLESS EXPOSURE

The current bill does create a misdemeanor penalty for intentional and successful transmission of an infectious or communicable disease, but legal experience has shown that proof of intent is almost impossible, and such statutes can rarely be used. The bill also creates a misdemeanor penalty for intentional exposure without requiring actual transmission, but the penalty of only 90 days is so mild for such an egregious offense as to be inadequate. The proposed amendments include increasing this penalty to six months, which was in the original wording of the bill. This is still a significant reduction from the current law, which makes intentional and successful exposure a felony when applied to HIV. Also, if our amendments were accepted (either alternative), there would be no remaining criminal penalties specifically relating to transmission of HIV, although ironically, criminal and civil penalties would remain for informing someone that a person has HIV without the consent of the infected person. This demonstrates that the supporting organizations want to evade all accountability for irresponsible behavior, and not to totally de-exceptionalize the disease.

SB 239 also creates a new offense entitled “reckless exposure to an infectious or communicable disease,” but it only applies for 4-8 days, and only if a health officer happens to know of a specific individual who poses a specific risk. SB 239 also does not specify a penalty for this offense, so as a misdemeanor it could be up to a year in county jail, 4 times more severe a penalty than for the more egregious offense of intentional exposure. Ironically, in the case of HIV, it is illegal for anyone (even a physician) to actually notify a health officer of a risky exposure situation without the infected person’s written authorization (see Health and Safety Code Section 121015), so this provision would almost be moot for that disease.

Imagine if the only penalty for other life-threating endangerments were to apply only if law enforcement were able to predict the perpetrator and the offense, and to have issued an order in advance not to commit the offense. That is not how the criminal justice system works; we rarely can predict a crime in advance, and we prosecute after the fact. The California penal code is unlike that of many other states in lacking a crime of reckless endangerment (reference: California Penal Code), so the offense of reckless exposure to an infectious or communicable disease can be most useful if it applies to actions that fulfill three of the five conditions for intentional, successful infection of another person, as provided in an alternative we proposed with our proposed amendments:
a)      The defendant knows of the infection (A above);
b)      The defendant engages in the reckless behavior causing exposure (C above); and
c)      The person exposed did not know of the infection (E above).
Violation of a health officer instruction would be an alternative criterion for this crime. The proposed amendments, Alternative 2, sets a maximum of 90 days of jail time, which would be appropriately less than for intentional exposure. All of the other wording in the section providing for protection of the defendant’s rights would be retained.

EXAMPLES OF WHY A CRIMINAL PENALTY FOR WILLFUL/RECKLESS EXPOSURE OF OTHERS TO COMMUNICABLE DISEASES IS NECESSARY FOR THE PROTECTION OF PUBLIC HEALTH

Public health ultimately relies on police powers, including the power to punish, isolate, or quarantine, to protect the public from serious communicable disease threats. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569983/) A significant portion of all transmission of communicable diseases is caused by behavior that exposes others without notifying them and without any precautions against transmission, and also without specific intent to infect an individual. Even a single person engaged in such behavior can cause an outbreak. It is this irresponsible type of behavior which cannot be deterred by threat of punishment in the current SB 239.

A man infected with multi-drug-resistant TB traveled through the U.S. and Canada and flew on commercial flights to get married, and was only isolated upon his return by a CDC order followed by the imposition of Georgia state law (https://en.wikipedia.org/wiki/2007_tuberculosis_scare.) Without such provisions in state laws, or the threat of incarceration, it can be impossible to control the spread of dangerous organisms.

Control of the SARS epidemic would not have been successful without involuntary isolation and the threat of punishment for violating it.

One young man with HIV in New York infected 13 girls at the school, several of whom became pregnant and had HIV-infected babies.

A patient at Patton State Hospital with some psychopathy traits wanted to infect as many men with HIV as she could, by seducing them and by exposing them to her blood, her rationale being that “some guy” had infected her. Had she gone to court, her behavior could have been proven, but she could have easily denied intent to infect any specific individual.

ARGUMENTS FOR PUNISHMENT FROM CRIMINAL JUSTICE THEORY

Penalties against endangering the lives and health of others are universal and considered necessary among all societies on earth, and they are directed at dangerous behavioral abuses rather than at a state of being.

 Criminal justice theory justifies punishment on several bases:
a        Utilitarian: deter future crime by the defendant; includes rehabilitation
     Retributive: includes keeping the offender off the streets to temporarily avoid re-offence
     Denunciation: make the public aware of the penalty, to deter future crime by others

All of these rationales are appropriate in the case of willful/reckless exposure to a communicable disease.

CONCLUSIONS:

Please veto SB 239 for all of the above reasons.

Sincerely,
Ronald P. Hattis, MD, MPH
President, Beyond AIDS