HIV Criminal Law Conscientization Strategic Plan Targeting African, Atlantic & Indian ocean-Islands-born Immigrants in USA 2016-2017

As a lesson learnt from the academy, the following is our strategic plan:

1. Objective: To develop a fact sheet that is easily read to be used as both a talk point and information tool on HIV Criminalization and Immigration by May 29th 2016.

OUTPUT: Developed fact sheet in a blog format highlighting at least 5 state level illustrations of the penal code and listed crimes following HIV transmission (alleged or otherwise) /non-disclosure.

OUTCOME: i. Brief synthesis of HINAC II and interconnectivity to immigration.

                    ii. Highlight the broad basedness of penalties across states

                   iii. Provide penalty examples in form of character and typology

                   iv. Highlight penalty enhancement as it varies across states

                    v. Show consequences and provide consequential based education

2. Objective: Inform HINAC ACADEMY Leadership by way of report by May 30th 2016.

OUTPUT: Send e-mail to Cindy and Tami briefing them on translation of learned knowledge from Academy.

OUTCOME:  i. E-mail 

                     ii. Link to fact sheets: 

http://qualitylonglifeinbayarea.blogspot.com/2016/05/hiv-is-not-crime-convention-in.html.

http://impreventionusa.blogspot.com/.

3. Objective: Draw an itinerary to promote and raise conscientiousness towards HIV Criminalization and modernization as an influence factor for acculturation and relation building in USA targeting African Immigrants in the Bay Area and Northern California from May 2016 to April 2017. 

OUTPUT: Rolled Plan to cover all Counties in Northern California

OUTCOME: i. Planned Community Dialogue events

                    ii. Location, venues and dates of implementation

                   iii. Feedback from different community dialogue events

                   iv. Identified Community Resource Persons/Social Change Agents

                    v. Report/model to be shared with HINAC ACADEMY and wider community by 2017.

BACKGROUND: 

BAY AREA HEALTHY LIVING SUPPORT AND COMMUNICATION PLATFORM-(BayHeal), is registered as a community Based Organization in California.

We provide information on where to access health services, nutrition tips/food and physical activity venues targeting African Immigrants in the Bay Area and Northern California. This is the gap we intend to fill. We are not a legal provision service however. We specifically, (but not limited to)  target African-Immigrants.

Our  core mobilization task is to engage in individual one-on-one solicitation and community organizing to improve health seeking practices and positive living. Most, especially, in the Bay Area. We address health, nutrition and physical activity issues. Our referral points include: Zuckerberg/San Francisco General Hospital and Trauma Center; Stanford Health, Kaiser Permanente; St. Francis, UCSF Benioff Children's Hospital and other health provision points in the Bay Area. 

We run dedicated blogs which are updated regularly with information we hope can be easily read, understood and utilized. We have covered cities in USA, Bay Area Counties and Towns where African-Immigrants reside, matched their locales and as much as possible provided information in form of: Services provided, social activities,location, addresses and contact numbers.

The blogs are accessible by anyone who can read English. We use easily read material to promote healthy living such as: 

http://qualitylonglifeinbayarea.blogspot.com/2016/04/a-guide-to-healthy-livelihood.html. 

HIV, HEALTHY LIVING SUPPORT AND COMMUNICATION:

Your number one concern is to be properly documented in USA. But, you still need to pay for the room you stay in, you have outlived your visa and you are frantically desperately scared of the immigration and border patrol police. Seeking care or checking for HIV status or any communicable disease you may be having would be the least priority. You are not alone.

Are you aware of the 7 major thematic preoccupations of African, Atlantic & Indian ocean Islands-born Immigrants: Dance, Drama, Dress, Diet, Disease, Documentation/Duty to US, Development?

More than 1.2 million people in the United States are living with HIV infection, and almost 1 in 8 (12.8%) are unaware of their infection. Gay, bisexual, and other men who have sex with men (MSM), particularly young black/African American MSM, are most seriously affected by HIV.

By race, blacks/African Americans face the most severe burden of HIV.

Blacks/African Americans continue to experience the most severe burden of HIV, compared with other races and ethnicities. Blacks represent approximately 12% of the U.S. population, but accounted for an estimated 44% of new HIV infections in 2010. They also accounted for 41% of people living with HIV infection in 2011. Since the epidemic began, an estimated 270,726 blacks with AIDS have died, including an estimated 6,540 in 2012. According to http://www.cdc.gov/hiv/statistics/overview/ataglance.html.

HIV is a crisis in African American communities, threatening the health and well-being of African American men and women across the United States. While African Americans face the most severe burden of HIV and AIDS of any racial/ethnic group in the nation, prevention efforts have helped to maintain stability in the annual number of new HIV infections among African Americans for more than a decade. Additionally, recent CDC data found indications of an encouraging decline in new infections among African American women. Still, African American heterosexual women continue to be far more affected by HIV than women of any other race or ethnicity, and young black gay and bisexual men now account for more new infections than any other group in the United States. According to https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/cdc-hiv-aa-508.pdf.

In 2014, 44% (19,540) of estimated new HIV diagnoses in the United States were among African Americans, who comprise 12% of the US population.

• Among all African Americans diagnosed with HIV in 2014, an estimated 73% (14,305) were men and 26% (5,128) were women.

• Among all African Americans diagnosed with HIV in 2014, an estimated 57% (11,201) were gay or bisexual men. Of those gay and bisexual men, 39% (4,321) were young men aged 13 to 24.

• From 2005 to 2014, the number of new HIV diagnoses among African American women fell 42%, though it is still high compared to women of other races/ethnicities. In 2014, an estimated 1,350 Hispanic/Latino women and 1,483 white women were diagnosed with HIV, compared to 5,128 African American women.

• From 2005 to 2014, the number of new HIV diagnoses among African American gay and bisexual men increased 22%. But that number stabilized in recent years, increasing less than 1% since 2010.

• From 2005 to 2014, the number of new HIV diagnoses among young African American gay and bisexual men (aged 13 to 24) increased 87%. But that trend has leveled off recently, with the number declining 2% since 2010.

In 2014, an estimated 48% (10,045) of those diagnosed with AIDS in the United States were African Americans. By the end of 2014, 42% (504,354) of those ever diagnosed with AIDS were African Americans. According to http://www.cdc.gov/hiv/pdf/group/racialethnic/africanamericans/cdc-hiv-africanamericans.pdf.

The following HIV-related disparities stand out in a glaring way:

Gay and bisexual men continue to be most affected by the HIV epidemic in the U.S. At current rates, 1 in 6 MSM will be diagnosed with HIV in their lifetime, including 1 in 2 black MSM, 1 in 4 Latino MSM, and 1 in 11 white MSM. African Americans are by far the most affected racial or ethnic group with a lifetime HIV risk of 1 in 20 for men (compared to 1 in 132 for whites) and 1 in 48 for women (compared to 1 in 880 for whites). People who inject drugs are at much higher lifetime risk than the general population, and women who inject drugs have a higher risk than men (1 in 23 compared with 1 in 36). People living in the South are more likely to be diagnosed with HIV over the course of their lifetime than other Americans, with the highest risk in Washington, DC (1 in 13), Maryland (1 in 49), Georgia (1 in 51), Florida (1 in 54), and Louisiana (1 in 56). According to http://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html.

The United States of America (USA) currently has around 1.2 million people living with HIV, with one in seven people unaware that they have HIV. The size of the epidemic is relatively small compared to the total population, however it is heavily concentrated among several key affected populations and geographically in the southern states – where 49% of all HIV new infections occur.  Since the beginning of the HIV and AIDS epidemic, 659,000 people have died of AIDS-related illnesses in the USA. Although the USA is the greatest national funder of the HIV epidemic globally, it is still facing a major ongoing HIV epidemic itself, with around 50,000 new infections per year. Stigma and discrimination continue to hamper people's access to HIV prevention, testing and treatment services, fueling the cycle of new infections. The USA lacked a comprehensive plan on HIV until 2010 when President Obama created a National HIV/AIDS Strategy. The latest strategy, released in 2015, is structured around four core aims: reducing new HIV infections; increasing access to care and improving health outcomes for people living with HIV; reducing HIV-related disparities and health inequities and achieving a coordinated national response to the epidemic. See more at: http://www.avert.org/professionals/hiv-around-world/western-central-europe-north-america/usa#sthash.0DWw7Kea.dpuf.

Regardless of sexual orientation, one in 20 black men and one in 48 black women will be diagnosed with the virus that causes AIDS in their lifetimes, according to the CDC. For Hispanic men and women, the risks are one in 48 and one in 227, respectively. According to http://www.thedailybeast.com/articles/2016/02/23/cdc-half-of-gay-black-men-will-get-hiv.html.

Gross inequities in the United States immigration system disproportionately harm HIV affected people, documented or otherwise, and their families. The legal, cultural, public health, and socioeconomic barriers created by the broken immigration system in the United States create substantial obstacles for people living with HIV and their advocates. The isolation and lack of health care available to immigrant populations impedes HIV testing, treatment, and prevention efforts. HIV-related restrictions for those visiting or immigrating to a country exacerbate these problems by breaking families apart, dividing spouses, separating parents from their children, limiting employment and educational opportunities for people with HIV, and discouraging individuals from seeking testing or treatment for fear of being denied entry or placed on deportation proceedings. According to http://www.hivlawandpolicy.org/issues/immigration.

If you are undocumented and you are within the US borders and have HIV, the US Federal Laws uphold your right to quality care. Indeed the issue of documentation plays a big part in the decisions to seek healthcare services. When a person enters the United States and resides in this country without authorization by the Department of Homeland Security (DHS), they are undocumented, which is against the law. Immigrants without documentation risk deportation, fines, penalties, and/or prosecution. United States law applies to all persons residing within its borders. Even if you are not a U.S. citizen, or are an immigrant without legal status, you still are entitled to certain rights and resources under U.S. law. According to http://legalcouncil.org/wp-content/uploads/2013/08/Undocumented_Immigrants_English.pdf.

When one mentions black people, one should understand that this applies to persons from many parts of the world such as: Canada, UK, South America, Australia and Africa. Black people have used different ways to get to USA. Many who enter through illegal entry points travel long distances and endure grueling experiences. Some are infected with HIV as they engage in survival commercial sex-work. Some of the children coming across the Mexican border are testing positive for HIV, the virus that causes AIDS, and a Texas health official says that some may have contracted the disease during their long journey north from Central America. According to Breaking News at Newsmax.com http://www.newsmax.com/US/illegal-immigrant-children-hiv/2014/06/28/id/579798/#ixzz4AHjZA5lF.

African and in USA; Locating Acculturation needs and Culturally Competent Care Spaces for Migrant Populations From Africa; a Public Health Perspective

Introduction:

The BayHeal Manager, took some time off observing how Africans who are new in America fit into the American urbanite-First World Society. Four geographic locations were the focus (served as exit brief cursory interview points too) of this field rapid analysis between March-May 2016 on different days of the week: Berkeley Town Farmer's Market; Embarcadero Market; San Francisco Civic Centre Farmer's Market; and Hunters Point (Kirkwood and Our Lady of Lourdes' Community Days for Seniors). The manager talked to 28 persons and this is their brief characteristics and typology: 

(a). Males above 35 years (5); males below 35 years (3); female above 35 years (4); female below 35 years (5); female above 65 (4); males above 65 (5); female below 22 years (1); and male below 22 years (1). 

(b). They have lived in USA between 10-37 years

(c). 5 were born in USA; 10 are naturalized Americans; 10 are permanent residents; 3 are in process of formalizing their stay documentation.

(d). 10 last attended a medical clinic when they were formalizing their green card eligibility.

(e). 5 have senior-related ailments that require regular medical check ups but 3 have missed two recent appointments.

(f). For 15, fresh foods, green vegetables and foods low in carbohydrates and protein are a concern (8 drive; all have expert street knowledge of locales in Bay Area or Northern California and mobility skills; 3 reside in Palo Alto; 2 live in San Francisco City; 2 live in Richmond; 1 lives in San Leandro;2 live in Berkeley; 3 live in Alameda; and 2 live in Antioch.

(g). For 10, have needs for understanding and managing a balanced diet and incorporating it as a life skill.

(h). 8 smoke and consider themselves chainsmokers.

(i). 15 expressed need for information on hazardous conditions, avoiding exposure and vulnerability (physical, sexual and social).

Public Health Significance:

Public health interventions, are possible and can be optimized  for African immigrants when African community-owned leaders are involved. In conducting this cursory interview, the BayHeal manager/health educator managed to generate interest in health issues. It is possible to tailor health campaigns targeting African immigrants. Such messages can be motivating when they show show how quality of life of African can be improved; when the programs are geared at improving health, physical activity, nutrition conscientization, disability reduction and decrease risks or vulnerability.

African immigrants need literature and awareness drives on exposure to hazardous conditions at work; exposure to hazardous conditions at homes; and understanding how to avoid transmission of infections. Community awareness sessions that raise conscience on practices that are particularly risky such as unprotected sex with multiple partners, commercial sex trade, IDU, early unprotected sexual intercourse and vulnerability within sexual networks (protecting partners of persons at risk).

Language and knowledge of say, addresses may influence access and usage of health promoting technologies/tools of healthcare or self-care. When key-leaders among African communities are identified and trained in peer-to-peer skills, they will be able to conduct community diagnosis of needs and report them for interventions.

Methods:

There is need to appreciate where most African immigrants live/reside and map out resources that are accessible to them. This will improve on their ability to demand and share the community resources in their different locales or addresses. It will also be possible to have interventions that address high risk behaviors and show how Africans can benefit from the social or physical environment in their area. This increased awareness risks and of community intervention resources is significant in health promotion and disease prevention.

Organizing for health promotion will require community partnerships and involvement; visioning to pursue common goals; assessment of forces of change, themes, systems; understanding prevailing community health standards and required status; identifying strategic issues; and formulating common goals.

Data on African immigrants that can be used to formulate quality health goals need not to be complicated. Collecting material that reflects character and typology is all that suffices. As much as possible point out health disparities, build an epidemiological profile and plan for or implement appropriate cultural/linguistic interventions. A community profile can capture: kind of population; language used; age; employment opportunities; incomes; skill levels; education; household status and compositions; ethnicity; information such as: insurance coverage; health/medical needs; and community events' involvement.

Work with community-owned resource persons within the African communities. This will make available experts in community's language, cultural beliefs, demographic intelligence that assists in offering culturally competent care environment. In such as an environment or space, it is possible for health care providers to educate community on specific diseases, risk factors and health promoting practices.

For persons involved in community mobilization and organization, knowledge of computer operation and directional finding using say, GPS locator tools is also a big help. There are different apps and tools available on phones or different interface platforms.  A GPS coordinate converter or other tools that the author relies on include: http://www.gps-coordinates.net/gps-coordinates-converter; Google maps; http://driving.directions.cm/lp/?partner=^BXV^xdm003&s1=google_ddcmdirections.

Conclusion:

It is no doubt that there is need to train African community leaders in: relational skills; collaboration skills; accountability; strategic planning; movement building; organized planning; involving as many people as possible; use of objectives to assess short or long term program outcomes; assist communities to improve health and quality of life; and developing information exchange platforms that increase participation in health care demand and delivery.

How to Get Health Care if Undocumented

Getting HIV Care Without Getting Deported (excerpts from different sources)

Ask your local AIDS service organization (ASO). Many can assign you a case manager who will help uncover the options available to you for HIV care and treatment. Find your local ASO at directory.poz.com ( used with permission). 

Even if you have no health insurance, funds are often available to pay for your health care. Ask your ASO case manager for information.

Find a community health center (by asking at a local hospital). These public clinics are devoted to serving the healthcare needs of low-income members of their communities. Most have an open-door policy when it comes to a patient's ability to pay.

If they don't ask, don't offer. Many clinics never ask for proof of citizenship, so you need not mention it. Some may require you to live in the area; as proof, they might request a utility bill or just a letter from someone you live with.

Know that health care workers are unlikely to report you to immigration authorities. Federal laws discourage anyone in a healthcare setting from revealing patient's confidential information. While immigration status is not necessarily covered by this, most providers won't divulge your information. Your best bet is a community clinic, where your health care needs are most likely to take priority over any interest in your immigration status.

Request a translator. Federal law requires health care facilities that receive any Medicaid or Medicare funds to provide translators.

Advocate for yourself! “The worst thing to do is to hide in fear,” says Charles King, CEO of New York City's Housing Works. “Then you effectively deny yourself the care you need.”

FOR THOSE IN CALIFORNIA:

If you live in the San Francisco County Area read the following resource to find help: http://qualitylonglifeinbayarea.blogspot.com/2016/04/immigrant-health-resources-for-you.

FOR THOSE IN ILLINOIS:

If you live in Chicago area:

http://www.rainbowwelcome.org/uploads/pdfs/Undocumented_Immigrants_English.pdf

FOR THOSE IN NEW YORK:

If you live in New York Area:

https://www.health.ny.gov/publications/0215.pdf

NB. With time, we shall be able to provide information for all US states.

HIV Is Not A Crime Convention In Huntsville, Alabama And How Its Outcomes Matter To An African Immigrant in USA

A FACT SHEET ON HIV CRIMINALIZATION AND BASIC CRIME DEFINITIONS FOR AFRICAN IMMIGRANTS IN USA

By Tom R. Muyunga-Mukasa*

The National HIV is not a Crime Training was an opportunity to hear from advocates, actors and survivors in the area of HIV Criminalization in the Americas. Themes varied from: HIV criminalization survivors and their families; How to commit to meaningful involvement of people living with HIV; Role of research in HIV Criminalization/Criminal law modernization; Antiblackness and HIV Criminalization/Grounding ourselves in racial justice; What's working? Where are we struggling? Focus on state strategies; Successes and Challenges; Towards a broader decriminalization agenda: How race, sexuality, and gender intersect with HIV criminalization; and HIV criminal Laws and Prosecution in the deep south. My take home lesson was that: HIV Criminalization and immigration are two intersecting events in an immigrant's life. 

Why? One may ask. There are a variety of answers to the question:

Prior to 2010, federal immigration law prohibited people with HIV from entering the country. The United States recently removed statutory and regulatory bans prohibiting people living with HIV from entering the country. Effective January 4, 2010, HIV is no longer a bar to entry into the United States for visitation or immigration purposes. This means that HIV status alone cannot be a reason for excluding, removing, or deporting a person from the United States.  HIV status may be a basis for applying for asylum, a form of immigration protection in the United States, if an immigrant is able to show past persecution or fear of future persecution because of their HIV status. Nevertheless, people living with HIV who are detained in immigration detention facilities, including those applying for asylum protection, often experience difficulty in accessing essential health care and drug therapies while in custody (http://www.hivlawandpolicy.org/issues/immigration).

There are a number of options for treatment even if one immigrated to USA and contracted HIV before being fully documented. No hospital or healthcare facility in USA can deny one treatment and care for HIV-related illnesses or AIDS-related issues.

Do not hide or suffer in silence. Seek medical care immediately as soon as possible. Everyone needs to know their status. The medical term you will hear is called "serostatus." The usage can be in form of knowing one's serostatus or testing for one's serostatus. It is good practice as we shall see. 

Many public health rationales are given for the need to disclose one’s HIV status to sexual partners. The first is prevention. 

Disclosure is understood to be a key part of this public health objective by motivating people to seek testing upon learning a partner’s HIV status and in changing behavior to prevent the further spread of HIV.

Disclosure is also seen as a way for individuals to receive support (http://www.americanbar.org/publications/human_rights_magazine_home/human_rights_vol38_2011/human_rights_spring2011/sex_and_hiv_disclosure.html).  

Once one is aware of their status, it is possible to make informed choices for say, prevention, treatment seeking, self-care, avoiding transmission and avoiding a conflict with law. 

Remember, in USA many states have broadly criminalized HIV transmission under  different sexual offense statutes. 

In California, criminal laws include these penalties e.g., wilful exposure; donating tissue; sexual intercourse; and penalty enhancements (http://www.criminaldefenselawyer.com/resources/transmitting-std-california.htm). The California Health and Safety Code states that “any person who exposes another to HIV by engaging in unprotected sexual activity (anal or vaginal intercourse without a condom), when the infected person knows at the time of the unprotected sex that he or she is infected with HIV, has not disclosed his or her HIV-positive status, and acts with the specific intent to infect the other person with HIV, is guilty of a felony.” The law clarifies that “a person’s knowledge of his or her HIV-positive status, without additional evidence, is not sufficient to prove specific intent.”

Michigan law criminalizes non disclosure, stating that if a person has been diagnosed with HIV and knows that he or she is infected and “engages in sexual penetration with another person without having first informed the other person that he or she has acquired immunodeficiency syndrome or acquired immunodeficiency syndrome related complex or is HIV infected, is guilty of a felony.”

Any manner that constitutes transmission, intention to transmit and suspicion can be grounds for being penalized in courts of law as felonies. Failure to disclose HIV status is penalized; in some states (WV, VA, DE, KY, AL, AK, FL, GA, LA, MS, NC, SC, TN and TX), sharing needles or any instruments (works) previously used by HIV+ve persons is penalized; in many states HIV intentional infection can be reason for being registered as a sex offender. This means, one has to be registered under the Sex Offender Registry; one has to be on the Public Notification Website. Other penalties that can be cited include: Felony enhancement, solicitation, non disclosure of HIV and trafficking ( http://www.hivisnotacrime.com/). 

In Iowa, criminal transmission of HIV, is a felony in the same category as manslaughter, drug crimes and robbery. In 2009, a man called Rhoades was sentenced to 25 years in prison. His sentence was later reduced to time served plus five years of supervised probation. He is also required to register as a sex offender for the rest of his life ( https://www.wklaw.com/california-hiv-disclosure-laws/).

Because of the above, stigma, discrimination and marginalization can arise. For immigrant communities this has devastating repercussions. The fires can burn brighter when stoked by race, sexuality, orientation, social economic status, gender and HIV criminalization in a given jurisdiction.

Before we wind up this short session, I want us to understand two aspects of US penal code. The words: Felony and misdemeanor.

Felony is a serious crime. It is a crime punishable by death or imprisonment beyond one year (Federal Government of US definition). Examples include: treason, kidnapping, grand theft, larceny, obstruction of justice, assault, perjury, mail/wire fraud, violating parole/probation, recognizance bond, threatening officials and other acts.

Misdemeanor is a minor offense such as not carrying one's driving license in a traffic violation.

Remember, always seek information, do not suffer alone. Ignorance of the law is no excuse. We are now living in an advanced country. Rule of law and mechanisms that are used to enforce the law are superior in America compared to Africa. Please be careful in the way you consummate your sexual desires! Find out your HIV/other STI's status; also ask your sexual partner their status; ask about their age too ( age of consent/discretion must be above 18). Negotiate for safer sex.

*The author of this combined article/factsheet on HIV Criminalization and Immigration is a Harvard trained Quality Improvement and Global Health Practitioner. He has special interest in addressing health disparity, inequality, promote constructive dialogue and durable solutions. He won the prestigious scholarship to attend the National HIV is Not A Crime Training (2016) at University of Alabama, Huntsville.