The Governor's Reply and I: Correspondence with the ADC.

Some of you may remember that I wrote to the Governor a couple of weeks ago about Davon Acklin, William Macumber, and the other prisoners that she's leaving to die behind bars - regardless of their illnesses, crimes or innocence. Yesterday I received a reply to that letter from the Office of Constituent Services at the Arizona Department of Corrections. Below is that email, followed by my response to it. I doubt I'll be hearing from them again - I kind of hit "send" when I was trying to "save" and proof it. This gives you the update, though.

FYI: the people I cc'd my response to are Charles Ryan (the Director of the ADC) and his corporate counsel, Karyn Klausner (who was pretty cool when she was a criminal defense attorney, in my book, because she stuck up for that 8-year old St. Johns kid that prosecutors wanted to charge as an adult for killing his dad. Still, try to avoid messing with her.)

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BETTY CASSIANO	Mon, Jul 26, 2010 at 12:23 PM
To: arizonaprisonwatch@gmail.com
Good morning Ms. Plews, Your e-mail message to the Arizona Governor's office concerning Arizona Department of Corrections inmate was forwarded to me for response. I sincerely appreciate your concern for both inmates and want to assure you that the Arizona Department of Corrections provides health care to incarcerated offenders consistent with community standards. Quality care and services responsive to the offender population include: medical services, mental health services, dental care, primary nursing care, and pharmacy services. Keeping offenders healthy is the basic platform from which the offender is prepared and supported to successfully complete basic education, work skills and experience, and recreational and leisure skills essential to building good citizenship and self-sufficiency. The Health Services Bureau also assists inmates in learning to develop and sustain personal wellness through ongoing education designed to augment healthy living while diminishing life-style habits that can lead to poor health and a decreased quality of life. As you may know, medical information is strictly confidential and not available to inquirers in accordance with federal and state statutes. Information about the Arizona Department of Corrections is available on the public website as follows: www.azcorrections.gov . I invite you to access the site for additional information about the Health Services Division and other areas of interest to you. The Constituent Services page provides access to a handbook which includes information about many areas of concern as well as a listing of applicable policies and contact numbers. Betty J. Cassiano ADC/Constituent Services Office

(sorry folks - technical difficulties I can't fix, so head over to Arizona Prison Watch for a readable copy of the following email response)

Peggy Plews	Tue, Jul 27, 2010 at 4:42 AM
To: BETTY CASSIANO Cc: CHARLES RYAN , KARYN KLAUSNER
Dear Mrs. Cassiano, Don't believe everything that Arizona Department of Corrections (ADC) health services administrators tell you - they either don't know squat, or they have a propensity for lying. In fact, their department can't even keep their medical records straight or accounted for. Davon needs a liver biopsy for anyone to be able to say how ill he really is (or isn't) from Hep C, and he needs genotyping to determine his chances of surviving this thing with early treatment. Unfortunately, resources are instead being spent trying to deflect his mother and I in our attempts to help him. These are just stalling tactics - as is being referred to you. She and I are both done with the games. I suspect it's going to cost Arizona more to fight us than it would have to competently diagnose and treat Davon early in the course of his infection, because now we're out to change the whole system. We may not be able to bust him out of there in time to prevent further damage from the virus, but he's going to end up getting options for medical care either now or later - all we need to do is to escalate this issue enough that the visibility brings other ADC families to us wondering why their mentally ill kid wasn't offered Hep C treatment, too, and we have a class action suit. In the meantime, you have a lot of highly-paid people spinning in circles doing absolutely nothing for that boy. That's a pathetic waste of precious taxpayer money, and we already spend more on you than on our schools. As for standard medical protocols - "we're just following the leader" is no excuse. You've been warned specifically that neglecting Davon's medical care because he has a serious mental illness is a violation of the Americans with Disabilities Act (ADA), and your algorithms giving you that out are based on research that's over a decade old. Did you realize that? Did Ryan or Karyn Klausner? They'd better not be counting on their dental staff for guidance about whether or not the ADC is following good medical protocol regarding Hep C. Given the advances in the areas of diagnosis, prognosis, and treatment in recent years, that's malpractice in my book. Furthermore, the argument that he's too close to his out date to begin treatment now (because you want to assure that he completes it) is pretty flimsy. You all know full well that Julie would make sure he continued his treatment once released - especially after all this. Few prisoners have as supportive a family to go home to as Davon does. What the American Correctional Association has to say about your protocols and standards is the last thing that will impress me - they're paid off by prison profiteers and have elected as their president the man who's presided over Mississippi's DOC as their prisoner mortality rate has shot up to the second highest in the country. In any case, I think every entity that promulgates the same standards that the ADC uses to determine who and when to treat for Hep C should also be sued for violating the ADA and the Civil Rights of Institutionalized Persons Act (CRIPA). I'm sure to find a good attorney in each pertinent jurisdiction who will agree with me. So, please don't bother writing to me again if you're just going to give me the standard line of ADC BS, as you do so well. It just pisses me off, and it disrespects those dying inside. Your people don't even know how sick Davon is because they refuse to do an adequate medical evaluation - lest a specialist finds something you have to treat (or get sued over for not treating) out of your grossly inflated budget. They apparently haven't even checked him out themselves, yet - for all the communication that Julie has had with you people all this time, now she's being told that unless Davon fills out a health request himself, he doesn't have any symptoms. That's very disconcerting - and the standard MO for departments of corrections trying to keep down health care/litigation costs by denying when prisoners are sick and putting up barriers to care in the first place. All of you are treating Julie like she's some kind of idiot - she probably knows more about Hep C now than most of your "experts". And she's learning fast where the money for Hep C + prisoners comes from and goes to (not to prisoners like Davon, clearly - the mentally ill, that is. They're apparently all a bad risk). Don't bother trying to talk to Julie again either, by the way - all you seem to do is insult her. As for disseminating info about funding mandates and ADA/CRIPA obligations (we're going to make new case law. Just watch): we have more than just Facebook and my blogs for public consumption. We see a whole lot of lives at stake here and are willing to put ourselves on the line over this - and our alliances now include the crew keeping a 24/7 watch at the capitol. They came to our vigil in May and cried as Julie told them about her son, while I passed out Spanish language literature about hep C. Then they blessed us with drumming and sage. Several former prisoners with Hep C came up to Julie to give her a hug and thank her for talking about it to fight the stigma; they always got the message that they're just criminals and therefore not worth saving. It was all pretty powerful. My brother has the video and is going to try to figure out how to put it on You Tube. I've also been contacted by a journalism student who does film editing and we discussed doing a project on Hep C in prison, using AZ as an example of what prisons do wrong. Especially to the mentally ill, who clearly aren't worth the expense or hassle of even finding out if they need treatment or not... Unless you want to be the example of someone doing something right by the most vulnerable people in custody, instead. I kind of doubt Ryan will choose that route, though. As for ADC's health services educating anyone, particularly prisoners: all Davon knows about his illness is what he feels and what his mother tells him. Clearly the people paid to "educate" patients and the public about Hep C aren't doing their job, or we wouldn't end up doing all this. I've read the literature they hand out on Hep C. After describing how ill one can get, one such fact sheet sarcastically concludes: "As you can see, it's better not to get this in the first place." Why am I writing a blog about Hep C and posting the latest research, not them? What did they do to recognize World Hepatitis Day in May? We want harm reduction programs in place both in and out of prison - this is absurd for this disease to still be killing people in 2010 when we know how to stop it. Prisoner health is public health, so don't think this starts and stops with you and no one else should worry about it. Remember ACT UP? You haven't seen anything yet. This (the first two photos below) was just to cheer Julie up - I staged it during AM rush hour in front of Fox News. Saving Davon is what this comes down to, not just freeing him. Once we aren't competing with SB 1070, we're going to be out there raising hell and digging up more witnesses and claimants. We can be pretty creative; I'll escalate it as necessary to get local and national media on this, and I have a lot of friends who are sympathetic to prisoners and down for just about any kind of direct action that counters state violence - which is what I consider medical neglect of institutionalized persons to be. I have no fear left in me and very few inhibitions - I was already assaulted the night we did the candlelight vigil (hence my silence on the anniversary of Marcia's death - I was abandoning my home that day), and my car was vandalized two days later (nearly killed me on the highway when my tire went). All coincidence, I'm sure, that just knocked me off my feet for a little while - blessings in disguise to teach me that no matter what happens to me, exposing you people is the right thing to do. As is exposing the Governor's brutality, who still has to answer for leaving Macumber to die. Even the New York Times is watching him (and now Liptak knows about Davon, as well), so please try not to kill him before he gets out of there. By the way, I can see the DOJ Googling your dead prisoners. I think they're on to you already for all those murders since Brewer/Ryan took over, aren't they? Maybe for the suicides, too - including that boy on the minors unit this spring. I have a packet to send off to them anyway, just in case they hadn't heard about everyone or didn't know that others cared out here. Finally, rest assured that I know how to find everything I need on the ADC website now - I even notice what isn't there - and please don't ever refer me to your handbook of propaganda again for answers to serious questions like these. Thank you for your time. Margaret Jean Plews (this email will be forwarded to the Governor's office and posted on my websites, lest it gets lost in the ether.) Morning Rush Hour: July 19, 2010 (W. Washington St/7th Ave, Phoenix) Morning Rush Hour: July 19, 2010 (W. Washington St/7th Ave, Phoenix) Early Afternoon: July 16, 2010 (W. Jefferson St/15th Ave.; across from the ADC) “The degree of civilization in a society can be judged by entering its prisons.” - Fyodor Dostoyevsky (1821-1881) Prison Abolitionist http://prisonabolitionist.blogspot.com Arizona Prison Watch http://arizonaprisonwatch.blogspot.com Arizona Juvenile Prison Watch http://azjuvenileprisonwatch.blogspot.com Hard Time: Hep C in AZ Jails and Prisons http://hardtimehepc.blogspot.com Free Marcia Powell http://freemarciapowell.blogspot.com ¡El pueblo unido, jamás será vencido!

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.

Fight HIV and HEP C with Sentencing Reform.

This is going down this week, folks. Wherever you are in the country, please call or e-mail your congressman today, and specify both HIV and HEP C as concerns. This action comes in from the Sentencing Project via our friends at UNSHACKLE.

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THIS WEEK: CALL ON CONGRESS
TO REFORM DRUG SENTENCING
TO FIGHT HIV/AIDS

This week, people in the worldwide fight against HIV/AIDS are gathering in Vienna for the International AIDS Conference. But there's important action we can take right here at home.

Members of the CHAMP Network and Project UNSHACKLE know that mass imprisonment is fueling the spread of HIV in this country. Obama's new National HIV/AIDS Strategy also notes the links between imprisonment and HIV:

Although the available data suggests that relatively few infections occur in prison settings, there is evidence that some people with HIV who had received medical care while incarcerated have difficulty accessing HIV medications upon release-affecting their health and potentially increasing the likelihood that they will transmit HIV. High rates of incarceration within certain communities can also be destabilizing. When large numbers of men are incarcerated, the gender imbalance in the communities they leave behind can fuel HIV transmissions by increasing the likelihood that the remaining men will have multiple, concurrent relationships with female sex partners. This, in turn, increases the likelihood that a single male would transmit HIV to multiple female partners.

CHAMP and Project UNSHACKLE believe that sentencing reform - meaning that less people are locked up, and for shorter periods - is a crucial part of the fight against HIV/AIDS.

Please join us in responding to this action alert from the Sentencing Project (below), calling on Congress to reform sentencing policies as a part of the fight against HIV/AIDS. When you make your calls, please be sure to say that the new National HIV/AIDS Strategy says that "High rates of incarceration within certain communities can also be destabilizing... and can fuel HIV transmissions":

from the Sentencing Project

Tell Congress To Vote Yes for Crack Cocaine Sentencing Reform

This week, the House of Representatives may vote on legislation, recently passed by the Senate, to reduce the 100 to 1 sentencing disparity between crack and powder cocaine to 18 to 1. The Fair Sentencing Act of 2010, S. 1789, would also eliminate the simple possession mandatory minimum (5 years for 5 grams without intent to distribute), limit the excessive penalties served by people convicted of low-level crack cocaine offenses, and increase penalties for high-level traffickers. The U.S. Sentencing Commission estimates the changes could reduce the federal prison population by 3,800 over 10 years.

Champions for sentencing fairness are urged to contact their representative in the House today to ask them to vote yes for the Fair Sentencing Act. Call the U.S. Capitol Switch Board at 202-224-3121 and ask for your representative. They will patch you through to the correct office.

Once you reach your representative, tell them you support the Fair Sentencing Act of 2010, S. 1789 because:

• The current 100 to 1 cocaine sentencing disparity is unfair. The five-year penalty for possessing as little as five grams of crack cocaine is the same for selling 500 grams of powder cocaine. The law imposes excessive prison sentences for low-level crack cocaine offenses that often exceed penalties for offenses involving powder cocaine trafficking.
• The current 100 to 1 cocaine sentencing disparity exacerbates racial disparity in federal prisons. Over 80% of those serving time for a crack cocaine offense are African American, despite the fact that two-thirds of users are white or Hispanic.
• The Fair Sentencing Act, S. 1789, is an historic opportunity to advance justice and restore faith in the criminal justice system.
• The Fair Sentencing Act will also save taxpayers money. Replacing the irrational 100:1 ratio with a new 18:1 ratio will save $42 million over five years, according to Congressional Budget Office.

When you have completed your call to your representative, please email kgotsch@sentencingproject.org and say how it went. Also, please consider forwarding this email to a friend.

Thank you for joining the effort to reduce the crack cocaine sentencing disparity. A broad consensus among criminal justice experts, law enforcement organizations, and policymakers has emerged that concludes the current 100 to 1 disparity cannot be justified. Organizations endorsing reform include: the NAACP; Leadership Conference on Civil and Human Rights; American Bar Association, American Civil Liberties Union; the National District Attorneys Association; and the Federal Law Enforcement Officers Association.



“The degree of civilization in a society can be judged by entering its prisons.”
- Fyodor Dostoyevsky (1821-1881)

Lessons in liberation: ACTing UP.

From the UNSHACKLE list-serve, well worth joining. This comes off of the AIDS and Social Justice blog at Wordpress. It's high time we start acting up, too, in our fight for prisoners affected by Hep C...

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Che Gossett on AIDS activist Kiyoshi Kuromiya’s legacy and the intersections between all movements for liberation

At Movements For Change, an event in honor of Kiyoshi Kuromiya on June 10th in Philadelphia, student activist Che Gossett incited a room of sleep-deprived AIDS activists to shouts and tears, reminding us why we are doing this work and inspiring us toward new ways of doing it. The event was hosted by longtime activist Chris Bartlett at the Church of St. Luke and The Epiphany, where ACT UP Philadelphia meets each Monday night at 6pm, and strategized for the future while remembering Kiyoshi, a beloved member of ACT UP who died 10 years ago.

“Kiyoshi believed in intersectionality long before that was a term people used,” Chris said in his opening remarks. “He brought what he learned from the Civil Rights, Gay Liberation and other movements to all of the work he did, and wherever people struggled for human rights and dignity, he was there.”

Che generously shared the text of their talk with us here. Enjoy!

“The white middle-class outlook of the earlier [homophile] groups, which thought that everything in America would be fine if people only treated homosexuals better, wasn’t what we were all about…We wanted to stand with the poor, with women, with people of color, with the antiwar people, to bring the whole corrupt thing down.”[1] Kiyoshi Kuromiya

This quote, especially the call to stand with the poor, women, people of color, anti-war people and for a radical alternative is what, in my understanding, animated Kiyoshi’s life. To me, it represents the core of his legacy and stands as an imperative for discussions of the future.

My talk is supposed to be about the future of gay rights, but how do we talk about a future that, as defined by homo-normative groups and political formations like the HRC [Human Rights Campaign], neither centers nor sometimes even includes those categories Kiyoshi mentions — women (trans and non trans), the poor and people of color? How can we hold a mirror up to a future in which we are not reflected? How is it that we, as queer and transgender people of color are evacuated and disappeared from a future we helped to create?

The Lawrence v. Texas legal decision that struck down sodomy laws has been heralded by gay rights groups, yet it is haunted by the racial violence of its past — the legal basis for the police invasion of Lawrence’s apartment was not “consensual sodomy,” but a false report of a weapons disturbance — the Harris County police dispatcher was called and told, “There’s a nigger going crazy with a gun.”[2] How is it that this racialized past now exists as a sign of a post-racial queer future? In which gay rights are the new civil rights, and the civil rights battles of the 60s have been won? How did we move from gay and trans liberation to queer neoliberalism? From gay anti-capitalism to the depoliticized neoliberal gay market niche? How did we get from the gay anti-imperialism of the Gay Liberation Front, the Philadelphia chapter of which Kiyoshi and Basil O’Brien created in May of 1970[3], to homonationalism — the marriage and military rhetoric — of today? Why, instead of fighting US imperialism, and standing in solidarity with anti-occupation struggles and against political repression, such as the recent Israeli military attack on the Gaza aid flotillas — are queers rushing to join wars rather than protest police and state violence?

In light of this political context, it’s all the more imperative that Kiyoshi’s legacy and the force of the quote be held out as a beacon with which to guide our collective, empowered and self-determined queer and transgender liberationist and feminist futures.

Kiyoshi was born in prison — an internment camp — in 1943, and he never stopped trying to “get free.” For most queer and transgender people of color, prison and police are a defining feature of reality. For many low income, no-income and houseless, queer and trans people of color, the distance between prisons and pride parades is not a chasm but instead, overlapping terrain. This is the terrain upon which prisoner justice, trans justice and abolitionist organizations — Institute for Community Justice, Transforming Justice, Critical Resistance, Hearts on a Wire and Prison Health News — operate in struggle. This is the political terrain, the ground on which ACT UP Philadelphia launched a campaign to decriminalize condoms in Philly jails, took over the BETAK nursing home so that people living with AIDS could have residential space, started an extra-legal needle exchange, and it’s the ground where ACT UP continues their fight against the criminalization and stigmatization of HIV/AIDS. This ground — St. Luke’s Church, is sacred ground, not in a religious sense, but in an activist sense, in a loss and mourning sense, in a memory sense and in a strength and hope sense.

The criminalization of HIV/AIDS was not limited to Reagan’s neoliberal regime, where the President’s Commission on HIV/AIDS funded only those states with criminal disclosure laws, but is happening presently, through the prosecution of black gay men as pathogenic and bio-terroristic threats, ranging from Gregory Smith to Daniel Allen. In November of 2009, Daniel Allen, a black gay Michigan resident, was charged with “bio-terrorism” for the “use of a harmful biological device,” his own (non-HIV-transmissible) saliva.[4] Segregation of incarcerated HIV positive people continues today, legally, in the South in states such as Alabama — the same state that is sending incarcerated people to clean up the BP oil spill[5] — and in Mississippi.[6] The stigmatization of HIV positive incarcerated people, many queer and transgender and of color, is not a new feature of the carceral apparatus, but only a current instance of a long and sordid historical pattern that dates back not only to 1974 when lesbians and gays (and those presumed to be) incarcerated in Florida’s Polk County Jail were segregated from the general population and made to wear pink bracelets, but also to the violence of the Holocaust and the Nazi pink triangle.[7] Reagan’s endorsement of HIV disclosure penalization statutes coincided with his allegiance to the continuing racialized “War on Drugs,” which emerged during the Nixon administration and extended throughout the Reagan and later Clinton presidency as where we get the “Three Strikes” law. The growth of the prison industrial complex, the assemblage of laws criminalizing HIV and addiction, all overlapped with and was underpinned by neoliberal economic policy in the 1980s and 90s.

Yet in the 70s, radical queer organizations organized in prison while being supported on the outside. In 1977, the George Jackson Brigade at Walla Walla prison founded a group that condemned sexual violence against gays. At New Jersey’s Rahway State Prison, the “Gayworld Organization” was formed, and the “Self-Help Alliance Group” (SHAG) was formed at Angola prison in 1984.[8]

This history of this overlapping and cross-movement participation traces back to the Black Panthers’ Revolutionary Peoples’ Convention held at Temple University in 1970. The convention represented a convergence of movements, for gay liberation, women’s liberation and third world and people of color liberation, that are usually seen as separate. A week before the convention, Philadelphia police, led by commissioner Frank Rizzo, raided the offices of the Black Panther Party and publicly forced several Panthers to strip naked at gunpoint, to be photographed by the Philadelphia Inquirer. “Imagine the big Black Panthers with their pants down”[9] Rizzo was quoted as saying — and to me, what Roland Barthes calls the “punctum”[10] of the photograph, or the part that pierces, is that in it, and in their act of police violence, the psychic humiliation of slavery and the auction block resurfaces in the image of the stripped black body.

Yet even in the face of this repression, 10,000 to 15,000 people attended the convention. Radical queer organizations from across the nation, inspired by Huey P. Newton’s August 21st “Letter to the Revolutionary Brothers and Sisters about the Women’s and Gay Liberation Movement,” published in the Black Panther newspaper, attended. Ortez Alderson, a gay black man and leader in the Chicago Gay Liberation Front and Third World Gay Revolutionaries drafted the “Working Paper for the Revolutionary People’s Constitutional Convention,” which outlined a radical anti-racist and anti-homophobic philosophy. Kiyoshi Kuromiya spoke at Temple University’s McGonigle Hall representing the “Male Homosexual Workshop.”[11] Afeni Shakur spoke to a workshop run by the Radical Lesbians. Trans justice activist Sylvia Rivera participated and met with Huey P. Newton. Inspired by gay liberationist activism, two London School of Economics students who attended and likely saw Kiyoshi speak, went back to London and started their own Gay Liberation Front. (I’m currently researching overlap and tension between the London GLF and the British Black Panthers — one member was the radical black feminist and squatter activist Olive Morris). Following the People’s Convention, Ortez Alderson was arrested for breaking into an Illinois draft board and was incarcerated for a year, first at Peoria County Jail for three months, and then he was transferred to a prison in Ashland County, Kentucky. While imprisoned in Kentucky, Alderson and three other queer men of color attempted to form a gay liberation chapter. In a 1972 interview with Motive Magazine titled “On Being Black, Gay and In Prison: There is No Humanity,” Alderson recounted his experience and activism inside:

What I’m trying to relate is the experience of how it was for me as a black and as a gay man to be within the jail system of America…The confrontation came on Gay Pride Day, June 28th, because we wanted to have a Gay Day celebration in prison. The prison officials said we could not have this celebration. At this point, we got up a petition attacking the institution’s discrimination against homosexuals. Craig, Green, Davis and myself were immediately arrested by the goon squad and put in the hole..[12]

Alderson would go on to become a central figure in both NYC[13] and Chicago ACT UP chapters.

I think one crucial dimension of the struggle to disrupt and heal from the historical trauma and violence of COINTELPRO, the FBI war on the black liberation movement — the MOVE bombing of 1985 and police raids targeting Revolutionary Action Movement in the 60s — and the government surveillance and infiltration of national queer organizations such as the Gay Activist Alliance, Gay Liberation Front and more recently ACT UP Philadelphia, the dismantling of welfare and the rise of the prison industrial complex, the criminalization of HIV/AIDS, institutionalized transphobia, racism, sexism — is to, as the movie and the principle “Sankofa,” suggests — “go back and fetch it” — to remember our history, our struggle, our survival, our fierce and fabulous power. Sankofa is an Akan word, often pictured as a bird with its head stretched backwards, and symbolizes a return to the past as a way to be self-determined and whole in the future. What happens when your past has been denied, suppressed and disappeared in history books and in academic institutions by those who operate as what Gramsci called “experts in legitimation”? Kiyoshi’s legacy and the intersectional nature of his involvement in civil rights, black power and queer liberation movements is a direct refutation of that violence.

Cornel West often talks about the etymology of the word human, and the Latin word “humando,” which means “burying.”[14] Sitting amongst Kiyoshi’s life work collected in over 50 boxes in the William Way Center, I felt an overwhelming combination of humanity and humility — my own humanity and humility in the face of Kiyoshi’s life work, and the force of his enduring humanity and courageous humility. That is what I feel now in this room of people here to honor him, it’s what I feel in the sense of collective possibility that emerges when community members come together for radical change. Sitting in that room, surround by artifacts — symbols and representations, Kiyoshi’s pictures and files — his presence was substantive, his historical importance for queer and trans people of color’s history, is indelible, striking and symbolic — just like the lighting bolt and clap of thunder that cut through the sky when he passed.[15] What humanity and what humility! I am proud to say how much he meant to me, even though I never physically met him. His presence is as real as ever, and I want to personally thank him for all of his untiring work, to thank those here who knew him in life and cared for him towards the time of his death, to thank those who carry on Kiyoshi’s legacy, to thank those who fight to open up spaces and horizons of radical futurity we can all be a part of.

[1] Highleyman, L. (2007, May 4). “Who Was Kiyoshi Kuromiya?”. Seattle Gay News . Seattle, Washington, United States of America., p. 30

[2] Eng, D. L. (2010). The Feeling of Kinship: Queer Liberalism and the Racialization of Intimacy. Durham, NC: Duke University Press., p. 36

[3] Stein, M. (2004). City of Brotherly and Sisterly Loves. Philadelphia: Temple University Press., p.316

[4] Heywood, T. A. (2009, November 17). “HIV-as-terrorism case could make legal waves”. The Michigan Messenger .

[5] Ferrara, D. (2010, May 29). Prisoners hired in oil relief efforts, trained for hazardous materials work. Retrieved June 9, 2010, from AL.com: http://blog.al.com/live/2010/05/prisoners_hired_in_oil_relief.html

[6] ACLU. (2010). Sentenced to Stigma. Washington, DC: ACLU., p.10

[7] Welch, M. (2005). Ironies of Imprisonment. Thousand Oaks, CA: SAGE., p. 65

[8] Kunzel, R. (2008). Criminal Intimacy. Chicago, IL: University of Chicago Press., p. 122

[9] Hevesi, D. (1991, July 17). Frank Rizzo of Philadelphia Dies at 70; A ‘Hero’ and ‘Villain’. The New York Times , pp. pgs. 1-2.

[10] Barthes, R. (1980). Camera Lucida. New York City: Hill and Wang., p. 26

[11] Teal, D. (1995). The Gay Militants/How Gay Liberation Began in America, 1969-1971. New York City: St. Martin’s Press., p. 171

[12] Alderson, O. (1972). “On Being Black and Gay In Prison: There is No Humanity”. Motive Magazine.

[13] Thanks to Mark Harrington for informing me of Ortez Alderson’s participation in ACT UP NYC on June 10th at the “Remembering Kiyoshi Kuromiya” gathering at St. Luke’s Church in Philadelphia PA.

[14] West, C. (2000). The Cornel West Reader. New York City: Basic Books., p. 551

[15] Sosa, A. (2010, June 11). Remembering Kiyoshi Kuromiya, Kiyoshi Video. (M. Seaman, Producer, & Mighty Head Entertainment/Philadelphia Fight) Retrieved June 12, 2010, from Philadelphia FIGHT: http://www.fight.org/subsection_1.php?cat=1&sec=18%E2%8A%82=4&sub_1=109

Hep C treatment: Time is of the essence.

Daily Checkup: Alcohol still risk, but viral hepatitis, fatty liver disease main causes of cirrhosis

BY Katie Charles

New York Daily News

Friday, July 16th 2010, 4:00 AM

As the chief of the division of liver diseases at Mount Sinai, Scott Friedman is a hepatologist who does research on how scar tissue forms in the liver.

Who’s at risk
“Fibrosis” is a term doctors use to describe the scarring of the liver that builds up over time as the result of liver damage. “Over many years, that scarring progresses and culminates in cirrhosis, which refers to an end-stage fibrosis,” says Friedman. “By then, the blood flow through the liver is impaired, and liver function may be compromised.”

A healthy liver has many vital functions, like detoxifying the blood, synthesizing critical proteins and hormones, fighting off infection and metabolizing sugars, fats and proteins.

Advanced fibrosis and cirrhosis are major public-health concerns that dramatically increase your chance of developing liver cancer.

“Liver cancer is the fastest-rising cancer in the U.S. and the third-leading cause of cancer mortality worldwide,” says Friedman. “The bulk of patients with cirrhosis in this country have it from hepatitis B or C − about 5.3 million Americans are living with chronic viral hepatitis.”

The second-leading cause of fibrosis is called “fatty liver disease,” in which fat accumulates in the liver and eventually leads to scarring. “Obese patients often overlook the risk of liver damage,” says Friedman. “Obesity often goes hand in hand with metabolic syndrome, which is associated with elevated blood lipids and blood pressure, insulin resistance and pro-thrombotic and an inflammatory state.” Fatty liver disease often improves after weight-loss regimens like bariatric surgery.

The underlying cause for fibrosis can also be alcohol abuse or rarer conditions like autoimmune diseases of the liver. “Alcohol abuse is definitely a risk factor, but the vast majority of patients with fibrosis and cirrhosis don’t abuse alcohol,” says Friedman. The old association linking cirrhosis solely with alcohol abuse no longer holds true now that viral hepatitis and fatty liver disease are the two primary causes of fibrosis and cirrhosis.

Signs and symptoms
One of the challenges of diagnosing and treating liver disease is that it most often develops stealthily.

“The liver is so resilient that it can compensate for years of disease, and the patient may have no symptoms until the disease is very progressed,” says Friedman. “In reality, many patients have advanced fibrosis but have no symptoms.”

The very late manifestation of symptoms means that it is even more important to identify if people are at risk and screen them to catch the disease early.

“People at high risk of liver disease include Asian immigrants, who are more prone to hepatitis B, and patients with evidence of metabolic syndrome, who are at high risk of fatty liver disease,” says Friedman. Other risk factors for hepatitis include people who got blood transfusions before 1990 and people who engage in high-risk behavior like needle-sharing. Alcohol abuse is still a risk factor, even if it is no longer the most common underlying cause.

New evidence shows that simple blood tests can do an excellent job of identifying a patient’s risk of liver disease. “We screen for ALT − alanine aminotransferase − an enzyme that enters the bloodstream if the liver is damaged,” says Friedman. “An elevated ALT level without explanation merits followup.”

Traditional treatment
“We have no treatments approved to attack the scarring in the liver yet,” says Friedman. “But we have some excellent treatments for the underlying diseases.”

There are effective medical therapies for hepatitis B and C. “For hepatitis B, the main drugs are molecules that block the multiplication of the virus,” says Friedman. “The hepatitis C treatments are a combination of the drugs interferon and an immunomodulatory drug called ribavarin, which together boost the immune system to fight the virus.”

New drugs that attack the hepatitis C virus directly are expected to be available next year. For patients with fatty liver disease, weight-loss regimens also reduce liver damage. “Anything from diet and exercise and medications to bariatric surgery can have great results,” says Friedman.

If alcohol abuse is the underlying cause, patients are usually required to enroll in a 12-step rehab program.

Once the liver disease progresses to the point of impairing liver function, doctors treat the resulting symptoms. “We try to treat all the liver problems and screen for liver cancer,” says Friedman. “For select patients, liver transplantation may be necessary.”

But doctors hope they can help more patients control their liver damage before it gets to that point. “There is now evidence that if we treat the underlying liver disease, even cirrhosis is reversible,” says Friedman.

Doctors are making liver disease an increasingly manageable illness through prevention, early detection and the treatment of fibrosis before it progresses too far.

Research breakthroughs

Some of the most exciting liver disease research is being done at the molecular level.

In 1985, Friedman identified the cell type that’s responsible for the formation of scarring tissue.

“Basically, we’ve gone from uncovering [what] causes scar formation to soon being able to treat and prevent fibrosis with medication,” says Friedman. “Our hope is that if we develop new treatments for fibrosis, we’ll be able to prevent the development of cirrhosis.”

Questions for your doctor

Hepatitis is a major public health risk, so be proactive about asking your doctor, “Am I at risk of hepatitis?”

Follow up with, “Should I be vaccinated for hepatitis A and B?” Another good question is, “Do I have any risk factors for liver disease?” and “Is my ALT elevated?”

What you can do

• Know your risk level.
  That means knowing the risk factors of liver disease — especially hepatitis and fatty liver disease — and knowing your ALT level. “If your ALT level is abnormal on even one reading, you should have it followed up,” says Dr. Scott Friedman. 

• Get informed.
  The American Liver Foundation has great patient information on support services and advocacy. See www.liverfoundation.org. 

• See a specialist.
  “If there’s evidence of chronic liver disease based on virus or blood tests, see a liver specialist,” says Friedman.

• Support liver disease research.
  “It’s a terribly underfunded research area,” says Friedman, who recommends giving to the American Association for the Study of Liver Disease at www.aasld.org.

Brewer's sick, dying, and innocent prisoners: Letter to the Governor.

My note to the Governor today via her website; posting it here, too, just to make sure it isn't lost:

First Name: * Margaret J
Last Name: * Plews
Phone: 480-580-6807
Email: * arizonaprisonwatch@gmail.com
Street: PO Box 20494
City: Phoenix
County: Maricopa
State: AZ
Zip: * 85036
Subject: legal/law *
Topic: Sick, dying, and innocent prisoners, and the Board of Executive Clemency

My friends and I at Arizona Prison Watch are gravely concerned about the number of state prisoners who are dying inside from medical neglect, from homicide, and from their own hand due to the despair of mental illness and incarceration - as well as those succumbing to terminal illness while awaiting compassionate release petitions which we suspect she has no intention of approving, just as Janet didn't. We find that totally unacceptable.

We are particularly concerned right now about the fates of prisoners William Macumber and Davon Acklin. The Board of Executive Clemency recommended Macumber for immediate release last year because they believed him to be innocent: the governor denied his petition, giving no reason. This is incomprehensible, and we'll be initiating a public campaign for his freedom if the governor doesn't take responsibility for acting on the Board of Clemency's recommendations in his case.

You may already be quite familiar with Davon Acklin's mom Julie, who has been trying to save her son's life - also going through the Board of Executive Clemency now. He's sick from hepatitis C and the ADC is refusing to treat him, we believe largely because of his serious mental illness, which appears to be the standard MO. This despite the stipulations of the Americans With Disabilities Act, which we intend to file a complaint about if appropriate care isn't provided to that child, or if he isn't sent home so his mother can get it for him.

We will also be seeking a new CRIPA investigation into the ADC - and possibly the AZDJC - if the other concerns we've raised aren't promptly addressed, and prisoners continue to die at present rates from neglect, abuse, and despair. The one poor child at Adobe Mountain appears to have been bullied to death; there's no excuse for that. Director Branham has, however, been quite gracious in trying to work with us given the limitations of confidentiality laws, so he may have bought some time. The ADC is out of time, however. As far as we're concerned, all of Chuck Ryan's prisoners are her prisoners too, and she bears a great deal of responsibility for their welfare. Criminalized or not, they are still real human beings with loved ones, hopes, and dreams. The state has a duty to protect them while they are in your care.

I do expect a response on these matters by Friday afternoon - our campaign to address them with the community and media will otherwise begin first thing Monday morning. We hear from these families and prisoners all the time - often we receive copies of letters sent to Governor Brewer pleading for assistance. We'll have them crying on the news every night and we'll be coming to her campaign events until the governor either steps in and steps up, or gets voted out. We can be extremely creative about these kinds of things, as can our friends - thousands of whom are already pretty outraged by SB 1070.

I will be looking forward to a reply from your office.

Thank you.


Margaret J Plews,
Arizona Prison Watch
Arizona Juvenile Prison Watch
Hard Time Alliance (Hep C in AZ Prisons)

Davon and Goliath: meet Michelle Burrows.

Sorry - this is a really long one, but it's worth it. The Progressive article below tells the story of the HCV-positive prisoners who became part of a successful 2004 class action lawsuit against the Oregon Department of Corrections for failing to provide adequate (or any) medical treatment for their disease. Note the importance of treating such patients before they begin to experience liver damage. Delaying treatment for even six months or a year could dramatically reduce a young man or woman's life expectancy - and that's a hell of a way to go.

Before the background story on Anstett et al v. the State of Oregon, though, I'm posting the links to the actual class action settlement documents. Some things there just sound too familiar. Please contact me if you or a loved one has/had Hepatitis C in prison and are being/were refused treatment by your state's Department of Corrections - especially if that state is Arizona. The best way to get my attention is through the following address or email:

Peggy Plews
Hard Time Alliance - AZ
PO Box 20494
Phoenix, AZ 85036

hardtimehepc@gmail.com

You may also want to hit the Hard Time Alliance blog for more information and links to resources about Hep C in prison. Most of the other links embedded in this post will take you there, too.

For those of you following what's happening with Davon Acklin: we're still hitting a wall at the AZ Department of Corrections. His mom, Julie, can't get them to do the lab tests, take him to a specialist, or provide the treatment he needs to clear this virus before it does more damage; his liver and kidney function tests are already abnormal now. She can't even get them to find out the genotype he has to determine his vulnerability and the likeliness that he'll respond to treatment.

The dentist who serves as the Interim Medical Director for ADC said that the Hep C committee (which I believe he has a voice in) determined that Davon doesn't meet the criteria for treatment, emphasizing that he's not a good candidate for treatment and is less than a year from his release (the ADC doesn't want to start treatment if they can't be sure it will be finished. Julie would make sure it was finished). They have about 25 other hurdles prisoners with Hep C have to clear before they qualify for treatment, though (it's what they call an algorithm, which I can no longer find on their website). I guess that's one way to keep down their medical costs, since they could shell out a hundred grand on his medical care before he's through there. The medical profession - especially in corrections - is also generally against treating people with serious mental illness with interferon, because we'd have to go off our psychotropic meds - which could destabilize us - and the interferon can make you pretty sick and crazy even if you're relatively well and sane. That means that if I get Hep C, too, I may well be refused treatment as a free woman - most certainly if I was a prisoner of the state of Arizona.

There are new drug trials going on now, though, with less toxic antivirals that people with psychiatric disabilities can tolerate better. The ADC could be looking into how to get patients like Davon into such trials. In any event, I think Davon and I should both have the right to decide what to risk ourselves - which may come down to a choice between a long, slow, painful death (during which time most of our meds would have to be stopped anyway, because our failing livers couldn't handle them anymore), or a year or more of chemotherapy for Hep C (which may or may not work, and could aggravate our respective psychiatric disorders, resulting in psychosis, mind-numbing depression, and/or suicide). It's kind of a tough choice, really - especially if the misery of cirrhosis is just a maybe in the distant future - for Davon the future is now, though.

As many of you know, Davon's mom has petitions and a Facebook cause page set up for him, and I threw together that Hard Time Hep C blog to be a resource as well as an outreach and organizing tool - this has never just been about him. He talks a lot about the men around him who are sick and dying, and is always asking Julie to help them, too. That's why we formed an alliance with other families, ex-prisoners, and community members concerned about people having access to health care in prison.

We didn't know how sick Davon was at first (Julie has his medical records now and we've both been doing our homework); we're trying desperately to get him treatment or a compassionate release, but we're also still trying to change the system for others - not just trying to force them into making an exception. There are nearly 6,000 men and women in Arizona's state prisons who are known to be Hep C-positive, and many public health experts believe that most people with Hep C don't even know they have it yet (which means they could be infecting others for years unknowingly). Compare that to the couple hundred people in our state prisons who have AIDS. I find that stunning. Those HCV+ prisoners constitute a pretty large class, and if testing was expanded it would grow considerably.

Davon doesn't have time for a lawsuit himself, though - he'll be too sick to benefit from treatment by the time he gets home at the rate he's been deteriorating. Julie was told by the ADC that Davon's life is not in imminent danger and he doesn't qualify for a recommendation to the Board of Executive Clemency for compassionate release. She saw him this weekend, though - she says he looks like he's dying - and came home even more determined to get him treated there and now or freed. The Executive Director of the Board told her that Davon could apply for a regular pardon, however - but that could take six months to come before them, by which time Davon could be too ill to benefit from interferon. I don't think the Governor can pardon someone without the Board's recommendation to do so - but she can refuse to pardon anyone and everyone she wants - even those the Board has declared are clearly innocent of their crimes. In any event, it apparently doesn't get to her until it goes through them.

So, we're working on a few back-up plans to Julie's petitions and letters and Clemency Board paperwork. As far as I'm concerned, withholding medical care like this is state violence that should be covered by the Civil Rights of Institutionalized Persons Act (CRIPA). I also think the policy or practice of excluding anyone with mental illness from treatment - simply by virtue of their diagnosis - is a violation of the Americans with Disabilities Act. I've already started investigating the implications of those laws for Hep C prisoners, in addition to the possibility of class action.

The consequences of not treating HCV+ prisoners are extremely grave, as you'll read below. Julie won't let her son keep suffering without putting up one hell of a fight. The ADC should immediately step up to their responsibility to help this kid in every way possible if they don't want to let him go on medical grounds. He needs nutritional support, counseling, and medication to rid his body of that virus; it almost seems like they're just stalling in hopes he doesn't cost too much or die before his sentence is up. If Ryan is concerned about saving money - if that's the bottom line - then his staff can recommend Davon for medical/compassionate release and ask the Board and governor to send him home now. That'll save them not only the cost of keeping him alive and confined, but also a fortune in legal fees and settlements down the road.


And it may help save Davon's life. God knows he's already more than paid for his crime of mental illness...


Ryan's a big believer in punishment, though, and of course he wouldn't be in that job if he didn't keep every last prisoner there as long as the courts ordered. I don't know if he's been misinformed by his people (like the dentist who seems to be making clinical recommendations about people with Hep C), or what kind of circumstance he would find extraordinary or moving enough to recommend someone for compassionate release - there are people dying of cancer, liver disease (many from Hep C), and old age. According to Tucson prisoners, one of the yards there is known as the Death Yard. Why aren't people being sent off to hospice to die instead? There are also prisoners who have had strokes or amputations and lost the use of one or more limb - the list goes on.


Children are dying in his prison, too; a boy on the minors unit just suicided in May, and 16-year old Edgar Vega died there last year - he just dropped dead. The paper said it was his heart, but his family said the autopsy wasn't clear. I think his dreams were shattered and his heart broke when he was sent there.


I'm sure most judges would reconsider some of their sentences if they knew what was happening to these folks...or maybe they do and don't think much about it at this point in their careers. Maybe they think of it as some kind of Divine Justice or something - I don't know. I find this all very troubling, but can't just walk away. I think we are all responsible for what is done to people by the state, and no one is more vulnerable to and dependent on the state than those committed to its custody and care. That's why I do what I do with my time.


Anyhow, thanks to all of you who have joined the cause and signed a petition or written a letter on Davon's behalf. Whether or not it matters in the end to the Board of Executive Clemency or the Governor, it makes a big difference to our morale right now. As Davon says, it means a lot to know that there are people out here who care about and believe in him.

---------------------From the National HCV Prison Coalition------------------


HCV Treatment Guidelines - OREGON

Oregon Department of Corrections Guidelines for
Evaluation and Treatment of Hepatitis C (7/28/2003)
oregon 1.02 Mb

HCV Treatment Guidelines for Oregon (no date)
oregon_bak 99.01 Kb

---

Documents for the April 6, 2004 settlement concerning Oregon Department of Corrections (ODOC) treatment of inmates with Hepatitis C (HCV).
[ posted Oct. 26, 2005 ]

Letter from Michelle R. Burrows, attorney, to clients regarding class action lawsuit, Anstett et al v. State of Oregon, USDC No. CV01-1619BR, May 26, 2004
burrows_letter_052604 87.11 Kb

Anstett et seq. v. State of Oregon et seq., USDC Case No. 01-1619BR, Plaintiff's Settlement Proffer: Part I and Part II "As Applied" Policy, 40 pages
or_settlement 1.95 Mb

Supplemental Release and Settlement Agreement, April 15, 2004, 8 pages
or_settlement_suppl_041504 318.23 Kb

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State of Oregon Hepatitis C Strategic Plan, Recommendations
of the Statewide Viral Hepatitis Planning Group, Prepared by
Ann Shindo, Ph.D., and Ann Thomas, M.D.
OR_strategic_plan 879.73 Kb


----------------------------The Progressive, March 2006------------------------

Prison Outbreak: An Epidemic of Hepatitis C.

(courtesy of the freelibrary.com)

Rodger Anstett's death in 2003 was neither sudden nor inevitable. The symptoms started back in 1998: the abdominal pain around his kidneys and liver, the achy joints, the debilitating fatigue. Blood tests later that year showed that his liver enzymes were far above normal--one of them was eight times higher than it should have been. It all pointed to advanced hepatitis C infection, but Anstett's doctor waited another two full years before giving him a test to confirm the presence of the disease. It was another year before the doctors for Oregon's corrections system, where Anstett had been locked up for twelve years, treated him, just a month before his release. At that point, his liver was far too damaged for the drugs to do much good, and he died a year and a half later.

Thousands of hepatitis C-positive prisoners around the country are today facing Anstett's dilemma--barreling towards a preventable death because they are at the mercy of corrections health systems that are refusing to treat them. Moreover, say an increasing number of public health watchers, the unchecked hepatitis C epidemic inside the nation's prisons is undermining efforts to bring it under control in the broader community.

"No matter what you're in prison for," says Rodney Anstett, who watched his brother Rodger wither away from liver failure, "you deserve basic human rights." Rodger was the lead plaintiff in a lawsuit making just that assertion. Two days before his death, Anstett recorded a deposition for a case that would be the first successful class-action challenge to a state prison system's hepatitis C treatment policies. Last year, the state settled the suit, agreeing to open up treatment, and a federal judge is now monitoring its compliance with that settlement.

But Oregon's case is unique only in that the courts have intervened. Hepatitis C infection rates in some incarcerated populations are as high as 42 percent, according to an article in the Clinical Infectious Diseases journal, and anywhere from 15 to 30 percent of all prisoners are believed to carry the blood-borne virus. More precise counts are unavailable because few systems have come up with effective ways to screen for it-indeed, few even tried until federal health officials prodded them into action in recent years.

"Most prison systems are purposely not testing for hep C," charges civil rights lawyer Michelle Burrows, who led the Oregon lawsuit, "so they can say 'we don't know who's got it,' and don't have to treat it."

Science didn't identify hepatitis C until 1989, and it has been overshadowed by its more prominent viral sister, HIV. But the U.S. Centers for Disease Control and Prevention (CDC) estimates at least three million people nationwide now have chronic hepatitis C infections-triple the HIV caseload. Most are injection drug users, since unlike HIV the hepatitis C virus spreads less easily through sex than through direct blood-to-blood contact--which explains the epidemic's intensity among people who cycle through prison.

Hepatitis C is emerging as a leading cause of death in several state prison systems, according to Scott Allen, the medical director of Rhode Island's corrections department. It's also the number one reason for liver transplants in America. The disease has overwhelmed the market, creating a waiting list of more than 15,000 people.

As with most diseases, early treatment separates the well from the ill. But hepatitis C-positive prisoners around the country testify that prison health care providers are delaying treatment as long as possible.

Many prisons insist that anyone with a history of drug or alcohol use--no matter how long ago--complete a rehab course before beginning treatment. And they usually add a requirement that inmates be far enough away from any potential release date to guarantee that they will complete the year-long treatment regimen while still locked up. Finally, many systems also bar anyone with potential mental health problems from getting care. Oregon denied Anstett's repeated requests for treatment based on his need for a psych evaluation, which he never got, and the requirement that he take a drug abuse class, which, he testified, he had previously completed.

There are few national or even state-by-state numbers on how many prisoners actually get medical care under these policies. But Oregon had treated just a dozen of its at least 3,500 hepatitis C-positive inmates when Burrows filed suit.

A Justice Department census in 2000 tried to uncover how many inmates are tested and treated nationwide. It found that around 57,000 hepatitis C tests were conducted in the preceding year (a quarter of which were in California), and a whopping 31 percent came back positive. But of these nearly 18,000 people, only 4,750 were being treated (and 40 percent of those were in California alone). In New York State, which has about 10,000 hepatitis C-positive inmates, the highest in the nation, only about 300 were being treated, according to the Justice Department's census.

In August, New York civil rights lawyers filed a class-action suit challenging that system's policy. The lead plaintiff, Robert Hilton, had begun treatment at a New York City public hospital for his hepatitis C and subsequent liver disease in 2002. A few months after starting, he became homeless, and his treatment was interrupted. In August of 2004, Hilton was incarcerated on a parole violation and, after a few days in a downtown holding cell, shipped to a facility upstate. Upon intake there, he underwent a routine exam, and he told doctors about his infection, his liver disease, and his treatment history. Court records show that the doctors received copies of a May 2004 medical record confirming Hilton's report and recommending that his treatment resume.

But the medical staff allegedly waited two months to conduct its own screening, and a full seven months to recommend him for treatment--a process that would have taken weeks at best on the outside. By May 2005, an outside specialist had also recommended treatment for him, he'd been cleared by a mental health evaluation, and he'd signed the necessary consent form. Then, according to the suit, state Chief Medical Officer Lester Wright stepped in and shut the process down by demanding Hilton first take drug addiction classes, even though no previous doctor inside or out of the system had suggested it, and even though Hilton professed to not having used drugs in thirteen years.

Wanting his treatment resumed, Hilton acquiesced and signed up for the class--only to be put on a lengthy waiting list, since the facility at which he was incarcerated didn't have enough classes to accommodate the demand. He was then transferred to another facility, where counseling staff again tried to enroll him in a drug addiction class. This time, his enrollment was denied because he would be eligible for parole before the class finished. "As antiretroviral treatment continues to be denied on the basis of this Catch-22," the class action complaint notes, "Mr. Hilton's liver continues to deteriorate."

The state declined to comment on this and other suits it now faces related to its treatment policy. It did, however, file court papers in November asking that the suit be dismissed because, it said, it had just changed its treatment policy to ensure that "programmatic needs for alcohol and substance abuse treatment do not interfere with medical requirement" for hepatitis C treatment.

But Alex Reinert, who is representing the plaintiffs for the firm Koob & Magoolaghan, charges that he has already received at least one complaint from a prisoner who says he was denied treatment for not going to rehab, even though that policy was supposedly repealed.

"What Dr. Wright is saying is, 'Trust us, you don't have to be involved anymore,' " Reinert says. "But our experience is, the only time an individual gets treated is when an attorney has stepped in."

Coincidentally or not, treating hepatitis C is one of the more expensive tasks in medicine. Unlike HIV, doctors believe it can be permanently eradicated from a patient's body. But doing so can cost as much as $35,000 per person. Even evaluation can be an expensive process.

Corrections officials around the country, however, say they're just following federal health agencies' guidelines. In 2002 and 2003, in response to growing concern about the hepatitis C epidemic, the National Institutes of Health (NIH) and the CDC each issued recommendations for treating the virus. Around that time, state correctional officials gathered in San Antonio to share their experiences and compare ideas. They came away agreeing that each system should come up with firm criteria for both screening and treatment decisions, according to people in attendance. The rehab, time-remaining-on-sentence, and psych evaluation requirements fast became national standards.

Corrections health officials do face a complicated set of considerations. Because hepatitis C is a slow-progressing virus and because medicine is still learning how it works, just how fatal it is remains unclear. Currently, the CDC estimates that 5 percent to 20 percent of those infected with hepatitis C might develop cirrhosis over two or three decades. When and how to treat those who may not progress to that stage is a difficult question, and not just because of the costs. Hepatitis C treatment is brutal. Even the most advanced therapies involve regular injections. Side effects include psychiatric problems, particularly depression, and flu-like symptoms similar to heroin withdrawal--taxing circumstances for someone trying to stay sober. Both the CDC and NIH guidelines urge caution in treating active users, because failed adherence can jeopardize treatment success.

But the prison systems' policies are far inferior to the standard of care on the outside. Both the CDC and NIH stress that even active drug use should not automatically rule someone out for treatment. And at least one study--conducted by Rhode Island's corrections department--found that pre-existing mental health problems don't get in the way of treatment. As a result, class-action suits have been lodged in at least four states since 2001.

Oregon's case has been the most watched. The settlement was unprecedented. Outside specialists crafted a treatment policy that Burrows calls "the Cadillac standard." Doctors can still demand drug rehab classes and delay treatment if there's not enough time left on the sentence to finish a course of medicines, but those judgments must be made case by case, and everyone who tests positive must get at least a full medical workup to determine whether immediate treatment is needed.

Since the agreement, Burrows estimates, the state has begun treatment on around 1,000 inmates. But the legal fight continues, as several inmates and families--including the Anstetts--filed a wrongful death and damage civil claim in May. A spokesperson for the Oregon Department of Corrections declined to comment on the case or the department's hepatitis C treatment policies.

While states are failing to provide adequate treatment for hepatitis C-positive inmates, they are doing even less to prevent further spread of the disease. In many places, prisoners receive no information whatsoever about how to live healthy lives with the virus and how to prevent passing it on.

Prisoners nationwide testify that the sorts of behaviors hepatitis C thrives upon are widespread behind bars. While locked-up users more often sniff or smoke heroin than shoot it, plenty inject it as well. Some fish used syringes out of hazardous waste buckets in the infirmary and sell them on the black market. Others fashion makeshift "works" out of an eyedropper and a needle.

"I actually made a syringe out of a Bic pen," says Greg, who spent seventeen years in New Jersey prisons and requested anonymity. "If you get one set of works, the whole wing's using it. And that's how HIV and hepatitis C are spread. That's where I believe I got it."

New Jersey faces at least one lawsuit challenging its hepatitis C treatment policy. New Jersey Department of Corrections spokesperson Matthew Schuman refuses to comment on the case or the state's hepatitis C policies. While he acknowledges that injection drug use through shared syringes takes place, he stresses the department has a "zero tolerance" policy and has made strides cutting out drugs of all sorts in recent years. "When you're dealing with inmates," he says, "it's always going to be a cat and mouse game."

Widespread tattooing inside prison offers a similarly efficient way to contract hepatitis C. Tattoo machines are as easy to make as syringes--just pull a motor out of an old Walkman and hook it up to anything sharpened into a point. The problem is the ink, which prisons ban. So jailhouse artists shave down lead pencils or burn checkers and use the ash. Because they go to such extremes to get this valuable commodity, the artists do not dream of making a new pool each time they have a new customer, as those on the outside do. Hepatitis C can live for a few days outside the body.

And then there's sex. In an informal survey by the Latino Commission on AIDS of just over 100 New York State prisoners and ex-offenders in 1999, 63 percent of respondents reported having witnessed other inmates having sex. Nearly a fifth acknowledged having had sex themselves. And more than 30 percent said they knew someone who had contracted HIV while in prison due to unprotected sex.

University of North Carolina researcher James Thomas says all of this raises questions about the relationship between the hepatitis C and HIV epidemics in prisons and in neighborhoods--particularly African American ones. His research suggests "incarceration is leading to STDs," he says, adding that there appears to be a dynamic interaction between sexually transmitted disease patterns in the street and in the jailhouse. An estimated 1.4 million hepatitis C-positive inmates are released from America's prisons and jails each year, according to the Clinical Infectious Diseases journal.

Greg doesn't know if he infected his wife or not. She left him after his last prison term and now refuses to tell him if she's hep C- or HIV-positive. But the possibility that he brought the virus outside the prison walls is one that America's corrections health care system doesn't seem to grasp.

"They really don't care," scoffs Greg. "They figure we're criminals, so we're going to die anyway one way or the other."

Kai Wright is a writer in Brooklyn, New York, and editor of BlackAIDS.org. You can read more of his work at KaiWright.com.

Genetic markers for treatment responsiveness.

Why can't Arizona coordinate with community service providers so people can start treatment in prison and successfully complete it after release? Is the ADC or the health department just not up to it? Or does it just not matter that much? Not worth the effort? or has no one even considered trying? Just because most other prisons do it one way, that doesn't mean Arizona can't do it better. We sure aren't copying the rest of the country on most other incarceration models and trends...

The rest of the article is fascinating, too - this testing being widely available for Hep C prisoners could make a difference for a lot of people who may otherwise be written off as poor treatment responders before they even get a chance.

------------------------------

Management of Hepatitis C Among Prisoners Using IL28B Testing
Society of Correctional Physicians
Originally published June 21, 2010

By Madhura A. Hallman, MD, MPH Candidate and Anne C. Spaulding, MD, MPH

Posted on June 21, 2010 -Over the past decade, availability of hepatitis C treatment for appropriate inmate-patients has increased in most state prison systems. Written policy has guided eligibility criteria, such as a length of stay sufficient to complete treatment1. In New York, where follow up care has been coordinated with local health centers, a possible return to the community no longer disqualifies candidates for treatment2. Nonetheless, these advances have not made treatment any easier. Among patients with genotypes 2 and 3, 80% clear the virus. The 50% success rate in treating genotype 1 continues to frustrate both clinicians and patients.

This situation may soon change since genetic analysis of the host will soon be able to predict which patients are more likely to respond to treatment. Just as testing for the HLA-B*5701 allele has helped physicians predict which HIV+ patients will have a hypersensitivity reaction to Abacavir, a similar genetic assay may soon be available to assist prediction of response to treatment for hepatitis C patients.

A paper published in September 2009 by Ge et al. represents an advance in personalized medicine that will address an issue important for many people. Researchers identified a polymorphism (rs12979860) near the IL28 gene on chromosome 19 that was highly correlated with a favorable response to interferon among patients infected with genotype 1 of the hepatitis C virus3. The methods for their genome-wide association study (GWAS) are explained in an editorial that accompanied Ge’s article4. In American patients of European and Hispanic descent, homozygosity for this allele was correlated with a twofold increase in response to treatment compared those in whom the allele was absent. In patients of African descent, a threefold increase in response was noted; however, homozygosity was rare among these patients, which could partially explain their low rates of response to interferon. The authors estimated that this genetic variant accounted for approximately half the difference in treatment response between African-Americans and European-Americans.

Suppiah et al. and Tanaka et al. identified a second polymorphism (rs8099917) in a similar region near the IL28 gene which was strongly associated with response to combination treatment with interferon/ribavirin in Australian and Japanese patients, all infected with viral genotype 15,6. Most recently, Rauch et al. conducted a GWAS including all viral genotypes 1-4, and found that the rs8099917 minor allele was associated with both progression to chronic hepatitis C and failure to respond to treatment, with the strongest effects in patients infected with genotypes 1 or 47.

Several of these findings have important implications for correctional medicine. If 25% of prisoners have hepatitis C disease8 and 70% of these have genotype 1, then this advance will be important for about 1 in 6 patients currently in US prisons. Moreover, given that this genetic variant could explain much of the low response to treatment in African-Americans, having a test for the variant will be a useful tool in guiding treatment decisions. If and when a test for this genetic variant becomes commercially available, there will be some important caveats to consider:

• Having the test result will be important for both pre-treatment and during treatment counseling, especially if interferon tolerability becomes an issue.

• Although the response rate in persons without this gene is low and since one cannot predict who will respond, its absence should not disqualify a motivated patient from attempting treatment after appropriate counseling.

It is clear that we still need more treatment options and more effective treatments for hepatitis C. Currently, HCV specific protease inhibitors are in phase three trials. For patients who are responsive to interferon, triple agent therapy (interferon, ribavirin and the virus-specific agents) may eventually improve treatment outcomes. It is unlikely that the genetic markers that contribute to interferon and ribavirin resistance will have an influence on direct antivirals. At this point in time, no interferon sparing regimen is currently in trials and so those who test negative for IL28B testing will continue to face poor recovery rates.


References

1. Spaulding AC et al. A framework for management of hepatitis C in prisons. Annals of Internal Medicine 2006;144(10):762-9.
2. Klein SJ et al. Promoting HCV treatment completion for prison inmates: New York State's hepatitis C continuity program. Public Health Reports 2007;122 Suppl 2:83-8.
3. Ge D et al. Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance. Nature 2009;461(7262):399-401.
4. Iadonato SP et al. Genomics: Hepatitis C virus gets personal. Nature 2009;461(7262):357-8.
5. Suppiah V, et al. IL28B is associated with response to chronic hepatitis C interferon-alpha and ribavirin therapy. Nature Genetics 2009;41(10):1100-4.
6. Tanaka Y, et al. Genome-wide association of IL28B with response to pegylated interferon-alpha and ribavirin therapy for chronic hepatitis C. Nature Genetics 2009;41(10):1105-9.
7. Rauch A, et al. Genetic variation in IL28B is associated with chronic hepatitis C and treatment failure: a genome-wide association study. Gastroenterology 1345;138(4):1338-45.
8. Weinbaum C et al. Prevention and control of infections with hepatitis viruses in correctional settings. CDC. MMWR Recomm Rep 2003; 52(RR-1):1-36. .

This is my friend, Davon.

This is a recent letter from my friend, Davon Acklin. He doesn't mention the campaign going on for him out here, but I know he's worried about the other guys there who are sicker than him; as Julie said at one point, this is about them, too.

We need to push on the clemency process so people don't have to die in prison who weren't sentenced to do so. We need more transparency and public dialogue about the treatment of hepatitis C in both the community and our human warehouses (prisons, schools, shelters, hospitals...). We need to make sure that health care is adequate in the prisons. And we need to bring home the sick and dying.




Anyway, this is the good soul I know Davon to be, describing the daily challenges of getting by in prison, worrying about how I was doing in the wake of a recent assault, and talking about having to always look tough in there to keep himself safe. He talks about his sister growing up, and what a terror he was at her age, and how he needs to be a good influence on his little sister, who looks up to him.

Here's a picture of Davon looking tough in his prison orange. He does a good job of it when he has to, but he's a real sweetie. That's why I'm posting this letter, which you can barely make out but you should get the gist of - he was worried about how I'd been getting along, and really touched that I brought his dad, Greg, down for a visit. He can't wait to see his sister and Mom, Not a mention of being sick; I think in a way he's a little uncomfortable with all this attention.

Despite his discomfort with being a poster child for prisoners with Hep C, Davon gave us his blessings to use our own discretion in all this organizing and activism around him because he thinks that by advocating for him his mom will end up helping the other guys he sees there. That's precisely what she's hoping to do.

Given the stigma associated with infectious diseases like HIV and Hepatitis (not to mention a psychiatric disability and a record as a violent criminal) I think that's a pretty courageous position for a young prisoner to take. Davon will be forever Googled back to these pages, with his mom and her friends laying out this crisis in his life for the world to see and judge - something he's willing to risk if doing so will help others.

Now, does that sound like a dangerous criminal? We call that 'lifting as we climb'. That's how we make sure we don't leave anyone behind in this revolution...

The ADC can cause Davon all sorts of grief if they want to, of course, but I don't think they'll stoop to that - it isn't necessary or productive, and it'll just set Julie off on them again. She's trying to focus on building membership in his facebook cause and getting his petition signed for the AZ Board of Executive Clemency right now, and if she's successful then she'll be out of the ADC's hair soon enough. It would be in their best interests to make every effort to help her succeed, not get in her way.

So, hit those links up there for us, and join and sign and spread the word. It's important to show that Davon has a community to come home to that will embrace him and help him keep both his liberty and his sanity. That community is global, now - Davon has friends he hasn't met yet as far away as the Netherlands. His community of correspondents are especially important for the Clemency Board to get personal letters from (in addition to signing the petition), no matter where you may be in the world.

Please help us free Davon.

Thanks for your time.

- Peggy Plews