Scott Burris

Can Sex Workers Regulate Police? Learning from an HIV Prevention Project for Sex Workers in Southern India

There is an argument that policing practices exacerbate HIV risk, particularly for female sex workers. Interventions that mobilize sex workers to seek changes in laws and law enforcement practices have been prominent in India and have received considerable scholarly attention. Yet, there are few studies on the strategies sex worker advocates use to modify police behavior or the struggles they face in challenging state institutions. This paper draws upon contemporary theories of governance and non-state regulation to analyze the evolving strategies of an HIV prevention non-governmental organization (NGO) and female sex worker community-based organizations (CBOs) to reform police practices in southern India. Using detailed ethnographic observations of NGO and CBO activities over a two year period, and key informant interviews with various actors in the sex trade, this paper shows how a powerless group of marginalized and stigmatized women were able to leverage the combined forces of community empowerment, collective action and network-based governance to regulate a powerful state actor, and considers the impact of the advocacy strategies on sex worker well-being.

Effects of an Intensive Street-Level Police Intervention on Syringe Exchange Program Use in Philadelphia, Pa

Repeated measurements and mixed-effects models were used to analyze the effects of an intensive long-term street-level police intervention on syringe exchange program use. Utilization data for 9 months before and after the beginning of the intervention were analyzed. Use fell across all categories and time periods studied, with significant declines in use among total participants, male participants, and Black participants. Declines in use among Black and male participants were much more pronounced than decreases among White and female participants.

Stigma, ethics and policy: a commentary on Bayer's "Stigma and the ethics of public health: Not can we but should we".

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The Case Against Criminalization of HIV Transmission

– see front matter 2008 Elsevier Ltd doi:10.1016/j.socscimed.2008.03.020 A man walks into a bar. He gets into a conversation with a friendly group of people he soon realizes are nonsmokers. Indeed, they come to this bar because it has an unofficial smoking ban, a fact he discovers when his companions make a big deal of glowering in the direction of a neighboring table where a couple has lit up. This is a problem for our man, because he smokes two packs day and needs a cigarette now. With a flush of shame, he faces the gap between the good person he thinks himself to be and the loser his companions would see were he to expose his addiction. He pleads another appointment and heads out to the street to light up. Has this man experienced stigma? Would it be a good thing if he has? And, if so, is it ethical for public health agencies to actively promote the stigma of being a smoker? In his article in this Special Issue, ‘‘Stigma and the ethics of public health: not can we but should we’’, Ronald Bayer argues that the answers are yes, yes and, under some circumstances, yes (Bayer, 2008). I believe he is wrong on every count. In building an argument around the idea that stigma is a matter of degree, he misses what makes stigma so bad – the core of the ethical question – but also why stigmatizing even clearly harmful health behavior is a losing public health practice – the key issue of policy.

Physicians' Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities

younger than 14 years (at which time the AAP recommends full disclosure for all patients, with a preference for earlier disclosure as appropriate), full disclosure of the diagnosis may not be necessary for meaningful assent. Rather, it may be necessary only that the child and family be engaged in an established disclosure process. Such a process requires that the clinician or researcher obtaining assent be familiar with the child’s development and progress through the disclosure algorithm. In addition, the language to be used in the assent process should be discussed and agreed on in advance with the family. At age 14 years, most children ordinarily are able to understand the implications of an HIV diagnosis and are ready for full disclosure. Wider debate and consensus building about assent and disclosure are needed among agencies that sponsor pediatric HIV research in the United States and internationally. Financial Disclosures: None reported. Funding/Support: This Commentary was supported in part by Cancer Center Support Core Grant P30 CA21765 from the US Public Health Service and by the American Lebanese Syrian Associated Charities (ALSAC). Role of the Sponsors: The Cancer Center Support Grant and ALSAC fund St Jude’s infrastructure but had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript. Additional Contributions: We thank Patricia Flynn, MD (Department of Infectious Diseases, St Jude Children’s Research Hospital), for information about the staged disclosure process at St Jude and for her critique of the manuscript. We also thank Sharon Naron, MPA, ELS (Department of Scientific Editing, St Jude Children’s Research Hospital), for editing and review of the manuscript. No compensation was received by those named herein. REFERENCES

The Law and the Public's Health: A Study of Infectious Disease Law in the United States

Naloxone, the standard treatment for heroin overdose, is a safe and effective prescription drug commonly administered by emergency room physicians or first responders acting under standing orders of physicians. High rates of overdose deaths and widely accepted evidence that witnesses of heroin overdose are often unwilling or unable to call 9-1-1 has led to interventions in several US cities and abroad in which drug users are instructed in overdose rescue techniques and provided a “take-home” dose of naloxone. Under current Food and Drug Administration (FDA) regulations, such interventions require physician involvement. As part of a larger study to evaluate the knowledge and attitudes of doctors towards providing drug treatment and harm reduction services to injection drug users (IDUs), we investigated physician knowledge and willingness to prescribe naloxone. Less than one in four of the respondents in our sample reported having heard of naloxone prescription as an intervention to prevent opiate overdose, and the majority reported that they would never consider prescribing the agent and explaining its application to a patient. Factors predicting a favorable attitude towards prescribing naloxone included fewer negative perceptions of IDUs, assigning less importance to peer and community pressure not to treat IDUs, and increased confidence in ability to provide meaningful treatment to IDUs. Our data suggest that steps to promote naloxone distribution programs should include physician education about evidence-based harm minimization schemes, broader support for such initiatives by professional organizations, and policy reform to alleviate medicolegal concerns associated with naloxone prescription. FDA re-classification of naloxone for over-the-counter sales and promotion of nasal-delivery mechanism for this agent should be explored.

Legal Aspects of Providing Naloxone to Heroin Users in the United States

Law plays crucial roles in the field of public health, from defining the power and jurisdiction of health agencies, to influencing the social norms that shape individual behavior. Despite its importance, public health law has been neglected. Over a decade ago, the Institute of Medicine issued a report lamenting the state of public health administration, generally, and calling, in particular, for a revision of public health statutes. The Article examines the current state of public health law. To help create the conditions in which people can be healthy, public health law must reflect an understanding of how public health agencies work to promote health, as well as the political and social contexts in which these agencies operate. The authors first discuss three prevailing ways in which the determinants of health are conceptualized, and the political and social problems each model tends to create for public health efforts. The analysis then turns to the core functions of public health, emphasizing how law furthers public health work. The Article reports the results of a fifty-state survey of communicable disease control law, revealing that few states have systematically reformed their laws to reflect contemporary medical and legal developments. The Article concludes with specific guidelines for law reform.

State Laws Restricting Driver Use of Mobile Communications Devices Distracted-Driving Provisions, 1992-2010

Naloxone hydrochloride is the standard treatment for heroin overdose. It is routinely provided by EMTs or emergency room staff. This medication is simple to administer, effective and has a very low risk of harm. Prescribing naloxone to heroin users for later self-administration in case of need is a simple, inexpensive harm-reduction measure that has the potential to reduce mortality from heroin overdose. Some physicians may be discouraged from distributing naloxone, however, by legal concerns. The legal analysis presented in this paper finds that the legal risks are low. Prescribing naloxone is fully consistent with state and federal laws regulating drug prescribing. The risks of malpractice liability are consistent with those generally associated with providing health care, and can be further minimized by following simple guidelines presented. Legal considerations should therefore not be a major impediment to wider use of take-home naloxone as an anti-overdose intervention in the United States.

Changing law from barrier to facilitator of opioid overdose prevention

BACKGROUND State laws limiting the use of mobile communications devices (MCDs) by drivers are being enacted at an accelerating pace. Public health law research is needed to test various legislative models and guide future legal innovation. PURPOSE To define the current state of the law, facilitate new multi-state evaluations, and demonstrate the utility of systematic, scientific legal research methods to improve public health services research. METHODS Westlaw and Lexis-Nexis were used to create a 50-state, open-source data set of laws restricting the use of any form of MCD while operating a motor vehicle that were in effect between January 1, 1992, and November 1, 2010. Using an iterative process, the search protocol included the following terms: cellphone, cell phone, cellular phone, wireless telephone, mobile telephone, text, hands-free, cell! and text! The text and citations of each law were collected and coded across 22 variables, and a protocol and code book were developed to facilitate future public use of the data set. RESULTS Thirty-nine states and the District of Columbia have at least one form of restriction on the use of MCDs in effect. The laws vary in the types of communication activities and categories of driver regulated, as well as enforcement mechanisms and punishments. No state completely bans use of MCDs by all drivers. CONCLUSIONS State distracted-driving policy is diverging from evidence on the risks of MCD use by drivers. An updatable data set of laws is now available to researchers conducting multistate evaluations of the impact of laws regulating MCDs by drivers. If this data set is shown to be useful for this public health problem, similar rigorously developed and regularly updated data sets might be developed for other public health issues that are subject to legislative interventions.

Emerging Strategies for Healthy Urban Governance

Opioid overdose is the leading cause of accidental injury death in the United States, taking the lives of over 16,000 Americans every year. Many of those deaths are preventable through the timely provision of naloxone, a drug that reliably and effectively reverses opioid overdose. However, that drug is often not available where and when it is needed, due in large part to laws that pre-date the overdose epidemic. Preliminary evidence suggests that amending those laws to encourage the prescription and use of naloxone will reduce opioid overdose deaths, and a number of states have done so in the past several years. Since legal amendments designed to facilitate naloxone access have no documented negative effects, can be implemented at little or no cost, and have the potential to save both lives and resources, states that have not passed them may benefit from doing so.