Dannyboy

Tim Barrus:

Make no mistake about it, the kid’s on fire. The other junkies call him Dannyboy. I do not usually do this — help them make a video to this extent. I usually tell the kids at-risk in Show Me Your Life that I won’t help them with text. Text or narrative or writing has to come from them (personally, I hate writing). I will help with video and audio. That is it. But I am breaking my rule here. Or there would be no video as Dannyboy is passed out on the floor again. 

The kid has major learning disabilities. I doubt that he has written a sentence in his life. His video is short, but it’s all the attention span he has.  

I don’t treat junkies. I don’t deal with addiction as a sickness. Mainly because that’s not my job. My job is to facilitate kids at-risk in expressing themselves. I met Dannyboy when I was visiting Los Angeles and staying at the Alta Cienega Motel in West Hollywood, where Danny was living with other night creatures of his kind. No parents. No school. Danny deals drugs, and he’s a thief.

When I met him I thought he was most definitely at-risk, and I think that now. The only difference between the Danny then and the Danny now is the cough. I suspect tuberculosis. I am glad to only be on the computer with him (and sometimes his junkie mates), but when we Skype, the coughing is painful to even look at. 

There has to be something redeeming about this kid. Even if you have to turn over boulders the size of mountains to find it. 

Danny’s into sports. Even if he does attend most sports events either high on meth or zombied out on heroin. I do not know Daddy’s world. And either do you. Those of you who are shaking your head knowingly, know nothing of this landscape. Stop pretending.

 I did not know that Danny could focus his head around images that are mainly of the spectators at any given game. He’s curious. But there is something off about the speeds at which the neurological connections here are made. You can put any kind of moral on this story that you want.

The skin, Homelessness and Human Immunodeficiency Virus (HIV)

The skin is the largest and most visible organ of the body. Maintenance of skin integrity in homeless people with HIV, poses a number of challenges.  Because of the nature of HIV it can be difficult, sometimes impossible, to heal open wounds or ulcers once they appear and poor hygiene conditions, frequent exposure to exacerbating factors (cold, moisture), and difficulties in medical access exacerbate the challenges for homeless people with HIV.

Approximately 90% of people living with the Human Immunodeficiency Virus (HIV) develop skin changes and symptoms at some stage during the course of their disease. The spectrum of skin changes in HIV infection is quite wide.  Skin infections (bacteria, fungi, virus, or yeasts), various rashes, skin cancers, drug rashes and other drug-induced skin changes are all seen.

Skin diseases can warn of progression of HIV disease, as many skin diseases are more likely to occur as the white blood cell (CD4) count decreases. Skin problems, however are very common and may not even be related to HIV infection.

With improvements in the anti-retroviral treatment of HIV, the skin diseases associated with HIV infection have also changed. With good viral control and preservation of the immune system, skin problems associated with opportunistic infections (infections other than HIV) and many other skin problems associated with HIV have become far less common, less severe and easier to treat. However, maintenance of skin integrity in people with HIV poses a number of challenges, because of the nature of HIV it can be difficult, sometimes impossible, to heal open wounds or ulcers once they appear.

[http://ibmi.mf.uni-lj.si/].

The symptoms can be ranged into three major groups: 

1. The most frequent disorders: seborrheic dermatitis, candidiasis, condyloma accuminatum, herpes simplex, Kaposi's sarcoma, and dermatophytosis. 
2. Dermatoses with aggressive course: syphilis, cutaneous leishmaniasis, necrotising folliculitis, necrotising gingivitis, herpes zoster, molluscum contagiosum, scabies and papular pruritic eruption.
3. Exceptional dermatoses: psoriasis, oral hairy leukoplakia, and prurigo. 

1. Most frequent Dermatoses

Seborrheic Dermatitis (SD)

Seborrheic dermatitis (SD) is without doubt the most common dermatosis in HIV-infected patients and is often the only sign of infection occurring in up to 50% of cases.

Clinically SD is characterized by a mild to severe erythema with irregular shape, whitish or yellowish scales and a greasy appearance, involving the seborrheic skin regions: the scalp, temples, retroauricular folds, outer parts of the ears, eyebrows, eyelids, glabella, nasolabial folds, and the midline areas of the chest and back. Less frequently intertriginous spaces are involved and widespread lesions may occur. The course is usually chronic.

The histopathologic findings are similar to those seen in non HIV-infected individuals.

Although SD is always associated with a constitutional seborrheic state and the clinical findings worsen as the disease progresses, and clear as the immune situation improves, this is due to infection to Pityrosporum ovale or Pityrosporum orbiculare.

The treatment is essentially local with shampoos containing imidazoles, corticosteroid creams and hygienic measures.

Oropharyngeal Candidiasis (OC)

Candida albicans is a facultative pathogenic saprophyte and in 60% of normal individuals colonizes the oropharyngeal tract, but in HIV-seropositive patients this may be a valuable marker indicating a compromise of defense mechanisms of the mucosa.

Oral candidosis is the most common infection in HIV-infected patients. It is evident that this infection can also be located on other mucosal surfaces like the gland, the coronary sulcus of penis, the vagina or anus, and even in the cutaneous folds and nails, but the relation with AIDS is more difficult to interpret. Disseminated candidiasis in severely immunocompromised HIV-infected patients has rarely been reported, but it is usually fatal.

Clinically there are small white lumps which, when removed, leave an underlying erythematous base located on the buccal epithelium of the cheeks, gums, palate or of tongue. In severe cases, extension to the pharynx or to the oesophagus may occur and erosive complications commonly cause severe symptoms resulting in inadequate food intake.

The treatments are always deceiving due to the frequent relapses despite the good immediate effects. Therefore a simultaneous local and oral treatment with flutrimazol, itraconazol, piroxolamin or fluconazol has to be used.

Condyloma Accuminatum (CA)

After SD and OC condyloma accuminatum (CA) is the third most common cutaneous affection in HIV-infected patients, detected in more then 30% of the seropositive individuals.

The clinical patterns that can be seen comprehend all the spectra known. In the early HIV disease, the clinical manifestations, clinical course and response to treatment are not unusual. With moderate or advanced immunodeficiency, the HPV lesions may become confluent, much more numerous, unresponsive to usual treatment, and may appear in unusual places.

Unfortunately, no therapy has been devised to eradicate HPV entirely; thus it is necessary to use a combined local treatment. A variety of antimitotic agents are widely employed like podophyllin resin, purified podophyllotoxin or 5-fluorouracil. Surgery, cryotherapy, electrocoagulation, lasertherapy, and intralesional interferon-alpha are also standard measures used for HPV infection. Recently new topics, such as imiquimod or 3% cidofovir ointment, have been successfully used.

Herpes Simplex (HSV)

There are two types of herpes simplex viruses. Herpes simplex I usually causes recurrent blisters around the nose and mouth which are commonly known as 'cold sores'. Cold sores are often triggered by sun exposure, infections such as colds and flu, and being 'run down'. Herpes simplex II is the main cause of herpes sores on the genitals. Herpes sores can, however occur anywhere on the skin. Normally herpes lesions heal within seven to fourteen days. The outbreaks of sores can recur, and usually become fewer and further apart over time.

In HIV, herpes simplex may recur more frequently, take longer to heal, be more severe and widespread or occasionally cause longstanding painful ulcers. One commonly misdiagnosed condition is herpes simplex ulcer infections, especially perianal herpes. Because of their location these ulcers can be mistaken for stage II or III pressure ulcers. Although continued unrelieved pressure to the lesions will certainly lead to wound deterioration regardless of etiology, treatment of herpes must include pharmaceutical management. Because medication is critical to healing it is of paramount importance to quickly recognize and treat herpes. To distinguish perianal herpes from pressure ulcers, with herpes there is generally more than one lesion and these lesions are usually distributed bilaterally. Also, herpes ulcers are more painful than pressure ulcers of similar depth, and aggressive pain management is often required. Finally, herpes ulcers will not respond to conventional treatment for pressure ulcers.

The onset of herpes is usually preceded by a burning and stinging sensation, then little fluid filled 'blisters' appear, which break down and crust over before healing. Topical creams are available for cold sores. For more severe episodes, or frequently recurrent or persistent sores there are several medication available to both treat and prevent these sores.

The treatment of choice for the HSV infection is Valaciclovir, an aciclovir prodrug, with a better oral availability. The use of a topical antiseptic may help to reduce the risk of secondary bacterial infection. In severe HSV infection, possibly resistant to aciclovir, systemic phosphonoformate (Foscarnet) may be considered.

Kaposi's Sarcoma (KS)

KS is a vascular neoplastic disorder and it is observed much more frequently in homosexuals than in intravenous drug users. KS is caused by the infectious agent HHV-8 (Human Herpes virus Type 8) that has been shown to be transmitted sexually.

The prevalence in Spain does not exceed 6% of the HIV-infected persons, contrary to what it happens in most countries worldwide where 11% of seropositives can be observed, though this prevalence has dropped significantly.

The treatment of this neoplasm has been based on Interferon alpha. However, at present the combined treatment with two virostatics and a protease inhibitor (HAART) is recommended.

Dermatophytosis

Up to 20% of HIV-infected persons have dermatophyte infections. This prevalence is similar to that seen in HIV non-infected individuals.

2. Aggressive Dermatoses

Practically all the dermatological pathology can be observed during the evolutionary stages of AIDS.

Syphilis (S)

Syphilis is quite frequent in patients with HIV infection, with a prevalence of 18-30%.

The symptoms of this oldest and best-known sexually transmitted disease in AIDS patients are less characteristic and thus more difficult to diagnose. Atypical clinical and serological findings are frequent. Examples include rapid progression from the primary chancre to the later stages of S. maligna and widespread gummata. The central nervous system manifestations are more frequent and more severe.

The Treponema pallidum has never shown resistance to penicillin and continues to be the treatment of choice.

Cutaneous Leishmaniasis (CL)

The main area of overlap is Southern Europe, especially Spain.

The clinical manifestations, though really aggressive, are not displaying necrosis. The lesions are situated in exposed areas, but the inoculation point is sometimes undetectable. The granulomatous lesions are usually spreading.

Making a smear of material from the sore and staining it with Giemsa on a microscope slide can confirm the infection by demonstration of the parasite while histopathology confirms histiocytes full of Leishmania with lymphocytic reaction that possibly facilitates the extension of injuries and even of the scattering. 

The treatment with pentavalent antimonials is efficient.

Necrotizing Folliculitis (NF)

All the pyogenic bacterial infections are commonly encountered in HIV patients with a prevalence of 3-11% of cases. Much more rare is the NF that is manifested as suppurative or abscess-like lesions with serohematic and blackish scabs developing in 2-3 days from isolated pustules. The lesions may be scattered anywhere on the skin. Generally, there is not a defined bacteriology, and the healing is slow and unaesthetic.

NF is treated with the application of topical antiseptics with good results, but in general it resolves with unaesthetic scars.

Necrotizing Gingivitis (NG)

A mixed flora like the fusospyrochetae complex, candida, gram-positive cocci, herpes virus, cytomegalovirus, and other organisms may cause acute necrotizing gingivitis in immunocompromised host.

The clinical manifestations, including gingival soreness, bleeding and halitosis may develop into necrosis and destructions with loss of teeth and further functional problems. There is often enlargement of the cervical lymph nodes with pyrexia and malaise.

The treatment is complicated because to the topical antiseptics we have to add antivirals like valaciclovir, metronidazole or penicillin depending on the gravity and the etiology.

Herpes Zoster (HZ)

The rash of herpes zoster (shingles) is due to reactivation of the chickenpox virus, which has lain dormant in the body since childhood. Pain often precedes a blistering and later a crusty rash appears in a band like pattern. Shingles usually only involves one side of the body. It commonly involves the trunk, or less often an arm, leg, or region of the face. Development of shingles may be the first clue that someone is infected with HIV and that their immune system has been weakened. This painful condition can last for several weeks and occasionally spreads to other parts of the body. Pain may persist for a while after the skin has healed due to inflammation of the nerves. Several oral anti-viral medications are helpful particularly when started very early after onset of shingles (within 3 days). Early treatment can reduce the severity and duration of pain associated with shingles. Topical lotions may also help symptoms and discomfort. There are also good treatments available for pain should it occur. According to the few publications, the prevalence oscillates between 6 and 9% of HIV-infected persons.

HZ in HIV-infected patients is more serious than similar infections in immunocompetent hosts, because painful atrophic scars, persistent ulcerations, multidermatomal involvement, recurrent zoster infections, and secondary episodes of varicella may be seen. Severe pain and persistent postherpetic neuralgia may also develop.

The treatment is with one of the thymidine kinase inhibitors, such as acyclovir, valacyclovir, and famcyclovir. Resistant cases require treatment with intravenous application of foscarnet.

Molluscum Contagiosum (MC)

MC is usually a benign viral infection. However, in immunocompromised patients it may become widespread, disfiguring and unresponsive to treatments.

Sometimes other cutaneous disorders (cryptococcosis, pyogenic granuloma, keratoacanthoma, basal cell carcinoma) can mimic Molluscum contagiosum infection, consequently a biopsy is often necessary.

MC infection is often accompanied by other viral infections, especially by papillomavirus.

The usual method of treatment is curettage, but due to the bleeding that can be produced, the cryotherapy and, recently, the cydofovir are advisable.

Scabies 

Scabies may be sexually transmitted and it is one of the most frequent skin disorders to develop in HIV-infected patients.

Scabies may have a number of different clinical manifestations in seropositive individuals, ranging from classic features to crusted (Norwegian) scabies in which a great number of mites are present and the itching is reduced.

Scabies in HIV-infected patients may mimic psoriasis, atopic dermatitis, seborrheic dermatitis, lymphomatoid papulosis, and insect bite reactions. The diagnosis is confirmed by examination of scrapings, which demonstrates mites and eggs.

Treatment is usually similar to that used in immunocompetent hosts, though several applications of a scabicide may be necessary. It is important that all partners should be treated simultaneously.

Papular Pruritic Eruption (PPE)

More and more frequently the PPE, an extremely pruritic dermatosis characterized by red or skin-colored, non-confluent micro-papules on a xerotic skin, involving widespread areas, most commonly the trunk, extremities and folds, can be observed.

Clinically and histologically, PPE is similar to eosinophilic papulosis of Ofuji, and in the early stages can easily be confused with scabies.

The classical therapies are systemic antihistamines, oral prednisone, and topical corticosteroid preparations, but the treatment that seems to be more effective is the exposure to ultraviolet B phototherapy.

3. Exceptional Dermatoses

The list in this group could be very long, but we will name only the lesions that may be more significant to suspect the HIV infection.

Psoriasis (P)

There are scores of descriptions ranging from the transitional whitening with the first symptoms of HIV infection to appearance of the first outbreak after the infection in an individual who has never before had a clinical disease. Nevertheless, nowadays the publications about complicated psoriasis are more frequent in view of the intensity, frequency and extension of the outbreaks, or due to the associated symptoms like arthritis, erythroderma or inverted psoriasis.

The therapy depends on the extension and the associated symptoms of the disease. The existing hematic and hepatic changes limit the systemic treatment. The use of psoralen and ultraviolet A therapy is also effective.

Oral Hairy Leukoplakia (OHL)

This clinical manifestation is detected in about 2.5-10% of cases, even though the incidence of this disorder is decreasing in HIV patients as a consequence of HAART (highly active anti-retroviral therapy) like other cutaneous manifestations of HIV infection.

Most commonly, OHL is manifested as corrugated, whitish and asymptomatic plaques situated along the lateral borders of the tongue, rarely bilaterally. With the electron microscopy papilloma virus and Epstein-Barr virus have been detected in the lesion.

The most practical treatment is the cryotherapy, though treatment is not always indicated.

Prurigo

The etiology of the process is not fully known. The clinical and histopathologic findings may resemble classic prurigo nodularis found in immunocompetent hosts. Nevertheless, prurigo seems to be a reaction pattern that may be associated with some bacterial or viral infections, especially in the anus area, secondary to HIV infection.

Treatment is mainly directed at suppressing the itching and avoiding secondary infections. Recently thalidomide has been shown to be effective.

Medical and Cutaneous Disorders Associated With Homelessness: Skin Diseases in the Homeless

Alexander J. Stratigos, MD, Andreas D. Katsambas, MD, Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece

http://www.medscape.com/viewarticle/455637_3

Cutaneous disease is a frequent cause of morbidity in the homeless. Several skin conditions, both infectious and noninfectious, have been described in the homeless population including trauma, cellulitis, pyodermas, impetigo, gas gangrene, tinea infections, leg ulcers, stasis dermatitis, immersion foot, frostbite, erythromelalgia, pellagra, scurvy, scabies, pediculosis, seborrheic dermatitis, eczematous dermatitis, rosacea, and pruritus. The incidence of skin disease is largely determined by a complex set of factors, namely geographic area, climate, living conditions, access to primary medical care, and coexistent medical conditions. Additional factors that are intrinsically related to homelessness, e.g., malnutrition, exposure to hazardous environments, and psychiatric illness, may have a negative impact on the extent and severity of skin disease. Many of the skin diseases of the homeless are easily diagnosed and treated, but because of the limited access of the homeless to health care resources and the high prevalence of mental illness and alcoholism in this population, homeless persons are likely to neglect skin care until their condition becomes disabling or even life-threatening.

Several studies have reported an increased incidence of foot problems, primarily superficial fungal and bacterial infections. In a cohort of 142 homeless men staying overnight in a major Boston shelter over a period of 3 months, 38% had tinea pedis, 20.4% had pitted keratolysis of the feet, and 15.4% had toenail onychomycosis. These diseases are usually related to poor foot hygiene, inadequate footwear, and excessive moisture. Overcrowding in shelters may also increase the risk of cutaneous infections due to exposure to potential pathogens. Tinea infections are quite common in the general population as well, but in homeless people they often represent a portal of entry for fungal and bacterial pathogens that, in the setting of compromised skin care, may lead to more serious or severe infections. Bacterial infections, such as cellulitis and pyodermas, are frequent causes of hospitalization among the homeless. In a survey of admissions to the inpatient dermatology service of a New York municipal hospital, 46% of the admitted patients were street-living or shelter-based homeless and almost one half of them (48%) were diagnosed with cellulitis or other skin infections.

Immersion foot (trench foot) is another problem seen with increased frequency among the homeless population. It results from cutaneous injury by water absorption in the stratum corneum of the skin and it is seen more often in street homeless due to improper footwear, prolonged exposure to moisture, and long periods of walking and standing. The syndrome of immersion foot can be exacerbated by peripheral neuropathy, peripheral vascular disease, and the use of tobacco or other vasoconstrictive drugs, e.g., cocaine. Infection or ischemic injury may complicate this condition, requiring antibiotics or surgical treatment.

Parasitic infestations of the skin are seen frequently in the homeless population, with scabies and pediculosis being the most prevalent. Recently, an increasing incidence of infection with Bartonella quintana, the etiologic agent of trench fever, has been observed in the homeless and is presumably transmitted through body lice. B. quintana endocarditis and bacteremia have been reported in homeless patients living in downtown Seattle, Oregon, and Marseille, France. In addition, prospective serologic studies have found antibodies to B. quintana in 25%, 30%, and 54% of the homeless population in Seattle, Marseille, and downtown Paris, respectively, compared with only 2% of the control group. In the latter study, the serologic profile suggested a recent or evolving B. quintana infection in 25% of patients with positive serologies. Independent risk factors associated with a positive serology include the age of patients (adjusted relative risk, 2.9 for age >40 years) and the duration of homelessness (adjusted relative risk, 3.0 for ≥3 years of homelessness). An association between B. quintana infection and body lice infestation has been shown, although, in multivariate analysis, the number of previous episodes of body pediculosis was not a risk factor for a positive B. quintana serology. It is possible that the total duration of infestation is the main risk factor, as opposed to the number of new infestations by body pediculosis. The consequences of this high seroprevalence of B. quintana in the homeless population is yet undetermined in terms of its related morbidity and mortality. B. quintana has been recently identified as a significant cause of blood-culture negative endocarditis, and, since heart disease is a major cause of death in homeless people, there could be a possible link between B. quintana infection and cardiac disease in this population. Aside from this hypothesis, current evidence suggests that prolonged homelessness is a major risk factor for B. quintana infection and that every homeless person with body lice infestation should be considered for serologic screening for B. quintana.

Common skin dermatoses, such as psoriasis, seborrheic dermatitis, and atopic dermatitis are also seen in the homeless population. Although their prevalence is not exactly known, it does not appear to differ from that of the general population. It is possible that the severity and extent of these diseases is greater because of poor hygiene conditions, frequent exposure to exacerbating factors (cold, moisture), and difficulties in medical access.   

Homelessness in The United States of America

The human right to housing, travel and migration as a part of individual self-determination rather than the human condition. The Declaration, an international law reinforcement of the Nuremberg Trial Judgements, upholds the rights of one nation to intervene in the affairs of another if said nation is abusing its citizens, and rose out of a 1939–1945 World War II Atlantic environment of extreme split between "haves" and "have nots."

The basic problem of homelessness is the human need for personal shelter, warmth and safety, which can be literally vital. Other basic difficulties include:

• personal security, quiet, and privacy, especially for sleeping
• safekeeping of bedding, clothing and possessions, which may have to be carried at all times
• hygiene and sanitary facilities
• cleaning and drying of clothes
• obtaining, preparing and storing food in quantities
• keeping contacts, without a permanent location or mailing address
• hostility and legal powers against urban vagrancy.
•  

Homeless people face many problems beyond the lack of a safe and suitable home. They are often faced with many social disadvantages also, reduced access to private and public services and reduced access to vital necessities:
 

• Reduced access to health care and dental services.
• Limited access to education.
• Increased risk of suffering from violence and abuse.
• General rejection or discrimination from other people.
• Loss of usual relationships with the mainstream
• Not being seen as suitable for employment.
• Reduced access to banking services
• Reduced access to communications technology

There is sometimes corruption and theft by the employees of a shelter as evidenced by a 2011 investigative report by FOX 25 TV in Boston wherein a number of Boston public shelter employees were found stealing large amounts of food over a period of time from the shelter's kitchen for their private use and catering.

Discrimination against the homeless is the act of treating the homeless, or those perceived to be homeless unfavorably. As with most types of discrimination it can manifest in numerous forms.

There is a growing trend in the United States towards criminalizing the state of being homeless. Proponents of this approach believe that punitive measures will deter people from a homeless lifestyle. To this end, cities across the country increasingly outlaw life-sustaining activities—such as sleeping, eating, sitting, and begging—in public spaces, and selectively enforce more neutral laws—such as those prohibiting open containers or loitering—against homeless populations. Violators of such laws typically incur criminal penalties, which result in fines or incarceration or both. Homeless people with new "criminal charges" have very restrictive housing and employment options, if either, for years.

In April 2006 the United States Court of Appeals for the Ninth Circuit ruled that "making it a crime to be homeless by charging them with a crime is in violation of the 8th and 14th Amendments."


NLCHP- Human Rights & Children's Rights

Constitutional Problems with Criminalization Measures, USA

As court challenges from around the country have shown, criminalization measures may violate homeless persons' constitutional rights. Homeless persons and advocates have filed lawsuits challenging, among other laws, anti-camping and anti-panhandling laws, as well as sweeps of homeless encampments and restrictions on food sharing in public.

Constitutional Problems with Anti-Panhandling Laws

Anti-panhandling laws vary from city to city, with some laws prohibiting begging or solicitation fairly broadly and others placing restrictions on begging or solicitation in only certain parts of the city or at certain times of day. In a case from New York City, the Second Circuit enjoined the New York City Police Department from enforcing a New York State statute that in effect banned begging city-wide, as the court found such a ban violated the First Amendment right to free speech (Loper v. New York City Police Department, 999 F.2d 699 (2nd Cir. 1993)). In its decision, the Second Circuit found that begging constitutes expressive conduct for purposes of First Amendment analysis. The court noted that begging usually conveys a need for food, shelter, clothing, and other needs and is, therefore, similar to messages conveyed by organized charities. Prohibiting individuals who beg peacefully from communicating with their fellow citizens did not serve a compelling governmental interest. Further, even if the state had a compelling interest, a city-wide ban on begging was not narrowly tailored, not content-neutral, and did not leave alternative channels of communication by which beggars could convey their messages of indigency. Other courts have found some anti-panhandling or anti-begging laws unconstitutional on First Amendment grounds as well.

While broader anti-panhandling laws have been found unconstitutional, others more narrowly tailored have withstood judicial scrutiny. The Seventh Circuit upheld an anti-panhandling law from Indianapolis that prohibited "aggressive" panhandling, verbal solicitations at night, and panhandling at bus stops, in public transportation, at a vehicle stopped in traffic, in a sidewalk café, or within 20 feet of an ATM (Gresham v. Peterson, 225 F.3d 899 (7th Cir. 2000)). The anti-panhandling law did not regulate or prohibit passively panhandling with a sign.

The Seventh Circuit agreed that beggars communicate important political messages through an appeal for money and, therefore, such speech is protected by the First Amendment. The court indicated that one could make an argument that the ordinance was content-based, since it prohibited solicitations for immediate cash donations, but not solicitations for other things, such as signatures, time, or labor. However, the plaintiffs in the case did not argue that the regulations were content-based. Therefore, the court found that the regulations should be upheld if they are narrowly tailored to meet a significant governmental interest and leave open alternative channels of communication. The court found that the city has a legitimate interest in promoting "safety and convenience" of its residents on public streets and that the city had narrowly tailored the regulations to address those interests by applying the regulations to "only those times and places where citizens naturally would feel most insecure in their surroundings." Further, the court found that alternative channels of communication were available as panhandlers could convey their messages vocally during the day on all public streets, except for the small amount of territory covered in the restrictions, and passively at night.

Constitutional Problems with Anti-Camping/Sleeping Laws

Homeless plaintiffs and advocates have successfully challenged laws or practices that punish homeless people for sleeping or conducting other life-sustaining activities in public. In a recent case from the Ninth Circuit, homeless plaintiffs successfully challenged the enforcement of a Los Angeles ordinance that makes it a crime to sit, sleep, or lie down in public spaces throughout the entire city (Jones v. City of Los Angeles, 444 F.3d 1118 (9th Cir. 2006)(vacated by Jones v. City of Los Angeles, 505 F.3d 1006 (9th Cir. 2007).

The plaintiffs were sleeping or resting on the sidewalk at the time they were arrested or cited for violating § 41.18 of the L.A. Municipal Code. The plaintiffs were able to show that with over 80,000 homeless people in L.A. County, there are almost 50,000 more homeless people than available shelter beds. As a result, thousands of homeless people in L.A. have no choice but to sit, sleep, and lie down in public due to lack of shelter space.

The Ninth Circuit concluded that unlimited enforcement of § 41.18 against homeless persons in L.A. violated the Eighth Amendment.

The Ninth Circuit found that involuntariness was a key factor when determining whether laws punishing acts that are integral to one's status violate the Eighth Amendment. Since Los Angeles does not have sufficient shelter space, homeless persons must engage in basic human acts such as sitting, lying down, and sleeping in public. Thus, punishment for such behavior violates the Eighth Amendment right to be free from cruel and unusual punishment. The case was ultimately settled before an appeal by the City for a rehearing en banc proceeded, and the Ninth Circuit ultimately vacated the decision per the settlement agreement (Id.).

A class of homeless plaintiffs in Miami won a similar victory using the Eighth Amendment argument in the 1990's in Pottinger v. City of Miami (810 F. Supp. 1551 (S.D. Fla. 1992), remanded for limited purpose, 40 F.3d 1155 (11th Cir. 1994)). In that case, homeless plaintiffs challenged Miami's policy of arresting homeless people for conduct such as sleeping, eating, and congregating in public. As in Los Angeles, the number of homeless people in Miami outnumbered the available shelter spaces. At the time of the trial, there were only 700 shelter beds for the 6,000 homeless persons in Miami. The District Court for the Southern District of Florida found that Miami's policy of arresting homeless people for conducting necessary life-sustaining activities in public was cruel and unusual punishment in violation of the Eighth Amendment, as homeless Miami residents had no choice but to conduct those activities in public due to lack of shelter space. The court also found that the practice of arresting homeless people for performing life-sustaining acts in public violated the plaintiffs' right to due process and right to travel.

In another case from the Eleventh Circuit, however, a homeless man was not successful in using the Eighth Amendment argument to challenge his arrest under Orlando's anti-camping law (Joel v. City of Orlando, 232 F.3d 1353 (11th Cir. 2000) cert. denied 149 L.Ed.2d 480 (2001)). As in the Jones in the Ninth Circuit, the Eleventh Circuit found that the success of the plaintiff's Eighth Amendment claim rested in whether the plaintiff had an opportunity to access shelter. In this case, the court found that at least one shelter in Orlando never reached its maximum capacity and people were never turned away; therefore, the plaintiff could have sought shelter there to comply with the anti-camping law. The plaintiff's equal protection and void-for-vagueness claims also failed in this case.

Constitutional Problems with Destruction of Property

Another issue addressed in other cases is destruction of homeless persons' personal property. In Pottinger, the court found the practice of seizing and destroying homeless persons' property or forcing homeless persons to abandon property at arrest sites violated the Fourth Amendment, as such practices amounted to unreasonable searches and seizures. Further, the court found that the seizure of plaintiffs' personal property violated the Fifth Amendment, which prohibits taking of private property for public use without just compensation. In other court cases, homeless plaintiffs have successfully used Fourth Amendment arguments to stop sweeps of encampments that result in the destruction of homeless persons' property.

Constitutional Problems with Food Sharing Restrictions

As cities have recently turned to ordinances to stop groups from sharing food with homeless people in public places, service providers have challenged those restrictions in court. Groups and individuals who regularly share food with homeless people in public parks in Las Vegas filed a lawsuit to challenge Las Vegas' law that prohibits sharing food with "indigent" persons in public parks (NLCHP Amicus Curae Brief). The plaintiffs challenged the Las Vegas ordinance on the grounds that it violates the right to free speech, the right to freely exercise religion, the right to freely assemble, equal protection rights, and due process rights. The plaintiffs also argued that the ordinance is constitutionally vague and over broad. The court granted a preliminary injunction to enjoin the city from enforcing the ordinance, finding that the ordinance is unconstitutionally vague and violated the Equal Protection Clause of the Fourteenth Amendment. While the court granted the preliminary injunction, it suggested a more narrowly tailored ordinance could pass constitutional muster. Groups that share food with homeless individuals in public in both Orlando and Dallas have also sued those cities challenging their food sharing restrictions. The court later entered a permanent injunction against this ordinance (Sacco v. City of Las Vegas, 2007 WL 2429151 (D.Nev. 2007)).

Human Rights Violations

Criminalization measures not only can violate homeless persons' constitutional rights, but they also violate human rights norms as laid out in international law. The United States has signed international human rights agreements, many of which prohibit actions that target homeless people living in public spaces. Treaty law is constitutionally equivalent to statutory law and is binding on the judges in every state. Once a country has signed an international treaty, it is obligated not to pass laws that would "defeat the object and purpose of the treaty." However, reservations made by the Senate in the ratification process prevent the treaties from being used directly as a cause of action in U.S. courts (i.e., "self-executing").

Nonetheless, international human rights treaties can be used persuasively to support legal arguments based on domestic law. For example, if domestic law is ambiguous on a certain topic, as in the case of the interpretation of the words "cruel and unusual", courts are required to read U.S. law consistent with our treaty obligations. With many traditional civil rights remedies under attack, progressive lawyers are frequently turning to international law for guidance and to bolster their arguments.

The Right to Intrastate Travel

The U.S. Supreme Court has not ruled explicitly to protect the right to intrastate travel. However, the right to movement has been established in international human rights documents, and has been considered customary international law by both scholars and domestic courts. Article 12 of the International Covenant on Civil and Political Rights (ICCPR), a treaty signed and ratified by the U.S. (though not self-executing), contains provisions that protect the right to movement. The Human Rights Committee (HRC), which oversees the ICCPR, has definitively stated that the right to movement and the freedom to choose your own residence are important rights that should only be breached by the least intrusive means necessary to keep public order. Many laws that target homeless people living in public spaces interfere with their right to freedom of movement, by either keeping them out of certain areas in a city or forcing them to move to other spaces involuntarily.

The Right to be Free from Discrimination

In addition, the majority of international human rights agreements have non-discrimination clauses. Article 26 of the ICCPR protects "equal protection of the law" and prohibits discrimination based on a variety of statuses. The United States participated in the 1996 Second United Nations Conference on Human Settlements and is signatory to the Habitat Agenda, which states that no one should be "penalized for their status." Laws that criminalize panhandling or performing life-sustaining activities in public, such as sleeping and sitting, target homeless people based on their economic and housing status.

Moreover, international law protects against both intentional discrimination and policies with discriminatory effects. Given that racial minorities and disabled individuals are disproportionately represented in the homeless population, criminalization measures inherently have a disparate impact on these groups. Following advocacy by U.S. NGO's, the HRC recently noted its concern about racial disparities in homelessness, and recommended the U.S. take affirmative measures to address these disparities. Arguing disparate impact may be difficult in U.S. courts which have a strong line of cases requiring a demonstration of discriminatory intent. However such arguments can provide useful support for positive policy alternatives to and against the passage of criminalization measures.

The Right to be Free from Forced Evictions

Forced evictions have long been contrary to international human rights agreements and destruction or "sweeps" of homeless encampments could be considered a violation of the Convention Against Torture, another treaty ratified by the U.S. In a case before the Committee Against Torture, the Committee found the forced eviction and destruction of a Romani settlement in Serbia and Montenegro violated Article 16 of the Convention, which prohibits acts of cruel, inhuman, or degrading treatment or punishment (Hijrizi v. Yugoslavia, Communication No. 161/2000: Yugoslavia, UN Doc. CAT/C/29/D/161/2000 (2 December 2002)). While the destruction and eviction was carried out by private actors, the Committee found that failure of police to take action to stop the destruction of the settlement violated the Convention. In U.S. cities, public officials are frequently the actors conducting "sweeps" of homeless encampments. These city actions are a form of forced evictions, contrary to international human rights principles. Advocates can consider using this case persuasively to inform the interpretation of "cruel and unusual" standards in cases with Eighth Amendment claims.

The Right to Sanitation

Access to proper sanitation is a key part of ensuring the basic human dignity of each person.  While cities can pass ordinances against public urination and defecation in the interest of public health, these ordinances should not be enforced against homeless persons if there are not adequate facilities where homeless persons can perform these basic bodily activities in private.  In November 2010, the UN Committee on Economic, Social and Cultural Rights issued a Statement on the Right to Sanitation which states, among other things, "States must ensure that everyone, without discrimination, has physical and affordable access to sanitation, in all spheres of life, which is safe, hygienic, secure, socially and culturally acceptable, provides privacy and ensures dignity."
 

United States of America

WARNING: Explicit Imagery and Colloquial Language

Human Immunodeficiency Virus (HIV)

Acquired Immune Deficiency Syndrome (AIDS)

The link between homelessness and HIV/AIDS: The Centers for Disease Control in Atlanta and the United Nations in NYC estimate that there could be as many as a million homeless people with HIV in North America, and as many as ten million homeless people with HIV in the rest of the world.
 

Timothée Barrus/ #1 The Building is Condemned: a Series

Jason cut his arm on a jagged piece of metal as he was crawling through the basement window of the abandoned building. This morning, his arm is red as a strawberry balloon and swollen like a piece of rotting sausage. We live in a river of antibiotics and they do work. This one will be IV and will require an IV nurse (I could do it but my insurance policy is having screaming fits of desk pounding fists of the fucking suits) to stick him who will come to the house unless his fever spikes, and then the routine to hospitals continues. People do not quite comprehend that this is par for us. There is nothing unique about one in the group — sometimes me — being hospitalized. The joke among the boys is that it’s more difficult to jerk off in the hospital because the staff is always annoying you. It’s adolescent gallows humor. Blood poisoning sucks. The building is condemned.

As are the lives of the kids who live there among the garbage on the floor. The place stinks like shit. From the outside, you honestly cannot tell anyone lives there let alone a constant retinue of changing populations of runaways and the adrift. It’s a social worker’s paradise. They get to be important. How many social workers do you know who are trying to eliminate their jobs because no one needs them. Many of these kids are coming down from psychiatric meds they were on somewhere else and the affect of the kids is dull, and mean as they sleep with their backs up against the walls in their smokey coats. There is a tent city of them behind this dilapidated structure. Behind the trees over by the tracks. These would be the camper kids who would rather shit in the bushes than on the floor of a building where their peers crawl into. The zombie eyes stare at the walls that seem to suck them up. It is a place of abandonment and rage. The rage, especially at parents or the lack of them, is skin deep. Scrap your arm on tetanus, and your veins will run hot with blackened piss. The infected and rejected. Coming down from the psychiatric clouds of just shut them the fuck up.

People say to me: Oh, you immoral meanie, Tim Barrus, you say bad words, and nekked people make us itch who says it’s art. (I do). Bumbleshoes, I only speak their language. The fact that it makes you cranky-pants is not my problem. I have bigger things to worry about than profanity. Kids sleeping in garbage makes me sick to my stomach. The agencies that used to warehouse these kids — places like the California Youth Authority — where we used to throw them away and medicate them into a dumb stupor are all being cut back as the poor and the ill-fed, and the ill-housed, and the mentally deranged, and the one-step-from-prison continue to pay, and will continue to pay for an economic downturn whose fault was Wall Street’s and the bankers that kept feeding a beast who made a few privileged people rich, and more than a few other sorts of people (you know riff-raff) homeless, who will bear the brunt of there isn’t enough to go around in a culture that prides itself as being abundant. Abundant for whom.

We arrest these kids if we finding them fucking up. The kids will tell you that the cops do not know about the abandoned structure the homeless crawl into every night like roaches scurrying about in the dark. Creatures from the cracks in floors, and walls, and broken windows. Western culture should be ashamed of itself. Don’t jump on my ass if I swear about it. You have bigger things to worry about, too, bitch.

Not that you fucking worry about anything that doesn’t affect you directly. I refuse to play some kind of social game where I get to pretend I am someone nice and smiley face that I assure you I am not. Take your smiley face and shove it up your selfish white ass. People shake the fingers of righteousness and god at my face, even as greed runs as rampantly as it ever did in a system that changes its spots, but it is the same system, and entire neighborhoods continue to be vacant as your children continue to sleep among the garbage and the rats. There is no way the cops don’t know about this place. It is simply fucking convenient, and turns my stomach into an acidic bile you will never know. Cocksuckers, so do not lecture me on the Internet or anywhere else because what you will hear in return is this.

Or another version of it.

I have this sick side where I can empathize with the glue sniffing because if I was one of them I would stick anything in my body, too, that would keep the cold and hunger out even as it ate my brain away into a stupid epiphany of numb me, fuck me, bury me in a pit because I already live in one. Death would be a release, and don’t look at me like I can take you back to my warm house, and my kitchen filled with food, and laughter; sometimes gallows humor, and we do not live with our lungs filled with the smell of shit.

We decided we would do a bunch of these videos, and if you do not like looking at what we do — seriously, who is holding your nose to a computer screen, or your comfortable face into the toilet overflowed with the waste from their ruinous guts; who is forcing you to look. No one. So look away. Rag my ass because I don’t play your polite games of charitable hypocrisy, and I have my own hypocrisies to tend to. None of them have to do with manners. The problem with anger is that it allows you to focus on it versus the real issue at hand.

My pissed-off piss is my weakness, not in any way an asset; it is a liability. But I am an ignorant, arrogant asshole who bores easily, and if I wasn’t giving you the finger, it’d be the finger to someone else. The day the sight of your children crawling through basement windows to get in out of the rain doesn’t sicken me, the moment a room filled with a dozen kids on the floor of an enclosure, or a tent, all of it saturated with the smell of glue doesn’t repel me is the day, just another day, one of many, I do not deserve to live among humanity.

I am your nightmare not your problem. All I am is one ineffectual, fundamentally powerless jerk who walks among your failures and your human garbage you have discarded to the streets. With a camera I can hide behind. I am not the point. You can make me the point, but the disingenuousness of the focus can only last so long. It’s the continuous litany of whining that I am the problem because I wrote a book about fetal alcoholism that you read where what you came away with was sex, sex, sex, ho-fucking-hum; translates to you aren’t going to like reading about these kids either, but, Bumbleshoes, you get the fucking culture you deserve. It is a romance that Eminem gets to wander among the typically destroyed. Eminem lives in a mansion in Los Angeles where a physical trainer arrives to run his ass. He means well. He’s the kind of person the kids can recognize who through his talent found ways to not fall between the cracks. Even I know all about those cracks because I still live in them. In fact, I pounded them open with hammers. Other people pay for this. They pay the bills, and they pay for the food on the table, and they pay for cameras, and they direct that their money be given to me when they die and it does. Shit. I would live in a mansion in Los Angeles as long as I did not have to mow the yard. Mansions surrounded by fences to keep the scum out. I want to make a mashedup underground guerrilla, cult-classic horror movie with zombies who scale the fences in search of vampire meat to bit into and chase down alleyways before the vampires can dart into their locked-down corporations. And everyone goes aaaaauuurrrrrgh blood poisoning the buildings all around them are condemned.
 

Bill Gates (Interview with Charlie Rose; February 11, 2011)

There will not be a cure for AIDS until people in specifically the United States begin to understand that it didn’t go away. It’s still out there. Countries in the southern part of Africa still have the worst part of the pandemic. We can’t get medications to all these people. Americans have convinced themselves that AIDS no longer means them. Until it means them, there will be no cure, and millions of people are going to die.


Tim Barrus

While HIV/AIDS in the Western, developed world is now a condition whose symptoms can be treated (not cured) with medications, the undeveloped world continues to struggle not only with death, but with Big Pharma’s influence at such organizations as the World Trade Organization (WTO). Where Big Pharma keeps the pressure on to ensure that its profits are protected by pharmaceutical copyright, and where countries that manufacture their own generic antivirals, to treat their people, are threatened, blackmailed (if you do not stop producing your own drugs at such cheap cost, we will deny you access to the WTO), discriminated against, and while there are charity programs whose focus has been to get medication to people in the Third World, these medications have only reached a tiny fraction of the people who need them.

The United States Trade Mission to the WTO (the loudest voice at the WTO denouncing countries that treat their own people) is supervised by the Department of Commerce. An agency whose chains are yanked at regular intervals by Big Pharma (the profits of antiviraldrugs are in the tens of billions) whose International Conglomerates make political donations to political candidates who pledge to enforce the pharmaceutical copyrights of the WTO against such nations as Brazil and India.

This is VideoArt. Show Me Your Life: a VideoArt workshop in cyberspace.

http://tim@showmeyourlife.org

"AIDS Crawling Up My Spine"
 

I can not say that on the night we should go and touch the stars. The stars are sneaky. They infect my bones with a madness that shocks the body and is not yet awake. My eyes bulged with electric chairs and AIDS crawling up my spine. Azalea stones stuck in my throat and ants are walking from my eyes. With two twisted strands of razor wire. Then, in a solemn choice we naked as a dog. Moving about the city as a hebephrenic schizophrenia licked ass on for lunch.