The Iowa Pride Network has released the finding from its 2009 School Climate Survey. Click to access the full report.

The Iowa Pride Network, a statewide organization that works to support lesbian, gay, bisexual, transgendered and questioning students, released its 2009 School Climate Survey today, the third in the biennial series.

While the 203 students who agreed to take the survey reported a decrease in the number of verbal attacks based on sexual orientation, gender or race, they also reported a significant increase in the amount of physical violence in their lives.

And, from responses to new questions added to the survey this year, it is clear that harassment and abusive situations are much more likely to begin a chain of events that can lead to LGBT students harboring suicidal thoughts.

“The whole point of the study is that it can serve as a guidepost for the public, community stakeholders, teachers and principals so that they can really take a look and reflect on where we are now,” said Ryan Roemerman, executive director of IPN.

“No matter how wonderful a teacher or administrator may think their school is, there is something valid in this survey for everyone. They can look at what these students have reported and decide what they could be doing better, because we know that we can always do better.”

The 2007 survey results were collected before the impact of legislative-mandated changes to the state’s Civil Rights Act and anti-bullying policies to include references to sexual orientation and gender identity could be assessed. Since the 2009 survey was the first that would measure the effectiveness of the changes, organizers were hoping to see movement toward greater student safety. What they found, however, was that more than half of the survey respondents did not know what the Iowa Safe Schools law is, and that roughly 72 percent did not feel that their school had adopted such a law.

“It seems like that since we have a safe schools law that everything should be find, but it is not fine,” Roemerman said. “As we all know, a law isn’t any good unless it is enforced.”

Surveys were collected earlier this year from May to June, and included 88 LGBT students, 86 LGBT-affirming straight students and 29 non-LGBT-affirming straight students. Although the surveys were distributed and collected in the months directly following an Iowa Supreme Court decision allowing same-sex marriage in the state, there was no direct question about the current event as a part of the survey. While it may seem reasonable to believe that some of the tension and celebration surrounding that event may be reflected within the survey results, Roemerman said there is simply no way to measure the role of marriage equality in the results.

“I can’t say that because there wasn’t a question on that,” Roemerman said. “I think we can pretty much access that students do pick up on what they hear in their home, but I don’t know if that was reflected in these students’ feelings or not. I’m sure some people might draw that conclusion, but I’m not going to. But, I think that some people might look at that as a possibility.”

When compared with 2007 results, the 2009 survey respondents were less likely to report having heard a homophobic remark in their school, and were also less likely to have been verbally or physically harassed — pushed or shoved — because of their sexual orientation. The 2009 results regarding physical assault — punching, kicking or weapon injuries — were significantly higher than what was reported in either 2007 or 2005. Sixteen percent of students reported some incident of physical assault because of their sexual orientation or gender expression.

“How I look at bullying and harassment is that it often starts with the verbal,” Roemerman said. “You know, a student will say things like ‘you are gay’ or ‘you are a faggot’ and it will start there. If no one intervenes then it tends to move to harassment. And then, after harassment, it starts to move to actual physical assault. So, to me, if we can stop the verbal harassment where it starts, then I think we are on a good path.”

Because IPN is seeing an uptick in violence, the group is launching a “Make It Real” manual that will help students understand the law changes, and how each can be applied to different situations. An online public service announcement about the manual and where to download it is also being distributed through social networking and other affiliated groups.

Roemerman reports that IPN has also worked closely with the Iowa Department of Education to create a standardized incident report form used by the schools and received by the state to include a check box for all the categories specified in the safe schools law.

“There was this jumbled narrative as to why someone was harassed,” he said. “What we asked the Department of Education to do was develop a report that would have all the categories so that the state can really monitor and find out how many students get picked because of sexual orientation or race. They will actually be able to have hard numbers instead of having a certain percentage of the incidents just being listed as ‘other’ on a form.”

The new reporting form is being piloted this year, according to Roemerman, and is expected to become a mandatory practice next year.

Another key piece for IPN is the creation of a Safe Schools Certification Program to reward schools that do reach beyond the basics of what is required to ensure that their staff and students understand the law.

“There is a difference between a school that simply says to look in this section of the student handbook, or to view this file on a Web site, to find out what the law is and a school that is really pro-active,” Roemerman said. “Technically, those schools that do the least are fulfilling their requirement, but what we are looking for is schools to go beyond that. We are looking for schools to make sure that their teachers discuss it and that their students know what it means and how they are protected.”

In addition to the new programs, IPN will continue to foster a network of gay-straight alliances and diversity groups throughout the state.

“It’s important to have these groups available because these are spaces where students feel comfortable,” Roemerman said.

In order to help all of Iowa’s students feel safe why they are at school, all Iowans — administrators, teachers, parents and even the general public — are going to need to become more involved.

“We know that students who feel they are not safe skip school, and that impacts their academic achievement. We also know that students who reported that they felt unsafe at school because of their sexual orientation were two times as likely as those who had not felt unsafe to report that they had considered suicide. Students who were verbally harassed because of their sexual orientation were 93 percent more likely to have considered suicide,” Roemerman said.

“This was the first time that we asked questions about suicidal thoughts and, for me, what we found was just really disturbing.”

U.S. Sen. Tom Harkin (Lauren Victoria Burke/WDCPIX.COM)

“You have to be a little bit careful here because the way the … amendment is written, it can now be taken to other steps. For example, every health insurance company in America could now lose some of its tax benefits that it gets for providing health insurance if it provides abortion services. You can take this on down. You could just say that anybody that got a federal loan for housing could not get an abortion. You can take this and just keep going on and on and on with no end in sight,” Harkin said.

The language inserted in the House came by way of the Stupak-Pitts Amendment, which prohibits abortion coverage for any health insurance product subsidized in any way by the federal government.  As it is written, the bill dictates that any person seeking insurance is barred from purchasing abortion coverage, even if the premium for such insurance is paid out-of-pocket, if the person receives any government assistance.

“I just fear that the House-passed language goes far beyond [previous restrictions] and will effectively prevent women from receiving abortion coverage under the new health exchanges even if they are using their own money to buy insurance,” Harkin said. “I think that is unfortunate and goes too far. So, we will be addressing this issue before [the Senate bill] goes to the floor. My hope is that we can strike the appropriate balance.”

Harkin said his personal preference, and the one he believed all lawmakers had agreed upon prior to the introduction of this amendment, was maintenance of a nearly three-decade agreement that barred use of federal funds for abortion except in cases of incest, rape and life of the mother.

“I think keeping the status quo is the best thing we can do,” he said. “I think it has worked well over the past 20-some years, and I see no reason to change it at this point.”

The Democratic senator from Cumming, who serves as chairman for the Senate Health, Education, Pensions and Labor Committee, did stop short of saying he would vote against a reform bill in the Senate that included language similar to what was in the House version.

“I’m willing to work with my fellow senators, and my refrain is going to be, ‘Don’t upset the apple cart.’ Right now, I believe everyone in our country — except, let’s face it, some fringe groups — like what we have right now. It works well. We have conscience clauses. We provide no federal funding for abortions anywhere except for incest, rape and life of the mother. I think time has shown that these provisions work well. I see no reason to go beyond that now and to let maybe one fringe group or the other upset our whole health care bill because they want to change what has been an accepted law and practice for the past almost 30 years,” he said.

Although every Republican member of the U.S. House voted in favor of the amendment to further restrict abortion access, only one Republican ended up crossing the aisle to vote for the whole reform bill.

“I think that there are a lot of people, and I think you’ll see this in the Senate debate, who want to vote for amendments and will never vote for the bill,” Harkin said, and noted that within the HELP Committee more than 200 Republican amendments were considered, and 161 adopted, yet no Republican member could find a way to vote for the committee’s final bill.

“I think it will become clear that those who are doing these things aren’t just amending the bill to make it better or to try to make it work better. They want to kill the bill. Period. Republicans have said that repeatedly. They want to kill this bill. They want to stop Obama. They want to stop these changes.”

“[This report] really highlights that the need for health reform that isn’t limited to people who are working outside their home — that it is a big issue for those who are self-employed and for people across the country,” said Andrew Cannon, a research associate with IPP and author of the study. “It’s not just an urban issue. It’s not just a rural issue. It’s an issue that touches Americans from all walks of life. Health reform needs to address the needs of all populations, including America’s rural population.”

Nearly 20 percent of America’s uninsured live in rural areas, according to the study, and are more likely than residents of urban areas to purchase their insurance on non-group, private markets where they typically pay higher costs.

The latest white paper from The Iowa Policy Project highlights the disparities facing rural Americans in need of health care insurance. Click graphic to view full PDF.

“The situation really is not sustainable barring some sort of reform,” Cannon said. “What we’ve seen over the past 10 to 20 years is that medical inflation, and health insurance inflation in particular, far out-stripping wage inflation. So, health insurance costs are going up 7 to 8 percent each year for this population while their wages are increasing 3 percent, if that. This is especially true in a recession like we are going through now, where people’s wages are stagnant or decreasing and yet their health insurance cost is increasing by 7 or 8 percent. That just puts this on an unsustainable trajectory.”

As The Iowa Independent has outlined as a part of  its rural health care series, residents in these geographic areas often have lower incomes and higher poverty rates, but seldom meet income and asset guidelines necessary to receive assistance through existing public health insurance options like Medicaid and the Children’s Health Insurance Program. The study estimates that 1.2 million rural residents in Iowa “need increased access to affordable, quality health insurance.”

The white paper also provide the first-hand account of a Grinnell farming family that is attempting to navigate health insurance in the current system.

“It’s irksome that I’m a healthy person and I can’t get decent health insurance,” Suzanne Castello is quoted as saying in the narrative.

Castello, who had hoped to be able to purchase non-group, private insurance once she left outside employment and began to run the family farm with her husband, soon learned that the process would not be as easy as she thought. When the couple learned that they were expecting a child, the pregnancy was added to a list of pre-existing condition exclusions for which no insurer wanted to help pay.

“We were hemorrhaging money, but we didn’t qualify for Medicaid,” Castello said. “It really rankles me that we’re seeing something as fundamental as childbirth as kind of like, ‘Would you like dessert with that meal?’ There’s a double-standard between group policies and individual policies, which cover most farmers.”

Nationally, Castello is far from alone. Researchers have taken a keen interest in rural women who, despite a desire to work full-time on the family farm, have accepted off-farm employment solely for health care insurance. The phenomenon is known as “third shift,” due to often sleep-deprived realities held by the women who attempt to juggle work, family and farm duties.

“I have looked at some of the research on the third shift and that is a growing issue for a lot of rural families,” Cannon said. “As far as numbers go, I’m not sure and I wouldn’t want to peg a number. What we do know is that while 8 or 9 percent of the population in the U.S. gets insurance on the non-group, private market, in rural areas in Iowa it is a much higher rate — up to 37 percent in some parts of rural Iowa.”

It is very difficult overall to provide an accurate picture of what’s happening in rural Iowa in terms of health care insurance. While there is very good data available to provide a national picture, no such data exists on the local or state-level. That’s why, Cannon says, white papers like this are important.

“I don’t think it is something that most people are aware of — particularly with the rate of uninsured,” he said. “That’s because the current surveys … don’t get large enough sample within individual states for us to really get any good information. So, we know what the picture looks like nationally, but it is a little bit harder to get to it on a state level, which I think makes awareness of the issue much more difficult for people.”

Des Moines anti-abortion activist Dave Leach appears in one of a series of Web videos arguing that killing doctors who perform abortions is justified, and that judges should allow the theory to be argued in court.

Leach told the Iowa Independent in an e-mail that he was not expecting to hear a decision from Roeder until Tuesday.

“But right after I got your e-mail he called and confirmed,” Leach said Monday afternoon.

Leach has been advocating to Roeder for months to use the necessity defense, even going so far as to draft a legal brief on his behalf. Roeder is charged with one count of first-degree murder in Tiller’s death and two counts of aggravated assault for threatening two ushers at the church where he shot Tiller on May 31. Roeder has pleaded not guilty and is scheduled to go to trial in January.

Roeder confirmed in an interview with the Associated Press that he murdered Tiller but that it was necessary to stop him from continuing to perform abortions.

By stipulating to the facts of the case, Leach said the judge will have no choice but to allow the jury to hear the necessity defense, which says it is permissible to commit a crime if it stops a greater harm. Legal experts disagree, saying it is unlikely a judge would allow an argument that murder is justified to stop something that is protected by law.

Leach said now that Roeder has made his intentions clear, the public can begin to see how important this case is.

“Now, hopefully, the public can begin to hear about how essential this defense is to the Rule of Law in America,” he said. “Our everyday lives would become insane if the letter of every law were enforced even in situations where that would cause tragedy and death.”

Scott Roeder (mugshot)

In addition to crafting the defense, Leach, who is not an attorney, redrafted a document called “Defensive Action Statement 3^rd Edition,” which states the belief that juries should be allowed to rule on whether Roeder was justified in killing Tiller.

“We further declare that Scott Roeder’s jury, but not his judge, is qualified to weigh the fact question of ‘when life begins,’ which determines whether lethal force is justified to defend the lives of unborn children,” the document states.

The statement is signed by 21 anti-abortion activists, three of whom are serving prison sentences for actions against abortion providers.

Leach publishes a newsletter called “Prayer & Action News,” which advocates the doctrine of justifiable homicide in the case of abortion doctors. Roeder was a contributor to the newsletter. Following Tiller’s murder, Leach’s association with Roeder garnered attention from the national media.

But Leach’s history of anti-abortion activism goes back more than a decade. In the mid-1990s, Leach’s association with the accused killer of a Florida abortion doctor helped persuade U.S. marshals to guard the Planned Parenthood clinic in Des Moines.

In the January 1996 issue, Leach published the Army of God manual, which advocates the killing of the providers of abortion and contains bomb-making instructions. Because of this, he was fired from his job as a writer for an Ankeny newspaper.

In 2002, he tried to air videotape of patients entering a local Planned Parenthood clinic on public-access cable TV. Mediacom Communications Corp. decided it would not allow him to air the footage.

Robert A. Bischoff, was charged in September with sexual misconduct, unprofessional conduct and disruptive behavior in the practice of medicine by the state board. The Board believed Bischoff engaged in an inappropriate sexual relationship with a former patient in 2007, and that the patient stole his prescription pad and illegally obtained prescription drugs. The board also alleges that Bischoff made inappropriate sexual advances toward a female co-worker in 2006.

Bischoff was the subject of a number of complaints from female patients who said that he engaged in inappropriate touching as well as unprofessional comments. It was reported that the doctor viewed and stored pornographic images on a workplace computer, and that he frequently became angry and yelled at co-workers and other providers.

On July, Bischoff completed a board-ordered comprehensive physical, neuropsychological, mental health, sexual misconduct and substance abuse evaluation. The results of the evaluation, according to the board, concluded that Bischoff is not safe to treat patients at this time.

According to the agreement, Bischoff will not treat patients “until the resolution of the pending contest case before the Board, whether in the family clinic, a hospital or any other setting.”

Bishop Richard Pates, of the Diocese of Des Moines, wanted parishioners at the 82 locations that comprise the diocese to contact their U.S. representatives and senators to encourage them to support amendments within health care reform that are anti-abortion.

Congregants with the 82 parishes affiliated with the Diocese of Des Moines received this information as an insert within their bulletin this weekend. Click to view larger PDF version.

“We are at a critical moment in encouraging people to engage in the debate,” Pates said and noted the bulletin inserts distributed to the parishes contained background on the health care reform debate and contact information for legislators.

According to Rob Boston, assistant director of communications for Americans United for Separation of Church and State, the insert is “an example of permissible issue advocacy.”

“Churches run into problems,” Boston said, “when they endorse or oppose candidates for public office. That is not permitted under federal tax law. They can also run into problems if they link candidates to certain issues and then comment on those issues. In the absence of an election, this looks like strictly issue advocacy which is permitted.”

Regardless of the legalities of the action, the Planned Parenthood Federation of America interpreted the action as their own call to arms.

“It’s clear that every group opposed to a woman’s right to choose is pulling out all the stops this week to bring all the progress we’ve made on health care reform to a grinding halt,” Cecil Richards, president of PPFA, wrote in an action alert to supporters Monday evening.

The organization is calling on its supporters to also contact Congressional lawmakers — especially those individuals who are Catholic and support women’s rights in relation to health care.

The U.S. Catholic bishops strongly support health care reform that “protects life and dignity of all, from the moment of conception until natural death.” The bulletin inserts were prompted by information from the U.S. Conference of Catholic Bishops that concluded none of the current bills approved by congressional committees contain policies against abortion funding or abortion coverage mandates. Analysis by other groups that have scrutinized the bills, however, has determined that the reform language will not usurp mandates of the Hyde Amendment, which prevents taxpayer funds from being used for abortion services.

“The only potential problem with something like this — and it really is a non-legal issue — is that whenever religious groups speak out on public policy some people perceive that as heavy-handed and then it just spurs them to do the opposite of what the church wants,” Boston said.

The U.S. Conference of Catholic Bishops has also lamented the lack of fully protected conscience rights in health care, as well as the lack of adequate access to health care for immigrants and the poor. Those items, however, were not addressed in the bulletin insert that was delivered to Catholics in Iowa this weekend.

“While Kansas and North Carolina have a few little rivalries going on, [Hagan and I] have had a great time working together on health care issues, and particularly for rural citizens in this country because both of us come from states with a significant rural population,” Sebelius said.

The conference call with reporters was held in conjunction with the release of a new report by Sebelius’ office. The report, titled “More Choices, Better Coverage: Health Insurance Reform and Rural America,” documents many of the challenges faced by the estimated 15 million rural residents who seek health care insurance in the current system.

“A lot of rural Americans are self-employed or work for small businesses, including family farms,” Sebelius said. “A lot of them have to buy insurance on the individual market where they don’t have many choices and they have extremely high prices and rules that don’t protect consumers. Even when they do secure insurance, many folks in rural America then have difficulty finding a doctor. Two-thirds of the under-served community in America are in rural areas.”

According to Sebelius and Hagan, reform would begin to solve many of the access and insurance problems currently faced by rural residents.

“North Carolina does have a very large sector [of population] in rural areas,” said Hagan, who serves on the U.S. Senate Health, Education, Labor and Pensions Committee that is led by U.S. Sen. Tom Harkin of Iowa. “I think one of the critical aspects of the health care reform effort in Congress right now is that it is going to improve the quality, accessibility and affordability in our rural area.”

Forty percent of self-employed workers living in rural areas are uninsured, compared to 32 percent of self-employed workers living in urban areas, Hagan noted.

“[In North Carolina], 65 percent of of the uninsured population who are full-time workers, work for small businesses — compared to about 46 percent in urban areas,” she said. “And whereas there are nine doctors for every 10,000 North Carolinians in the larger cities, there are only about six-and-a-half for every 10,000 in rural areas. People in rural North Carolina are four times as likely to live in a county with lower access to health care professionals.”

Residents who live in these rural areas, according to the report, not only have more difficulty affording and accessing care, but typically have higher rates of poverty and chronic disease such as diabetes and heart disease. Because many of these same residents work for small businesses, or work part-time or seasonal jobs, it is much less likely that they will have private, employer-sponsored health care benefits. Nationally, a third of all rural residents work for small businesses, yet less than half have health insurance — a figure expected to climb as more small business owners drop health insurance coverage in order to keep their businesses afloat.

Farmers and agricultural workers are especially challenged in today’s insurance market. A multi-state survey of farm and ranch operators found that, while 90 percent of farmers have insurance coverage, one-third purchased it directly through an insurance agent (compared to a national average of 8 percent). The other two-third likely have a spouse that is forced to work off-farm so that the family can be provided with consistent health insurance coverage through an employer.

Sebelius and Hagan also acknowledged that simply providing rural Americans a way to pay for health care doesn’t always translate into access to health care. There were only 55 primary care physicians per 100,000 residents in rural areas in 2005, compared with 72 per 100,000 in urban areas. In the nation’s most isolated and small rural areas, that figure drops to 36 per 100,000. Hagan asserted that although the earlier stimulus had already addressed an expansion of the federal program for loan repayment of medical professionals who agree to practice in under-served areas, the current reform measure provides an extensive and necessary boost to further those efforts.

“There will be scholarships and loan-repayment programs for primary care providers who actually practice in these under-served areas,” she said. “The National Health Service Corps will provide grants and scholarships and loan-repayment programs to providers that’s going to include nurses, nurse practitioners, physician assistants, dentists and mental health providers who actually work in these under-served areas.

“The idea is to increase this dramatically from where it is right now, to be sure that we can get people who hopefully have lived in rural areas to actually go to these medical schools and into these medical professions and then return to their homes, or to agree to living in a rural area for a period of time.”

The current proposals would also provide payment bonuses to primary care providers practicing in under-served areas. Those who have studied ‘doctor drain’ acknowledge that the problem focuses on getting doctors and other health care professionals to begin a practice in an under-served.

“One of the things that we’ve found around the country is that once a person begins a practice, such as a practice in a rural area, [he/she] tends to voluntarily stay,” Sebelius said. “So it really hasn’t been necessarily the challenge of keeping folks there, it has been the challenge of getting them there and getting them back.”

Both women also expressed their optimism that the confirmation of Dr. Regina Benjamin as U.S. surgeon general would be forth-coming, as well as their belief that her personal experience will be a positive influence for young medical students to take advantage of incentive programs to not only serve in rural areas, but to build practices that add to the fabric of those communities.

When Iowa Department of Public Health officials planned their health provider flu vaccinations, they learned that many Iowa providers were above the recommended age requirements to receive the live virus H1N1 vaccination. In fact, no providers in Van Buren County were below the cut off age of 49.

Expanding insurance coverage is important, experts say, but that is only half the battle. For many Americans, particularly in rural parts of the country, access to high quality health care services could remain elusive.

“We have some serious challenges in Iowa as it relates to the number of providers that we have,” said Tom Newton, executive director of the Iowa Department of Public Health. “We do have a high percentage of our population in Iowa that is insured at this time, and I would tell you that even some of them struggle right now to get access to health care. You can’t just assume that by providing people with a source of payment that you’ve provided them with access to health care.”

As The Iowa Independent has previously reported, the Hawkeye State, like many other rural states, is coping with a plummeting number of health care professionals, including specialists, primary care physicians, nurses and behavioral health professionals.

While several factors such as perceived career stress and compensation issues are at the root of the decline, the problem is also being amplified by a rapidly aging health care workforce.

As a part of H1N1 flu response and vaccination plan development for health care providers, Newton said he spoke with a public health administrator in Van Buren County about the department’s plan to utilize flu mist, a live-virus vaccination that is delivered through the nose like a nasal spray. Because that vaccination contains a live virus, its use has been restricted to certain age groups.

“Health care providers were going to be our targeted audience for using flu mist, at least in some cases. But, in Van Buren County they do not have any health care providers that are under the age 49,” Newton said, noting that regulations prohibit anyone 49 and up from using the live virus. “That presents problems for us from a vaccination standpoint, but what does that say about health care providers in those communities? There are probably going to be some of those folks who are eligible to retire within five years.”

The alarming demographics and shrinking number of health care workers in rural areas are not just limited to primary care doctors. Other components of health care are also in short supply in much of Iowa.

“We aren’t just talking about those people that are traditionally thought of as health care providers – it’s dentists, it’s mental health and it’s even pharmacy,” said Cheryll Jones, a southeastern Iowa pediatric nurse practitioner who serves on the board of the Iowa Rural Health Association. “There aren’t necessarily huge numbers of pharmacies in rural areas. So, even if you have a provider, you may have to travel a fair distance to get your prescription filled.

“[Workforce] is a concern that we have, and not just for rural, but especially for rural. Certainly, the need for folks to have health insurance is important, and that is where a lot of the focus has been, but access to insurance does not equate to access to care.”

A declining and aging workforce is probably the most publicly visible of the challenges facing a health care system, but it is far from the only challenge for rural areas. According to Tim Size, executive director of the Rural Wisconsin Health Cooperative, his state, like Iowa, has maintained a relatively low uninsured rate.

“We are very used to dealing with rural health in an environment where most people have insurance cards,” Size said. “People having insurance cards is much better than people not having insurance cards, but it doesn’t deal with the long, long list of issues that we have to struggle with.”

As health care companies react to the current global economic recession, there will be efforts to make health care services more centralized, which isn’t always in the best interest of rural consumers or providers.

“We need collaborative ways for rural to work with rural and for rural to work with urban that maintains services available in the rural areas,” Size said. “From that respect, we have to be very concerned about the economic incentives that will come with reform. … There are a lot of models floating around out there that have tended to be developed in urban communities and we need to be very cautious about those being mandated into rural communities without any demonstrating or testing of the idea.”

When it comes to the debate over improving health care, Newton said, “It all comes down to how you define access.” For many rural residents, the definition is likely to remain too narrow to make much of a difference.

Nick Rhoades (Courtesy Black Hawk County)

Just four months ago, Rhoades, 34, entered a guilty plea in Black Hawk County to criminal transmission of HIV, a Class B felony. Rhoades, whose only previous offense had been a 2006 operating-while-intoxicated conviction, was sentenced to 25 years in prison and a lifetime of parole — the most severe penalty available. In handing down his sentence, District Court Judge Bradley Harris allowed a 12-month window for reconsideration of the case. That reconsideration hearing, complete with letters for and against and evaluations of Rhoades, took place last Friday. That evening, Rhoades walked out of jail and began a five-year period of probation.

“There is no denying the fact that there was a victim involved and that [this] derailed his life for several months of uncertainty,” said Rhoades, referencing the consensual encounter he had with another man in early summer 2008 that led to his ultimate conviction.

“It’s something that I think anyone who is infected has been through. It’s frightening — not only for him, but for his family and friends. It disrupts everything in your life while you are going through that time of just not knowing. It can be terrifying. I know what it was like, and I never would have wished it on anyone else. So, I do understand exactly why he would feel the way that he did and does.”

The decision by Judge Harris to provide Rhoades “a taste of prison” and then significantly reduce the sentence to only probation came as a shock to Rhoades, who was expecting to remain behind bars for several years. But even as he sat in jail he began to notice what he termed as “inconsistencies” in his sentence even as it related to other felonies of the same class. For instance, another man who had brutally attacked his girlfriend and cut her throat was given a 15-year prison sentence.

“When compared to other crimes and other laws on the books, it seems [my sentence was] a stiff penalty — especially considering the fact that it wasn’t considered a violent crime, that it was a consensual situation between two adults and that there was no infection [of the victim] showing up to this day,” he said. “It does seem that 25 years is excessive to me.”

According to Iowa law, the fact that Rhoades did not disclose his status prior to having intimate contact with another person is the chief issue in determining guilt. That is, the Iowa law specifically states that actual transmission of the HIV virus does not have to occur in order for someone to have violated the law. Iowa code, written and adopted in 1998, also makes no allowances for other variances well known within the medical community as factors in determining the potential spread of the virus — condom use and viral-load counts. At the time of the encounter, Rhoades’ viral count was non-detectable, meaning that the possibility of him transferring the disease even without condom was greatly reduced.

“Unfortunately, lay men and even people within the judicial system are not up to date with how fast progress has been made,” Rhoades said. “I think that is a problem considering the law and how it is imposed and the sentences provided in conjunction with it.”

Although Iowa has laws on the books that are used in general public health areas, HIV is the only medical condition singled out for regulation by the state.

“It is the most stigmatized medical condition that I can think of,” said Rhoades, adding how humiliating it was for his status to be “strewn across the media” and become fodder for the gossip mill. He believes that there is still a lot of misinformation and a lack of understanding about the disease and its risks.

“My family is very, very close, but I do have a step-brother who is not informed — despite attempts by myself and other members of the family to educate him about HIV,” Rhoades said.

When Rhoades, his mother and step-father planned to visit, the step-brother specifically asked that Rhoades not come. The family had welcomed the addition of a new child and “he was afraid that somehow I was going to infect his baby.”

“It just goes to show how widespread the ignorance is — even when it is family and there is a first-hand opportunity for knowledge,” he said.

While in prison, Rhoades informed cell mates of his status to offer them the opportunity to change cell assignments if they were uncomfortable with his disease. One of the cellmates told Rhoades that he didn’t understand, that he believed that, regardless of condom use or other factors, anyone who had intimate contact with someone who was HIV positive would automatically be infected.

“Again, that’s just another example of ignorance of the virus,” he said. “Actually, I hate saying ‘ignorance,’ because I think that comes across as an insult and I don’t mean to be insulting. Perhaps ‘naiveite’ is a better way to put it.”

Now that Rhoades is on probation, he is attempting to get his life back on track. He has already checked in with state officials and has begun a job search, but he knows that life after prison or as a registered sex offender isn’t going to be easy.

“It’s difficult to fill out applications, you know? I’m a criminal and have to list that on the forms,” he said.

Prior to his conviction, Rhoades had volunteered with HIV/AIDS awareness and education groups. Although he wants to continue to help others and give back in that way, he isn’t yet comfortable with the idea of putting himself before large groups.

“In some ways this has been liberating,” Rhoades said, indicating that before the court case he had only openly shared such private portions of his life with family and close friends. “I’m not at all proud and I do take responsibility for my own actions and mistakes. But there is no denying that it is all out there now.”

Donald Baxter of Iowa City was considered for prosecution under Iowa's criminal transmission of HIV law as a result of an altercation where Baxter claims he was only defending himself.

An interesting person with a history that spans from civil rights activities in Alabama and Georgia to clashes with local law enforcement in Iowa City, Baxter’s life story alone would likely be enough to prompt this article. But that’s not the reason for this interview. The unfortunate reality is that Baxter is one of about 3,000 people in living Iowa who are identified by the state as dangerous weapons worthy of regulation.

Sixteen years ago this month, Baxter learned that he was HIV positive.

Looking Back

“I like to tell people that I got HIV from doing what I thought I was supposed to be doing,” he said. “That is, I was living in a supposedly monogamous relationship. At the time, I don’t even quite know what I was thinking about the possibility of the person I was seeing being HIV positive. I think, looking back on it, I probably knew.

“I was doing HIV testing counseling. I was telling people how to have safe sex — mostly young men who were going out to bars and picking up men that maybe they didn’t know very well. That wasn’t what I was doing. Still, I ultimately was not following my own advice.”

Baxter, who was then a resident of Atlanta, had been living with another man for roughly three years, and, for a variety of reasons, the couple was aware that the relationship was coming to a close. Baxter made plans to get tested in September, a yearly activity he did in conjunction with his birthday. Although he asked his boyfriend to come with him and be tested, the man refused. The couple broke up shortly after that, and before Baxter learned that he was HIV positive.

“He may have known and he may just have not wanted to tell me,” Baxter said. “Ultimately … it was my responsibility. I mean, this person did not give me HIV. I got it from him. I got it by the decisions that I made not to be safe or to be as safe as I could have been.”

That attitude of personal responsibility toward his own disease has sparked Baxter’s interest about Iowa’s criminal law regarding HIV, which is among the second-most-serious felonies that can be committed in the state. Although the law is titled “Criminal transmission of human immunodeficiency virus,” the reality is that actual transmission of the disease is not required for there to be a criminal act. A person who is aware of his/her HIV positive status, according to the law, can be charged with criminal transmission for engaging in intimate contact with another person, providing bodily fluids or organs or sharing non-sterile drug paraphernalia. The only defense for a person with a positive status who is charged with the offense is to prove that status was disclosed prior to the offending action.

In the 11 years since Iowa began prosecuting behavior that could result in transmission of HIV, a total of 36 individuals have faced charges. Of those, 24 have been convicted and have received sentences ranging from a few months on probation to several decades in prison. Baxter, who bit another man during a bicycle-vehicle traffic dispute in Iowa City, was considered for prosecution under the law.

Iowa Impact

“This guy was poking me in the face. One of his jabs went into my mouth and I bit down hard,” Baxter said. “I didn’t even think about it. I wasn’t thinking that I was HIV positive and that I shouldn’t be doing it. I was just thinking that this guy just shoved his f***ing finger in my mouth.”

Baxter had been riding his bicycle on a street near the University of Iowa. The man was driving a van, and, according to Baxter, came up too close behind him, honked and moved into the other lane to pass before pulling abruptly back in front of him, effectively cutting him off. When the man then made a turn and came to a stop outside the school of pharmacy building on campus, Baxter followed and confronted him.

“I hit the side of his window — still straddling my bike — and he gets out of the van. He reaches back between the front seats and gets a four-foot-long windshield scraper and starts beating the hell out of my face,” Baxter said. “His wife comes out of the building and she tried to get him to stop, but he pushed her and she fell down.”

Baxter, who admitted to confronting the driver, was charged several weeks later with assault causing injury, a serious misdemeanor. Nearly a year later, and following a jury trial, Baxter was found guilty and ordered to pay fines, complete community service and take an anger management class.

“When I was sentenced, which I think was about two weeks after the trial, I was pretty shocked. I had actually deluded myself into thinking that I could win it,” Baxter explained. “When we lost our motion to suppress [my] HIV [status] at trial, my lawyer told me we lost the case. He said that he had been at a wedding in Davenport over the weekend and just sort of threw this out as a hypothetical. As soon as the HIV status came up there was absolutely no sympathy for me whatsoever. The people at the wedding thought that I put this person in jeopardy.”

Whether or not Baxter did place the man in jeopardy is a subject of contention. Most virus experts agree that the possibility of transmitting HIV through saliva or other bodily fluids that are not blood is minuscule, but no one is ready to definitively say the disease cannot be transferred by those means. Also the Iowa law is written with a broad brush, encompassing any and all bodily fluids, and making no exceptions for condom use or viral loads, information the medical community has acknowledged as playing a large role in possible transmission.

On a personal level, Baxter took at least two lessons away from the incident. First, Iowa law makes it difficult for a person who initiates a confrontation to later claim that he/she was acting in self-defense. And, second, “if you have HIV, you lose your right to self-defense.”

“I think that I would have stood a pretty good chance of winning the case if it was not for HIV,” he said, adding that his status creates an odd circumstance of living. “Really, HIV, despite the fact that it in some ways sort of runs my life, I’ve never been ill from it.”

Sledgehammers and Thumbtacks

Baxter, who is in his 50s and remains an avid bicyclist, is in physically better shape than many men half his age. He manages his disease by taking medications — four pills a day, usually before he goes to bed. The worst health he has known as a result of the disease is attributed to the initial side effects of the medications before his body adjusted to them.

“My ideal HIV law would probably not require transmission, but it would require intent,” he said. “I think that intent certainly has to be a factor. It should be difficult [to convict] … I mean, beyond a reasonable doubt, right?”

Baxter also advocates moving Iowa laws closer to those in neighboring Illinois. That state did not write a criminal code specific to HIV, but used existing public health laws to deal with any crimes associated with sexually transmitted diseases.

“I think the law we have here is a sledgehammer that is mostly looking for a thumbtack. I think the latest thumbtack was Nick Rhoades,” Baxter said in reference to a Black Hawk County case earlier this year where a 34-year-old man was sentenced to 25 years in prison following a one-time consensual encounter that did not result in transmission.

“I get no impression from him other than the fact that he is probably a 34-year-old man who is not a paragon of responsibility. He obviously has had some substance abuse issue, which is actually pretty common in the gay community. He is not a criminal, and his sentence angers me on a couple of fronts. He’s probably never transmitted HIV to anybody, let alone the person who made this complaint against him. As a taxpayer in the state of Iowa I also realize that we are probably spending between $65,000 and $70,000 per year to keep him behind bars. That pisses me off. That would piss me off if I weren’t HIV positive.”

Although knowledge about HIV has increased in the decade since Iowa wrote its criminal transmission law, the law itself remains untouched. Baxter acknowledges that another decade will bring more knowledge and perhaps changes.

“Yes, we are learning more and, as older judges and prosecutors are replaced by younger ones, there will likely be changes,” he said. “So, yes, I think that time will take care of this — but how much time?”