Can you get hepatitis from criminalizing homelessness?

A recent investigation told San Francisco what most of us already knew: The sidewalks are really, really dirty.

NBC Bay Area’s Investigative Unit surveyed 153 blocks spanning downtown neighborhoods where concentrated poverty rubs elbows with concentrated wealth. Investigators measured the incidence of hypodermic needles, discarded trash and human waste within the surveyed neighborhoods. Their findings — including 100 needles and 300 piles of feces — point to severe contamination, including risks of exposure to HIV, hepatitis B and C and several other viral diseases, such as the rotavirus, which can be inhaled from dried and airborne feces.

That contamination exists is not as interesting as the reasons cited for it. Dr. Lee Riley, an expert on infectious diseases and slum health at UC Berkeley, concluded the extent of San Francisco’s sidewalk contamination is “much greater than communities in Brazil or Kenya or India.” There, slum-dwelling urbanites see their homes as permanent and exercise what Riley calls “a certain sense of ownership” to maintain sanitary conditions for their families, friends and neighbors.

By contrast, San Francisco’s poorest residents live in temporary encampments, where their existence is subject to 23 quality-of-life laws that criminalize basic activities and enforce a move-along culture from sidewalk to sidewalk. The most recent law — Section 169 of the police code — authorizes officials to clear encampment sites with only 24 hours’ notice and an offer of one night in shelter. During Section 169’s first year on the books, San Francisco’s homeless outreach team issued nearly 200 move-along notices to residents at downtown encampment sites. But encampments are often cleared without placing residents into long-term housing, so they return to the same streets, but different sidewalks.

As a result, the only permanent thing about San Francisco’s tent encampments is how temporary they are.

“Forcing people to sleep on the sidewalks and then forcing them to move constantly only exacerbates their homelessness and the crisis all San Franciscans are witness to and affected by,” said Jennifer Friedenbach, executive director of the Coalition on Homelessness.

Section 169 started as a symbolic ballot measure: San Franciscans voted by a narrow margin to ban encampments — not because anyone expected a workable ban, but because, on principle, people shouldn’t be living in tents. But until public investment can provide an adequate supply of affordable housing, tent encampments will remain a means of survival for The City’s poorest residents. And municipal codes like Section 169 will make them permanently temporary, diminishing the ability and incentives of residents to maintain sanitary conditions on the sidewalks.

Skeptics will argue that many homeless people have inherently diminished capacity to maintain sanitary living conditions, whether or not they have the incentives and whether or not encampments have any kind of permanency. It is true that many San Franciscans experiencing homelessness have acute service needs, but the answer to service needs is services. It is not quality-of-life enforcement that makes each experience of homelessness as difficult as possible, aggravating the conditions that give rise to service needs in the first place. Our laws should reduce harm, not cause it.

There is a certain logic to the idea that sidewalk contamination adds another cost to the price tag for quality-of-life legislation. It is well-documented that quality-of-life laws rack up direct enforcement costs, as well as indirect costs, to the public safety net. In June 2016, the Budget and Legislative Analyst’s Office calculated a direct cost of more than $20 million to cite individuals for quality-of-life violations in 2015. Indirect costs include the cost of providing fully subsidized housing to violators whose criminal records disqualify them from rental market housing. Add to that the Department of Public Works’ $30 million budget for needle and waste cleanup, and quality-of-life legislation adds up to a bad deal for all city residents.

A better result would be to trade punitive quality-of-life laws for practical waste disposal options. At a minimum, this should include revisiting the trash can cutbacks under former Mayor Gavin Newsom. It should also include scaling initiatives like the Pit Stop program. At a cost of $200,000 per “pit stop,” these portable facilities combine clean toilets with safe needle disposal boxes. The problem? There are 17 pit stops citywide for an estimated 7,500 people experiencing homelessness (and a distinct population of 22,000 intravenous drug users), and the pit stops don’t operate overnight. The solution is an expanded, around-the-clock Pit Stop program, with the upside potential to avert public health emergencies like the hepatitis A outbreak in Southern California, where officials have called for emergency portable toilets.

If quality-of-life enforcement contributes to extreme contamination on our sidewalks and in tent encampments, then it is the laws, and not the encampments, that should be banned.

Mary Kate Bacalao, director of public funding at Larkin Street Youth Services, a local nonprofit that provides a continuum of housing and services to youth experiencing homelessness.

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