Fabulous post on Oxfam's #FP2P blog on including sexual health (and pleasure!) in the development agenda

Friday, October 24, 2014

Global health and human rights advocates have worked tirelessly for years against systemic oppression of women and sexual violence that present concrete barriers to women's health. Just this week, the global health community mourned the death of anti-FGM activist Efua Dorkenoo, and on Wednesday, Dr. Denis Mukwege - Congolese vaginal fistula surgeon, women's rights advocate, and all-around BAMF, won the Sakharov Thought Prize for his work. Obviously, all of this work is important. However, Oxfam's Chloe Safier argues that the development industry should focus on sexual well-being - specifically including sexual pleasure - as part of the strategy to combat gender inequality and promote bodily integrity a well-being:
The notion that sexual satisfaction and pleasure is a core aspect of people’s lives hasn’t gained traction amongst international development NGOs, nor in government agendas, donor agencies or in any international protocol. Sexual pleasure doesn’t make an appearance in Bhutan’s Gross National Happiness Index. There’s no ‘pleasure indicator’ in any widely published index, no UN report on who’s enjoying sex and why. This despite a widespread understanding since the 1980s, building on the work of Amartya Sen, that development must go beyond relieving economic poverty and towards an approach that is centered on human well-being, in which freedom of choice and desire fulfillment are fundamental.
Our present reality is that women and LGBTQI people in almost every part of the world have less power, access and voice than heterosexual cisgender men. The ways in which the patriarchy has been manifest in sexual enjoyment and rights is readily apparent. Female genital mutilation is recognized by many as an abuse of women’s bodies and can be directly linked to the ability to experience sexual pleasure; it’s an area of work where women’s right to sexual pleasure is implicit in the discussions, though explicitly it’s largely spoken about as a woman’s right to bodily integrity. Discrimination and ‘corrective rape’ of lesbian women – who pose a threat to men by taking pleasure in each other’s bodies – show how sexual pleasure can play a political and subversive role in a patriarchal, misogynist society (and can put some women and LGBTQI people at risk).
The full post is well worth the read.

Cuba shows US up in its response to #Ebola outbreak...leading to a thaw in relations

Cuba, whose health system has been hailed by leftists and public health advocates as a model to follow despite the country's economic setbacks, has put most of the developed world to shame in its response to the Ebola outbreak in West Africa. Unlike most other industrialized nations, which have responded mainly with funding and supplies, Cuba has stepped up and sent 165 medical professionals to Sierra Leone, with 91 about to begin working in Guinea and Libera. There are plans to send about 200 more. From Yahoo!:
The island's response to the epidemic, which has killed more than 4,500 people in west Africa, has won plaudits from humanitarian workers who say the international community's reaction has otherwise been lacking.

"The international response has been slow.... The virus is spreading faster than we're all setting up," said Sean Casey, director of the International Medical Corps' emergency response team in Liberia, where Cuban advance teams have been laying the groundwork for the new medical team's arrival.

"It's good that the Cubans are coming. We need more countries to step up," he told AFP.

Cuba's contribution has also won plaudits on the international stage -- even in the United States, where Cold War bitterness toward the island still lingers, more than 50 years after the Cuban Missile Crisis and the severing of diplomatic ties.

US Secretary of State John Kerry paid Cuba a rare compliment last week, singling out the country for its "impressive" response to Ebola.
These rare displays of warmth have been reciprocated on the Cuban side.

Fidel Castro, the retired father of the island's communist revolution, said Cuba "will gladly cooperate with American personnel" on Ebola, in an article published in state media Saturday.

His brother Raul, who succeeded him as president in 2006, echoed the sentiment at a regional Ebola summit Monday in Havana, the first of its kind in Latin America.
Diplomacy wins through public health! Warm fuzzies all around.

Progress? Myanmar increases HIV funding

Thursday, October 23, 2014

I know this is kind of old news, but as both HIV and Myanmar are areas of interest for me, I am posting it anyway.

Last week, Myanmar confirmed in a meeting with the United Nations Secretary-General’s Special Envoy for AIDS in Asia and the Pacific, J.V.R. Prasada Rao, that it will increase funding for domestic HIV programs by 5 million USD:
There were 190 000 people living with HIV and 6700 new HIV infections in Myanmar in 2013. More than 65 000 people were receiving HIV treatment in 2013 and the Ministry of Health estimates the new funding will enable 40 000 additional people living with HIV to access antiretroviral medicine and will increase the national HIV treatment target coverage to 85%. The Minister of Health has asked his staff to work with UNAIDS to determine the cost of reaching 100% coverage.
The Minister of Health also pledged an additional US$ 1 million to further scale up opioid substitution therapy for 10 000 people by the end of 2016. Studies show that harm reduction programmes such as needle–syringe exchange programmes and opioid substitution therapy are effective in reducing the spread of HIV.

In Myanmar, key populations, including people who inject drugs, sex workers, men who have sex with men and transgender people, are at higher risk of HIV infection. Mr Rao urged the government to amend policies that violate the human rights of key populations and praised the country’s draft intellectual property law, which will help protect access to affordable medicines.
Lovely. Now, if they could just quit throwing journalists in jail and repeal the law that was obviously designed to prevent opposition leader Aung San Suu Kyi from running for president, that would be great.

A new Afghan president: New hope for Afghan women?

The new president of Afghanistan, Ashraf Ghani, made a statement - and waves - when he mentioned his wife in his inauguration speech. The gesture was simple enough - he thanked her for her support of his campaign and promised that she would have an influence in his presidency - but in Afghanistan, a deeply conservative country with an entrenched tribal culture, it has sparked both hope and concern:
Ghani’s public acknowledgement of his wife Rula sends a positive message to Afghan women but makes others throughout Afghanistan uneasy.

The most important issues facing Afghan women today are security, health, and education, as well as social and economic empowerment.

Although the country’s constitution guarantees women’s right to be educated and to work, making advances in these areas still means confronting and challenging the conservative nature of Afghan society and family.
But despite advances in education and political empowerment, Afghan women face a consistent struggle against the fundamentally conservative nature of the country.

Afghanistan has historically been a nation of traditional tribal values and the rise of Islam in the 8th century introduced further conservative beliefs and customs.
Against this historical backdrop, the gains over the last thirteen years during the administration of former President Hamid Karzai have been immense in terms of the empowerment of Afghan women. Women have the constitutional right to work, to be educated, to vote, and to hold public office. Whether a woman wears a veil or not is up to her.
Both President Ghani and his former rival and now chief executive, Abdullah Abdullah, made strong campaign promises to uphold and protect women’s constitutional rights going forward.
But what history shows us is that any progress in the empowerment of Afghan women has to be gradual and participatory.
The VOA article goes into the country's 20th century history a bit and is a decent primer. Rula Ghani sat down with the BBC for an interview shortly after her husband's inauguration that revealed her to have a progressive, but cautious, vision:
During the election campaign of her husband, Ashraf Ghani - the eventual winner of the 2014 presidential race - Rula Ghani was the only candidate's wife to appear in public.

And when the new leader paid an emotional tribute to his wife in his inauguration speech, it became a talking point for the whole country.

Mrs Ghani says it was a revealing gesture which summed up her vision of how attitudes to women could change.

"By mentioning me the way he did, my husband really showed exactly what I mean by helping Afghan women be more assertive, more conscious of their role, more respected."

Mrs Ghani is clearly aware of the sensitivities in Afghanistan's conservative society and says that her vision doesn't contradict traditional values which are a keystone of Afghan life.
Mrs Ghani's own contribution will come from her newly established office in the presidential palace and she says for the first three months she will be in "listening mode" finding out what's important for Afghans.

"I don't necessarily see myself as an activist, running down the street and knocking at every door," she says. "Besides I have reached a certain age where ladies stay at home more. I'm in my sixties and I see myself much more as a facilitator."
But she has a clear goal ahead.

"If I've achieved a higher respect for women and for their role in society then I would be very happy. That would really be my greatest wish."

Sexual violence in South Sudan has gotten really, really (really) bad

Wednesday, October 22, 2014

As if perpetual civil war wasn't bad enough, a UN special representative is now saying that the sexual violence present in South Sudan's conflict has become so widespread and pervasive that toddlers are being raped:
Rape and other forms of sexual violence by all sides in South Sudan's civil war have become so widespread that a 2-year-old child was among the victims, the U.N. special representative on sexual violence in armed conflict said on Monday.
"Survivors and health care workers told me heartbreaking stories of rape, gang rape, abduction, sexual slavery and forced marriage," Bangura said. "Those who try to fight back against their attackers are often raped with objects instead. Some victims have even been raped to death."

She said the victims included women, men, girls and boys, with 74 percent of them below the age of 18, according to South Sudanese hospital officials.
She said both sides in the conflict have committed sexual violence, adding that orders had been given within the military forces to perpetrate rapes on the basis of ethnicity.

Bangura added that said a radio station in Bentiu called Radio Bentiu FM was used to broadcast appeals for men to rape women and girls based on their ethnic backgrounds and what was believed to be their political loyalties.

Bitter Harvest: Amnesty International reports abuse and exploitation of migrant workers in South Korea

Yesterday, Amnesty International released Bitter Harvest, its report documenting extensive abuse and exploitation of migrant workers in the South Korean agricultural industry. VOA reports:
The report said the country's Employment Permit System, or EPS, is designed "to provide migrant labor to small- and medium-sized enterprises that struggle to hire a sufficient number of national workers."
The report, based on interviews with migrant agricultural workers across South Korea, documents a range of exploitation, including intimidation and violence, squalid accommodations, excessive working hours, no weekly rest days and unpaid overtime.

Amnesty said while an EPS employer can terminate a migrant's contract without having to justify the decision, migrants who want to leave their jobs must obtain an employer-signed release form.

Without the release, migrants run the risk of being reported as "runaways" to the immigration authorities by their employers, subjecting the migrants to arrest and deportation.

Amnesty International found that employers responsible for exploiting migrant agricultural workers rarely face any sanctions.
Sadly, this does not surprise me after living and working there for nearly two years. South Korea is a wonderful place in many respects, but racism and xenophobia are very common and can often lead to apathy about these types of abuses. Opposition to "multicultural marriages" (very common for Korean farmers, who often marry Southeast Asian women because they cannot find a Korean bride), is widespread. Although white Westerners enjoy a relative amount of respect and prestige, I knew several English teachers who were deprived of benefits and forced to work overtime (often in violation of their contracts) for private academies, or risk losing their job and visa. Stories of teachers fired so that their employers could avoid paying severance were everywhere, and the legal system is notoriously difficult to navigate for foreigners. For migrant laborers, it is clearly much worse.

Chikungunya in the Caribbean: Jamaica declares a state of emergency

Tuesday, October 21, 2014

Well, this is bad news. The global health blogosphere has been following Chikungunya ever since its jump across the Atlantic to the Caribbean at the end of last year, and then to Florida this summer. However, apparently it's gotten so bad now that Jamaica has declared a state of emergency in response to it.
Jamaican prime minister Portia Simpson Miller announced that the island nation is in a 'national emergency' this week over the outbreak of Chikungunya.

The mosquito-borne virus shares similar symptoms to Dengue, often leading to fever and joint pain that can last from days to years.

"I want to stress that we are in a national emergency," Simpson Miller said, "I have therefore, assumed a lead role in mobilizing the nation and national resources."

Earlier this month the Jamaican government launched an Emergency Response Team to coordinate national actions to contain the Chinkungunya virus and reduce the number of cases. The government designated US$4.5 million in state resources for the team's efforts.
I traveled to St. Lucia this month, and the local people are definitely concerned; I even met an unfortunate Canadian women who had contracted both dengue and Chikungunya at the same . Lucky for us, a vaccine is in the works and has shown promise in early clinical trials.

We have lost an anti-FGM warrior: Efua Dorkenoo dies of cancer

Efua Dorkenoo, "mother" of the African-led movement against female genital mutilation (FGM), has died of cancer at age 65.
Dorkenoo – known affectionately to many as “mama Efua” – was a leading light in the movement to bring an end to FGM for more than 30 years, campaigning against the practice since the 1980s.

The girls’ and women’s rights campaigner saw the progression of the movement to end FGM go from a minority, often ignored, issue to a key policy priority for governments across the world. Proof of this arrived with the launch of The Girl Generation on October 10 – a major Africa-led campaign to tackle FGM across the globe, run by a consortium of charities and organisations and funded by the department for international development. Dorkenoo – the natural choice to lead the consortium, wrote simply on the day of its launch: “ Finally, The Girl Generation: Together to End FGM is here, and I hope you like it.”
In 1983 she co-founded FORWARD (The Foundation for Women’s Health, Research and Development), which became a leading organisation in the battle to raise awareness about FGM. The procedure, which still affects more than 125 million girls and women worldwide and is widely practised in 29 countries in Africa and the Middle East, was outlawed in the UK in 1985. She published a seminal text on FGM – Cutting the Rose: Female Genital Mutilation: The Practice and Prevention, in 1994.

What ground my gears (and otherwise irritated me) this week: Ebola hysteria, infection control terminology, and the US abortion wars

Friday, October 17, 2014

I was posting often when I launched this blog at the beginning of the year, but then things got slow during my travels and after I came back to the states and was job searching. Now that I have settled into my new position, I am able to post here more frequently and am beginning to wonder if I should set some routines or designate certain days for regular features, like so many other global health blogs do. Fridays seem to be popular (e.g., WhyDev's Last Week Today and my personal favorite, Wronging Rights's WTF Friday). I'll have to meditate on establishing a "Peeves of the Week," or "What Ground my Gears This Week" routine, but a preliminary assessment confirms that it suits my character pretty well.

Maybe I'll go with the "Gears" option; after all, I love memes.

Gear Grinder #1: Ebola hysteria and the media's inability to use "isolation" and "quarantine" correctly
I sometimes wonder if public health professionals are doomed to a lifetime of exasperation with crappy media coverage of health topics. Global health bloggers already constantly bitch that the media's m.o. is to ignore diseases until they become relevant, and then to immediately transition into full-blown PANIC! mode. On top of the overal doomsday tone, however, I have noticed that most news stories seem to use the terms "isolation" and "quarantine" interchangeably, when they actually mean two very different things:
  • Isolation separates sick people with a contagious disease from people who are not sick.
  • Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.
Get it right, people. It's not that hard.

Gear Grinder #2: The ongoing US abortion war, otherwise known as "the never-ending public debate in which people scream past each other"

I make it a point to pretty much never get into this topic, because most people can't seem to stay rational while discussing the issues of abortion and contraception. But today conservate troll blogger Matt Walsh (along with a zillion others) offered his take on the woman who posted an open letter to the "little life [she] won't get to meet" to Reddit. Cue controversy. What consistently frustrates me, among other things, is how it doesn't occur to anyone that young women who become pregnant unexpectedly might not feel so trapped if the relatively commonplace life event of having a child in America didn't cost a fortune or severely damage women's career prospects. In fact, this image of a hospital bill following a C-section birth in Philadelphia went viral this week:

Remember, my fellow Americans, we live in one of the only countries in the developed world without any kind of guaranteed paid maternity leave or subsidized childcare. Perhaps pro-life advocates who want young pregnant women to "choose life" should make it so that pregnancy doesn't have to be such a bloody crisis.

Nifty Infographic of the Day: Are [US] Hospitals Prepared for a Natural Disaster or Emergency?

The answer, as you might have guessed, is that they are not: most hospitals, like many agencies, are simply not ready for a disaster.

Dallas Presbyterian on #Ebola: "Our bad, guys! Sorry about that."

Thursday, October 16, 2014

In a very quietly arranged Congressional hearing that almost nobody heard about until after it started, officials at Dallas Presbyterian Hospital, the hospital that screwed the pooch on treated America's first Ebola case (resulting in infecting two of its own nurses due to its shoddy infection control practices and utter lack of training and emergency preparedness), issued an official apology as part of their testimony.
The chief clinical officer of the Texas hospital system that treated a Liberian Ebola patient apologized for what he said were mistakes made by the hospital in Dallas in the original diagnosis of Ebola and in providing inaccurate information.

The remarks, part of prepared testimony for a congressional hearing later Thursday, came a day after a second nurse in Dallas was found to have Ebola. Her diagnosis came after she had taken a flight, prompting health officials to track down other passengers and include them in a growing list of people being monitored for symptoms.
In the prepared remarks, Dr. Daniel Varga, the chief clinical officer for Texas Health Resources, the medical group that oversees Texas Health Presbyterian Hospital, said that “unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and a highly skilled medical team we made mistakes.”

He added: “We did not correctly diagnose his symptoms as those of Ebola. We are deeply sorry.”
Well, I guess that's settled - now that the hospital has said they're sorry, we can all go home now.

Meanwhile, National Nurses United, a nurses' union, published an anonymous statement compiled and submitted by nurses from the aforementioned hospital. The statement, contrasting sharply with confident and rosy proclamations from the hospital about how it was doing everything it was supposed to, paints a disgraceful (lack of) response when the CDC has been warning hospitals to prepare themselves and publicizing infection control guidelines for months.
The statement alleged that when Duncan was brought to Presbyterian by ambulance Sept. 28 with Ebola-like symptoms, he was “left for several hours, not in isolation, in an area” where up to seven other patients were. “Subsequently, a nurse supervisor arrived and demanded that he be moved to an isolation unit, yet faced stiff resistance from other hospital authorities,” they alleged.

Duncan’s lab samples were sent through the usual hospital tube system “without being specifically sealed and hand delivered. The result is that the entire tube system … was potentially contaminated,” they said.

The statement described a hospital with no clear rules on how to handle Ebola patients, despite months of alerts from the Centers for Disease Control and Prevention in Atlanta about the possibility of Ebola coming to the United States.

“There was no advanced preparedness on what to do with the patient. There was no protocol. There was no system...nurses were essentially left to figure things out on their own as they dealt with “copious amounts” of highly contagious bodily fluids from the dying Duncan while wearing gloves with no wrist tapes, flimsy gowns that did not cover their necks, and no surgical booties, it alleged.

“Hospital officials allowed nurses who interacted with Mr. Duncan to then continue normal patient-care duties,” potentially exposing others, the statement said.
So much fail.

Nifty Video of the Day: What in the Health Is Public Health?

The following short animation, written and animated by Fielding School PhD student Adam Carl Cohen explains the role of public health in preventing disease. It's not super in-depth or anything, but it's a nice short overview for the general public.

What in the Health Is Public Health: Treatment vs. Prevention from UCLA Fielding SPH on Vimeo.

HIV stigma in Africa is not getting better, according to recent studies

Wednesday, October 15, 2014

Despite public education campaigns and progress in expanding availability of HIV medications in countries with high burdens, two recent studies have shown that HIV-related stigma in Africa is not going away. From this week's NAM aidsmap newsletter:
Many people hope that as HIV treatment becomes more widely available, people’s fear of HIV might decrease. But a study from rural Uganda, conducted between 2006 and 2012, is not encouraging on this point. Annual surveys with people living with HIV showed that concerns about disclosing HIV status and measures of internalised stigma had increased during this time. And surveys done with the general population showed that an increasing number of people said they would expect people living with HIV to experience stigma when disclosing their HIV status.

The second study was conducted with nearly 40,000 schoolchildren, aged 12 to 14 years, in nine southern African countries in 2007. In four countries, one-in-five children said that they would “avoid or shun” a friend who revealed that they had HIV. In three countries, over a third of students believed that children living with HIV should not be allowed to continue to attend school.

Children from poorer families and children living in rural areas were more likely to have stigmatising attitudes.
Interestingly, the first study - examining both internalized stigma among people living with HIV (PLHIV) and attitudes among the general population - found that while internalized stigma among PLHIV increased over the five-year study, attitudes regarding HIV among the general population actually improved:
Overall, participants in 2011 were more likely to have accepting attitudes towards HIV (59 vs 46%, p < 0.001).

However, in 2011 a higher proportion stated that they would expect people living with HIV to experience stigma when disclosing their status (61 vs 47%, p < 0.001).

The investigators offer two suggestions for this apparent disparity in their findings. First they suggest that answers about feelings of stigma towards HIV may have been affected by social desirability – participants provided researchers with the answers they thought they ought to. Alternatively, the authors suggest that attitudes towards HIV genuinely had changed among the study participants, but they perceived that the attitudes of others in their society had not.
The second study examined attitudes related to HIV among schoolchildren in Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. Generally, the study found that students with more accurate knowledge about HIV and its modes of transmission were less likely to have discriminatory attitudes, and there were major differences in knowledge and attitudes between rich and poor students, and also between students in urban and rural areas, with rural and poorer students more likely to have discriminatory attitudes.
The two countries with the lowest scores for discriminatory attitudes, Malawi and to a lesser extent Swaziland, are small countries with high HIV prevalence that have mounted particularly strong public awareness campaigns and more recently have concentrated on providing access to antiretroviral therapy and, in the case of Malawi, especially to testing.

The researchers comment: “Our study points towards the need for early interventions (age 13 or before) to reduce stigma and discrimination among children, especially in schools in rural and poorer areas. In particular, interventions should aim to correct misconceptions that HIV can be transmitted via casual contact with people living with HIV.”
This should come as little surprise - similar studies have demonstrated that the better informed a population is about HIV, the less likely they are to have negative attitudes about it. Both studies underscore the continued need for public education campaigns about HIV, and that increasing the availability of medications, while important, should not take away from the need to inform the population.

Mandy Moore heads to Tanzania for PSI to promote recognition of the importance of #healthworkers

Thursday, October 9, 2014

Note/disclaimer: I am drawing attention to this trip, which I do honestly believe highlights an important group, at the request of one of my colleagues and fellow bloggers who works for PSI, though I am not getting paid for it.

Though the issue of celebrities foraying into global health and development is somewhat controversial (and occasionally scandalous), I maintain that it is not necessarily a bad thing. IMO, it all depends on who they are working with and what they are doing. Thus, starting your own charity like Alicia Keys or Madonna is probably not the best approach, signing on as ambassadors can, I think, draw attention to important issues and groups by putting a celebrity face on an organization's efforts.

Which is why I'm happy to point out that Mandy Moore is back in Africa with PSI, this time in Tanzania, to draw focus on the importance of a critical but vastly underappreciated resource in global health: health workers.
A robust and effective global health workforce must be a top priority for the international community, and Mandy Moore is helping to champion this cause along with Jennifer James, founder of Mom Bloggers for Social Good, a coalition of more than two-thousand mom bloggers who currently span twenty countries who care about spreading the good news about the amazing work nonprofit organizations and NGOs are doing around the world. They’re visiting health workers in Tanzania with us along with IntraHealth International, with whom PSI partnered to produce the latest issue of Impact Magazine, focusing on the global health workforce.

Follow @TheMandyMoore, @JenniferJames, @SocialGoodMoms, and @IntraHealth as well as @PSIImpact and PSI’s @MarshallPSI, @Mandy_McAnally and @regaroni, who will be tweeting and Instragramming the trip all week using #HealthWorkersCount. We’ll be creating a Storify every day to collect some of the best photos, tweets, and commentary from Mandy and the group in Tanzania. We would love to include your thoughts and tweets about the value of an empowered global health workforce.
As a side note, I had no idea that there was "a coalition of more than two-thousand mom bloggers who currently span twenty countries" dedicated to giving press to nonprofit action, though I'm not surprised. Based solely on my experience on Facebook, I have concluded that "mommy bloggers" are a terrifyingly influential collective and a force to be reckoned with.

#Globalhealth insight on Reddit

Wednesday, October 8, 2014

My entry into global health blogging, which was due to joining APHA's International Health section and eventually led me to becoming the chair of its Communications Committee, has also taken me to some very interesting social media and other internet community platforms. Along with my generation's love-hate relationship with Facebook, the questionable attempt to gain utility from LinkedIn, and the standard activist's presence on Twitter, I have recently forayed into Reddit's health-related communities (including /r/globalhealth, /r/doctorswithoutborders, /r/publichealth, /r/epidemiology, /r/humanrights, /r/worlddevelopment, and /r/internationaldev), some of which are more active than others. Most of what is useful comes in the form of news articles posted, although there are opportunities for mentorship, giving and receiving education and career advice, and even a weekly journal article discussion.

However, you occasionally find public health gems on other, less serious boards, including the occasionally inane /r/adviceanimals. For example, yesterday I stumbled onto some rather apt commentary on the ethically dubious rush to develop Ebola treatments:

US waives child soldier sanctions on six nations - again

Friday, October 3, 2014

H/t to fellow global health bloggers Mark Leon Goldberg and Tom Murphy who point this out every year - as they should, because it is even more disappointing every time it happens.
President Barack Obama on Tuesday fully waived sanctions and lifted bans on international military, education and training assistance to Yemen, Rwanda and Somalia applied under the Child Soldier Prevention Act, said deputy assistant secretary Michael Kozak.

Central African Republic, the Democratic Republic of Congo and South Sudan were also given partial waivers for specific military purposes, while sanctions were maintained on Myanmar, Sudan and Syria, found guilty of the widespread recruitment of children into their armies.

Waivers did not mean the United States was turning a blind eye to the use of child soldiers or providing an "unlimited flow of security assistance," Kozak said.

"The waiver doesn't mean that they are not guilty of recruiting child soldiers. To the contrary, it means they are, and therefore the sanction in law would apply but for the waiver," Kozak said, adding the idea was a bit like "a doctor treating a patient."

"You don't want to do something that's going to kill the patient. If you have al-Shebab take over in Somalia because we couldn't support the government at all, that's not going to help the child soldier problem or any other human rights problem."
I'm pretty sure that waiving sanctions to allow the Somalian government to recruit child soldiers year after year hasn't really helped with the al-Shabab problem; last I checked, it was still a failed state. I suppose we can just add it to the list of this administration's failures, along with closing Gitmo and living up to a prematurely-awarded Peace Prize.