More HIV discrimination from the ROK government: Korea disqualifies students with HIV from receiving scholarships

Monday, December 14, 2015

Regular readers will be familiar with the Korean government's ongoing misrepresentation of its HIV-related immigration restrictions: while it continues to receive undeserved recognition from the UN for being a country free of HIV-related travel restrictions, it mandates HIV tests for native-speaking English teachers, EPS workers (manual laborers), and entertainment workers. Despite claims from KCDC and Korea's ministry of foreign affairs that immigration restrictions have been lifted, one English teacher won a discrimination case with the UN CERD earlier this year, and another case is pending with the ICCPR. I was even successful in pushing through a resolution on immigration restrictions tied to HIV status at this year's APHA Annual Meeting that called Korea out specifically for its double-talk.

Now there more evidence of discrimination to add to the list. The Korean Government Scholarship Program, which provides funding and airfare for non-Koreans interested in pursuing post-graduate degrees at a Korean university, is open to a small number of foreign nationals each year and is actively advertised on Korean embassy websites and even featured on several university websites for current undergraduates who might be interested. The program "is designed to provide higher education in Korea for international students, with the aim of promoting international exchange in education, as well as mutual friendship amongst the participating countries," and the payment includes tuition, airfare, a monthly allowance, a research allowance, relocation (settlement) allowance, a language training fee, dissertation printing costs, and medical insurance. Which sounds lovely, except:
Applicants must submit the Personal Medical Assessment (included in the application form) when he/she apply for this program, and when it’s orientation, an Official Medical Examination will be done by NIIED. A serious illness (For example, HIV, Drug, etc) will be the main cause of disqualification from the scholarship.
It is also worth noting that pregnancy can disqualify candidates as well. Awesome.

The best part is that this information is not even hidden: a Google search on the above line pulls up dozens of results, and the restrictions on prominently featured on the websites of Korean embassies to the US, the UK, Australia, Malaysia, plus the Korean Education Center in New York, GWU's Sigur Center for Asian Studies, and even Seoul National University (DOC), the most prestigious university in the country.

Public data set highlights: Mass shootings and foodborne illness outbreaks

Friday, December 11, 2015

The last two editions of Data is Plural have featured databases and commentary on mass shooting data in the U.S. I was disappointed to see Jeremy feature ShootingTracker.com in the first one with very little commentary, considering the methodological disagreements on gun death data collection that have been pointed out by WaPo, NYT, Reason, and Vox:
Mass shootings in America. ShootingTracker.com provides datasets listing all U.S. mass shootings — defined as “when four or more people are shot in an event, or related series of events” — since 2013. So far in 2015, mass shootings have killed 447 people and wounded an additional 1,292.
To his credit, however, he included a follow-up entry in this week's edition with more links to editorials discussing the finer points of data collection on the politically fraught issue:
More data (and discussion) on mass shootings. Last week, Data Is Plural highlighted ShootingTracker.com, a source for data on shootings that wounded at least four people. Other resources include the Gun Violence Archive and Mother Jones’ detailed database of mass shootings since 1982. The Mother Jones database takes narrower approach, focusing on shootings that killed at least four people in a public setting. In a New York Times op-ed, published shortly after last week’s San Bernardino shooting, the editor behind that database argues that broader methodologies don’t distinguish between a “a 1 a.m. gang fight” and “the madness that just played out in Southern California.” A Washington Post article weighs the pros and cons of broader and narrower approaches.
I am getting really sick of the dead-horse-beating that is happening on the interwebz about gun violence, so (in a rare departure from my usual m.o.) I will refrain from comment. What I will highlight, though, is the very real damage done by the Dickey amendment: it is impossible to have an informed debate on gun violence because Congress continues to block funding for CDC research that would lead to authoritative research and statistics.
"If there is no research, it is harder to make suggestions for policy reform," said Dr. Garen Wintemute, director of the Violence Prevention Research Program at the University of California, Davis. "And if you have a vested interest in stopping policy reform, what better way to do it than to choke off the research? It was brilliant and it worked."
Or, put much more succinctly by Dr. Jeffrey Swanson at Duke University, "It’s odd, but if you’re trying to do policy-informed research, you run into the fact that there are elected officials who don’t want to know the answer."

Doesn't seem that odd to me.

Anyway, in a much more classic public health vein, this week's Data is Plural also featured CDC data on foodborne illness outbreaks:
Good FOOD, bad food. The CDC’s Foodborne Outbreak Online Database (FOOD) contains 18,000+ outbreaks, which resulted in 358,000+ illnesses and 13,000+ hospitalizations, from 1998 through last year. In 2008, a multi-state Salmonella Saintpaul outbreak hospitalized 308 people — the highest count in the database.

@WHO Video: Reforming its emergency response

Wednesday, December 2, 2015

Note: This was cross-posted to the IH Blog.

Last week, the WHO posted a five-minute video to YouTube outlining the intended reforms to its emergency response protocols. The video opens with some fairly dramatic clips of an explosion or two and then mainly consists of clips of primary and emergency medical care being administered to a wide variety of harrowed-looking disaster refugees mixed in with people waiting in line for food and shots of damage caused by a mishmash of catastrophes. The voiceover, which sounds like somebody reading from a technical report, explains that "[g]uided by an advisory group of global emergency experts, WHO is instituting change to make the organization more adaptable, predictable, dependable, capable, and accountable in its work in outbreaks and emergencies. It is adopting game-changing measures across all levels of the organization." The rather verbose narration contrasts oddly with the quietly urgent soundtrack.


The accompanying description reads:
WHO launched in 2015 a wide-ranging reform of the Organization's work in outbreaks and emergencies with health and humanitarian consequences. The outputs of the reform will include creating a unified programme for WHO's work in outbreaks and emergencies, featuring a platform for rapid response to outbreaks and emergencies, a global health emergency workforce and a Contingency Fund for Emergencies. Guiding this reform process is the objective of strengthening Organizational capacities, particularly in-country, to better prevent and prepare for, respond to and recover from outbreaks and emergencies.
I certainly do not disagree that the WHO needs reforms, but they might consider sending their social media guy to a class on how to make engaging videos (or maybe just connect him with MSF's guy).

The WHO has actually been doing quite a bit this year in the way of assessing its response protocols and drawing up a roadmap (PDF) for improvements. They even have a newsletter! Unfortunately, none of this information is mentioned in the video or linked to in the description.

@MSF Video for World #AIDS Day: People with #HIV still face major hurdles

Tuesday, December 1, 2015

Note: This was cross-posted to the IH Blog.
Another year and another December mark the passage of another World AIDS Day. This has been an exciting year for HIV research and policy, with the WHO updating guidelines to recommend that anyone diagnosed with HIV get on ARVs, PrEP gaining traction in the US (even in my own Lone Star State!) and approval in France, new optimism in the effort to development a vaccine, and talk of ending AIDS by 2030. Aw, yeah.

Alas, we are not there yet - and World AIDS Day is an important day to remember that. While many countries have turned the tide of their HIV epidemics, it is getting worse in several others and, in South Korea's case, presents the potential for a fast-approaching crisis. MSF is always a good resource for bringing optimists back to reality. In this video, they remind us that in order to keep up the progress we have made against AIDS by treating HIV, we need to make sure that those who are infected stay in care - which will take sustained efforts in treatment, policy, and funding.

Public data set highlights: Crime and police misconduct in Chicago and refugee demographics

Monday, November 30, 2015

Last week's Data is Plural newsletter featured two data sets of interest: one on complaints of police misconduct in Chicago (which is interesting as it comes on the heels of the APHA Annual Meeting held in Chicago this year) and one on demographic data of refugees settled in the US since 2002:
Complaints against Chicago police. The newly-launched Citizens Police Data Project has collected more than 56,000 allegations of police misconduct. The data, covering 2002-2008 and 2011-2015, includes demographic information about the complainant and the officer, as well as the type and location of the incident. Click here to download the raw data. Related: The City of Chicago’s wide-ranging data portal includes a spreadsheet of every reported crime in the city since 2001; you can explore neighborhood trends via the Chicago Tribune.

Refugees in America. The Department of State publishes demographic reports on refugee arrivals since 2002. The data includes country of origin, resettlement city and state, religion, age, gender, and more. Related: At BuzzFeed, I used the data to chart the past decade of refugee arrivals. Also related: The UN’s refugee data portal.

Public data set highlights: Arms transfers and health data breaches

Thursday, November 19, 2015

This week's Data Is Plural newsletter highlights two data sets of interest to public health:
Follow the F-17s. The Arms Transfer Database tracks the international flow of major weapons — artillery, missiles, military aircraft, tanks, and the like. Maintained by the Stockholm International Peace Research Institute (SIPRI), the database contains documented sales since 1950 and is updated annually. SIPRI provides a download tool, which outputs rich-text files, but it’s also possible to download the data as CSV.
...
Health data, unprotected. Under the HITECH Act of 2009, companies must notify the government of any data breach involving the HIPAA-protected health data of 500 or more people. Summaries of those reports are available at the Department of Health and Human Services’s Breach Portal, which currently contains more than 1,300 incidents. Related: In April, JAMA published an analysis of the breaches.

The trouble with models

Wednesday, November 18, 2015

Note: This was cross-posted to the IH Blog.

As a research epidemiologist, I love all things data. I will totally nerd out with a book on best practices for designing and maintaining disease surveillance systems all over the world (which I may have done this summer by reading this book by my apartment complex pool). My husband joked once that "you are one of probably five people who read MMWR in the entire country...ten, tops." I spent a significant portion of my time at APHA in Chicago scoping out doctoral programs, so research is kind of my thing. Nonetheless, I found myself agreeing with an editorial in Lancet Global Health two issues ago which discussed the value and limitations of theoretical/mathematical epidemiological models. I had intended to write about it, but things have an unfortunate tendency to slip off my radar during busy days...and then, unexpectedly, another editorial in the current Lancet Global Health issue, this time on a malaria vaccine trial, jogged my memory.

@Lancet editorial: Iran and Global Health Diplomacy

Friday, November 13, 2015

Note: This was cross-posted to the IH Blog.
Global health diplomacy is an emerging field that has been gaining traction and attention recently. There was a session on it at this year's APHA Annual Meeting (which I unfortunately had to miss), as well as a pre-conference workshop for the bargain price of $30 - certainly a steal compared to the $100 pricetag on the Global Health Fellows Program's Saturday session. Interestingly, Lancet Global Health ran an editorial on global health diplomacy in its new issue that was released this week, focused specifically on Iran. The piece is open access and short enough to be worth copying here in full.

Data Newsletter by @JSVine Spotlights Public Data Sets

Thursday, November 12, 2015

For all you data scientists, analysts, coders and netizens who like to nerd out on data, I recently discovered a delightful weekly e-mail newsletter that spotlights various publicly available data sets on related to all kinds of health, government, and civil society issues and activities. The newsletter, Data is Plural, was launched last month by Buzzfeed's data editor Jeremy Singer-Vine and contains links to, and short descriptions of, data sets on everything from police department activity and traffic stops to behavioral data on American habits and Wikipedia editor activity. Each newsletter features four or five data sets and distributed once a week on Tuesdays.

#APHA15: The Highlights

Wednesday, November 11, 2015

A few readers may have noticed that this blog has been taking a nap over the last few months. Part of this is due to increased responsibility at work, but most of it has been because I was preparing for the Annual Meeting of the American Public Health Association in Chicago. The meeting went pretty well, and I had a lot of success with my own personal goals related to advocacy on the forced HIV testing in Korea issue that was ruled to constitute racial discrimination by the UN CERD earlier this year. In addition to presenting my abstract on the topic, I also authored a late-breaker policy resolution that passed in the Governing Council meeting on Tuesday. You can read my play-by-play blogging of the conference here.

I also got a "Ninja for Health" t-shirt.

Small victories (maybe): China finally ends its abuse-fraught one-child policy

Friday, October 30, 2015

I suppose we should celebrate victories when we can, which is what I did yesterday when the news that China had officially ended its one-child policy hit my various social media feeds. Whether or not it is really a victory remains to be seen, as it is pretty clear that the Communist Party has buckled to concerns over its aging population (and the inability of its social security programs to support it) and gender imbalance, rather than a sudden concern for the rights of its citizens. Nonetheless, it will do nothing to erase the infamous human rights abuses perpetuated under the policy for nearly four decades, not to mention all of the children who were born in "violation" of it who now do not have papers, which means no access to social services.

@MSF Video on the Challenges of Vaccination Campaigns

Wednesday, October 28, 2015

This video by MSF (Doctors Without Borders) on the main barriers to carrying out vaccination campaigns went up last week for World Polio Day. In addition to videos highlighting their work in specific regions and conflicts, MSF occasionally produces narrated animations like these to provide information on a particular topic (usually a problem or policy that they are challenging or working to change). I generally like them because they are short and hard-hitting - just my style.


Other publications of note included an article in last week's MMWR on the status of polio eradication in Afghanistan and this special XKCD comic commissioned by Bill Gates on the topic, which appears to poke some light fun at Bill Gates:

Well played, XKCD. Well played.

Podcast Review: @MarkLGoldberg's Global Dispatches for @UNDispatch

Tuesday, October 27, 2015

As I have prepared for my upcoming presentation at the APHA Annual Meeting in Chicago next week while managing a massive database project at work, I have allowed this blog to sleep a bit - somewhat longer than I realized, in fact. With the meeting right around the corner, it occurred to me that I ought to have some recent content here when people Google me, so I thought I would kick things back into gear with a podcast review - specifically, a review of Global Dispatches, the foreign policy and world affairs interview podcast series done by UN and foreign policy expert Mark Leon Goldberg for UN Dispatch.

@Amnesty International votes to decriminalize sex work; controversy ensues

Thursday, August 13, 2015

Note: This was cross-posted to the IH Blog.

At its International Council Meeting in Dublin on Tuesday, human rights organization Amnesty International adopted a resolution allowing the organization to develop a policy toward the decriminalization of sex work, with the goal of strengthening human rights protections for sex workers around the world.

UN intern living in a tent reveals that UN internships favor those with money - and people are (apparently) shocked

This has been a pet peeve of mine for a while, but apparently most of the world was unaware of it: because UN internships are unpaid, only those with money (read: young adults with personal fortunes and/or rich parents) can take them. The BBC ran a story yesterday on an intern who was living in a tent on the shores of Lake Geneva because he could not afford the city's rent, and the world was apparently shocked:

@theIRC Makes its Commodity Tracking System #opensource

Wednesday, August 12, 2015

The International Rescue Committee, a humanitarian relief and refugee resettlement organization, has released the source code for its Commodity Tracking System, which allows the organization to keep track of aid shipments to help ensure that they reach their intended destination. In its press release, the IRC explains:
The IRC like other INGOs cannot deliver medical aid and other supplies such as shelter materials or heating supplies inside Syria for security concerns, so it works with local civil society groups inside Syria that pick up IRC’s shipments at border points from Turkey, Iraq and Jordan and they deliver them to intended locations inside Syria.
...
Every IRC package going into Syria is tagged with a QR code. Using GPS-enabled smart phones with dedicated software the civil society groups that IRC works with scan these shipments as they are crossing the borders to various distribution points.
...
Intended recipients confirm receipt of the shipments via email or Skype providing additional levels of assurance to the tracking system.
The concept itself is nothing new, and other aid groups use similar tracking systems to monitor their shipments, but this is the first time that the source code for such a program has been made freely available. You can access it on GitHub here. H/T to Tom Murphy at Humanosphere for this one.

#Polio eradication may indeed be in sight: Africa is polio-free for one year today

Tuesday, August 11, 2015

More great news on the polio eradication front: today marks one year that the African continent is polio-free. According to the Guardian:
No cases have been identified in Africa since 11 August last year in the Hobyo district of Mudug province in Somalia, meaning that the continent is two years away from being certified polio-free.

But both Somalia and Nigeria, which also saw its last polio case in 2014, are battling Islamist militant groups – al-Shabaab and Boko Haram respectively – raising fears that vaccines will not reach children displaced by conflict.
...
Despite the turmoil, Nigeria could soon be removed by the World Health Organisation (WHO) from the list of countries where polio is endemic. As recently as 2012 the country had more than half of all the world’s cases, but numbers fell by 92% between 2013 and 2014. Somalia suffered 194 cases of polio in 2013, most of them children, but this was cut to just five in 2014, all in the north-east region of Puntland.

Africa’s progress intensifies pressure for action in the only two other polio-endemic countries, Pakistan and Afghanistan, where there have been 28 and six cases respectively so far this year. Global health experts hope that by 2018 polio will become the second human infectious disease, after smallpox, to be wiped out.
These active Islamist insurgencies are an important asterisk to the good news, as unrest has enormous potential to undo public health progress in a devastatingly short amount of time (as we have seen in Iraq and Syria). It is also important to remember that while wild poliovirus is mostly gone, vaccine-derived poliovirus continues to circulate, so ongoing vaccination campaigns will be critical. Nonetheless, this is enormously encouraging.

Toothpaste ads: a #publichealth #fail for your Friday

Friday, August 7, 2015

This public health fail-tastic piece of advertising crossed my social media feeds earlier this week, but my day job has kept me busy for the last couple of days and I did not have a chance to share it until now. The ads, which were designed by a Korean advertising agency for the European market, show a tooth having a grand old time with a range of characters that are bad for both teeth and health with the slogan "enjoy life."




"Branding in Asia," which features all sorts of jaw-dropping ad campaigns from the East, notes:
The ad was produced by the highly-acclaimed Seoul-based creative agency Cheil Worldwide, which was founded in 1973 by Samsung patriarch Lee Byung-chul, and now has 48 offices and 8 affiliates in 41 countries.

Ijota Super Whitening Toothpaste is produced by Greenpeer. They are also based in Seoul and tapped Cheil for the print ad campaign aimed at the European Market -where it’s already raising eyebrows.

A Korean blogger made note that these ads will likely not appear in the Korean market due to their sexual nature, adding that the ad commission would likely insist that they be toned down.
This is a public health fail on so many levels, and going into them all just seems gratuitous, so...I am just going to leave them there and wish everybody a good weekend.

Go enjoy life.

Nifty Infographic of the Day: #HDX generates a data heatmap for East Africa

Monday, July 27, 2015

I saw this post last week in HDX's RSS feed and thought it was pretty nifty:
The Humanitarian Data Exchange (HDX) team established a Data Lab in Nairobi, Kenya in late 2014 to offer data services to partners and to connect data systems from across the region. One of our first projects was a data hunting exercise on behalf of the OCHA Regional Office for Eastern Africa.
...
The exercise showed the challenges contributing to the data-deficit in the developing world: data is either not being collected or when it is, it is not shared in accessible formats. These findings are in line with the data availability for indicators included in the Millennium Development Goals, as reported by the UN expert’s group in A World That Counts.

The lack of data has implications for gaining an accurate understanding of regional vulnerability. These caveats need to be made clear when the analysis is prepared so that decision makers don’t mistake an impression with reality. At the same time, new data sources, such as sensors and mobile phones, can be explored to fill some of these gaps. A recent article in The Economist on Africa’s ‘missing data’ explores these issues further.
The team used what they found (and didn't find) to generate a data heatmap for the each of the various indicators they focused on and that data available for them by country. It's fairly large, so I could not get a good screen capture, but you can follow the link to see it.

Things that caught my eye at #IAS2015: Updated treatment guidelines and 90-90-90 targets possible

Friday, July 24, 2015

There were quite a few studies and announcements that made headlines at this year's IAS conference, which wrapped up in Vancouver earlier this week (NAM aidsmap provided some great coverage of the conference), but two in particular caught my eye. The first, which has actually been making the rounds for several months now, is that the WHO is updating its guidelines for HIV treatment with antiretroviral medication. It is now recommended that individuals diagnosed with HIV begin treatment as soon as possible, regardless of CD4 cell count (previous guidance advised waiting until a person had a count of below 350 cells/mm3):

NYT on the relationship between health and climate change: unraveling the science is "tricky" but the risks are real

Monday, July 20, 2015

Last week, the New York Times published a nuanced and thoughtful piece on the complicated scientific relationship between climate change and health outcomes. It lays out several health effects that advocates frequently bring up - vector-borne diseases, natural disasters, and temperature extremes - and examines the strength of the research behind each association.

Good news on the global HIV/AIDS front (with an asterisk)

Friday, July 17, 2015

The UN's Ban Ki-moon proclaimed the possibility of "the end of AIDS" in a cautiously optimistic tone after a new UNAIDS report was released in Addis Ababa this week showing, among other things:
...a 35-percent drop in new HIV infections from 15 years ago.

The positive news was also coupled with calls for more funding, with the objective of eliminating the virus by 2030. The United Nations also warned that continuing stigmatisation of sex workers, drug users and homosexuals were barriers to progress.
...
"After a decade of unprecedented growth, financing for the AIDS response has levelled off. At the same time, the world now has compelling evidence that people with HIV benefit by accessing anti-retroviral therapy as early as possible," it said.

UNAIDS said further increases and efficient reallocation were needed to address the "increased need of earlier initiation of anti-retroviral therapy" and called for AIDS spending of $32 billion (29 billion euros) annually between now and 2020 in the hope of eliminating the virus by 2030.
...
The UN has set up an ambitious treatment target to help end the AIDS epidemic, aiming to ensure that 90 percent of all people living with HIV will know their status and that 90 percent of those diagnosed with HIV will receive anti-retroviral therapy.

The third target is that 90 percent of all people receiving anti-retroviral therapy will have viral suppression.
That's the "90-90-90" goal, for short.

While it is certainly true that the world as a whole has made great strides toward "the end of AIDS" (a phrase which a lot of activists nevertheless have issues with) and reduction of HIV transmission in general, efforts to eliminate AIDS as a clinical condition globally will be held back by countries where incidence rates are still increasing and infection is highly stigmatized. For example, new infections in South Korea continue to steadily rise, and most are diagnosed very late, as HIV is largely viewed as a "foreigner's disease" and Korean nationals largely avoid testing, even if they are high-risk.

WHO Video: Touchy-feely response to harsh international criticism?

Thursday, July 16, 2015

Yesterday, the WHO released a short YouTube video, "If you can beat Ebola, you can beat anything," featuring the story of a Liberian doctor who contracted Ebola and recovered with the help of his family. After some dramatic music and musing from Dr. Philip Ireland, the video goes on to interview several other clinicians who provide hopeful reflections on how to better prepare African countries to respond to future outbreaks.

MSF Video: Could Antibiotic Resistance Threaten Public Health?

Thursday, June 25, 2015

This short video by Doctors Without Borders/Médecins Sans Frontières (MSF) examines antibiotic resistance and how it could threaten global public health. While most of their videos spotlight their own work in various countries or conflicts, they occasionally create pieces like this one that are more generally informative, which I like.

China bans Ramadan observances in Xinjiang region

Thursday, June 18, 2015

In a move that should surprise no one, China has once again declared its annual ban on observances of Ramadan, the Islamic holy month during which the faithful are called to fast during daylight hours and encouraged to pray and recite the Qur'an. Remaining true to its troubled history with religion in general, and Islam in particular (due to the perpetual unrest in the mostly Muslim Xinjiang province), the Chinese government has banned the observance of the lunar month in schools and by government employees, with particular emphasis on fasting:
Most Muslims are required to fast from dawn to dusk during the holy month, which began on Thursday, but China's ruling Communist party is officially atheist and for years has restricted the practice in Xinjiang, home to the mostly Muslim Uighur minority.

"Food service workplaces will operate normal hours during Ramadan," said a notice posted last week on the website of the state Food and Drug Administration in Xinjiang's Jinghe county.

Officials in the region's Bole county were told: "During Ramadan do not engage in fasting, vigils or other religious activities," according to a local government website report of a meeting this week.
...
As in previous years, school children were included in directives limiting Ramadan fasting and other religious observances.

The education bureau of Tarbaghatay city, known as Tacheng in Chinese, this month ordered schools to communicate to students that "during Ramadan, ethnic minority students do not fast, do not enter mosques ... and do not attend religious activities".
As with most government suppression, however, people find ways to quietly defy the ban:
Yet, Abdul Razzak and other Uighurs said the attempt to clamp down on religious expression has backfired in Kashgar, with more and more locals flaunting the restrictions.

Nearly every business in Kashgar's old city is closed during the hottest part of the afternoon when Al Jazeera visited this week during Ramadan. In the evening, throngs of young women in headscarves or full face veils pass signs posted at Kashgar's main hospital reminding them veiled women cannot enter.
...
"Sure, it's against the law to bring kids to the masjid [mosque], but we do it anyway," said Ghulam Abbas, a middle-aged Uighur man who makes a living selling fried fish on the main boulevard in the old city.
...
Asked if Uighurs are forgetting how to recite the Quran as a result, Abbas called his eight-year-old son over and, after some coaxing, convinced him to recite a chapter from memory. "They want to cut our children off from Islam," Abbas said. "We are not allowed to teach them the Quran, but we do, at home - secretly."

It is not the only restriction that is being ignored by the Uighurs in Kashgar.

"The Chinese don't want us to have kids, but we just pay fines or bribe people," says Abdul Razzak, who has five children - three more than allowed by law. His three extra children, two sons and a daughter, have cost him around 60,000 yuan ($9,670) in fines.

Sad Infographic of the Day: Violence against Children in Africa

Friday, June 5, 2015

I came across this infographic by the Economist yesterday afternoon. It visualizes recorded incidents of harm against children under age 16 from 2005 to present, color-coded according to the type of perpetrator. You can view all points together on the map or select a class of perpetrator to view just those data points. I have included a screen shot here.

The Economist describes the map as follows:
Some 353 separate attacks resulting in the death or physical harm of one or more under-16-year-olds have been recorded over the past decade, by the ACLED (Armed Conflict Location & Event Data) project. Incidents are concentrated around central Africa. Political militias, like Boko Haram in Nigeria or Anti-Balaka in the Central African Republic, have been responsible for the majority of attacks in each year since 2005, totalling 197 overall. Rebel forces, such as the Lord’s Resistance Army in central Africa, and ethnic militias have harmed or killed children in 57 and 45 separate incidents respectively. It is not only extralegal groups doing damage, however; in Egypt, Sudan and South Sudan government and mutinous forces—both military and police—are responsible for a large share of the violence against children.
This subject matter is too depressing for my usual "nifty infographic of the day" feature, so I went with sad ("horrible didn't seem right, either, since it's a decent-quality graphic).

New Lancet Paper Examines Scale-Up of #HIV Services for Bangkok #MSM

A paper in Lancet HIV on scaling up HIV testing and linkage to care among MSM in Bangkok grabbed the attention of the HIV and global health communities after it was published at the end of March. The study, funded by the World Bank and the Australian National Health and Medical Research Council, used HIV surveillance and service capacity data to model the costs of scaling up HIV services in Bangkok to achieve universal ART coverage. From the abstract:
An additional $55·3 million investment would link an extra 46 700 (30 300–63 200) MSM to HIV testing and 12 600 (8800–16 600) to ART, achieving universal ART coverage of this population by 2022. This increased investment is achievable within present infrastructure capacity. Consequently, an estimated 5100 (3600–6700) HIV-related deaths and 3700 (2600–4900) new infections could be averted in MSM by 2022, corresponding to a 53% reduction in deaths and a 35% reduction in infections from 2012 levels. The expansion would cost an estimated $10 809 (9071–13 274) for each HIV-related death, $14 783 (12 389–17 960) per new infection averted, and $351 (290–424) per disability-adjusted life-year averted.
While I do not usually take an interest in cost forecasting studies (though I probably should), the study struck me because it pointed out how little Thailand spends on HIV prevention in MSM, despite the fact that they have a relatively high share of the HIV risk burden - and it is growing:
Although intervention programmes have effectively targeted female sex workers and people who inject drugs, the Thai national response to HIV in MSM has been largely neglected and, consequently, HIV prevalence in MSM was 20–30% in 2011, and has been increasing. Transmission by unprotected anal intercourse in MSM accounts for about 60% of 43 040 new HIV infections predicted in Thailand from 2012 to 2016...Despite this prediction, investment in prevention for MSM accounted for only 1·3% of the total budget in the 10th National HIV Plan.
I suspect that a large part of that is the relative political unpalatability of interventions targeting MSM - while it is easy to get stakeholder and donors to pitch in to "save" sex workers (e.g., through anti-trafficking initiatives), many are hesitant to get behind programs that reduce risk to MSM. However, MSM are consistently one of the groups at highest risk for contracting HIV - particularly in light of the heavy stigma they face for both their sexual orientation and (for positives) their HIV status.

Indeed, the study notes that "[i]f stigma and discrimination barriers can be reduced such that available infrastructure is used, then capacity is available to service all need." The infrastructure is already there! It is stigma and discrimination that present barriers to those at high risk from accessing services:
More importantly, because of persistent social stigma, MSM are often afraid of being seen by peers and discriminated against by health-care workers when receiving HIV tests. Stigma and discrimination are the most important barriers to the scale-up of services for MSM. Inconvenient operating hours of testing sites, concerns about confi dentiality, and non-friendliness of medical personnel are characteristic of the barriers to HIV testing.
Thailand certainly has a long way to go to service its populations at high risk for HIV, but it is certainly not unique in its challenges. Studies like this that provide a kind of "funding roadmap" are certainly helpful and encouraging. The one thing I was disappointed to see in the limitations section was the fact that the study did not distinguish between MSM who identify as men and transgender individuals (rather, it grouped them all together) - hopefully this can be an area of further research.

Nifty Infographic of the Day: The Internet is Replacing Print Media

Thursday, June 4, 2015

This infographic, courtesy of Statista, basically visualizes what we already knew: around the world, internet usage is on the rise at the expense of traditional (particularly print) media:
According to data published by ZenithOptimedia this week, people around the world now spend more than eight hours a day consuming media, with the Internet taking up an increasingly large chunk of total media consumption.

In 2014, people spent 110 minutes a day online, up from just 60 minutes in 2010. Meanwhile traditional media usage, i.e. TV, newspapers, magazines, radio and cinema declined from 402 to 376 minutes a day.

While television consumption fell by just 6% between 2010 and 2014, the print industry is suffering most from the new digital competition. Newspaper and magazine consumption dropped by 26% and 19%, respectively, since 2010 and is expected to see further declines in the next few years.
Infographic: The Internet Is Gradually Replacing Traditional Media | Statista


Another related infographic from Statistica earlier this year shows that the media being consumed (at least among Millenials) appears to be primarily entertainment - mostly because news is free and comes through your Facebook feed anyway:
It’s not that they don’t value information, according to the report it’s very important for them to stay informed, it’s the way they consume news that has changed fundamentally. While previous generations had to rely on newspapers and magazines to stay on top of current events, Millennials have a plethora of news sources at their disposal, many of them free and available at the touch of a finger. 82 percent of Millennials get most of their news from online sources with social media playing an increasingly important role. Facebook in particular is a popular tool to stay informed throughout the day, although dedicated news media remain the primary source for “hard” news topics such as the economy, foreign affairs and national politics.
Infographic: Millennials More Inclined to Pay for Entertainment Than for News | Statista

Insights from #IODC Last Week from @SunFoundation

Unfortunately, I was not in attendance, but I still followed last week's International Open Data Conference with some interest. (It helped that I was out of work at the University of Texas's Summer Statistics Institute, and I could be on my laptop during classes.) I spoke to one professor here on campus who described it as "preaching to the choir"; indeed, several attendees seem to have walked away with that impression.

This piece from the Sunlight Foundation came across my social media feed and struck me as particularly astute:
Openness of government is a value that NGOs, civic hackers, journalists and policymakers within this field want to work toward...However, we still haven’t gotten to the core of how we can use data to shake unjust power structures and make governments more effective and accountable. Skeptics have coined the term “open-washing” as attempts for governments to be perceived as open, while keeping all important decisions and actions closed. And, alongside many others, we commonly complain that “openness” always seems to end at high-value datasets by which governments may feel threatened.
...
It’s much easier to show the impact of a tool in terms of how many people used it than to show how open data has made citizens’ lives better and transformed government in the long term — and demonstrating value is something that both civil society organizations and governments are under constant pressure to do. Unfortunately, though, the impact of this work will not suddenly become visible overnight, especially given the problems we are trying to solve. At the core of it, we’re trying to use data to solve an age-old problem: How can government serve its citizen better?

When M&E falls short (and can even hinder): Scale-up dilutes impact of #HIV intervention among #sexworkers in India

Tuesday, June 2, 2015

My husband has taken an interest in ethnographic research after taking an Asian Ethnographies class last spring. As a data analyst and a quant-oriented person in general, I tend not to warm to qualitative research (particularly of the social sciences variety), but there are undoubtedly places where it is valuable. In some cases it can fill in the gaps that monitoring and evaluation cannot reach - and even highlight areas where standard M&E approaches fail and, sometimes, do more harm than good.

Last week, NAM aidsmap highlighted two such studies in India, one in Andhra Pradesh and one in Mumbai:
Two qualitative studies, investigating the implementation of a massive programme of HIV prevention through community mobilisation in India, have identified challenges to the rapid scale-up and roll-out of a programme in which grassroots action was meant to be central. While the programme was intended to empower sex workers to tackle the social conditions which made them more vulnerable to HIV, a more narrow focus on condoms and clinical services took over. This discouraged sex workers from getting involved in the programme.

Implemented in six Indian states with a high HIV burden, Avahan was one of the largest HIV prevention programmes ever delivered. It aimed to slow the transmission of HIV in the general population by raising the coverage of prevention interventions in high-risk groups such as female sex workers and men who have sex with men. Funded by the Bill & Melinda Gates Foundation, there was a strong emphasis on efficient delivery and scale-up of a defined package of interventions, in order to achieve saturation coverage. Monitoring and evaluation showed that this was achieved.
...
The Avahan programme aimed to replicate this success. But what happened in practice? Separate qualitative studies of the delivery of Avahan’s sex worker programmes in Andhra Pradesh and Mumbai have recently been published in Global Public Health and PLOS One respectively.
The original focus of the program was on community mobilization. Women who were well-connected and active in the community were engaged as peer workers who "not only distributed condoms, brought sex workers to clinics and provided sexual health information, but acted as community organisers to change conditions which produce HIV risk. They challenged police violence and harassment" and other conditions that contributed to HIV risk. They organized into community-based organizations and held rallies. However, when the program was transferred from the Gates Foundation to the Indian government and scaled up, these elements of the program were lost at the expense of more easily measured outcomes such as condoms distributed and clinic visits:
Less attention was given to community mobilisation, collectivisation and the formation of community-based organisations. While responding to incidents of police violence had been retained as a programme activity, the nature of the response changed. Rather than sex workers mounting a collective response, they were encouraged to approach existing public institutions such as the legal aid authority. In the end, sex workers faced with police or partner violence stopped involving the community-based organisations that Avahan had helped set up.

Whereas meetings had previously helped sex workers forge a sense of collective identity, there were now fewer structured opportunities for peer workers to meet with other sex workers or peer workers. Previously, sex workers had been interested in engaging with the community-based organisations, but the organisations’ new narrower health-focused remit felt less relevant.
These studies underscore why successful programs are holistic in nature. While "measurable" outcomes are important and necessary to demonstrate that a program is working (or not), a disproportionate emphasis on them can actually harm a program - in this case, implementers focused on them at the expense of the elements of the intervention that had real value to the target population. Qualitative and quantitative approaches must complement each other.

Nifty Infographic in Development: Open Data Impact Map

Friday, May 29, 2015

This is not an infographic in the strict sense, but because I use the general category for all visual representations of data that I want to showcase here. In this case, the Open Data Impact Map - currently in development by the Center for Open Data Enterprise and scheduled to be showcased at the International Open Data Conference - will be an interactive map showing open data use cases from around the world:
The Open Data Impact Map will provide a searchable, sortable database of open data use cases from around the world. It will include all types of organizations using open data in an effort to capture the broad spectrum of open data uses. The Map will make it possible to explore the applications of open data through a number of filters, and has been structured to facilitate comparative analysis by region, country, and city.

Its goals are to:
  1. demonstrate the value of open government data in a range of applications;
  2. identify key trends and best practices in open data use; and
  3. provide a basis for research on the impact of open data globally.
Bringing research together
The Map will support cross-national analysis by using common classifications for data types, data sources, organizations that use the data, and areas of impact. This system builds on past efforts to develop systems for analyzing the uses of open data. The Map can inform the Measurement Action Session and other work at the IODC on the assessment of use cases. We hope it will help refine common approaches to capturing examples and help build a broader and more in-depth shared knowledge base about open data use cases and impact.
On a related note, NYU's GovLab has compiled a repository of open-data repositories for the very same conference. Totes meta.

Bravo, Nebraska: The first conservative state to repeal the #deathpenalty in 40 years

Thursday, May 28, 2015

While I normally scoff at the concept of American exceptionalism, there is one area in which that concept legitimately applies, to our shame: the U.S. is now the only highly developed country in the world that still executes criminals. While this is partly a function of our somewhat unique governance structure - criminal prosecution is up to each state, and nearly half of them have abolished the death penalty entirely - it is still on the books at the federal level for a handful of crimes (e.g., treason). Whether a pending Supreme Court decision will abolish it remains to be seen. In the meantime, the solidly conservative midwestern state of Nebraska defied the odds and legally abolished it, overriding the governor's veto:
The state has a unicameral legislature in which all bills must be voted on three times. The bill to abolish the death penalty passed all three rounds, 30-16, 30-13, and finally 32-15 in its third vote. The governor vetoed the bill on Tuesday.

Legislators needed 30 votes to override the veto, and it earned 30. Nineteen voted against. The repeal is the latest move in what some experts believe is a new conservative push against executions.
Let's hope so. Frankly, the fact that so many conservatives are in favor of it, despite many of them claiming to be religious (the risk of executing innocent people is very real considering the number of death penalty sentences overturned on the basis of new evidence) and being in favor of reducing spending (it is much more expensive to execute someone than it is to imprison them for life), is shocking to me. But Nebraska's governor was willing to go to extremes to be able to carry out executions:
Executions in the US have ground nearly to a halt this year as states wait to hear the result of a supreme court argument over whether one state’s execution protocol amounts to cruel and unusual punishment.

The case, Glossip v Gross, was argued in the Supreme Court in April, and focuses on the drug cocktail used to carry out Oklahoma death sentences.

The state’s reliance on the drug midazolam led to the high-profile “botched” execution of Clayton Lockett, in which it took 43 minutes for the man to be pronounced dead. That led to a challenge by Oklahoma inmate Richard Glossip. Several death penalty states have relied on the drug as part of an execution cocktail since pentobarbital, long used for executions, became scarce as the result of a European-led boycott of execution drugs.

Nebraska does not use midazolam in its lethal injection process, but instead relies on a cocktail of similar drugs, which the governor recently said he had secured from a pharmacy in India.
Hopefully Nebraska will serve as an example to the rest of the holdout states (although I predict that my own - Texas - will be the last to abolish it, if they ever do); that is, unless the Supreme Court renders the issue moot.

It's (UN) official: South Korea's mandatory HIV testing for foreigners is racial discrimination

Wednesday, May 27, 2015

Note: This was cross-posted to the IH Blog.
South Korea has come under fire in recent years for its treatment of immigrants, migrant workers, and non-ethnic Koreans (and even their own working-class people). Last fall, Bitter Harvest, Amnesty International's report on the country's treatment of agricultural migrant laborers highlighted how Southeast Asian migrants went unpaid, were subjected to harsh treatment and squalid living conditions, and were either deprived of medical care or forced to pay for their own care out of pocket (from their own meager wages). In some cases, the migrants were forced to take (and pay for) an HIV test, with employers requiring a negative test result.

In the case of migrant workers, this is clearly illegal - currently, the only visa category for which the South Korean government requires an HIV test is E-2 (native-speaking English teachers from the US, Canada, the UK, Ireland, South Africa, Australia, and New Zealand). However, even this requirement - first implemented in 2007 in response to a racially-fueled moral panic - has been determined to be discriminatory and racially motivated, according to a ruling from the UN's Committee to End all forms of Racial Discrimination (CERD) handed down last week. The ruling, issued in response to a case filed by a New Zealand woman who lost her job in 2009 after refusing to take an HIV test to renew her contract - has been long awaited by the expat ESL community in Korea. Whether the Korean government will remove the requirement remains to be seen.

The case was brought to CERD by Benjamin Wagner, an international human rights attorney who co-authored a legal paper on the issue of South Korea's use of HIV testing as a proxy for racial discrimination with Matt van Volkenburg. The paper (PDF) provides an excellent background on the history, political and cultural climate, and xenophobic advocacy efforts that led to the implementation of the testing requirement, as well as how the requirement is a clear example of South Korea shirking its international human rights obligations:
The HIV and drug test requirements for foreign teachers were first established as emergency measures in 2007 by the Ministry of Justice (“MOJ”), which claimed they were necessary in order to “ease the anxiety of the citizens.” Part II of this Article examines the background and context of the implementation of these requirements and argues that they were introduced during a period of media hysteria and moral panic...a civil society group called the “Citizens’ Group for Upright English Education”...succeeded in courting public opinion against foreign English teachers by contributing to highly sensationalized media reportage replete with lurid tales of perversion, sex crimes, drug use and AIDS. This group was also successfully able to influence national policy by petitioning the government for measures against foreign teachers, including mandatory HIV and drug tests.

Part III examines the ROK’s international commitments to eliminate discrimination and stigma based on actual or presumed HIV status and examines how and why the ROK has failed to honor these commitments.
...
Korea’s HIV restrictions for foreign teachers are among the most extreme form of HIV restrictions in the world...Of the forty-nine countries in the world that continue to have some form of HIV-related restrictions in place for foreigners only about six have restrictions so extreme as requiring in-country testing for foreign workers that must be repeated on a regular basis, and nowhere are teachers subject to such restrictions. Indeed, the ROK’s extreme position toward its foreign teacher population has attracted the attention of UN Secretary-General Ban Ki-moon who has urged the ROK to eliminate its HIV restrictions on foreign teachers.
Obviously, any foreigner who tests positive for HIV is immediately detained and deported; in 2008, the Korean CDC reported that it had deported 521 out of 647 HIV-positive foreigners. Non-nationals of Korean ethnicity have been able to successfully challenge such deportations, but the Korean judicial system explicitly differentiates between the legal rights of citizens versus foreign nationals.

Interestingly, South Korea has given CERD "the same authority as domestic law" regarding foreign nationals; however, this means next to nothing as Wagner explained in a different piece last week:
Professor Kyong-Whan Ahn...remarked that the constitutional analysis used by Korean courts to determine whether an incidence of discrimination has occurred is relatively underdeveloped. The method relied upon by courts is the “reasonableness test”. But, Ahn complains, decisions are all too often “a foregone conclusion” with little analysis or scrutiny.
...
[T]he status of the CERD is unique in that “it has the same authority of domestic law and does not necessitate additional legislation,” as the Republic of Korea has made clear to the Committee on several occasions. Nevertheless, the Committee has responded, “although the Convention forms part of the domestic law and is directly applicable in the courts of [South Korea], there are no court decisions which contain references to or confirm the direct applicability of its provisions.” The Committee has pointed out to the government that the situation may be the result of “a lack of awareness of the availability of legal remedies” and has recommended “information campaigns and education programmes on the Convention and its provisions.” Unfortunately, however, the treaty remains relatively unknown in Korea and neither the government nor the courts have done enough to change that.
van Volkenburg, who has been covering this issue (and its origins) since it all began in 2005 at the long-running Korean expat blog Gusts of Popular Feeling, has a great summary of the ruling and its implications (as well as the best collection of links to the news coverage of the ruling):
The summary makes public the justification the UMOE offered for the tests - something that many people taking these tests have known for years, but never admitted by the government: [D]uring arbitration proceedings, L.G.’s employers, the Ulsan Metropolitan Office of Education (UMOE), said that HIV/AIDS tests were viewed as a means to check the values and morality of foreign English teachers.

One of the Committee's recommendations isn't very surprising:
The Committee recommends that the State party grant the petitioner adequate compensation for the moral and material damages caused by the above-mentioned violations of the Convention, including compensation for the lost wages during the one year she was prevented from working.
It continues with much more sweeping recommendations, however:
It also recommends that the State Party takes the appropriate means to review regulations and policies enacted at the State or local level related to employment of foreigners and abolish, both in law and practice, any piece of legislation, regulation, policy or measure which has the effect of creating or perpetuating racial discrimination. The Committee recommends the State party to counter any manifestations of xenophobia, through stereotyping or stigmatizing, of foreigners by public officials, the media and the public at large, including, as appropriate, public campaigns, official statements and codes of conduct for politicians and the media. The State party is also requested to give wide publicity to the Committee’s Opinion, including among prosecutors and judicial bodies, and to translate it into the official language of the State party.
This doesn't just refer to English teachers, but to regulations for all foreign workers. And as I've covered here, the references to the conduct of the media and politicians is very pertinent, considering the 'Citizens Group for Upright English Education' (also known as Anti English Spectrum) worked closely with the media and had access to politicians when pushing for the creation of the HIV testing policy (among others) in the first place.
It will be interesting to see how the Korean government will respond to the CERD's ruling - whether it will in fact change the law in accordance with its treaty obligations. Based on South Korea's history of human rights protections, it does not look promising. Even when human rights principles are codified into law, employers (and often police officers) who violate workers' legal rights do so with widespread impunity and are rarely prosecuted or held accountable - as demonstrated by the cases of the migrant workers in Bitter Harvest and the workers enslaved on salt farms on the islands of Jeollanam-do. The admission that HIV tests were seen as a way to "check the values and morality" of visa applicants is a slap in the face - doubly so considering that only foreigners are required to have "upright values" in order to get jobs.

Nonetheless, the CERD ruling is a major victory - a solid foundation on which to pressure the South Korean government, which has demonstrated that it wants to be taken seriously in the international community.

A modern 1984-esque piece? China's military wants to bring the (ideological) fight to the internet

Tuesday, May 26, 2015

Last week Ars Technica featured a delightful piece of scaremongering propaganda from the People's Liberation Army Daily, the newspaper of the Chinese military, that calls for an ideological defense of Chinese values from Western encroachment through tighter restrictions on internet content and protection by - you guessed it - the Chinese military:
In the view of the PLA Daily, Western powers and Chinese "ideological traitors" have used the Internet to wage war on the Party: "Their fundamental objective is to confuse us with 'universal values', disturb us with 'constitutional democracy', and eventually overthrow our country through 'color revolution'," the article stated—an allusion to the "Orange Revolution" in Ukraine and other popular uprisings against Communist authoritarian governments in the former Soviet Bloc. "Regime collapse that can occur overnight often starts from long-term ideological erosion."
...
To counter "domestic and foreign hostile forces" from spreading their ideas and rumors, "propaganda departments must strengthen their management and control...using various means to fight back the wrong words and thoughts, and guarantee the purity of the network environment," the article continued. "At the same time, we should dare to take the initiative, effectively use the communication capacity of the network, so that the mainstream values (of the Party)​ occupy every corner of the network, deep into the hearts of every Internet users, providing inexhaustible spiritual strength characteristics of China's socialist construction."
Just remember, guys: war is peace, and freedom is slavery.

World still lamenting that Aung San Suu Kyi is not a superhero, still missing the point that Nobel Prizes do not saints make

While the plight of the Rohingya Muslims of Myanmar is nothing new (and was in fact what originally drew my attention to Myanmar), international outrage has grown to a fever pitch in recent weeks - particularly in light of the boat full of them that was passed back and forth between Malaysia and Thailand last week and the mass graves found yesterday. Violence between Burmese Buddhists and Rohingya Muslims has been simmering for over a year at this point and has gotten so bad that the Rohingya are fleeing Myanmar (which views them as illegal Bangladeshi immigrants) en masse (hence the boat).

Throughout all this have been calls for Aung San Suu Kyi - opposition leader, Nobel laureate, democratic champion, iron orchid, and "Lady" - to use her magical human rights powers to make it stop: call out the government for inaction, stop the violence, call for peace, et cetera. Her persistent silence is becoming increasingly frustrating to commentators, the latest of which took figurative pen to paper in Al Jazeera to shame her for shirking her human rights obligations:
So, where does Suu Kyi fit into all this? Well, for a start, her silence is inexcusable. Her refusal to condemn, or even fully acknowledge, the state-sponsored repression of her fellow countrymen and women, not to mention the violence meted out to them by Buddhist extremists inspired by the monk Ashin Wirathu (aka "The Burmese Bin Laden"), makes her part of the problem, not the solution.

"In a genocide, silence is complicity, and so it is with Aung San Suu Kyi," observed Penny Green, a law professor at the University of London and director of the State Crime Initiative, in a recent op-ed for The Independent. Imbued with "enormous moral and political capital", Green argued, Myanmar's opposition leader could have challenged "the vile racism and Islamophobia which characterises Burmese political and social discourse".

She didn't. Instead, she spent the past few years courting the Buddhist majority of Myanmar, whose votes she needs in order to be elected president in 2016 - if, that is, the military will allow her to be elected president, or even permit her to stand - by playing down the violence perpetrated against the Muslim minority, and trying to suggest a false equivalence between persecutors and victims of persecution. In a BBC interview in 2013, for example, Suu Kyi shamefully blamed the violence on "both sides", telling interviewer Mishal Husain that "Muslims have been targeted but Buddhists have also been subjected to violence".
These criticisms are certainly much harsher than Nick Kristoff's mild finger-wagging last June, where he observed that "[t]he moral giant has become a calculating politician." Because apparently getting a Nobel prize precludes you from being a calculating politician?

I certainly do not argue with the criticism; I agree that Suu Kyi should use her standing and influence to try to help the Rohingya. Nevertheless, these laments at her lack of heroism drive home the folly of assuming that a Nobel prize automatically makes a person (or organization or government) a champion of all things right and good. The Nobel committee gave Suu Kyi the prize after she had been put under house arrest for running for president in a democratic uprising - not for defending anybody's rights. Yes, she did that via nonviolent means, and her speeches since then all seem to indicate that she values "struggle against oppression" on some level, but during 18 years of house arrest the rest of the world decided who and what she was without ever seeing her in action. Now the world is disappointed that she is living up to a label that she never intended to claim for herself.
Why weren't we listening when the opposition leader and former political prisoner told CNN in 2013 that she had "been a politician all along", that her ambition was to become president of her country?

The sad truth is that when it comes to "The Lady", it is well past time to take off the rose-tinted glasses. To see Suu Kyi for what she is: A former prisoner of conscience, yes, but now a cynical politician who is willing to put votes ahead of principles; party political advancement ahead of innocent Rohingya lives.
Maybe we should indeed listen when she talks. "I’m always surprised when people speak as if I’ve just become a politician. I’ve been a politician all along. I started in politics not as a human rights defender or a humanitarian worker, but as the leader of a political party. And if that’s not a politician then I don’t know what is," is the full quote that is referenced above. Perhaps the mistake was assuming that she has not been cynical all these years. After all, optimistic and upright people tend to not make it to the presidency.

#Polio eradication in @CDCMMWR: Are we finally on the cusp of that elusive dream?

Monday, May 25, 2015

Note: This was cross-posted to the IH Blog.

I came across a very encouraging article in last week's MMWR (the CDC's Morbidity and Mortality Weekly Report) this morning about polio eradication. After several reappearances in 2013, cases are down again this year and, if things continue to go well, the end may be in sight:
Four of six WHO regions have been certified as free of indigenous WPV, and endemic transmission of WPV continued in only three countries in 2014. In 2013, the global polio eradication effort suffered setbacks with outbreaks in the Horn of Africa, Central Africa, and the Middle East; however, significant progress was made in 2014 in response to all three outbreaks. Nonetheless, the affected regions remain vulnerable to WPV re-importation from endemic areas and to low-level, undetected WPV circulation. Continued response activities are needed in these regions to further strengthen AFP surveillance and eliminate immunity gaps through high-quality SIAs and strong routine immunization programs.

Progress in Nigeria since 2012 has brought the goal of interrupting the last known chains of indigenous WPV transmission in Africa within reach. Elimination of all poliovirus transmission in Nigeria in the near term is feasible, through intensified efforts to 1) interrupt cVDPV2 transmission, 2) strengthen routine immunization services, and 3) increase access to children in insecure areas. Similar efforts should be implemented in all countries in Africa, where 9 months have passed without a reported WPV case, and 6 months have passed since the last reported cVDPV2 case.
Number of cases of wild poliovirus type 1 in countries with recent polio outbreaks, by territory* — January 1, 2013–March 30, 2015

*Central Africa (Cameroon and Equatorial Guinea), Horn of Africa (Ethiopia and Somalia), and Middle East (Iraq and Syria).


The eradication push has suffered major blows in the last two years. In 2013, after six years of being polio-free, a major outbreak in Somalia contributed more polio cases to the year's tally than the rest of the world combined; meanwhile, the virus made its way back into Syria that same fall after a 14-year hiatus. Luckily, extraordinary efforts in the midst of conflict zones on the part of health workers were able to beat the virus back to the heart of the fight - the final three countries in which it remains endemic.
Number of cases of wild poliovirus type 1 among countries with endemic poliovirus transmission, by country — January 1, 2013–March 30, 2015
Most (86%) WPV cases in Afghanistan in 2014 resulted from importation from Pakistan; however, the detection of orphan viruses highlights the need to strengthen the quality of both polio vaccination and AFP surveillance (10). Efforts are also needed to increase population immunity by intensifying routine polio immunization activities to ensure high coverage among infants with at least 3 OPV doses.

Recent challenges to the secure operation and public acceptance of the polio eradication program in Pakistan are unprecedented (10). Although poliovirus transmission has been concentrated primarily in the FATA region of northwest Pakistan, transmission has continued in the greater Karachi area, and WPV cases have been reported from all major Pakistan provinces. Successful efforts to enhance security to protect health workers and increase public demand for vaccination are urgently needed.

The recent gains in control and elimination of poliovirus transmission globally must be maintained and built upon through innovative strategies to access populations during SIAs in areas with complex security and political challenges, improve AFP surveillance, and strengthen routine immunization. With the progress achieved in 2014 to interrupt endemic WPV transmission in Nigeria and polio outbreaks in Africa and the Middle East, permanent interruption of global poliovirus transmission appears possible in the near future, provided that similar progress can be made in Afghanistan and Pakistan; progress there would also reduce the risk for future importation-related outbreaks in polio-free countries.
While there have been several cases of circulating vaccine-derived poliovirus in northern Nigeria, the fact that no wild poliovirus has been seen in the country since last July is extremely encouraging - eradication in Africa may be in sight. The final stronghold will be Pakistan and Afghanistan (primarily its regions that border Pakistan) - where, as the global health community has discussed ad nauseum, militants take advantage of the lack of public trust in eradication owing to bad intelligence schemes, among other things.

Obviously, it is still too early to tell. Gaps in surveillance mean incomplete data; there are most likely more cases that have not been reported. Furthermore, ongoing conflict (not to mention the recent Ebola outbreak) has left the health systems of many countries devastated, so vulnerabilities are everywhere. Nevertheless, with continued dedication (and a little luck), we may very well get there. Here's hoping.

WFP and OCHA are providing hunger and food insecurity data on HDX

Friday, May 22, 2015

Because my job as an epidemiologist is so data-focused, I have been diving into the "big data" and "open data" conversations, trying to learn more about data trends and skills (and hopefully beef up my resume in the process, of course). While nobody seems to be able to define "big data" very well (and I have seen it dismissed as little more than a buzzword more than once), open data is a growing movement that I have taken particular interest in. In re-tuning my social media feeds to more data-oriented signals, some nifty stuff has crossed my radar - including this announcement from the World Food Programme earlier this week:
The United Nations World Food Programme (WFP) and the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) have teamed up to provide access to global data on hunger and food insecurity. The data can be used to understand the type of food available in certain markets, how families cope in the face of food insecurity and how WFP provides food assistance in emergencies to those in need.

The data is being made available through OCHA’s Humanitarian Data Exchange (HDX), an open platform for sharing crisis data. The collaboration between WFP, the world’s largest humanitarian organization fighting hunger worldwide, and OCHA began at the height of the Ebola crisis when WFP shared its data on food market prices in affected countries in West Africa.

With funding from the UK’s Department for International Development (DFID) and the Bill & Melinda Gates Foundation, WFP has since been able to make large amounts of its data available dynamically, making it easier to integrate with other systems, including HDX.
While I am not sure whether the development community at large will buy into these types of data repositories and contribute enough to make them a truly valuable resource, it looks like it is moving in that direction (and now I know about HDX, which I was completely unaware of before).

World Human Right Cities Forum Advances Interdisciplinary Rights Dialogue

Thursday, May 21, 2015

Gwangju, the "City of Light" and capitol of Jeollanam-do province in South Korea, is also the country's historical epicenter of democratic activism and civil disobedience. In addition to being known for its flavorful food and spicy kimchi, the city has made a name of itself as a champion of human rights. Aung San Suu Kyi accepted an award for democracy there in 2013 (that had been awarded to her in 2004, while she was still under house arrest), and the city hosts an Annual World Human Rights Cities Forum. I am so proud of the fact that my own time in Korea was there, and that I became actively involved in the Gwangju International Center - a non-profit organization focused on cultural exchange that organizes and co-hosts the forum - while I was there. My husband and I both still have a strong affinity for Gwangju, which is why he chose to do his internship for his Master of Global Policy Studies program at the GIC. He had the good fortune of attending this year's forum and even had the opportunity to speak with several panelists. He graciously agreed to share his experience and observations - even those that relate to public health - so that I could feature them here. What follows is his coverage (and photos!).

Note: This was cross-posted to the IH Blog.

Gwangju, South Korea - From May 15th to May 18th Gwangju, South Korea played host to the 5th Annual World Human Rights Cities Forum. Begun in 2011, the World Human Rights Cities Forum (WHRCF) has grown into a premier forum for human rights advocacy and policy with an emphasis on community-level programming. The foundational concept for the forum is that of the “human rights city,” which, according to the Gwangju Human Rights Charter, is a city built on “the historical assets and the infrastructure of democracy and human rights the city has, a democratic administration of participatory autonomy, and civic consciousness that functions as a catalyst in implementation of the human rights.” Gwangju’s interest in human rights stems from its history as the site of the May 18 Democratic Uprising, a popular revolt that played a key role in South Korea’s transition to democracy in the 1980s.

The WHRCF aims to draw activists, community organizers, and city government officials together in order to encourage the exchange of policies and ideas involving human rights advocacy and implementation. While acknowledging that city-level government is often unable to set a national tone for human rights policy, the role of municipal governments in implementation of human rights policies is key. Sessions at the 2015 WHRCF covered a variety of different themed sessions including topics of state violence and torture, gender, disability, education, and social economy. In total, over one hundred speakers from twenty-three countries presented or participated in panel sessions.

Public health interests were well represented among the panelists. The thematic session on disability placed a significant focus on self-determination in access to care, particularly for patients with mental disabilities. Discussions involved the rights of the disabled to humane treatment when institutionalized in long-term facilities, and how municipal and provincial policies can encourage proper oversight and legal protection for long-term patients at psychiatric facilities. Areas of additional concern were policies protecting the disabled from involuntary sterilization and strategies to advance public education capabilities for developmentally disabled children. Many of these are areas where local ordinances or regional organizations can have a major effect on at-risk populations, even in situations where national healthcare and education policies are lacking in their protections for the disabled.

Panelists and audience members listen to a speaker at the
special session on psychological support for torture victims
participating in legal proceedings.
A topic of particular relevance in many countries, including even the United States given the ongoing racial tensions and unrest in places like Baltimore or Ferguson, was the thematic session on assisting victim of state violence and torture. In an interview following the session, panelist Pinar Onen, a clinical psychologist working with the Human Rights Foundation of Turkey, spoke about the need for psychological treatment for victims of state violence, and the difficulty of finding treatment for victims who distrust state authority and state-operated healthcare system due to their association between oppressive violence and state authority. Other speakers talked about the challenges facing legal activism in support of victims of state violence, particularly re-traumatization associated with the legal challenges needed to get redress for state violence or torture. An additional concern is the need to relax or eliminate statute of limitations laws for state violence and torture, as they prevent accountability of government figures and represent an inherent conflict of interests when the body instituting the statute of limitations stands to directly benefit from the inability to hear legal action involving state violence and oppression.

Assembled dignitaries and representatives at the closing of the
2015 World Human Rights Cities Forum on May 17th, 2015.
The WHRCF is particularly valuable as a platform for coordinating research and policies involving human rights across a variety of different fields and locations. The opportunity for dialogue and discussion helps activist gain insight on how to institute local government policies or to effectively run advocacy organizations working to increase access to human rights protections across the world. More recognition needs to be given to worker on the regional and municipal levels who are actually involved in policy implementation and development, as broad, national directives can make a statement about human rights but cannot actually benefit citizens without effective implementation on the ground. It is absolutely essential for those in need of assistance and expertise in implementing these policies to have platforms such as these to gain knowledge and information on managing and implementing the desired programs.

As the WHRCF continues in the future, there is great need for further participation of researchers, policy-makers, and professionals in related fields to continue this dialogue regarding methods for ensuring human rights protections. Public health plays a crucial role in this endeavor, as evidenced in the Universal Declaration of Human Rights Article 25, which establishes access to medical care and social services as a basic human right. When protections are needed for children, elderly, infirm, or disabled persons, public health professionals are best equipped to provide input on the needs and challenges of these at-risk populations, and their input is absolutely necessary for administrators and policy-makers to be able to craft the laws and regulations necessary to realize human rights protections for all.

Two countries, opposite approaches: HIV on the rise in Russia and the Philippines

Wednesday, May 20, 2015

Note: This was cross-posted to the IH Blog.

Two different articles on rising HIV rates in two different countries crossed my social media news feeds today; I though I would juxtapose them here because they embody very different approaches to a problem (embedded within two very different sociopolitical environments, of course).

The first piece from the BBC focuses on an alarming rise in HIV rates in Russia:
For years Russia has remained remarkably silent on the challenge it faces from HIV and Aids. Now that silence has been broken by an epidemiologist who has been working in the field for more than two decades - and he calls the situation "a national catastrophe".

Vadim Pokrovsky, the softly spoken head of the Federal Aids Centre in Moscow, has watched as the figures have climbed remorselessly upwards.

There are about one million people living with HIV today in Russia and year on year the rate of infection is rising, unlike sub-Saharan Africa where the rate of increase is slowing. This is according to Russia's official figures, which almost everyone agrees are a substantial underestimate of the true position.
The epidemic in Russia, argues Mr. Pokrovsky, has been driven by ideological (rather than evidence-based) policies on sex education and injection drug therapy that have been pushed by the Russian Orthodox Church and a conservative government. Education officials argue that comprehensive sex education will encourage kids to have sex (despite plenty of evidence to the contrary), while the use of methadone replacement as a harm reduction strategy for injection drug users is ridiculed and banned (despite the method's success in reducing HIV transmission through injection drug use in Europe and Australia). HIV infections have predominantly been driven by injection drug use in the past, but sexual transmission is on the rise. Apparently Russia is not on the evidence-based health policy bandwagon.

According to Al Jazeera, meanwhile, the picture of rising HIV rates in the Philippines looks quite different:
In the last five years, HIV cases have gone up 277 percent in the Philippines. While the total number is less than one percent of the 100 million population, it continues to rise. From one reported case every three days in 2000, there are now 21 new cases recorded every day, according to the latest government report.

A separate UN study ranks the Philippines as among the seven countries with over 25 percent or more increase in HIV cases annually from 2001 to 2009, even as the worldwide trend continues to fall.

"Unlike in other parts of the world, the AIDS Epidemic in the Philippines has been growing rapidly," the Philippine National AIDS Council said.
...
Danton Remoto, university professor and gay rights activist, however, said that the real number could be 10 to 20 times higher. And he attributed the underreporting to the stigma associated with the disease, particularly among the gay community, the section of the Philippine society worst hit by the disease.
In the case of the Philippines, it has largely been government inaction (rather than counterproductive policies) and social stigma surrounding homosexuality and safer sex practices in the overwhelmingly Catholic country that have driven the epidemic. There is a silver lining here, however, as governments have begun to move (albeit slowly):
Cortes said that only a handful of the 1,634 cities and towns in the country, have programmes related to HIV prevention. She also said that a "very low condom use and low overall knowledge" about reproductive health has contributed to Filipinos engaging in risky sexual behaviours.

It was only in 2014, when the country's reproductive health law was given a greenlight by the Supreme Court, after it was challenged by the Catholic Church as unconstitutional. The law mandates sex education and access to artificial birth control methods, including condom use.

It also includes provisions on HIV-AIDS awareness and treatment.