Fat Kim's haircut is old news, but I am posting this anyway because it's funny

Wednesday, February 25, 2015

North Korea's kid dictator Kim Jong Un debuted a ridiculous absurd bizarre unusual new haircut (and also, apparently, shaved eyebrows) last week, which makes this Vox piece by Amanda Taub old news...but I thought I would share it anyway, simply because it is funny, but also because the video that Vox included at the bottom is rather insightful.
The style is a variation on Kim's signature shaved sides, but with the top now sculpted into a high, wedge-shaped pompadour that sits atop Kim's head like a hat, or perhaps a small, dormant woodland creature. The North Korean despot accessorized his new look with partially-shaven eyebrows that now stop just above his pupils.

This new haircut raises a number of important questions for anyone who follows North Korean politics. For instance:
  1. What instructions did Kim Jong Un give his barber that resulted in this style?
  2. Was it, "Hey, you know trapezoids?"
  3. Or perhaps, "You know my main priority is to ensure that my ears do not feel crowded, let's work on a 'do that really lets the old face-handles breathe"?
  4. Kim Jong Un famously adopted his shaved-sided, center-parted haircut as a way to signal connection with his grandfather and the country's founding leader, Kim Il Sung. Now the sides are still shaved, but the center part is GONE. What does it mean?
  5. Could it be that the the new style conveys an intent to embrace the legacy of his father Kim Jong Il, who also often sported a uniform crest of hair unbroken by any parting?
  6. Or is it intended to signify that North Korea, like Kim Jong Un's hair, is reaching new heights and cannot be stopped by gravity or any other natural force?
  7. Does his haircut sail majestically ever-upwards, unlike the North Korean Unha rocket that failed spectacularly after launch in 2012, breaking up over the Sea of Japan?
And so on.

The video, on the other hand, is a tidy two-minute summary of why North Korea's MO seems so bizarre to the West, and how it harnesses the West's fascination with its nuclear program to distract us from its human rights abuses.

After 30 years, @WHO finally begins pushing single-use syringes

Tuesday, February 24, 2015

Yesterday, the WHO officially updated its injection safety recommendations to call for the widespread adoption of single-use syringes, as well as a reduction in unnecessary injections (e.g., administering medications orally if they do not need to be injected):
A 2014 study sponsored by WHO, which focused on the most recent available data, estimated that in 2010, up to 1.7 million people were infected with hepatitis B virus, up to 315 000 with hepatitis C virus and as many as 33 800 with HIV through an unsafe injection. New WHO injection safety guidelines and policy released today provide detailed recommendations highlighting the value of safety features for syringes, including devices that protect health workers against accidental needle injury and consequent exposure to infection.
Transmission of infection through an unsafe injection occurs all over the world. For example, a 2007 hepatitis C outbreak in the state of Nevada, United States of America, was traced to the practices of a single physician who injected an anaesthetic to a patient who had hepatitis C. The doctor then used the same syringe to withdraw additional doses of the anaesthetic from the same vial – which had become contaminated with hepatitis C virus - and gave injections to a number of other patients. In Cambodia, a group of more than 200 children and adults living near the country’s second largest city, Battambang, tested positive for HIV in December 2014. The outbreak has been since been attributed to unsafe injection practices.
WHO is urging countries to transition, by 2020, to the exclusive use of the new “smart” syringes, except in a few circumstances in which a syringe that blocks after a single use would interfere with the procedure. One example is when a person is on an intravenous pump that uses a syringe.
Setting aside my horror that repeat use of non-sterile needles in still a thing in healthcare facilities here in the US, I saw this as a positive move on WHO's part and assumed that the "smart" syringe referred to in the press release and several headlines was something only recently developed. After all, injection drug use has been the primary driver of HIV and hepatitis infections in Eastern Europe and Central Asia for years, and it is a significant component of the epidemics in southeast Asia and China's Yunnan province as well.

Imagine my chagrin when I came across this piece from the Guardian's Global development professionals network. It tells the story of Marc Koska, the British inventor of the K1 single-use syringe, who has apparently been trying - unsuccessfully - to get the global health community to jump on this bandwagon...for 30 years.
Using existing technology Koska came up with a syringe that falls apart after one use, and sold his first one in 1997. Even though he’s sold more than 4 billion auto-disable syringes since, he has been repeatedly frustrated in his attempts to make the world aware of the problem caused by reusable syringes. “It’s been a very frustrating journey. Thirty years to get WHO turned around. Thirty years to get the manufacturers turned around. You’ve got too many parts to expect it to be a three year journey.”

“There is a very basic reason why it hasn’t happened and that is because the manufacturers haven’t had a market,” he argues. “If the manufacturers could sell a product and it was identified where they were going to sell it and who was going to pay for it, they would make it.
“Today, [WHO Director Margaret] Chan is a hero, but I think the next chapter might be just as challenging as the first bit,” he says.

“My gut feeling is that the ministries of health will be most resistant, because they’ve been saying for so long that they don’t have a problem of reuse in their countries. They’re never going to say that ‘we’ve got a terrible problem with hepatitis C because I can’t be bothered to buy enough syringes’. So now ministers have got to change their position and say, from Tuesday, we’re only going to buy auto-disable syringes.”
The frustrations of market forces blocking the development or widespread adoption of critically-needed global health resources is an old hat to most in the field, but this seems particularly egregious...WHO really should have caught on much sooner.

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

AIDSVu Maps the HIV Care Continuum at HIVContinuum.org

Monday, February 23, 2015

AIDSVu announced today that it has launched HIVContinuum.org, a project that maps the HIV care continuum (also known as the HIV treatment cascade). The project currently looks at the elements of the cascade in five different cities - DC, Philadelphia, Atlanta, Chicago, and New Orleans - and is hoping to expand to other areas:
The HIV care continuum, also known as the HIV treatment cascade, demonstrates each stage of HIV care from initial diagnosis to achieving viral suppression. Understanding patterns in how different populations are impacted by HIV – such as health disparities related to race, age and geographic location – are critical to improving the health of people living with HIV, and to reducing its spread.

HIVContinuum.org features include:
  • Maps depicting five HIV care continuum elements: New HIV diagnoses, late HIV diagnoses, linkage to HIV care, engagement in HIV care, and suppressed HIV viral load.
  • Ability to filter each indicator by sex, race/ethnicity, and age for a deeper understanding of the state of the epidemic
  • HIV testing and treatment locations can be shown overlaying the HIV care continuum maps
  • Downloadable slide decks, including slides of the individual maps available on HIVContinuum, to help those who work in HIV prevention and treatment educate others. HIVContinuum.org allows local communities, health departments and policy makers to visualize areas of success and opportunities for improvement in HIV testing, care and treatment.
We encourage you to share this interesting new tool with your networks and let us know if your city would be interested in participating in the HIVContinuum project. HIVContinuum as always accessible from the AIDSVu site by clicking the logo in the footer of the site.

Pakistan (actually) battles to #vaccinate children against #polio while America "debates" the benefits of vaccinations

Friday, February 20, 2015

Extolling the benefits of vaccination - and decrying the utter lunacy of the "debate" on their safety and efficacy that the American media continues to perpetuate - will soon become an old hat (if it hasn't already), but the ongoing struggle to eradicate polio in Pakistan has a funny way of putting it all into perspective. While "crunchy" California moms explain to the New York Times that they allow their children to get sick with preventable diseases because they do not want to inject them with "toxins," community health workers in Pakistan (particularly its northwestern tribal region) risk their lives to inoculate as many children as possible. Sadly, these workers battle the same types of rumors and misinformation, albeit for very different reasons.
Long eradicated in the West, polio remains endemic in Pakistan after the Taliban banned vaccinations, attacks targeted medical staffers and suspicions lingered about the inoculations.

The persistence of this crippling, sometimes fatal virus shows just how difficult wiping out a disease can be, even amid campaigns seeing thousands of vaccinators go into the field to offer polio drops to children, sometimes under armed guard.
But instead of parents' groups worried about autism and celebrities relying on a discredited scientific article like in the U.S., Pakistan's anti-vaccine campaign has been waged at the end of the barrel of an assault rifle. The Pakistani Taliban banned vaccinations in 2012 after U.S. Navy SEALs launched a raid in Abbottabad in 2011 that killed al-Qaida leader Osama bin Laden. Ahead of the raid, the CIA sent in a local doctor who claimed to be conducting a hepatitis vaccine program to collect DNA from children at bin Laden's home. That sparked widespread distrust, in a country where many also fear the inoculations are a plot to sterilize Muslim children.

By December 2012, militant gunmen began targeting vaccination teams in what became a "horrendous serial killing," said Elias Durry, the World Health Organization's point person in Pakistan on polio. An estimated 75 people involved in Pakistan's vaccination efforts have been killed since, Safdar said. On Tuesday, authorities in Pakistan's Baluchistan province found the bullet-riddled bodies of four people who disappeared Saturday while preparing for a polio campaign.

Infected children and others who travel outside of the region can lead to fresh outbreaks in cities — and even other countries — where polio has already been wiped out. Outside of Pakistan, only Afghanistan and Nigeria are countries where polio remains endemic.
I personally wish the CIA's ridiculous half-baked plot to find bin Laden under the cover of a fake vaccination program received half as much attention as self-styled anti-vaccine advocates who make up their science as they go along. If only.

HIV on the rise in Africa's youth and IDUs

Thursday, February 19, 2015

Two HIV-related stories were in the headlines yesterday, both out of Africa. The big one is the finding, released by UNAIDS, that AIDS is now the leading cause of death for adolescents in Africa, and the second leading cause of death among adolescents globally (behind injury and traffic fatalities):
About 120,000 people aged between 10-19 years died of AIDS-related illnesses in 2013, the eight international organizations said while launching a global campaign in Kenya to stem the spread among adolescents.

Adolescent girls, particularly in sub-Saharan Africa, are most affected, said the organizations which included UNAIDs, U.N. children's fund, World Health Organization and the U.S. President's Emergency Plan for AIDS Relief or PEPFAR, among others.

In South Africa in 2013, more than 860 girls became infected with HIV every week, compared to 170 boys, they said.

Girls are more vulnerable because of physiological factors that see them more susceptible to infection, said Dr. Lilian Otiso, director of services at LVCT Health, an NGO that deals with AIDs prevention and treatment across Kenya.

Social-economic factors that see girls having sex at younger ages than their male peers also play a major role, she said. They might date older men who can provide for them, she said. Others, such as the 16-year-old, are forced to fend for themselves at young ages and become victims of sexual exploitation, abuse and rape, Dr. Otiso said.
Most of the 2.1 million adolescents living with HIV in 2013 became infected at least 10 years ago, the organizations said. Their mothers were pregnant and delivered at a time when anti-retroviral medicines that can greatly reduce the possibility of HIV transmission were not available, the organizations said.

Adolescents often don't come forward for testing and drop out of treatment regimes because their emotional needs aren't targeted, said Dr. Otiso.
Meanwhile, HIV infections are on the rise among injecting drug users, a trend more typically seen in Eastern Europe and MENA in the past:
Rick Lines, head of Harm Reduction International, said unsafe injecting drug use is a major driver of HIV/AIDS worldwide.

“Traditionally, we’ve seen regions such as Eurasia and Asia and the Middle East and North Africa sort of be epicenters of a lot of injecting drug use and a lot of unsafe injecting drug use. And so we see very high rates of HIV amongst people who inject drugs in those countries. But in recent years, researchers and community health organizations in a number of sub-Saharan Africa countries have also begun to document an increase.”

He said there are “new and emerging patterns of injecting drug” use in such places as Tanzania, Zanzibar Uganda, Senegal and Kenya.
Lines said the increase in injecting drug use in sub-Saharan Africa is connected to a change in drug trafficking routes. The drugs pass through the continent on their way to Western Europe.

The Global State of Harm Reduction 2014 report calls for an increase in programs to help drugs users. One such program is called OST or opioid substitution therapy.
Another way to help stop the spread of HIV among injecting drug users is the needle or syringe exchange program or NSP. Lines said, it too, has been in use for decades.
[Lines] said needle exchange programs are widely credited with reducing HIV infection rates in Western Europe and Australia in the late 1980s. The Global State of Harm Reduction report says Malaysia, Iran and Australia have seen the “steepest increase” in needle and syringe exchange programs.

Challenging HIV Criminalization in Zimbabwe

Wednesday, February 18, 2015

The human rights organization Zimbabwe Lawyers for Human Rights (ZHLR) is set to challenge a law in Zimbabwe that criminalizes HIV transmission and, they argue, unfairly targets women. The law is set to be challenged in the country's Constitutional Court today:
The Court will hear arguments on behalf of two applicants – Pitty Mpofu and Samukelisiwe Mlilo – both of whom were unfairly convicted of “deliberate transmission of HIV” in 2012, and who are now represented by Zimbabwe Lawyers for Human Rights (ZHLR).

“The provision is too wide, arbitrary and therefore violative of the protection of the law guarantee. It is submitted that the legislature has created an offence which is as scary as the evil that it seeks to redress.”
Although the ‘crime’ in Section 79 is called “deliberate transmission of HIV”, a wide range of variables are possible that involve neither being deliberate nor actually transmitting HIV.

It is a crime for anyone who realises “that there is a real risk or possibility” that he or she might have HIV to do “anything” that the person knows will involve “a real risk or possibility of infecting another person with HIV.”
Zimbabwe Lawyers for Human Rights are using the Constitutional Court hearing as a springboard for a campaign against overly broad HIV criminalisation, highlighting the case of Samukelisiwe Mlilo who features in a powerful 15 minute documentary produced by ZLHR, ‘Alone But Together – Women and Criminalisation of HIV Transmission: The story of Samukelisiwe Mlilo’.

Today, they will launch the documentary in Harare under the banner; ‘HIV on Trial – a threat to women’s health’.

Ms Mlilo was found guilty of ‘deliberately’ infecting her husband with HIV and faces up to 20 years in jail despite there being no proof that she had infected her husband. She claims she had disclosed her status to him following her diagnosis during pregnancy, and that her husband only made the complaint in revenge for her own complaint of gender-based violence following the breakdown of their marriage.

“At this point we do not know who infected who,” ZLHR’s Tinashe Mundawarara told Voice of America News in August 2012. “This is an example of the violation of women’s rights. Women are likely to know of their status first. Mlilo might have been infected by her husband, no one knows, and got charged and convicted.”

The other applicant, Pitty Mpofu, was also found guilty of ‘deliberate’ transmission of HIV a month after Ms Mlilo.

It was alleged that he infected his wife sometime between October 2009 and June 2011 , although he wasn’t diagnosed until “sometime in 2010.” No proof regarding timing nor direction of transmission was provided during the trial.

John Oliver takes on Big Tobacco in Last Week Tonight

Tuesday, February 17, 2015

Many thanks to Dr. Don Zeigler, who passed this on through APHA's Trade and Health Forum listserv. In last week's Last Week Tonight (har), John Oliver explains how the tobacco industry is compensating for the fall in smoking rates here in the US by utilizing impressively convoluted international legal tactics and taking its business to developing countries in its usual style - shady as hell. The video is long (about 18 minutes), but is seriously worth every second.

US #vaccination rates are beginning to resemble those in developing countries

Monday, February 9, 2015

In light of the ongoing measles outbreak in the US, the Guardian published a piece last week pointing out that the US and Canada have lower measles vaccination rates than several African countries. According to Good Governance Africa's 2015 Africa Survey, 21 African countries have higher rates than the U.S.:
The US has a 91% vaccination rate, while in Canada, which is currently experiencing an outbreak in Toronto, it is 84%, according to a UN estimate. A 95% rate is required for so-called “herd immunity”.

A survey this week by Canadian researchers found that a fifth of the population still believed the long-debunked myth that the measles vaccine causes autism.
GGA, a research and advocacy organisation based in South Africa, produces a collection of social, political and economic indicators from all 55 African countries, including information on the fight against measles from World Health Organisation (WHO).

The survey shows that 16 countries in Africa, including Tanzania, Morocco, Libya, Mauritius, Eritrea, Gambia and Egypt have almost 100% vaccination rates, and five others - Zimbabwe, Algeria, Kenya, Botswana and Lesotho, have higher rates than the US.
Obviously, the message that should be taken away from this story is that vaccination is a powerful, low-cost intervention that can reduce death and disease in the most resource-poor communities. As countless development wonks and bloggers have pointed out, "You're worse than Africa!" is not exactly a constructive conversation. Still, it brings this Tweet, which went viral last week, to mind:

Not to mention this bit with Trevor Noah on the Daily Show:

Love that guy.

Don't ruin Disneyland, people. Vaccinate your freaking kids.

Lancet reminds us to include health in #humanrights analysis

Friday, February 6, 2015

This should go without saying, but it is always nice when a respected, high-impact journal reminds us that health should be a central consideration in every human rights discussion and "necessary component of resilient human security." In its most recent issue, British health journal Lancet published an editorial on HRW's World Report 2015, lauding it for drawing attention to health-related human rights failures around the world while expressing disappointment that it "did not identify health as a core element in its analysis":
In his opening essay, HRW's Executive Director, Kenneth Roth, writes, “The world has not seen this much tumult in a generation…it can seem as if the world is unravelling”. Indeed, this 656-page report is a grim read in a year marked by extensive conflict and extreme violence. But when one delves deeper, there is a hidden story that often does not make the headlines. That story is the health dimension of human rights. Viewed through the lens of health, the report contains several compelling and disturbing themes.
The editorial noted numerous examples in the report of attacks on healthcare facilities, both in conflict zones and in the areas of West Africa struck by the Ebola outbreak, as well as spotlights on gender-based violence, a dearth of mental health services, targeted killings and persecution of health workers, and inadequate access to palliative care. While the report contains valuable analysis, the editorial contends that it does not go far enough in incorporating health as a human rights foundation:
This latest HRW report is an important call to arms to protect health as a fundamental human right. It is a pity that HRW did not identify health as a core element in its analysis, not only as part of a comprehensive package of human rights protections but also as a necessary component of resilient human security. Their analysis should prompt all governments and international health organisations to reflect carefully on their actions to make health a core responsibility and right of all citizens.