Public dataset highlights: Antibiotic resistance

Friday, June 16, 2017

This is a big one and has been getting a lot more attention ever since the UN met last September to wring their hands over it. This week's Data is Plural features a publicly available dataset on antibiotic resistance genes:
Antibiotic resistance. ResistoMap is an interactive visualization of antibiotic drug resistance, based on more than 1,500 bacteria genome samples from people’s intestinal tracts. The data behind the visualization is available to download. It’s partly based on two prior datasets: McMaster University’s Comprehensive Antibiotic Resistance Database (“a bioinformatic database of resistance genes, their products and associated phenotypes”) and the University of Gothenburg’s BacMet (“an easy-to-use bioinformatics resource of antibacterial biocide- and metal-resistance genes”).

Public dataset highlights: Migrating scientists, workplace injuries, and beach bacteria

Wednesday, June 7, 2017

This week's Data is Plural features three datasets of public health and scientific interest - including one that includes yours truly! I have an ORCID, which means my research profile is included in the first dataset.
Millions of scientists, and their migrations. ORCID is a nonprofit organization that provides unique identifiers for researchers — mostly scientists so far — to make it easier to distinguish between them. It has issued more than 3 million IDs so far, and provides annual bulk downloads of all researchers’ public profiles . In many cases, the researchers have supplied their education and employment histories. That enabled Science magazine to analyze the migrations of more than 110,000 researchers who’ve listed multiple countries in these public CVs. (The data and code underlying the analysis are also available to download .)

Severe workplace injuries. Beginning in January 2015, the Occupational Safety and Health Administration began requiring U.S. employers to report “all severe work-related injuries, defined as an amputation, in-patient hospitalization, or loss of an eye.” You can download a spreadsheet of these injuries — some 20,000 in 2015 and 2016 combined. It contains the injury dates, descriptions, and outcomes, as well as the employers’ names and locations. Previously: OSHA’s more detailed (but slightly more cumbersome) inspection data and API (DIP 2016.07.13).

E. coli at Ocean Beach. The San Francisco Public Utilities Commission’s Beach Water Quality Monitoring Program measures bacteria levels at fifteen locations on the city’s shoreline. You can download the measurements by clicking the “raw data” link below this map . The data powers the (unsurprisingly) unofficial @BeachPooBot account on Twitter.

Things I loved this week: #LegalEpidemiology, @HepVu, and @CDCgov's Healthy Behavior Data Challenge

Friday, May 19, 2017

Part of why I love my new gig at Cadence Group is that, in my responsibility to be informed and up-to-date on all things public health, I am constantly nerding out on new and exciting topics in my favorite fields. I had the chance to watch a webinar on one of those emerging areas - legal epidemiology - earlier this week. It's basically exactly what it sounds like: "the scientific study of law as a factor in the cause, distribution, and prevention of disease in a population." Despite its potential as a complex and fruitful area of study, there isn't much literature out there on the topic, though CDC's Public Health Law Program appears to be the best place to start). Lucky for me (and anyone else who is curious), the National Environmental Health Association is hosting a three-part webinar series on the topic this summer. The first webinar was held last week, with the recording and slides posted. The second installment is on June 14th, and the third on August 16th.

Data visualizations are one of my favorite things, a perfect marriage between my love of data and my experience leading the Communications Committee for APHA's International Health Section. Naturally this meant I got super excited when AIDSVu launched, happened just before I began working as an epidemiologist with the Texas HIV prevention program. Today I discovered that the initiative has launched a similar site, HepVu, which (as the name implies) makes hepatitis surveillance data available via interactive maps and data visualizations.

Finally, I stumbled across the Healthy Behavior Data Challenge, a call by CDC "for new ways to address the challenges and limitations of self-reported health surveillance information and tap into the potential of innovative data sources and alternative methodologies for public health surveillance":
The Healthy Behavior Data (HBD) Challenge will support the development and implementation of prototypes to use these novel methodologies and data sources (e.g., wearable devices, mobile applications, and/or social media) to enhance traditional healthy behaviors surveillance systems in the areas of nutrition, physical activity, sedentary behaviors, and/or sleep among the adult population aged 18 years and older in the US and US territories.

The collection of health data through traditional surveillance modes including telephone and in-person interviewing, however, is becoming increasingly challenging and costly with declines in participation and changes in personal communications. In addition, the self-reported nature of responses particularly in the areas of nutrition, physical activity, sedentary behaviors, and sleep has been a major limitation in these surveillance systems, since self-reported data are subject to under/over reporting and recall bias. Meanwhile, the advent of new technologies and data sources including wearable devices ( such as: smart watches, activity trackers, sleep monitors, etc.), mobile health applications on smartphones or tablets, and data from social media represents an opportunity to enhance the ability to monitor health-related information and potentially adjust for methodological limitations in traditional self-reported data.

The Healthy Behavior Data (HBD) Challenge will be conducted concurrently with a similar challenge proposed by the Public Health Agency of Canada. This will enable the two countries to learn from their respective challenges and leverage information. We expect increased efficiency with a dual challenge.
It struck me as pretty reminiscent of the Data for Climate Action challenge by UN Global Pulse.

Happy Friday!

Public dataset highlights: The cost of food

Wednesday, May 17, 2017

This week's Data is Plural features a dataset on global food prices:
Global food prices. The UN World Food Programme’s vulnerability analysis group collects and publishes food price data for more than 1,000 towns and cities in more than 70 countries. The dataset, which goes back more than a decade, covers basic staples, such as wheat, rice, milk, oil, and more. It’s updated monthly and feeds into (among other things) the UNWFP’s price-spike indicators. Related: The Humanitarian Data Exchange, which hosts the dataset for the UN. Also: The Economist’s Big Mac Index. [h/t Andrew McCartney]

Spatial epidemiology on @NPR @MorningEdition: #Malaria and gold mining

Thursday, May 11, 2017

I've unexpectedly found myself in hog heaven since moving to the Maryland side of DC for a new position at the beginning of this month. I'm staying with a friend while I look for my own place and, while I have a much longer commute than I am used to, I am enjoying all 40 minutes of it because I am spending all of them listening to WAMU, the DC-area NPR station out of American University. I've always liked NPR, not only because they provide (I feel) balanced coverage of major news items, but also because they feature so many interesting stories that wouldn't normally get much press, including engaging pieces on public health and human rights.

Case in point: Yesterday's Morning Edition featured a story on how illegal gold mining has been linked to malaria in Colombia. The segment featured an interview with Sandra Rozo, an economist with USC's Marshall School of Business, whose recent work has focused on providing an evidence base for qualitative data suggesting a link between alluvial gold mining and higher incidence of malaria:
As illegal gold mining is mainly performed in open sky mines that are commonly located inside or close to water surfaces where large pits are dug, it is plausible to conceive that these pits are later filled with water, which would make them ideal breed sites for Anopheles mosquito larva. Because these mines do not follow any protocols or rules and are not registered with local authorities, it is likely that illegal miners have limited knowledge of the need for or methods of malaria prevention. They are likely to leave the pits open and do not take any measures to protect themselves against malaria. Finally, illegal gold miners are also a population that sustains high migration rates, which could also help to propagate the parasite incidence to other areas. Due to data limitations, however, at present, the existing evidence has been concentrated on qualitative studies or on documenting correlations between malaria incidence and gold exploitation.
As she points out in her paper, however, there are a number of other factors that could contribute to the correlation without the relationship being causal per se - hence the value of supporting quantitative epidemiological analysis. Rozo is not the first to explore this from an epidemiological perspective, either. This paper by Castellanos et al finds a strong correlation between gold production rates and malaria cases using malaria surveillance data and government data on legal mining activities. One major limitation, though, was that they could examine correlations to legal mining activities - that is, mining operations that are registered with, and regulated by, the government. The paper also notes that between the two types of mining (traditional alluvial vs. the more modern "open sky"), the "open sky" technique is less regulated and more likely to be performed illegally.

Rozo's analysis is interesting for a couple of reasons. She combines satellite data identifying mining operations with geographic data on geochemical anomalies of gold and matches that to malaria surveillance data to determine the relationship between gold mining activity and malaria incidence. She also controls for several potential confounders, including poverty levels, presence of government and health institutions, climactic factors, and chronic disease.

This is the type of analytical application that makes spatial epidemiology so exciting and demonstrates how epidemiology can be used to build or strengthen the case for policy change to benefit public health. It also spotlights why political and economic forces that we don't typically think of as explicitly health related are still very much relevant to public health researchers and policy makers. Less than a month before Rozo's paper was posted, the New York Times ran a story on how malaria has come back with a vengeance in Venezuela since the economic crisis. As many professionals had turned to gold mining to survive, they were repeatedly getting sick with malaria - and taking it back to the cities with them.

Public dataset highlights: Groceries and PhDs

Wednesday, May 10, 2017

This week's Data is Plural edition features two health-related datasets that caught my eye: one on grocery shopping from Instacart and one from the National Science Foundation on doctoral degree holders in the science, engineering, and health fields.
Three million grocery orders. Groceries-on-demand startup Instacart has released a dataset containing 3 million orders from 200,000 (anonymized) users. “For each user, we provide between 4 and 100 of their orders, with the sequence of products purchased in each order,” the company’s head of data science writes. “We also provide the week and hour of day the order was placed, and a relative measure of time between orders.” Here’s the data dictionary.

What do you do with a PhD in science?The National Science Foundation’sSurvey of Doctorate Recipients “is a longitudinal biennial survey conducted since 1973 that provides demographic and career history information about individuals with a research doctoral degree in a science, engineering, or health (SEH) field from a U.S. academic institution.” You can download aggregated data and detailed survey responses going back to 1993. The next release is scheduled for this month. Related: The NSF has published an interactive graphic of the data. [h/t Peter Aldhous]

Progress toward #polio eradication is a much-needed reminder that global health is still winning

Monday, May 8, 2017

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

I always love spotlighting polio eradication. Along with Guinea worm, it is one of the few candidates to follow smallpox to the eternal (or so we all hope) halls of eradicated diseases. While the eradication effort has suffered its setbacks in recent years, public health workers have persisted, steadily marching onward. And frankly, there has been so much hand-wringing in global health in recent weeks that it is important to occasionally remember that there are still wins we can, and should, celebrate.

What makes this success possible in addition to trackable is the global network of polio surveillance systems, which was featured in CDC's MMWR at the beginning of April:
The primary means of detecting poliovirus transmission is surveillance for acute flaccid paralysis (AFP) among children aged [less than] 15 years, combined with collection and testing of stool specimens from persons with AFP for detection of WPV and vaccine-derived polioviruses (VDPVs) WHO-accredited laboratories within the Global Polio Laboratory Network. AFP surveillance is supplemented by environmental surveillance for polioviruses in sewage from selected locations. Genomic sequencing of the VP1-coding region of isolated polioviruses enables mapping transmission by time and place, assessment of potential gaps in surveillance, and identification of the emergence of VDPVs. For public health nerds like me, all of MMWR's polio reports can be found here.
Basically, a combination of syndromic and environmental surveillance allows public health systems to track polio where it pops up, and genetic sequencing helps to trace how the virus got to where it did to shed light on transmission patterns and find gaps in surveillance.

The WHO followed with two YouTube videos featuring the global polio surveillance system and polio vaccination, which is what will make eradication possible:

This is all pretty straightforward stuff - we all know generally that surveillance systems do, in fact, work when their infrastructure is properly supported and that children should be vaccinated against polio. But it's important to not lose focus on our successes and global health progress, even when it is simple, straightforward, and sometimes slow.

Public data set highlights: Women's empowerment and family planning

Saturday, April 29, 2017

This week's Data is Plural features two datasets of public health interest: one on women's empowerment metrics from India's National Family Health Survey and one on metrics related to family growth and family planning in the US.
Women’s empowerment in India. For each of India’s 36 states and Union Territories, the country’s latest National Family Health Survey includes 114 metrics, such as the percentages of “households using iodized salt” and “men who have comprehensive knowledge of HIV/AIDS.” Unfortunately, the government publishes the reports only as PDFs. But the Hindustan Times has extracted the data for the survey’s eight “women’s empowerment and gender based violence” metrics, including the percentages of “ever-married women who have ever experienced spousal violence” and “women having a bank or savings account that they themselves use.” They’ve published that data as a spreadsheet and used it to construct an interactive Women Empowerment Index. [h/t Gurman Bhatia]

Marriage and divorce, pregnancy and infertility in the U.S. The CDC has been running its National Survey of Family Growth since 1973. For the first three decades, it surveyed only women ages 15-44. Starting in 2002, it began also surveying men. The latest surveywas conducted in 2013-15, when it collected data from 10,205 residents about sexual activity and contraception, pregnancy and infertility, marriage and divorce, adoption, parenting, and more. [h/t Allen B. Downey]

Policy on #HIV related travel restrictions adopted by @WFPHA_FMASP at #WCPH2017 now posted

Friday, April 21, 2017

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

After APHA adopted its permanent policy statement on HIV-related immigration restrictions at last year's Annual Meeting, I worked with my colleagues in the International Health Section to submit a corresponding policy proposal on behalf of APHA to the World Federation of Public Health Associations, which held its 15th World Congress on Public Health this month in Melbourne, Australia. The proposal was accepted and passed by the WFPHA Policy Committee at the meeting, and has now been posted the website (PDF). The text of the policy (excluding references) is below.
Scientific evidence and treatment needed to combat the spread of HIV - not ineffective travel bans

Submitted by the American Public Health Association
(Contact person D. Walker)

HIV-related restrictions against entry, stay, and residence remain common around the world. Various countries have policies that mandate HIV testing of all or certain groups of foreign nationals as a condition of obtaining a visa for employment. These policies have no basis in science and violate migrant workers’ human rights to confidentiality and informed consent to testing, exposing them to exploitation by their employers. According to UNAIDS, 35 countries currently have official HIV-related travel restrictions. Furthermore, HIV-related travel restrictions against foreign nationals have been shown by international treaty bodies, international legal scholars, and human rights organizations to constitute discrimination based on race, ethnicity, and/or country of origin.

Scope and Purpose
Restrictions on travel, immigration, or residence related to HIV status are a violation of the principles of nondiscrimination and equal treatment in all international human rights laws, treaties, and agreements. The International Covenant on Civil and Political Rights guarantees the right to equal protection under the law, free from discrimination based on race, color, sex, language, religion, political or other opinion, national or social origin, property, birth, or other status, and the UN Commission on Human Rights has determined that this includes discrimination based on health status, including HIV infection. According to the Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights, while international human rights law allows governments to restrict rights in cases of emergency or serious public concern, the restrictions must be the minimum necessary to effectively address the concern - and HIV-related travel restrictions have been overwhelmingly ruled as both overly intrusive and ineffective public health policy. Within such restrictions, compulsory HIV testing is a serious violation of numerous human rights principles, including the right to bodily integrity and dignity. The accompanying deportation and/or loss of employment and residency status of HIV-infected migrants that frequently accompanies such testing violates the rights of PLWHA to privacy, work, and appropriate medical care. The International Labour Organization (ILO) has specifically stated that neither HIV tests nor private HIV-related personal information should be required of employees or job applicants.

Despite this robust evidence base, according to UNAIDS, 35 countries currently have official HIV-related travel restrictions openly acknowledged and enforced by the government. These restrictions vary from outright entry bans, which bar PLWHA from entering the country, to restrictions on stays longer than a specified period of time or to obtain employment visas or residency status. Others have inconsistent policies and/or intentionally misrepresent their policies with HIV-related restrictions. Such policies and practices, and the number of migrants impacted by them, are difficult to track because of differing or ambiguous definitions and a lack of data. Some of the most restrictive policies subject immigrants to mandatory HIV testing, either when applying for residency or for an employment visa, which is frequently required by states for legal residency.

The two primary justifications provided by governments for mandatory HIV tests for migrant workers and other HIV-related travel restrictions are to protect public health and reduce the cost burden on the country’s healthcare system imposed by providing HIV care services to foreign nationals. While countries have the right to employ measures to protect their populations from communicable diseases of public health concern, HIV is not transmitted by casual contact, meaning there is no scientific basis for attempting to control its spread via immigration policies. Furthermore, countries that do not have HIV-related travel restrictions have not reported any negative public health consequences compared to those that do, and recent analysis suggests that even migration from countries with generalized HIV epidemics does not pose a public health risk to destination countries.

In fact, immigration policies banning or restricting entry or employment based on HIV status often have the opposite effect of their protective intention, causing direct harm to the health of both of immigrants and citizens. They marginalize PLWHA, regularly discourage people from accessing HIV testing and treatment, and reinforce stereotypes and discriminatory attitudes against PLWHA in the general population. Regulations requiring HIV tests of immigrants can promote the idea that foreigners are dangerous to the national population and a public health risk, as well as creating a false sense of security by reinforcing the notion that only migrants are at risk for infection. Additionally, such attitudes can adversely impact the host country’s own HIV epidemic, as citizens who are unaware of their HIV-positive status, underestimating their own HIV risk and avoiding testing due to stigmatization, are more likely to transmit the virus to others, driving up infection rates.

State-enforced HIV screening of migrants costs far more than it saves in treatment costs. Screening travelers and migrants for HIV is impractical and expensive.[5][13][19] Labor migrants (both regular and undocumented) bring significant economic benefits to their host countries, in addition to themselves, and this cost-benefit balance remains even when migrants are HIV-positive and rely on the host country’s health care system for treatment and support.

Fields of Application:
  • National public health associations and their members
  • Human rights and HIV advocacy groups
  • The World Federation of Public Health Associations
Action Steps:
The WFPHA joins with UNAIDS, the World Health Assembly, and other HIV and human rights organizations (e.g., Amnesty International, Human Rights Watch, ILO) to call on all countries that still maintain and/or enforce HIV-related restrictions on entry, stay, or residence to eliminate such restrictions, ensuring that all HIV testing is confidential and voluntary and that counseling and medical care be available to all PLWHA within its borders, including migrants and foreign nationals.

The WFPHA affirms the following principles:
  • All people have the right to confidential and voluntary HIV testing and counseling.
  • Persons living with HIV/AIDS (PLWHA) have the right to privacy, to work, and to appropriate medical care.
  • All HIV-related travel and immigration restrictions currently in place should be removed.
  • Agencies and businesses who employ foreign nationals should not use HIV tests as a means to discriminate against potential employees.
  • Governments should provide HIV prevention and treatment services that are equally accessible to citizens and foreign nationals.
  • Migrant workers should have access to culturally appropriate HIV prevention and care programs in languages that they can understand.
The WFPHA recommends that:
  1. Public health associations in every country should:
    1. Develop policies opposing HIV-related travel restrictions;
    2. Document and/or support human rights and HIV advocacy groups in documenting immigration policies that explicitly discriminate, or allow employers to discriminate, against migrants based on HIV status;
    3. Document and/or support human rights and HIV advocacy groups in documenting any HIV testing practices that are not voluntary or confidential;
    4. Inform their members and the public that HIV-related travel restrictions and compulsory HIV testing of foreign nationals is a violation of human rights and does not protect public health or reduce health care costs; and
    5. Advocate for the removal of any and all HIV-related travel restrictions enforced or condoned by their country governments.
  2. UNAIDS should take steps to ensure that its protocols to research and investigate countries’ HIV-related travel restrictions are sufficiently thorough by monitoring and documenting any reported instances of HIV-related discrimination targeting immigrants, particularly when presented with evidence demonstrating that recognition of a country’s removal of HIV-related travel restrictions is unwarranted, in order to ensure that governments are not able to misrepresent their policies in order to gain undeserved recognition for supporting human rights with regard to HIV/AIDS.

WFPHA supports the removal of all HIV-related travel restrictions and travel related mandatory testing.

Public data set highlights: Prescription data and vaccination rates

Wednesday, April 19, 2017

This week's Data is Plural features several datasets of public health interest. The first item highlights monthly prescription drug data in England made available by the UK's National Health Service, US Medicare prescription drug data, and Australian prescription drug data. The second features vaccination rates by US state.
UK, US, Rx.The UK’s National Health Service publishes monthly data on drugs prescribed in England through the country’s single-payer health care system. (Drugs prescribed in Scotland, Wales, or Northern Ireland aren’t included.) For each prescriber-and-drug combination, the dataset includes the quantity and cost of prescriptions for each month since August 2010. The US publishes similar data about prescriptions issued through Medicare, but only on an annual basis and currently only covering 2013 and 2014. Related:ProPublica’s Prescriber Checkup, which uses the Medicare data to examine doctors’ prescribing patterns. Previously: A decade-plus of Australian prescription data (DIP 2016.08.24). [h/t Adam Crahen]

Vaccination rates by state.The CDC’s National Center for Immunization and Respiratory Diseases collects and publishes state-by-state vaccination rates for infants, kindergartners, teens, and adults — plus, flu vaccination rates for several age groups. Each dataset includes several years’ worth of data, with many going back to 2008 or 2009. Related: California Shows The Rest Of The Country How To Boost Kindergarten Vaccination Rates,” by my colleague Peter Aldhous, with additional county-level data from the Golden State. Previously: International vaccination rates and policies (DIP 2016.08.03).

Public data set highlights: Pirated peer-reviewed research and MCH aid

Thursday, April 13, 2017

This week's Data is Plural highlights one dataset of interest to global health professionals (particularly maternal and child health specialists) and one that is potentially contentious within the scientific community at large. Posted without comment or value judgment re: research piracy.
Pirated papers. Sci-Hub, which describes itself as “the first pirate website in the world to provide mass and public access to tens of millions of research papers,” recently released a list of the 62,835,101 academic papers it has collected. That dataset identifies each paper only by its DOI — a short, unique ID. Helpfully, graduate student Bastian Greshake has extracted the journal name, publisher, and publication ear from those DOIs. Greshake has also combined that data with six months of Sci-Hub download data (previously featured in DIP 2016.05.04), and analyzed the datasets together. Among his findings: Both are “largely made up of recently published articles, with users disproportionately favoring newer articles and 35% of downloaded articles being published after 2013.”

International aid for maternal and child health. Researchers at the World Health Organization have assembled a dataset of international aid — both from official government assistance and private grants — devoted to reproductive, maternal, newborn, and child health from 2003 to 2013. The dataset, which the researchers described in a recent academic article, draws on 2.1 million records, and is based largely on the OECD’s Creditor Reporting System. Related: Earlier this month, the U.S. State Department cut all its funding for the UN's family planning agency; it was the agency’s third-largest donor.
Note: You can see all of the public health relevant open datasets I've featured to date here. At this point, most of them come from Vine's Data is Plural, but I'm hoping to branch out and find more. Then again, he seems to be pretty good at spotlighting the best ones, so maybe I won't reinvent the wheel for the time being.

#D4CA Challenge: UN Global Pulse calls for research proposals to analyze business data to combat #climatechange

Friday, April 7, 2017

One of my colleagues from APHA's International Health Section sent me information about the Data for Climate Action challenge, which I thought I would share in an attempt to wake up this slumbering blog. It's an initiative by the UN's Global Pulse to recruit researchers and data scientists to "leverage private big data to identify revolutionary new approaches to climate mitigation and adaptation" - that is, use corporate datasets, which have been de-identified and made available by participating companies, for projects or analyses that "generate innovative climate solutions." According to the press release:
Data for Climate Action will target three areas relevant to the United Nation’s Sustainable Development Goal on climate action (SDG 13): climate mitigation, climate adaptation, and the linkages between climate change and the broader 2030 Agenda.

The challenge aims to generate original research papers and tools that demonstrate how data-driven innovation can inform on-the-ground solutions and transform efforts to fight climate change. It builds upon the model of data science competitions pioneered by organizations like Kaggle, and company-specific initiatives to share big data for the public good, such as the “Data for Development” challenges hosted by Orange.

Researchers who are selected to participate in Data for Climate Action will have four months to conduct their research. A diverse panel of experts in climate change and data science will evaluate final submissions based on their methodology, relevance, and potential impact. Winners will be announced in November of 2017.
The data being offered includes retail transaction data, social media posts, meteorological and air quality data, and user-generated data on road conditions. Data sets can be combined with each other or with other publicly available datasets like those featured on Data is Plural. Individuals or teams can submit proposals, and the only apparent requirement is that all participants be at least 18 years old.

They've apparently extended the deadline from April 10th to the 17th, so any analysts or programmers who aspire to code for the public good still have ten days to get their applications together and apply.

APHA Component letter to @UNAIDS: South Korea’s #HIV immigration restrictions

Tuesday, April 4, 2017

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

After two years, two APHA policy statements (one interim and one permanent), dozens of e-mails (and perhaps just as many drops of blood, sweat, and tears), and a few phone calls, we have finally sent a letter to UNAIDS urging it to revoke its recognition of South Korea's status as a country without any HIV restrictions - until it actually produces and enforces policies that actually reflect that status.

Heartfelt thanks to Dr. Laura Altobelli, our Section Chair; Mona Bormet, our Advocacy/Policy Committee's policy coordinator; and all of the Components who signed on to this hard-won letter (and the policy proposals that led up to it):
If there is one thing I have learned through this odyssey, it is that the work of advocacy is exhausting. It takes the old adage of "marathon not sprint" to a whole new level. The patience required to work within the boundaries, and according to the rules, of whatever framework you are trying to leverage to produce change can be maddening at times, but I suppose that is the inevitable price we pay to work with others. The larger your advocacy "vehicle" is, the more likely it is to be effective, but the more restrictions you have to work within. Or around, as the case may be.

On a more positive note, we also got a corresponding policy approved for adoption by the World Federation of Public Health Associations at their assembly (which kicked off today!). It will be posted here as soon as it is published, with potentially more letters to follow. Stay tuned.

The full text of the letter, followed by an embedded PDF, is below.
Dear Executive Director Dr. Michel Sidibé:

On behalf of the International Health Section of the American Public Health Association (APHA), we write to notify you of a new APHA policy statement, “Opposition to Immigration Policies Requiring HIV Tests as a Condition of Employment for Foreign Nationals,” which was adopted at the Association's 2016 Annual Meeting.1 As you may know, APHA was founded in 1872 and is the oldest organization of public health professionals in the world. It has a long-standing commitment to promoting global health and protecting human rights, recognizing that these two go hand-in-hand.

HIV-related travel restrictions are recognized as a violation of human rights and have been well-established as ineffective at reducing the spread of HIV. Such policies further marginalize people living with HIV/AIDS (PLWHA), discourage people from accessing HIV testing and treatment, and reinforce stereotypes and discriminatory attitudes against PLWHA in the general population. According to APHA's policy statement, “[immigration] policies that mandate HIV testing of [foreign nationals] as a condition of obtaining a visa for employment...have no basis in science and violate migrant workers’ human rights to confidentiality and informed consent to testing, exposing them to exploitation by their employers.”

Increasing awareness of the harms of mandatory testing and accompanying pressure from multilateral institutions and human rights advocates has begun to prompt countries to lift travel bans and change their immigration policies. We recognize that UNAIDS has been instrumental in this effort and laud the organization both in its leadership on this initiative and the progress that it has made. APHA's policy statement specifically cites the work of the UNAIDS International Task Team on HIV-related Travel Restrictions and notes that “[a]dvocacy efforts using [the Task Team's findings] have resulted in several countries loosening these restrictions or, in some cases, dropping them entirely: the number was reduced from 59 to 45 countries in 2011 and, as of September 2015, to 35.” APHA's policy statement calls on UNAIDS and others to “continue to call on all countries that still maintain and/or enforce HIV-related restrictions on entry, stay, or residence to eliminate such restrictions, ensuring that all HIV testing is confidential and voluntary and that counseling and medical care be available to all PLWHA within its borders.” We urge UNAIDS to continue this work to make further progress in the remaining countries that enforce HIV travel restrictions.

The policy statement also recommends that “UNAIDS take steps to ensure that its protocols to research and investigate countries’ HIV-related travel restrictions are sufficiently thorough by monitoring and documenting any reported instances of HIV-related discrimination targeting immigrants, particularly when presented with evidence demonstrating that recognition of a country’s removal of HIV-related travel restrictions is unwarranted, in order to ensure that governments are not able to misrepresent their policies in order to gain undeserved recognition for supporting human rights with regard to HIV/AIDS.”

One such example of misrepresentation of HIV-related immigration policy can be found with the Republic of Korea (ROK), which subjects foreign nationals applying for visas to work or study under several visa categories to mandatory HIV testing.2,3 Recent decisions by the UN Committee on the Elimination of Racial Discrimination4 and the National Human Rights Commission of Korea5 both confirm the ongoing existence and enforcement of mandatory testing for E-2 visa applicants and recommend that they be struck down. Unfortunately, despite this discriminatory requirement, ROK representatives declared at the 2012 International AIDS Conference that their government had removed all HIV-related travel restrictions and, as a result, the country was granted “green” (restriction-free) status by UNAIDS6, while other states with HIV-related restrictions similar to those enforced by ROK7 are still classified as “yellow” on this map. This inconsistency in the application of UNAIDS' assessment criteria could threaten the progress made on reducing HIV-related travel restrictions. We strongly urge UNAIDS to revoke ROK's status as a country with no HIV-related travel restrictions until it eliminates all mandatory HIV testing policies.

Finally, we express our continued commitment to the UNAIDS goals of reducing HIV transmission, fortifying the rights of all who live with HIV/AIDS, and eliminating stigma and discrimination.


Laura C. Altobelli, DrPH, MPH
Chair, International Health Section

Willi Horner-Johnson, PhD
Chair, Disability Section

Randolph D. Hubach, PhD, MPH
Chair, HIV/AIDS Section

Lea Dooley, MPH, MCHES
Chair, Population, Reproductive, and Sexual Health Section

Gabriel M. Garcia, PhD, MA, MPH
Chair, Asian Pacific Islander Caucus

Titilayo A. Okoror, PhD
Chair, Caucus on Refugee and Immigrant Health

Gabriel Galindo, DrPH, MPH, CHES
Chair, LGBT Caucus of Public Health Professionals

Benjamin Mason Meier, JD, LLM, PhD
Chair, Human Rights Forum