Public Health Reader: What's on Kushibo's iPod

I'll be making my "What's on Kushibo's iPod" posts a regular feature, but one of the things I'd like to do is split up into categories the noteworthy podcasts I think are worth a listen (mostly from PBS's Newshour, the single best program for getting a thought-provoking, informative, and objective perspective on a wide breadth of political, social, and health-related issues of the day).

So I will sometimes combine these posts with the occasional Public Health Reader (a subject near and dear to my heart), as in this post. Some of these are about stuff important to me or my views, such as the first one, which I believe underscores my own opinion — widely derided as xenophobic or "anti-teacher" by many in the K-blogosphere — that all people in South Korea (i.e., foreign nationals of all visa types as well as all ROK nationals) should be tested for HIV, with the former group being tested before they enter the country.

• Study: Early Treatment 'Extremely Impressive' in Preventing HIV Spread

• New FDA Guidelines Help Consumers Spot Sunscreen Effectiveness

• A Media Post Mortem on "Death Panels"

• Web Sickness (cyber-induced hypochondria)

• Catholic Church Looks to Lead Conversation on Combating HIV/AIDS

• Are Nurse Practitioners the Solution to Shortage of Primary-Care Doctors?

• Study: 'Good' Cholesterol-Boosting Drug Fails to Reduce Heart Attacks, Strokes

• New Promise Shown in Treatments for Melanoma, Breast Cancer

• AIDS at 30: Who's at Greatest Risk of Infection Now?

• Certain Antibiotics Spur Widening Reports of Severe Side Effects

• Chefs Cook Up Ideas for Healthy School Lunches

• Neurosurgeon: 'Your Cell Phone Is Not Necessarily a Safe Device'

• Denver Hospital Sets the Bar for Patient Safety

• Colorado Clinic Helps Diabetics Avoid Problems With 1-Stop Coordinated Care

• Is Technology Wiring Teens to Have Better Brains?

• Whooping Cough Returns to California After Decades of Decline

• Ukraine Struggles to Curb HIV Epidemic Amid Drug Shortages, Political Hurdles

• Minds, Machines Merge to Offer New Hope for Overcoming Impairments

• Study: Food Allergies in Children Becoming More Common, Severe

• Autism's Causes: How Close Are We to Solving the Puzzle?

• Autism Now: How Should We Address Deepening 'National Health Emergency'?

The last two are from an excellent series on autism put together by one of their main reporters, whose grandson has autism.

(UPDATED) Kia WTF ad...

I'm not sure what they're smoking down in Brazil, but it makes them come up with things that would not go over well in the United States.

Courtesy of Huffington Post, we get word of this Kia of Brazil (?) advertising campaign that won a silver at the Cannes Creativity Awards.

Above is the offending picture (click it to enlarge and read the text). The idea is that the small-size Sportage SUV has a dual-zone climate control, so the two sides of the car can have very different temperatures, exemplified by one side being kiddish, and the other side very adult.

The other ad in this series makes the point with more clarity and less controversial. It depicts a cartoonish prince charming coming in to a castle, declaring in the upper left frame that he will break the spell that has the princess in a deep sleep by kissing her. In the upper right frame, in a style more reminiscent of the cover of romance novels, he is approaching her with both their tongues out, ready to Freedom Kiss.

In the middle left frame, the re-cartoonized prince (who looks a little like a slim version of Bob of Bob's Big Boy) is declaring to the re-cartoonized princess (who does look a bit younger than the steamy romance novel version of the princess) that he has come to rescue her. In the middle right frame, with her finger enticingly on her mouth, she declares, "Oh, it's my Prince Charming and his huge stallion."

Okay. In the lower left frame, the re-re-cartoonized prince takes the princess's hand and dreamily says, "Indeed, my beloved lady." (Lady, so she's of legal age, I guess.) But in the lower right frame, the romance novel version of the princess, whose dress is falling off and practically revealing her boobs, asks if the prince has any interesting ideas on how she can show him her gratitude.

Okay, then. One side is kiddish, and the other side is adult. Dual themes of the same scene. But in the prince-rescues-princess sample, there are no hints at something untoward. Not so with the ad way up above, where at the very least, it seems to be promoting the idea of teachers and students becoming sexually involved. At worst, it inserts the very icky suggestion that an adult figure might look at young and innocent schoolgirl as a sex object.

[source]

Okay, this Brazil and France, where, I'm guessing, anything goes, relative to the US (or South Korea). But in America where pedophilia and sex with minors are are very serious issues, this is offensive. Some two-thirds of the HuffPost readers think so, anyway.

Frankly, I can't imagine this fitting in with the old adage that there's no such thing as bad press. It's one thing to sell sex (and loads of people say they're offended by that, but it always manages to get attention), but it's another to seem to pander to pedophiliac proclivities. Really, even if that was not the intent of the ad creators, it's such an obvious conclusion for just about any reader, and I can't see how Kia can get out of this without distancing itself from this ad and apologizing. That is, if this news gains traction.

UPDATE:
Prompted by a comment from gbnhj at The Marmot's Hole, I went looking for news that Kia had denied they had anything to do with this ad campaign. At this site I found a denial by Kia:

Kia Motors America (KMA) has become aware of an offensive piece of advertising material that was created by an ad agency in Brazil that KMA has no business relationship with and has never worked with. This ad was not created in the U.S. by Kia Motors America or any of its marketing partners and does not reflect the opinions or values of KMA or Kia Motors Corporation. The ad is undoubtedly inappropriate, and on behalf of Kia Motors we apologize to those who have been offended by it. We can guarantee this advertisement has never and will never be used in any form in the United States, and our global headquarters in Seoul, South Korea is addressing the issue with the independent Brazilian distributor.

That site says the advertising company broke the rules by submitting an ad campaign that was not actually run, and they appear likely to get the prestigious award yanked. In an earlier posting, they had harsh words for Kia, along with some interesting background on other award-winning ads' boorishness (see below for an example involving Hillary Clinton and Barack Obama in a Reporters Without Borders advert, with the caption, "Censorship tells the wrong story").

That actually reminds me of a gag series I'd been planning for a future post, one inspired by an old gag on Jimmy Kimmel Live: inappropriately pixelated pictures of Kim Jong-il.

That's right. I'm fourteen years old.

UPDATE 2:

Instead of getting back to work, I perused a number of posts at the very interesting BNET advertising blog, The Tagline, which included this bit of Hitler-themed artwork at right. In fact, I had written a post on this back in September 2009, with a title I am embarrassed to have written but which still cracks me up. 

National HIV Testing Day

UCI's giant red ribbon for
World AIDS Day 2009.

It's too late to go get tested today, but Monday (which it still is, here in Hawaii) is National HIV Testing Day.

Go get tested.

Ban Kimoon wants mandatory HIV testing to end for foreign teachers

Back in the 1980s, there was a joke about AIDS that went something like this:

Q: What's the toughest part about getting AIDS?
A: Trying to convince your parents you're Haitian.

Read a bit further and you'll see the relevance (and if the joke makes no sense to you, that should underscore my point about living like it's 1985).

Anyway, remember a few weeks ago, when I pointed out that E6 and E9 visa holders getting compulsory HIV testing lifted while E2 visa holders would have to continue with the mandatory testing was the result of two different government ministries making two different policies? [In case you're new to South Korea's visa regimen, the E6 is ostensibly an "entertainer" visa, but many of the people who get this visa are sex workers. ATEK, the Association of Teachers of English in Korea, "applauds" removing mandatory HIV testing for this group.]

At the time, I subtly hinted that the mandatory HIV testing requirement would eventually be lifted for E2 visa holders as well, and it appears that day may be sooner rather than letter. None other than the Secretary-General of the United Nations, Ban Kimoon, is pressuring Seoul to drop the tests:

U.N. Secretary-General Ban Ki-moon is urging South Korea to scrap a requirement that foreign teachers take an HIV test, an official said Tuesday.

South Korea dropped a travel ban in January for most foreigners with the virus that causes AIDS, drawing praise from the United Nations. But it still requires foreign teachers, most of whom teach English, to take HIV tests. The ban is largely the result of pressure by parents.
In a meeting last week with Prime Minister Kim Hwang-sik in Seoul, Ban urged that the HIV test requirement be abolished, said Yoo Sung-sik, a spokesman for Kim. Ban, a former South Korean foreign minister, was in Seoul to attend a summit of the Group of 20 leading economies.

This, ladies and gentlemen, is what we call a globalism-enforced PC standard, and make no mistake, it will mean more people dying in South Korea. Based on the state of HIV and AIDS a quarter century ago, when most cases in the US were transmitted through homosexual contact, testing for this fatal disease became a privacy issue that was deeply enmeshed with gay rights. Today, however, HIV is manageable as a chronic disease if it's caught early, yet instead of treating HIV infection like tuberculosis, hepatitis, or prostate cancer, we still treat it in such a way that reduces the chance of survival of the already-infected and increases the likelihood of more new infections.

SecGen Ban would also like you to not do that monthly breast self-exam, forgo that prostate checkup, not bother to make sure your Thanksgiving turkey is cooked long enough and at a high enough temperature, choose not to wear a seatbelt, walk out into the street without making sure no traffic is coming, and encourage your government to gut their meat inspection duties.

So why is ATEK applauding the removal of mandatory HIV testing for sex workers? In a country where 800 of the total 7800 confirmed HIV infections are foreign nationals (from places like the US, where 1 in 200 are HIV-positive), why is Ban Kimoon trying to eliminate HIV testing of foreign workers?

The answer is simple: HIV and AIDS are treated as if nothing has changed since 1985, when instead we should be treating this deadly infection primarily as a public health challenge, not a human rights issue. (And mandatory HIV testing is not the only public health arena where "human rights" are being used to trump legitimate public health concerns; there are groups trying to eliminate the ban on homosexual men from donating blood, a legally upheld prohibition aimed at preventing HIV transmission through blood transfusions by blocking the group of people with the greatest risk of HIV infection.)

This is being driven by a twisted sense of PC-influenced "fairness" and "equality" for foreign workers, when in fact most South Korean nationals are tested for HIV infection in some way and the government provides mandatory HIV treatment if they test positive. Late last year I asked what would be a fair policy for HIV testing in Korea, but what I had in mind then and now is something that applies fairness in the other direction:

1. Mandatory testing for anyone with a visa that allows them to stay in South Korea beyond the period of a tourist visa (preferably in line with mandatory testing for all ROK nationals residing in South Korea as well).
2. Deny long-term visa if they test positive (except for F-series family visas)
3. Provide foreign residents who test positive during their residency in South Korea with the same comprehensive HIV treatment that ROK nationals would receive. Provide a long-term medical treatment visa for such individuals, if necessary.

If you're truly concerned with foreign workers' rights in South Korea, that last one is the one you should really get behind.

Now I know mine is not a popular position, but calling mandatory HIV testing a human rights issue does not magically take the risk away. It could, however, remove the stigma. South Korea is in a unique position where (a) its infection rate is low and manageable, in part because of a high degree of testing, and (b) it provides comprehensive care to those who are infected, in a way that saves lives and prevents new infections. In other words, South Korea is poised to achieve an HIV-managed status, and it's in a situation where it's cost-effective to try to achieve that.

Why, then, are we trying to muck it up with a "human rights" approach to HIV testing that will lead to more HIV infections and more AIDS-related deaths?

UPDATE:
This post from June 2009 discusses the notion, apparently misleading, that foreign nationals who test positive for HIV are all summarily deported.

ATEK is happy that foreign sex workers in Korea are no longer required to be HIV tested

From their press release (courtesy of Popular Gusts):

The Association for Teachers of English in Korea (ATEK) applauds the Korean Ministry of Health and Welfare for its decision to remove mandatory HIV testing from the E-6 and E-9 visa requirements, and extends congratulations to the activists and advocates whose efforts led to this change. “This is a positive step for all migrant workers in Korea,” says ATEK Vice President Darren Bean.

The E-6 visa, ostensibly for entertainment workers, is also used as a visa for foreign women who come to South Korea to work — knowingly or duped — in the sex industry. In other words, if there ever was a group in South Korea that should be tested for HIV, this would be it.

I'm a believer that we should realize the fundamental differences between HIV in 2010 and in 1985 and recognize that it's now primarily a public health issue and not a human rights issue. Testing saves lives and prevents future infections, and I believe everyone should be tested — E2s, E1s, F4s, E7s, F2s, D8s, and ROK nationals — but to say that not everyone agrees with such an approach would be an understatement. E2 visa holders, coming from places like the US where 1 in 200 people are HIV-positive, might feel they are being discriminated against, and I'm sympathetic to that.

But for the love of God, can someone please explain to me the justification for removing sex workers from the required testing regime, why activists and advocates thought that was worth removing, and why ATEK is "applauding" that?

A tale of two ministries

Read this. Then get pissed. Then go read so-and-so's blog rant about how f'ed-up xenophobic this shows Korea is.

Then take a closer look at the article and realize that it's most likely two different ministries and two different independent policies at work here. No, they're not out to get you.

(And while we're at it, we're now at the point where it's time to stop treating HIV testing like a human rights issue and recognize it for the public health issue that it is. Everyone should be tested — E2s, F4s, F5s, E6s, and ROK nationals — period. Especially in a country like South Korea where HIV treatment is guaranteed, even mandatory. But that's a post for another time.)

UPDATE:
There are some good discussions on this at The Marmot's Hole and Brian's.

Discuss: What is an acceptable HIV testing policy for foreign nationals?

The requirements that E2 visaholders be subject to one-time or annual HIV tests has been a great source of controversy this year. Anti-English Spectrum pushing for this has made the policy seem rooted in xenophobia, even though public health officials in South Korea have pushed for such regulations even before AES ever existed.

HIV testing is caught between public health concerns and human rights concerns. The government and health authorities have a role to protect the public from the spread of dangerous or deadly diseases, especially when they end up footing the bill for costly treatment, but mandatory testing can be seen as an invasion of privacy or even stigmatization. When it seems to be directed only at certain groups, which may be the case with testing foreign

So that's my question: What is an acceptable HIV testing policy for South Korea vis-à-vis foreign nationals?


Consider the following questions:

• If most but not all ROK citizens, through their jobs and the National Health Insurance Corporation, military service, blood donation, etc., are routinely tested for HIV, is it acceptable to require the same of all seekers of E2 visas? 
• If ROK citizens are typically tested for HIV only once (say, during military conscription or when they first enter a corporation), is it acceptable to require foreign residents to be tested repeatedly when their visa comes up for renewal? 
• What if most ROK citizens are not tested at all? Is it still acceptable to require some or all foreign nationals to be tested upon entering the country with a new visa?
• Is it acceptable to test only some foreigners, like just teachers (i.e., E2s, E1s, and any F2, F4, or F5 who teaches children) or just those with teaching-specific visas (i.e., E2 or E1) or just those who might teach children?
• If E2s and E1s should not be tested, then what about E6 visaholders (i.e., those on "entertainment visas" who are often knowing employees for Korea's de facto legal sex industry? (That many of the women who come to Korea on E6 visas are duped into the sex trade is not something I wish to ignore, but if possible, I wish to treat that as a separate issue.)

Separate from the fairness issues above, should we look at this completely as a privacy issue? Specifically:

• Is the problem with testing for E2 visaholders one not of fairness at all but one of privacy? In other words, would any mandatory testing policy be unacceptable, even if every ROK national in South Korea were subject to HIV testing? 
• Should ROK nationals be subject to regular HIV testing or is it too stigmatizing?
• Does a blanket requirement remove stigma or increase it? Do public health concerns trump this?
• If mandatory HIV screening is a stigmatizing and therefore should not be done, does this apply to other diseases, like tuberculosis or syphilis? What, if anything, makes HIV different?

I'm genuinely curious what others think about this. I think a sincere discussion about some of these questions might be a way to reach a consensus about an acceptable policy.

I'll be up front, however, that one of my biggest concerns is that we've let a heightened sense of so-called "human rights" trump good health care planning. Yes, getting HIV tested may be unpleasant and even humiliating, but not nearly as much as getting HIV. South Korea has — so far — largely kept HIV at bay, but it's not necessarily clear what factors or policies have led South Korea to that point. Would a purely "human rights"-oriented approach dismantle the dikes and bulwarks, or would they just remove archaic practices that are designed to make the public feel good but are inefficacious or even detrimental?

Just curious

I plan to do a lot more fact-finding on HIV/AIDS policy, particularly testing, once I'm back in the ROK, to affirm or refute the claims made by Ben Wagner (of ATEK's no-testing-for-all campaign) and the activist AIDS/HIV report used for the human rights campaign he spearheaded. The above graphic, which appeared in Ben Wagner's Korea Herald article on the subject, is related to the following claim from the report:

As of 2004, there had been 459 HIV/AIDS cases reported among foreigners in Korea. Once a non-Korean is found to be HIV-positive, he or she is forced to leave the country without any care or counseling. Between 1985 and 2002, more than 200 foreigners were deported from Korea under the Immigration Control Law (Article 2, Paragraph 1) after their HIV/AIDS diagnoses became known.

I do not want to make light of the issue, but the claim (cited by Ben Wagner in various places) doesn't entirely jive with the statistics presented. Specifically, if an HIV-positive non-ROK national is "forced to leave the country," how did the 200 or so HIV-positive people cited in the above paragraph or the 126 people (647 minus 521) end up not being deported?

I'm not asking to be glib or to catch Ben Wagner in a "gotcha" moment. I am asking because I want to know about the actual process and its enforcement? Are these people who were found to be HIV-positive before or shortly after they arrived in the Republic of Korea? Are long-time residents who test positive for HIV also kicked out? Are people of certain visa types more likely or less likely to be deported? 

The same report seems to suggest that the Korean government does something a lot of other countries don't, which is to pay for fairly expensive treatment to keep the HIV-positive healthy:

The KNIH monitors the immunological status of PLWHA free of charge, and the Korean government pays for 100% of the cost of highly active antiretroviral therapy medication for Korean PLWHA. Seven AIDS shelters throughout the Korean peninsula are available for PLWHA. The shelters provide board, counseling, rehabilitation services, and education.

PLWHA refers to "people living with HIV or AIDS." 

Even though the above part of the report uncharacteristically paints the ROK authorities in a positive light, I probably should investigate this claim as well, including seeing how much (if any) the Korean health insurance scheme pays for people suffering from full-blown AIDS (i.e., the latter stages of the disease when patients are quite sick, a point that the antiretroviral regime hopefully will prevent). 

Now here is where it gets sticky. If South Korea is paying such a significant amount of money for each HIV-positive individual, can it afford to take on the health care costs of non-citizens who became infected with this deadly virus prior to ever residing in the country? 

From a national policy perspective or an insurance theory perspective, such a thing would become unsustainable. It would create a moral hazard of sorts, where HIV-positive individuals would have a tremendous incentive to get themselves into the system, which could end up with dire fiscal consequences that end up adversely affecting the citizens and legal residents for whom the insurance scheme was set up. 

I am not trying to justify deportation of HIV-positive foreign nationals. If I were forced to formulate an opinion right now, it would be that foreign nationals who became infected with HIV while living in the Republic of Korea should not be deported and should be covered by the National Health Insurance Corporation the same as any ROK national. Ditto with the "vouched for" foreign nationals (i.e., F2, F4, and F5 individuals), at least those whose spouse, parents, or children were ROK nationals. 

Anyway, this post is not meant to make a statement, but to ask the questions listed above. I'm writing this largely for my own notes, so I know what questions to pursue, along with my investigation as to what testing regimen is part of mandatory health checkups for teachers (both "regular" and "irregular") in the schools ("public," "private," and "extracurricular"). 

Thus far, it appears that both regular and irregular teachers at the public and private school level are given health exams that include testing for HIV, syphilis, and several other STDs, contrary to the report often cited by Ben Wagner as evidence of unequal treatment faced by E2 visa holders. 

Teachers at extracurricular schools (i.e., hagwon), however, are not faced with this kind of thing as part of their employment, though it appears that most would be subject to HIV testing through other activities in their life (e.g., military service and later military training, other types of health checkup, etc.).