Future of Conflict Minerals murky under Trump administration

You’ve likely heard the term “blood diamonds.”  Also known as “conflict diamonds,” these precious stones have helped fund civil wars and contributed to some 3.7 million deaths in Angola, Sierra Leone, and the Democratic Republic of Congo (DRC) according to an Amnesty International report.

The term “conflict minerals” doesn’t have quite the same ring, nor a titular film starring Leonardo DiCaprio, but they are at the center of a recently leaked memo from the White House.  The memo seeks to dismantle the Conflict Minerals Rule in the 2010 Dodd-Frank Wall Street Reform and Protection Act.  Under Dodd-Frank, companies had to disclose whether or not their products contain minerals mined in the Democratic Republic of Congo or a neighboring country.  The reason to withdraw this clause that valued human life over electronics?  Perceived job loss and costs to American companies, estimated at $3-4 billion in upfront compliance costs and $200 million annually thereafter.

What is life like for the miners of conflict minerals – tin, tantalum, tungsten, and gold ore – in the Democratic Republic of Congo and neighboring countries?  The Guardian reports a systematic web of sexual violence, kidnapping, child labor, and modern-day slavery.

An overwhelming abundance of human suffering all so we can play Bejeweled on an almost dizzying array of devices.  Tech giants, Apple and Intel, have spoken out against the repeal of the Conflict Minerals Rule, but fear that enforcement will be difficult without written law.  Human rights groups representing some 100 organizations in and around DRC have also spoken out against repeal of the Rule:

Thanks to the Dodd-Frank Act, Eastern DRC has to date more than 220 certified green mining sites, more than 300 mining police officers trained and deployed to secure mining sites,an independent audit mechanism, and a regional certification system. These advances undoubtedly contribute to reducing the rate of crime and human rights violations, including rape of women and exploitation of children in mining areas. All these efforts and progress will be destroyed if the US Government decides to contradict itself by repealing the Dodd-Frank Act.

It isn’t just Big Business that has taken a hit under the Conflict Minerals Rule.  A healthy dose of criticism cites that the Rule has actually made miners and their families in DRC poorer.  In many ways, the implementation of the Rule slowed down, or stopped, mining due to implementation issues of the government and business variety.  Millions, out of work, were left between the proverbial rock and the hard place: either face starvation or join the militias that the very Rule were designed to protect them against.  Closing of mines is felt throughout communities:

With less money flowing in, shops in Luntukulu have closed. Many people struggle to feed their families through farming. “If Obama’s law wasn’t signed, the ban would not have existed,” said Waso Mutiki, 41, president of the miners’ co-operative in Luntukulu. “It destroyed everything.

Others who contest the Rule say that the it does not acknowledge or alleviate deeply systemic issues afflicting the region, such as in this open letter signed by academics, politicians, and civil society professionals:

First, while the minerals help perpetuate the conflict, they are not its cause. National and regional political struggles over power and influence as well as issues such as access to land and questions of citizenship and identity are just some of the more structural drivers of conflict. The ability to exploit and profit from minerals is often a means to finance military operations to address these issues, rather than an end in itself.

The authors of the open letter above offer some alternative strategies which seek to buoy the economy by incentivising better practice and fair competition for international and Congolese businesses. Dollar for dollar, the Democratic Republic of the Congo is one of the richest countries in the world when it comes to untapped mineral resources.  The people who seek to own that wealth and exploit its potential are many, and unfortunately, Congolese citizens and their communities are not among those to first reap those benefits.

So, what is the bottom line?   Some might say the Conflict Minerals Rule sees the forest but not the trees, doing significant damage to local economies and livelihoods despite the progress made by eliminating a driver of local conflict.  It serves as yet another example of the need for policies to be developed and refined with community feedback. A globally engaged U.S. administration might attempt to build on the successes of the Rule with foreign and trade policy that takes such feedback into account. But the current administration seems to have different priorities. Rather than approaching policymaking in a way that benefits the communities most heavily impacted, or even that takes into account the expectations of American consumers, President Trump fights for the common man…the average, American CEO:

Government and community collaboration are key in achieving meaningful reform. Whether or not the U.S. Administration will take part in that exchange remains to be seen.

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World AIDS Day & the need for SSPs

December 1st, 2016 marked World AIDS Day.  This year’s theme is “Leadership.  Commitment. Impact.”  The White House National HIV/AIDS Strategy for the United States praises the collective efforts of the healthcare workforce, including “increased access to new, sterile syringes and other injection equipment to minimize infections from injection drug use.”

Syringe services programs (SSPs) have proved beneficial to countries across the globe.  In Hong Kong SAR, pharmacies can provide new syringes without a prescription.  Surveys by the health department find that only 2% of HIV infections are attributable to persons who inject drugs (PWIDs) in this country.  In Berlin, Germany, 77% of PWIDs use syringe vending machines at least 4 times per week.  Elsewhere in Germany, syringe SSPs in jail dramatically reduce rate of new infections.

The evidence is clear: Syringe exchange programs work.  Not only do they decrease HIV transmission among PWIDs, but they don’t recruit new drug users and they are cost-effective compared to treating individuals with HIV.  So what’s the hold up?  We need only look at the United States to see that legislation for SSPs is far from universal.

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There are currently, 228 SSPs in 35 states, the District of Colombia, Puerto Rico, and the Indian Nations.  In states without SSPs, the impact to PWIDs is devastating:

In jurisdictions in the United States, where drug paraphernalia laws were strictly enforced, higher prevalence of HIV infection was observed despite lower risk-taking behavior.  Legal barriers in Maryland and Texas in the United States resulted in a high prevalence of HIV with   up to 25% of PWIDs infected in Baltimore, Maryland and 35% of PWIDs infected in Houston, Texas.  These findings overall suggest that injecting paraphernalia legislation that restricts needle and syringe availability inadvertently increases HIV infection.  There is no convincing evidence that this legislation reduced HIV prevalence.

Whereas Maryland now has one SSPs, Texas is still one of 15 states that do not offer this service.  This is especially concerning due to the prevalence of HIV on the US-Mexico border. Made possible by a combination of illegal and legal sex work, PWIDs, and the highly transient nature of the population, HIV is rampant and largely unchecked in Mexico border towns adjacent to US cities.

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While syringe exchange programs are key, more needs to be done to educate the citizens of both countries:

And with Mexico’s border cities serving as funnels for workers and goods traversing the two countries, Tijuana’s AIDS crisis poses a direct threat to the United States.

“I call HIV the uninvited hitchhiker,” said Steffanie Strathdee, a leading AIDS researcher at the University of California’s Division of International Health and Cross-Cultural Medicine.

A survey by university researchers found that 64 percent of 116 HIV-positive Tijuana residents crossed into the United States at least once a month. Nearly half of men having sex with men in Tijuana and 75 percent of those in San Diego reported having partners across the border. And of 1,000 prostitutes interviewed in Tijuana, 69 percent had U.S. clients who crossed the border for their services.

The federal ban on syringe exchange programs was lifted in the first few weeks of 2016, largely in response to a nationwide heroin and HIV epidemic in America’s heartland.  Federal monies cannot be allocated to purchase needles, but cover all other expenses including staff, vehicles, and gas.  State and local funding could be used to purchase needles.  Still, adoption of programming has been slow.

Globally, only 90 needles are available per PWID annually.  This is less than half the recommended amount of 200, and many countries provide far fewer.

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With a dubious history of HIV prevention and intervention, it is no wonder Russia’s HIV epidemic is increasing 10-15% each year.  Recent data show that 1 in 50 people in Russia’s 4th-largest city are HIV-infected.  When outside funding for SSPs was withdrawn in 2010 – as Russia was then classified as a high-income country – SSPs dwindled from 80 to 10.  Intravenous drug use accounts for 58% of HIV infections.

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Under Putin’s conservative regime, HIV infections have nearly doubled since 2010 – 500,000 to 930,000 registered carriers – and are projected to reach 3 million (2 million registered carriers) within the next 5 years.  Despite annual spending of $418 million (US) rates are increasing as the lion’s share is spent on antiretroviral therapy, not prevention.

President-elect Trump has been surprisingly vocal in praising Putin, and unsurprisingly obtuse about how he plans to address HIV domestically and abroad.  When asked whether he would support the President’s Emergency Fund for AIDS Relief, Trump was not un-supportive:

Well, I like committing to all of those things. Those are great things. Alzheimer’s, AIDS, so many different — you now, we are close on some of them. On some of them, honestly, with all of the work that has been done — which hasn’t been enough, we are not very close. But the answer is yes. I believe so strongly in that. And we are going to lead the way.

In perhaps the weirdest twist yet, Vice President-elect Mike Pence could prove to be an ally for continued funding of SSPs in the US.  In 2015, an upsurge in HIV infections in Indiana led then-Governor Pence to advocate for syringe exchange programs after a career of staunchly opposing such legislation.

And what of those border states?  Perhaps Trump’s fabled wall might come in handy.

Video @WHO: Intimate Partner Violence

Home should be a place of safety and sanctuary, but for a third of women, this is not the case.  Around the world, 800 million women are subject to physical and sexual abuse at the hands of their husbands and partners.  Per the World Health Organization, intimate partner violence (IPV), also includes emotional abuse, such as threatening to take children away, and controlling behaviors, including isolation and restriction of financial resources, employment, education, and medical care.

IPV causes injury and death, mental health and substance abuse issues, and harm to children who are born to women abused by their intimate partner.  That being said, intimate partner violence isn’t a women’s issue.  IPV is a social concern that runs rampant and largely unchecked in any society that supports – implicitly or explicitly – sexual assault and rape.  Counter to the woman-as-victim trope, violence can occur in any intimate relationship, including between same-sex couples.

What can we do to help millions of men, women, and children in violent homes?  Dismantle those structures which facilitate power imbalance between partners as well as systems that support sexual violence.

Rape culture is a term that is bandied about in regard to leniency and light sentencing of perpetrators, especially on college campuses, in the military, or if the perpetrator is an athlete.  Instead, victims of rape bear the brunt of the burden, such as in the case of a 14-year-old student raped repeatedly by her 49-year-old teacher.  The rapist was sentenced to one month in jail.  The victim took her own life.  A judge declared that the victim was equally in control of the situation because she “seemed older” than her chronological age.

Rape culture doesn’t exist just in our most esteemed institutions, but in the laws that govern our behavior.  A 2010 article published in The Georgetown Law Journal speaks to one of these laws, which allows rapists to seek visitation and custody of children conceived through rape.  Contrary to former State Representative Todd Aiken’s assertions, women can indeed get pregnant as a result of rape as the female body has no mechanism to “shut the whole thing down.”

Once again, we confront another myth of rape culture: that children conceived through rape are unloved and women who choose to keep these children are not true victims.  Statistics show that 80% of rape victims know their attacker, and without laws to revoke paternal custody, some will be forced to continue association with their rapist for at least the next 18 years.

What other institutions contribute to domestic violence?  Child marriage itself is a form of violence perpetrated on some 37,000 girls each day.  Girls who are married before the age of 18 are twice as likely to be beaten and three time more likely to be raped by their spouse.  Abuse is so endemic to this institution that a third of girls married before age 18 believe that, under some circumstances, a man has the right to beat his wife.

For society as a whole, rates of intimate partner violence are intricately associated with the state of society as a whole:

On issues of national health, economic growth, corruption, and social welfare, the best predictors are also those that reflect the situation of women. What happens to women affects the security, stability, prosperity, bellicosity, corruption, health, regime type, and (yes) the power of the state. The days when one could claim that the situation of women had nothing to do with matters of national or international security are, frankly, over.

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As you can see, there is a lot of work to be done.

Further Reading:

Sexual Violence is a tool of war, but we have the weapons to end that.  The Guardian

Guatemala sexual slavery verdict shows women’s bodies are not battlefields.  The Guardian

Ten Things to End Rape Culture.  The Nation

2016 Public Health Gift Guide

On this most hallowed online shopping day, Cyber Monday, as we traverse a plethora of retailers – from Amazon to Zappos – take a moment to check out these charities that are addressing much-needed pubic health issues:

1.This bar saves lives. Otherwise known as Plumpy’Nut, this shelf-stable, nutrient-rich paste made from peanuts, milk powder, sugar, vegetable oils, vitamins, and minerals saves the lives of severely malnourished children worldwide.  Hailed as the most important public health innovation since penicillin, Plumpy’Nut’s little brother, Nutributter, is designed for children under two to prevent stunting caused by malnutrition which can save children from lifelong health issues.

Partnering with Save the Children and the Foundation for International Medical Relief of Children, Plumpy’Nut produces amazing results for very little money.  It costs $50 for a two-month supply.

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How can you help? It’s easy: Buy a bar, feed a child.  Every purchase of the Non-GMO, gluten free, fair trade, bee friendly bars gets Plumpy’Nut to the children who need it most.  Click here for a 60 Minutes piece about Plumpy’Nut.

2.  Apopo. As a rat owner, Apopo is a cause near and dear to my heart, and one I’ve written about before on this blog.  Apopo trains Gambian pouched rats to save lives through mine and tuberculosis detection.  From humble beginnings in 1998, Apopo has exploded (pun intended) into a force that has destroyed over 100,000 landmines, cleared 20 million square meters of land, and freed nearly a million people from the threat of explosives.

Apopo added tuberculosis detection to its ratty repertoire in the mid-2000s.  Rats can sniff out TB in a fraction of the time it takes to run a diagnostic test, and with great accuracy.  This means that over 10,000 additional TB cases have been detected with 60,000 TB infections halted.

Training rats takes time and money, but the people of Apopo have made your Holiday shopping that much easier.  Donations between $10-20 will buy a basket of bananas (a favorite treat of HeroRats), safely detonate one landmine, or provide a health checkup for one rat.  If you have a little more to give, consider $32.00 to clear 30 square meters of a minefield or $56.00 to screen 200 TB samples.

Want to follow the journey of a HeroRat?  Consider adoption!  For $7.00 a month, you can adopt a rat.  Your donation comes with a welcome pack, adoption certificate, and monthly updates about your rat’s progression and life-saving successes.

3. Days for Girls. Nothing quite says Happy Holidays like a donation of menstrual care products, but the reality is that girls worldwide miss school and face social isolation because of their periods.  Without modern menstrual products, girls are forced to use whatever they can find, including leaves, rags, mattress stuffing, feathers, and cow dung to name a few.

Days for Girls makes it easy to get involved.  Can you sew?  Consider making Days for Girls kits, which included washable, reusable pads, soap, washcloth, two pairs of underwear, and visual instructions on use of all items.  You can also join an international team or fundraisers or donate directly to this great cause.

Dignity for girls during their period is the first step toward making 2017 the Year of the Girl!

4. Against Malaria Foundation. In 2015, there were 214 million cases of malaria worldwide.  While deaths caused by malaria have decreased nearly by half between 2000 and 2015, there are still roughly half a million deaths each year.

For just $2.50, you can send one long-lasting insecticide treated net (LLIN) which lasts for 3-4 years and protects up to two people from mosquitos that are most active between 10 pm and 2 am.  For every 50 to 250 nets that is implemented, the life of one child is saved.  So far, nearly half a million people have donated $92 million to distribute over 30 million nets.  One-hundred percent of your donation goes toward purchase and distribution of LLIN.

5. The Natural Resources Defense Council. If saving the planet is your thing or you’ve read the startling report that the world’s top soil could be gone in 60 years, the Natural Resources Defense Council (NRDC) is for you.

Focused on all aspects of the environment, from climate change, to food, to the wild, NRDC is working hard to safeguard our planet in a way that is meaningful to you.  You can donate to save elephants, protect the ocean, or give the gift of clean water.

So, there you have it!  A very short list of some worthwhile causes that could use some help today and always.  Know of a great charity that is addressing a public health issue?  Leave it in the comments below.

Disclaimer: The International Health Section is not affiliated with nor does it endorse any of these organizations.  All opinions are the author’s own.

The Year of the Girl

The United Nations declared October 11th the International Day of the Girl Child.  Everywhere I looked for this post’s inspiration, I saw story after story of the daily violence perpetrated against girls worldwide. I had to ask myself, why just a day?  Aren’t girls – roughly half of the world’s population – deserving of much more consideration? I say that we declare 2017 the YEAR of the Girl and devote our efforts to address the following issues.

Female Genital Mutilation

Female genital mutilation, or FGM, is a global concern. Some 200 million girls and women in 30 countries have undergone FGM, usually between infancy and 15 years of age. In many countries, FGM is a deeply entrenched cultural practice that has seen little decrease in the decades since foreign aid workers have been campaigning for is abolition. The risks might be high – infection, infertility, and complications of childbirth – but the perceived social benefits outweigh the physical costs. Bettina Shell-Duncan, an anthropology professor working as part of a five-year research project by the Population Council, has witnessed this conflict firsthand among the Rendille people of Northern Kenya:

One of the things that is important to understand about it is that people see the costs and benefits. It is certainly a cost, but the benefits are immediate. For a Rendille woman, are you going to be able to give legitimate birth? Or elsewhere, are you going to be a proper Muslim? Are you going to have your sexual desire attenuated and be a virgin until marriage? These are huge considerations, and so when you tip the balance and think about that, the benefits outweigh the costs.

Despite cultural ties, FGM is decreasing in some African countries as evidenced by rates from the prior generation.  However, with prevalence as high as 81% (Egypt), 79% (Sierra Leone), and 62% (Ethiopia), there is still much work to be done.

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For example, with prevalence at 60-70%, FGM in Iraqi Kurdistan is a “hidden” epidemic.  Prevalence of this practice elsewhere in Iraq is 8%.  Outlawed in 2011 by the Kurdistan Regional Government under the Family Violence Law, FGM has continued largely unabated due to poor implementation and push-back from religious leaders.  You can read the Human Rights Watch harrowing report about FGM in Iraqi Kurdistan here.

Rape and Child Marriage

Last Friday, the BBC reported on a bill under consideration by the Turkish Parliament that would clear a man of statutory rape if he married his victim.  This bill is evidence of increasing violence against Turkish women.  Between 2003 and 2010, the murder rate of women increased by 1,400%.  Of course, the bill isn’t couched in terms of legalizing rape, but as a loophole for those offenders who know not the errors of their ways:

The aim, says the government, is not to excuse rape but to rehabilitate those who may not have realised their sexual relations were unlawful – or to prevent girls who have sex under the age of 18 from feeling ostracised by their community.

If passed, the bill would release 3,000 men from prison as well as legitimize child rape and marriage. Per Girls Not Brides, Turkey has one of the highest child marriage rates in Europe with 15% of girls married before the age of 18. Globally 34% of women are married before the age of 18 and every day 39,000 girls join their ranks. According to a study recently published in the International Journal of Epidemiology, child marriage comes with health and social consequences. Along with unintended pregnancies, infant and maternal mortality, and HIV, girls who are married suffer from social isolation, power imbalance, and experience higher lifetime rates of physical and sexual intimate partner violence.

Coming-of-age “Cleansing” Rituals

Practiced in parts of Africa, girls as young as 12 are forced to have sex as part of a sexual cleansing ritual.  The men, known as “hyenas,” are paid by parents to usher girls through the transition between girlhood and womanhood.  Girls are coerced into this practice through familial and societal pressure.  It is believed that great tragedy will befall the family and community should she not comply.  The use of a condom is prohibited.

A BBC radio broadcast found that communities believe the spread of HIV to be a minimal risk since they can pick men they know are not infected. One Malawian hyena, Eric Aniva, has been charged with exposing hundreds of girls and women to HIV. Aniva knew of his HIV status but did not disclose to his customers.

Forty percent of the global burden of HIV infections are in Southern Africa. Thirty percent of new infections in this area are in girls and women aged 15-24. Young women contract HIV at rates four times greater than male peers and 5-7 years earlier, linked to sexual debut or sexual cleansing rituals.

Let’s face it: Girls around the globe are being short-changed. Though progress has been made, there is still much work to be done. The Sustainable Development Goals have promised to “end all forms of discrimination against all women and girls everywhere” by 2030. Others attest that it will take at least another century for women to reach wage equity in the United States.  However it happens, rest assured it will take more than a day.