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

Note: This was cross-posted to my own blog.


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

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

The case was brought to CERD by Benjamin Wagner, an international human rights attorney who co-authored a legal paper on the issue of South Korea’s use of HIV testing as a proxy for racial discrimination with Matt van Volkenburg. The paper (PDF) provides an excellent background on the history, political and cultural climate, and xenophobic advocacy efforts that led to the implementation of the testing requirement, as well as how the requirement is a clear example of South Korea shirking its international human rights obligations:

The HIV and drug test requirements for foreign teachers were first established as emergency measures in 2007 by the Ministry of Justice
(“MOJ”), which claimed they were necessary in order to “ease the anxiety of the citizens.” Part II of this Article examines the background and
context of the implementation of these requirements and argues that they were introduced during a period of media hysteria and moral panic…a civil society group called the “Citizens’ Group for Upright English Education”…succeeded in courting public opinion against foreign English teachers by contributing to highly sensationalized media reportage replete with lurid tales of perversion, sex crimes, drug use and AIDS. This group was also successfully able to influence national policy by petitioning the government for measures against foreign teachers, including mandatory HIV and drug tests.

Part III examines the ROK’s international commitments to eliminate discrimination and stigma based on actual or presumed HIV status and
examines how and why the ROK has failed to honor these commitments.

Korea’s HIV restrictions for foreign teachers are among the most extreme form of HIV restrictions in the world…Of the forty-nine countries in the world that continue to have some form of HIV-related restrictions in place for foreigners only about six have restrictions so extreme as requiring in-country testing for foreign workers that must be repeated on a regular basis, and nowhere are teachers subject to such restrictions. Indeed, the ROK’s extreme position toward its foreign teacher population has attracted the attention of UN Secretary-General Ban Ki-moon who has urged the ROK to eliminate its HIV restrictions on foreign teachers.

Obviously, any foreigner who tests positive for HIV is immediately detained and deported; in 2008, the Korean CDC reported that it had deported 521 out of 647 HIV-positive foreigners. Non-nationals of Korean ethnicity have been able to successfully challenge such deportations, but the Korean judicial system explicitly differentiates between the legal rights of citizens versus foreign nationals.

Interestingly, South Korea has given CERD “the same authority as domestic law” regarding foreign nationals; however, this means next to nothing as Wagner explained in a different piece last week:

Professor Kyong-Whan Ahn…remarked that the constitutional analysis used by Korean courts to determine whether an incidence of discrimination has occurred is relatively underdeveloped. The method relied upon by courts is the “reasonableness test”. But, Ahn complains, decisions are all too often “a foregone conclusion” with little analysis or scrutiny.

[T]he status of the CERD is unique in that “it has the same authority of domestic law and does not necessitate additional legislation,” as the Republic of Korea has made clear to the Committee on several occasions. Nevertheless, the Committee has responded, “although the Convention forms part of the domestic law and is directly applicable in the courts of [South Korea], there are no court decisions which contain references to or confirm the direct applicability of its provisions.” The Committee has pointed out to the government that the situation may be the result of “a lack of awareness of the availability of legal remedies” and has recommended “information campaigns and education programmes on the Convention and its provisions.” Unfortunately, however, the treaty remains relatively unknown in Korea and neither the government nor the courts have done enough to change that.

van Volkenburg, who has been covering this issue (and its origins) since it all began in 2005 at the long-running Korean expat blog Gusts of Popular Feeling, has a great summary of the ruling and its implications (as well as the best collection of links to the news coverage of the ruling):

The summary makes public the justification the UMOE offered for the tests – something that many people taking these tests have known for years, but never admitted by the government:
[D]uring arbitration proceedings, L.G.’s employers, the Ulsan Metropolitan Office of Education (UMOE), said that HIV/AIDS tests were viewed as a means to check the values and morality of foreign English teachers.

One of the Committee’s recommendations isn’t very surprising:

The Committee recommends that the State party grant the petitioner adequate compensation for the moral and material damages caused by the above-mentioned violations of the Convention, including compensation for the lost wages during the one year she was prevented from working.

It continues with much more sweeping recommendations, however:

It also recommends that the State Party takes the appropriate means to review regulations and policies enacted at the State or local level related to employment of foreigners and abolish, both in law and practice, any piece of legislation, regulation, policy or measure which has the effect of creating or perpetuating racial discrimination. The Committee recommends the State party to counter any manifestations of xenophobia, through stereotyping or stigmatizing, of foreigners by public officials, the media and the public at large, including, as appropriate, public campaigns, official statements and codes of conduct for politicians and the media. The State party is also requested to give wide publicity to the Committee’s Opinion, including among prosecutors and judicial bodies, and to translate it into the official language of the State party.

This doesn’t just refer to English teachers, but to regulations for all foreign workers. And as I’ve covered here, the references to the conduct of the media and politicians is very pertinent, considering the ‘Citizens Group for Upright English Education’ (also known as Anti English Spectrum) worked closely with the media and had access to politicians when pushing for the creation of the HIV testing policy (among others) in the first place.

It will be interesting to see how the Korean government will respond to the CERD’s ruling – whether it will in fact change the law in accordance with its treaty obligations. Based on South Korea’s history of human rights protections, it does not look promising. Even when human rights principles are codified into law, employers (and often police officers) who violate workers’ legal rights do so with widespread impunity and are rarely prosecuted or held accountable – as demonstrated by the cases of the migrant workers in Bitter Harvest and the workers enslaved on salt farms on the islands of Jeollanam-do. The admission that HIV tests were seen as a way to “check the values and morality” of visa applicants is a slap in the face – doubly so considering that only foreigners are required to have “upright values” in order to get jobs.

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

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

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 my own professional blog.

IH News Global Health Weekly News Round-Up

  • May 31 was observed as World anti-tobacco day by the World Health Organization.
  • The Fitness Industry Council Canada has announced June 1 as National Health and Fitness Day.

Politics and Policies:

  • The Republic of Congo has passed a law that prohibits the purchase, consumption and possession of tobacco for minors, pregnant women and mentally ill. The advising and any kind of promotion of tobacco are also prohibited in the country. Smoking is prohibited in public places.
  • According to the World Health Organization On June 10th Ethiopia is launching an emergency mass-vaccination campaign against yellow fever.
  • According to the Ghana’s Minister of Health, the country is committed to ban all forms of tobacco advertisements and promotions.
  • Smoking in presence of children equaled to physical violence in Latvia.
  • Russia’s smoking ban came into effect on Saturday. It involves no smoking in public places and curbing cigarette advertising and sales.

Programs:

  • The World Health Organization (WHO) in Gambia is launching polio campaign to vaccinate 400,000 children under five years.
  • The Ministry of Finance of Lesotho has signed two agreements totaling $17 million with the Global Fund to fight against HIV/AIDS, tuberculosis and malaria.
  • Professionals for Humanity International (PROFOH) have announced its third free medical screening in this year in Nigeria.
  • After the discovery of polio this week, United Nations emergency team rushes to vaccinate 424,000 people living in a refugee camp in Kenya.
  • Zimbabwe is going to conduct its first national tuberculosis prevalence survey with an objective to determine the national prevalence of bacteriologically-confirmed pulmonary TB among people aged 15 and over.
  • Rotary India extends its help to Pakistan in its polio vaccination drive.
  • The World Health Organization is calling on the countries to ban advertising about the tobacco products.

 Research:

  • Improvement of maternal health and reduction in child mortality in some countries was highlighted in a recently released report ‘Accountability for Maternal, newborn and Child Survival ‘.
  • According to the director of the National Institute of Combat of HIV (INLS), the prevalence of HIV in Angola has not changed since 1997.
  • According to the researchers patients who have developed oral cancer due to HPV can have sex with their spouses or long term partners.
  • According to a study done by the researchers at the Institute for Clinical Evaluative Sciences, rates of diabetes have jumped 15 fold within a decade for the Chinese Canadians.
  • A systemic review confirms that the licensed medicines for smoking cessation are successful in assisting people to quit smoking.
  • Scientists are using new optics-based single virus detecting methods for determining the exact viral load of a sample by counting individual virus sample.
  • New malaria vaccine developed by the team Japanese researchers has cut the infection rates by 72%.
  • A study conducted in over 13 hospitals in Indonesia, Singapore, Thailand and Vietnam shows that doubling Tamiflu vaccine dose does not help in severe flu.
  • Results of a study warn development of resistance to drug used in treatment of H7N9 virus.
  • A group of scientists discover how a single gene mutation helps brain cancer cells to survive and drive tumor growth.
  • According to the United Nations scientists, Fukushima No.1 nuclear plant has very low radiation doses and there is no increased risk of cancer on local residents.
  • According to the experts nearly one-sixth of young adults in Sri Lanka are overweight. Lack of nutrition education and food culture of the country are reasons for this problem.
  • A study states that particular combination of bacteria in the human digestive system can identify patients who have or are likely to develop Type 2 diabetes.
  • A study shows that the Coenzyme Q10 cuts the mortality rate by half in heart failure patients.
  • Report released by EU says that several new health risks are emerging from new chemicals, products and changing lifestyle patterns. It is important to address these issues all together.
  • According to a study fizzy drinks do harm to the teeth as drugs.
  • New vaccine for lung cancer has been developed by the scientists of Argentina and Cuba. It activates the body’s immune system to promote its destruction.

Diseases & Disasters:

  • Tornadoes hit Oklahoma again on 1st June. Death toll rises to 9.
  • A report issued by the Chinese Ministry of Land and Resources state that the ground water of China is poisoned. It did not address the severity and scope of this problem.
  • Death toll from bird flu has risen to 38 in China.
  • According to the reports of the United Nations, there is a suspected outbreak of Ebola fever in the north of the Democratic Republic of Congo.
  • According to the reports by Ghana Health Service, cholera outbreak hits greater Accra region.
  • The World Health Organization is concerned about the new strain of Coronavirus which has killed 55 of the confirmed cases.
  • A Starbucks in Hong Kong used water from the public restroom to brew coffee.
  • Pakistan is facing a severe measles epidemic. Since the start of 2013 about 239 deaths have been reported.
  • According to the Ministry of Health, Philippines, new cases of HIV infections recorded in the month of April were 388. It was 67 percent higher than those recorded in April 2012.
  • According to the reports Singapore is facing Dengue epidemic. More than 7,700 people are reported to be infected as of May 25.
  • Frozen berry and pomegranate mix has been reported to be linked to hepatitis A outbreak in five states in U.S.

Global Health Weekly News Round-Up

Politics and Policies:

  • A partnership between the Government of Benin and the U.S. government was launched to help Benin achieve its objective of eliminating neglected tropical diseases by 2020.
  • U.S. Supreme Court weighs dispute over AIDS funding.
  • HHS announces new digital and mobile health application to help people to stay healthy.

Programs:

  • Nigeria may soon relax the criteria for placing people living with HIV on antiretroviral (ARV) treatment in order to increase number of people being treated.
  • Imbuto project has announced its plans to set up a model facility in Bugesera district, Eastern project. It will integrate elimination of mother to child transmission of HIV/AIDS services through its family package project.
  • The Embassy of the Republic of China (Taiwan) and the Ministry of Health and Social Welfare of the Gambia have signed an agreement on maternal health improvement program.
  • The Word Bank has approved a $7 million line of credit to improve the delivery of healthcare services in Djibouti.
  • Smile Train and Operation Smile in collaboration with the Government of the Republic of Rwanda have announced the launch of Rwanda Smiles to create the first-ever country in Africa.
  • A national strategic plan for HIV, tuberculosis and sexually transmitted infections has been adopted during South African National AIDS Council meeting in Secunda, Mpumalanga.
  • A two year maternal health project aimed at promoting community involvement in the assessment of the performance of selected health facilities and providers in the delivery of maternal health services was launched in Koforidua.
  • The UN refugee agency has appealed for millions of dollars to help to meet the needs of Malian refugees including healthcare, water and sanitation.
  • Canada funds IOM humanitarian projects involving emergency health, water and sanitation projects in Zimbabwe.
  • A partnership between Samaritan’s Purse Canada, University of Calgary, Canadian International Development Agency is running a healthcare project that is helping people of South Sudan.
  • To save upto 2 million children every year from deaths caused by pneumonia and diarrhea, the World Health Organization and UNICEF has launched a new Global Action Plan.
  • Cuba’s second round of anti-polio vaccination campaign starts on Friday through April 25 to keep this island free of this debilitating disease.

Research:

  • According to the reports from the municipal public health supervisor over 20 HIV/AIDS positive cases have been reported during the first quarter of this year.
  • According to the reports Kogli (Nigeria) has cases of HIV/AIDS rising since last 2 years. This rise has been attributed to lack of availability of funds for the state action committee on HIV/AIDS.
  • Global fund has increased funding (additional $25 million to 12 states and the Federal Capital Territory) for HIV/AIDS in Nigeria.
  • According to the Kwara State Ministry of Health Coordinator (Nigeria) for HIV/AIDS about 1.8 million children have been orphaned by HIV/AIDS related death in Nigeria.
  • A study states that breast feeding for more than four months lowers mother-to-infant HIV risk through their milk.
  • According to a qualitative research marriages in Malawi are a risk factor for HIV infection in females.
  • Results of a study involving people of Uganda states that food access and diet quality are associated with health-related quality of life.
  • Scientists from the University of Kansas made a discovery that aspirin directly and indirectly suppressed the proliferation of two different breast cancer strains.
  • Statistics from Chinese Center for Disease Control and Prevention states that China now has nearly 120,000 new cases of multi-drug-resistant tuberculosis.
  • According to the scientists DPP-4 inhibitors have cardio-protective effects on type 2 diabetes mellitus.
  • A study finds a relation between endometrial cancer at young age and risk for endometrial cancer.
  • A study reports that highly active retroviral therapy (HAART) may help to protect hearts of young patients.
  • Scientists from Indiana School of Medicine links beer with increased levels of dopamine in the brain.
  • The new U-M National Poll on Children’s health about 40% parents give young children cough/cold medicine that they shouldn’t.
  • According to a research letter published in the journal Emerging Infectious Diseases, some visible signs of Lyme disease are easily missed or mistaken.
  • A study indicates that high salt diet and ulcer bacteria together combine to increase the risk of cancer.
  • According to a study lung cancer mortality rates linked to primary care provider density.

Diseases and Disasters:

  • Plaque draws scientist’s attention as potential terrorism weapon.
  • Death count due to bird flu reaches 20 in China.
  • An earthquake of magnitude 7.0 struck China on Saturday. It is discouraging volunteers in the earthquake zone.
  • Vietnam has announced that special measures have been adopted to prevent the H7N9 avian flu from entering the city.
  • The Department of Health of Minnesota has alerted the doctors to a new strain of influenza  for the patients who have travelled to Asian nation and have flu-like symptoms.
  • According to the scientists, new strain of bird flu virus that has killed 17 people in China has acquired a significant genetic diversity.
  • Honduras reports two deaths from hemorrhagic dengue fever. In addition about 3,000 cases of classic dengue cases have been registered this year.
  • Reports have indicated a presence of a bird flu virus in Norfolk, UK.

Global Health Weekly News Round-Up

Politics and Policies:

  • Swaziland has launched a new national framework to eliminate new HIV infections among children by 2015 and keep their mothers alive.
  • According to a report Pakistani politicians have pledged for health and education of their people.
  • A Texas Senate bill would revise the state’s end-of-life procedure.
  • Bloomberg’s campaign might close off the remaining means of access to cheap cigarettes and little cigars which make it easier for teenagers to experiment with smoking and progress to smoking regularly.

Programs:

  • World Bank has approved a concessionary loan of US $200 million to Sri Lanka to further enhance the quality of the health sector service.
  • §  Britain is going to launch a £179 million five-year healthcare program in the Democratic Republic of Congo which aims to reach about six million people.
  • The Food and Drug Administration (FDA) is planning to clamp down on the sale of non-iodized salt.
  • UNICEF has increased its support from four to ten districts in the Upper East region in Ghana to implement a 5 year child survival program known as the Essential Newborn Care (ENC).
  • A regional health agency has been launched in Kigali, Rwanda, East Africa aiming to facilitate and improve regional health sectors.
  • US AIDS agencies have begun their five-year effort with Malawi’s government to improve health care services for HIV/AIDS virus infected people.
  • Irish aids program helping African people suffering from HIV/ AIDS.
  • Niger’s first lady commits to stopping new HIV infections in children.

Research:

  • According to a study done by the scientists at Queen’s University, the risk of getting head and neck cancer can be reduced by 22% by taking a weekly or even monthly dose of over-the counter aspirin.
  • A study shows that climate change can worsen the public health threat of diarrheal disease in Botswana.
  • According to a global health study HIV/ AIDS and tuberculosis are two top killers among the people of Russia.
  • A study on a disease- konzo- indicate that its physical effects on body is accompanied by impairment of children’s memory, problem solving capability and their cognitive functions.
  • Scientists in United Kingdom have been successful in making a vaccine for foot-and-mouth disease. Since it is not made from live virus, its production will require no special containment.
  • United Nations analyst says that Tanzania might achieve millennium goal on maternal health.
  • Kenya Aids Research Coordinating Mechanism chairperson has called for teamwork in HIV/Aids research.
  • According to a study early detection of bowl cancer can help to prevent cancer. They say that those who participated in the screening program were the people who were the most easiest to treat.
  • A study says that a ‘new diagnostic test may be safe and easy screening method that could improve the prognosis of patients with pancreatic cancer through early detection’.
  • Study shows that obesity makes a person to exercise less.
  • According to a study elderly people who have many social interactions may live longer than those who are more socially isolated.
  • According to a NIH study pregnant women who experienced financial, emotional or other personal stress in the year before their delivery had an increased chance of having stillbirth.
  • A study by U.S. Centers for Disease Control and Prevention many mothers in U.S. start infants on solid foods earlier than experts recommend.
  • A study done by the scientists at Boston School of Public Health finds a link between childhood abuse and fibroids.
  • Researchers at Boston University School of Medicine say that improving levels of vitamin D in the blood via supplementation could help to fight disease by affecting gene expression and boosting the immune system.
  • Italian scientists say that people who suffer from migraines are more likely to have brain abnormalities at birth and some develop them over the course of time.

Diseases and Disasters:

  • According to the reports about two people have died due to infection of a new strain of Avian flu in China.
  • UNICEF warns that 2 million children in Central African Republic are without basic supplies.
  • United Nations has been forced to delay desperately-needed food-aid to nearly 300,000 people in Guinea Bissau as it has so far received no donations to support its operation.
  • According to the United Nations reports about 240,000 Pakistani children have missed their UN sponsored polio vaccinations due to the security concerns in the country’s tribal regions.
  • According to the reports, skin lightening is popular among the females in Senegal despite of health concerns over the product.
  • Reports show that the public health centers in Tanzania do not have enough medicine and hospital supplies.
  • Clusters of vancomycin resistant enterococci cases in Kowloon Central Cluster (KCC), in Queen Elizabeth Hospital, Hong Kong have been reported.
  •  Visitors urged to stay away from Beaumount Hospital Dublin due to flu outbreak, according to the reports.
  • The health officials of Australia have become alarmed after the report of first death from XDR-TB- drug resistant tuberculosis.
  • According to the reports, more than 7,000 people might have been exposed to HIV and or hepatitis in Oklahoma dentist’s office.