Wednesday, July 8, 2009

To be fisked later

This was a couple weeks ago, but Human Rights Watch has taken Benjamin Wagner's human rights complaint — flaws and all — about HIV testing and sent it virtually unchallenged to the National Human Rights Commission of Korea

I'll fisk it later. In addition to retelling what is likely inaccurate information about HIV testing among ROK nationals, it relies on a naïvely self-serving notion that prevention programs will be effective even while trying to take the most effective tool away: knowing who all is HIV-positive and training them and their partner in always having safe sex.

This is most un-PC of me, but keeping HIV as a privacy issue a this stage instead of a public health issue has killed people and will kill many more. 

If stigma exists for HIV-positive people, an HIV-positive person will experience it eventually. If the stigma is in getting an HIV test, then that shame could be dissipated if all are required to get the tests (and as I've stated, I believe most ROK nationals do, but I have to verify that). But instead, the ones claiming privacy would rather have a situation where we do not know a person is HIV-positive until they get around to voluntarily checking, meanwhile possibly infecting others. 

In other words, the rights of one group that is in need of care that will be provided by the state to not be embarrassed trumps the rights of a larger group not to get infected with a deadly but preventable disease. And that, to me, is messed up. 

Moreover (and this is no small matter, either), Korea's monitoring of the immunological status of HIV-positive people free of charge, and the Korean government "paying for 100% of the cost of highly active antiretroviral therapy medication" for people in Korea with HIV may be endangered by prohibitively mounting costs if Korea is forced to take in people who have contracted HIV in other countries. 

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7 comments:

  1. What do you think about US immigration refusing entry to HIV-positive individuals?

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  2. I don't know. I would have to read up on it, but I thought the policy was changed last year or something.

    Anyway, there is one major difference, if what I'm reading is correct: South Korea has mandatory universal health care which (I think) obliges the state to pay for HIV treatment, which is expensive.

    The US, on the other hand, has no such thing. In both places, the danger of an HIV-positive person infecting others is there, though the risk is largely mitigated with married persons (but not all of them).

    In Korea, however, there is not just a health risk but also a significant financial burden of allowing a non-citizen infected outside the country from coming in and then receiving the mandated health care.

    My thinking right now is that non-ROK nationals who were infected prior to living in the ROK should be kept outside the country unless (a) they are the spouse or visa-sponsorable family member of a ROK national or permanent resident or (b) they submit themselves to the HIV-prevention regimen that exists (see the link) and make arrangements to pay for their own HIV treatment.

    If you throw open the door, there is a moral hazard of sorts that creates an unsustainable health care need. Eventually, those who have paid as ROK nationals or legal residents will be cheated out of the care they are supposed to get.

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  3. I must vehemently disagree with your point. If we could expect to use HIV tests to prevent AIDS (identify who is infected and teach them and their partners) then we could talk about something.

    As it stands the Korean government will not use information from the HIV test in anything resembling this manner.

    It is clear that this test is directed at foreigners and furthermore, is inviolation of my firm belief that a government should not violate any individuals rights and force them to participate in a medical test.

    Furthermore any situation that could result in negative consequences, loss of job, etc is counterproductive to addressing HIV.

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  4. Having seen firsthand what happens when people do get tested and 'hopefully' treated in Africa, I have to insert a few caveats:
    1 - While I agree that not knowing a persons HIV status is worrying, especially if you are having unprotected sex with everyone who takes your fancy, the prevention lies not in knowing what their status is, but knowing what yours is and then taking steps - if you are HIV negative, use condoms, get checked regularly, if positive, sign up for a treatment program and stop having unprotected sex. (And yes, I know condoms are not a 100% failsafe, but they have been proven to help dramatically).
    2 - If you're going to test, test everyone, not just a selected group.

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  5. i think the term "human rights" is a very much abused word, always taken out of context

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  6. I don't know the details but in the US the ban has been lifted in law but not in practice. In 2008 Bush by lifting the ban, essentially handed over the administrative task of lifting the ban to the Dept of Health and Human Services (DHHS). DHHS still classifies HIV as a highly communicative disease thereby allowing immigration to screen out HIV positive individuals from entering the country. However DHHS is currently reviewing the status of the disease and is expected to fully lift the ban later this year.

    For me this is more than a discrimination issue. It is also a health issue. If the country in question has the means to treat HIV positive persons without undo burden on its economy, then there is no reason to have the ban. But if the opposite is true, such as if a significant number of HIV positive persons migrate to Korea to take advantage of free HIV services (a potential abuse as Kushibo suggests) then the country in question can discriminate in whatever way they want.

    So the real question for me is how much of a threat is HIV to the Korean public and its economy? If it can be shown that HIV is of no threat, then no reason for the ban.

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  7. to clarify, when I say the country can discriminate in whatever way they want, I'm using the word "discriminate", meaning to make distinctions. Not in the sense of the word meaning unjust prejudice.

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