Tuesday, November 16, 2010

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.

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11 comments:

  1. I couldn’t agree more.

    Mandatory AIDS testing is not a human rights issue and it should not be treated as such. I wouldn’t want an HIV-positive teacher teaching my kids in the same way I wouldn’t want a teacher with TB or typhoid teaching my kids. The fact remains that HIV, while extraordinarily difficult to catch through person-to-person contact, is still a communicable and fatal disease.

    I think though that behind the applause from groups like ATEK is a sense that E2 visa holders are being discriminated against. Non-Korean teachers are required to get the test to get their visa but F-series visa holders are exempt. And I can sympathize with sentiment: Koreans don’t trust us and think we’re all HIV positive, but Gyopos (and to a lesser extent long-term residents and marriage visa holders) are trustworthy solely because of their heritage.

    I would argue that a better solution is not to get rid of the mandatory testing requirement, but rather require all teachers, regardless of nationality or place of work, to get the test.

    ReplyDelete
  2. Sorry Kushibo, didn't get the Haitian joke. Unless, the joke has a sarcastic reversal of truth in the punch-line. I.E. Haitians had the highest rate of HIV infections at the time and the overall tone of the joke shows just how backwards the thinking is when passing laws on this subject via the human rights mode rather than the obvious public saftey modus.

    Holy Cow, am I that dense? It's been a rough week!

    ReplyDelete
  3. 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.

    That's not quite accurate. If Korea were acting as if it were 1985, then there would be mass mandatory testing of Korean citizens. The first AIDS Prevention Act went in 1987. By 1990, 2.3 million Koreans were screened. They worked in food plants, hair salons, hotels, and as sex workers. By 1996, 4.9 million were tested.

    The ROK decided to scrap the mass testing approach, not because of "a globalism-enforced PC standard" but because they were netting about one detection for every 58,000 tests. The government had spent more than 60% of its HIV/AIDS budget on testing. The voluntary anonymous testing centers produced higher results for less cost. (See "HIV/AIDS Policy in South Korea," CHO Byong-Hee, School of Public Health, Seoul National University, 2008.)

    Protecting human rights (privacy, anonymousness, confidentiality, treatment) and decreasing stigma encouraged more people to seek out testing and yielding even higher results and public health benefits.

    Not surprisingly, in a recent study the Korean CDC and the Division of AIDS, Center for Immunology and Pathology, Korea National Institute of Health came to the conclusion:

    "A question on the efficiency of current mandatory test is raised because the seroprevalence of mandatory test takers was low. However, HIV ISG included voluntary test takers was high in our result. Therefore, we suggest that Korea needs to develop a method encouraging more people to take voluntary tests at PHCs, also to expand the anonymous testing centers and Voluntary Counselling and Testing Program (VCT) for general population to easily access to HIV testing."
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689198/

    The intense stigma surrounding AIDS in Korea means the suicide rate of Koreans living with HIV/AIDS is 10 times higher than the general population (already among the highest in the world). (Cho). Those choosing not to end their life often don't seek treatment or remain undiagnosed. Thus the 2010 results of the Division of AIDS, Korea Centers for Disease Control and Prevention, Seoul study entitled: "Increasing late diagnosis in HIV infection in South Korea: 2000-2007". The conclusion of which reads:

    "HIV infection was primarily detected by voluntary testing with identification . . . It is important to encourage voluntary testing for early detection to decrease the prevalence of HIV infection and AIDS progression."
    http://www.biomedcentral.com/content/pdf/1471-2458-10-411.pdf

    If it could be shown that foreign teachers were unwilling to go for voluntary tests then perhaps the argument for mandatory tests would be stronger, but recall that it was their eagerness to be tested that cited as the cause to put the mandatory tests in place. Bill 3356, pending at the National Assembly, that would require mandatory testing notes that a high percent of foreign teachers were seeking voluntary tests.

    There used to be a voluntary testing center right in Itaewon but businesses didn't want it around so it relocated near Sunshin Univ.
    http://www.khap.org/Eng_Html/Contact.php

    You are obviously concerned with Korea's public health. As I understand you are interested in universal testing, but I don't think you're opposed to voluntary testing. Perhaps you could do a posting on voluntary testing centers in Korea. If you are interested I can provide you with a list. Unfortunately, there's not as many as there should be but there are options.

    ReplyDelete
  4. Milton,

    You might want to do some research as AIDS is not longer the fatal disease/death sentence that it once was--just ask Magic Johnson or Greg Louganis. I believe Greg has been living with the disease for over twenty years and Magic nearly as long.

    kushibo,

    While Greg and Magic were responsible for their own choices, no one deserves a disease like this, and then to have what happened to Ryan makes it a human rights issue because unless you are a celebrity, there will always be a severe stigma attached to this disease.

    ReplyDelete
  5. I appreciate all the comments, but I will answer them slightly out of order, for coherence's sake. I'd like to add that Ben Wagner himself left a lengthy response as well, but he seems to have removed it. That's a little disappointing to me, because I had some good responses prepared for his thoughtful (and thought-provoking) comments.

    Anyway, I'll start with a quote from the November 18, 1985, edition of People, which was promoting an NBC TV movie about AIDS and may be where I first heard "the Haitian joke":

    Louie fidgeted in one golden armchair while his father perched in a matching one beside it. In a room that features religious statues in one corner and framed photos of grandchildren in another, Louie's mother, Alice, sat on the green sectional sofa, as did her four other offspring. Louie's married sister, Adria, had already guessed what the news was: "Are you going to announce you're getting engaged?" she asked.

    Earlier that day Louie Nassaney had learned from his doctor that he had Acquired Immune Deficiency Syndrome. He told his family he had a lesion on his right leg that was Kaposi's sarcoma, a cancer that afflicts AIDS patients. He said he had at most two years to live. "I touched the sore on his leg and put my hands on his head," recalls Alice, who started to sob. "I just stood next to him. He did all the talking. I said nothing. That's all there was to say—nothing."


    So there's the joke, Zilchy (and it was a common joke). The idea, back in 1985 when an HIV-positive reading was not only a death sentence but also a forced coming-out as a homosexual for almost all non-African or non-Caribbean men in America, was that the stigma of being gay was so great in the United States (and many other countries) that it trumped even being diagnosed with a painful, fatal disease.

    (The Haitian reference in the joke was that there were, essentially, two types of people who were contracting AIDS, other than those who had gotten tainted blood: Haitians and homosexuals.)

    ReplyDelete
  6. milton wrote:
    Mandatory AIDS testing is not a human rights issue and it should not be treated as such. I wouldn’t want an HIV-positive teacher teaching my kids in the same way I wouldn’t want a teacher with TB or typhoid teaching my kids. The fact remains that HIV, while extraordinarily difficult to catch through person-to-person contact, is still a communicable and fatal disease.

    Up to a point I agree with you. A person with a deadly communicable disease can be a person who works with the public and still keep the public (and him/herself) safe and healthy, but the ability to do so is dramatically diminished if he/she is not aware of their condition. HIV, TB, and other communicable diseases can be curbed more effectively when they are properly diagnosed, the infected person and their care group is informed of appropriate behavior, and they are removed from situations where they might spread the infection. This does not necessarily mean they must be removed from the classroom, though some kinds of precautions may be necessary.

    That said, parental opposition to the remove of the ban is a side show, not the main event. It's a reason not to remove it, but for people in public health, parental beliefs was not the reason for implementing mandatory HIV tests for for foreign teachers or other foreign workers.

    In the US, 1 in 200 is infected with HIV, while in South Korea it's about 1 in 6000. The average American is thirty times more likely than the average South Korean to be HIV-positive. Curbing the introduction of new "patient zero" vectors is a legitimate public health concern.

    I think though that behind the applause from groups like ATEK is a sense that E2 visa holders are being discriminated against.

    Agreed. And that's pretty much all that it's about.

    And I do get the discrimination angle, but if fairness and equality are what they have in mind and they don't want to get anybody else killed, then instead of dismantling HIV testing, they should push for it applied to all, just as should be done with background checks for teachers, and push for foreign nationals who become infected with HIV during their residency in Korea to be able to equally receive the benefits of South Korea’s comprehensive HIV treatment regimen.

    ReplyDelete
  7. My response to milton continues...

    Non-Korean teachers are required to get the test to get their visa but F-series visa holders are exempt. And I can sympathize with sentiment: Koreans don’t trust us and think we’re all HIV positive, but Gyopos (and to a lesser extent long-term residents and marriage visa holders) are trustworthy solely because of their heritage.

    When it comes to teaching, whatever is applied to E2 or E1 teachers should also be applied to F-series teachers: background checks, HIV tests, etc. Instead of sinking to the lowest common denominator of no tests, raise things up to a higher standard of testing all.

    That said, I want to emphasize there is a general misunderstanding about F-series visas, including the F4. The F-series visas are family visas. This includes the F4, which is not a "kyopo visa," but a returning family visa.

    In fact, most ethnic Koreans in the Korean diaspora are decidedly NOT eligible for the F4, as well as (I guess) around 10 to 30 percent of kyopo living in English-speaking countries. To be eligible, you must be a former ROK national or the direct descendant of a former ROK national who had ROK citizenship after 1948 when the Republic was officially declared.

    Note the word former. If your parents have a green card in the US but never renounced their ROK citizenship, you cannot get an F4. You can then get a type of relatives' visa, but you won't be allowed to work (at least, that was the case in mid-2009, the last I checked).

    If you're Korean by way of the early immigrants who went to Hawaii or California before 1948, you're also screwed, unless your granddaddy had the amazing foresight to go to a Republic of Korean government-in-exile office in Honolulu or San Francisco and register his presence, which could have rendered him stateless and eligible for deportation from the US (because you'd be putting your imposed Japanese citizenship in jeopardy). If you're an ethnic Korean in China or the former Soviet Union, you're screwed for the same reason: you don't qualify under the 1948 establishment provision.

    At the same time, the F2 and F5 are open to a lot of people who are not ethnic Koreans at all, but they have the same benefits as F4 visa holders who are in South Korea on their parents' or grandparents' coattails.

    I would argue that a better solution is not to get rid of the mandatory testing requirement, but rather require all teachers, regardless of nationality or place of work, to get the test.

    Testing for all, including ROK nationals, no problem.

    ReplyDelete
  8. John from 大田 wrote:
    Milton,
    You might want to do some research as AIDS is not longer the fatal disease/death sentence that it once was--just ask Magic Johnson or Greg Louganis. I believe Greg has been living with the disease for over twenty years and Magic nearly as long.


    Well, you're both right (without either one of you really being wrong). HIV is a fatal condition if it is not caught early and aggressively managed, which is all the more reason why universal testing should be implemented.

    HIV infection can now be managed as a chronic condition instead of a terminal illness, if it is caught in time and the person receives regular and sustained treatment. This can be costly, but South Korea is already footing the bill for this mandatory HIV treatment (which other activists are fighting as a violation of human rights).

    Magic Johnson and Greg Louganis should be held up as reasons to be realistically hopeful even in the face of an HIV diagnosis, but instead, many people have gotten the message that they can be blasé about safe sex behaviors. (That's going off from your point, John, I know.)

    kushibo,
    While Greg and Magic were responsible for their own choices, no one deserves a disease like this, and then to have what happened to Ryan makes it a human rights issue because unless you are a celebrity, there will always be a severe stigma attached to this disease.


    No one deserves this disease. True, which is why discovering new vectors earlier rather than later, through universal testing instead of voluntary testing, will reduce the number of new infections.

    At the same time, I'm not so sure the stigma of the disease will always be so severe (perhaps, one day, no more than hepatitis or tuberculosis, where the stigma can also be a bit high), especially if HIV testing were universal. Information, not conflict avoidance, are the ways to fight stigma.

    ReplyDelete
  9. "I'd like to add that Ben Wagner himself left a lengthy response as well, but he seems to have removed it."

    It was a lengthy response and the blogger comment system gave me the "Request-URI Too Large The requested URL /accounts/ServiceLogin... is too large to process" notice after I posted it. I was hoping you'd caught it in your filter or receiving through email since when I clicked back the content was gone.

    Please post it if you've got it.

    ReplyDelete
  10. [The following is Ben Wagner's original post. I have several major work and school tasks due between tomorrow and Monday, so I don't know how in-depth my response will be. I might just have to hit a highlight or two.]

    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.

    That's not quite accurate. If Korea were acting as if it were 1985, then there would be mass mandatory testing of Korean citizens. The first AIDS Prevention Act went in 1987. By 1990, 2.3 million Koreans were screened. They worked in food plants, hair salons, hotels, and as sex workers. By 1996, 4.9 million were tested.

    The ROK decided to scrap the mass testing approach, not because of "a globalism-enforced PC standard" but because they were netting about one detection for every 58,000 tests. The government had spent more than 60% of its HIV/AIDS budget on testing. The voluntary anonymous testing centers produced higher results for less cost. (See "HIV/AIDS Policy in South Korea," CHO Byong-Hee, School of Public Health, Seoul National University, 2008.)

    Protecting human rights (privacy, anonymousness, confidentiality, treatment) and decreasing stigma encouraged more people to seek out testing and yielding even higher results and public health benefits.

    Not surprisingly, in a recent study the Korean CDC and the Division of AIDS, Center for Immunology and Pathology, Korea National Institute of Health came to the conclusion:

    "A question on the efficiency of current mandatory test is raised because the seroprevalence of mandatory test takers was low. However, HIV ISG included voluntary test takers was high in our result. Therefore, we suggest that Korea needs to develop a method encouraging more people to take voluntary tests at PHCs, also to expand the anonymous testing centers and Voluntary Counselling and Testing Program (VCT) for general population to easily access to HIV testing."
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689198/

    The intense stigma surrounding AIDS in Korea means the suicide rate of Koreans living with HIV/AIDS is 10 times higher than the general population (already among the highest in the world). (Cho). Those choosing not to end their life often don't seek treatment or remain undiagnosed. Thus the 2010 results of the Division of AIDS, Korea Centers for Disease Control and Prevention, Seoul study entitled: "Increasing late diagnosis in HIV infection in South Korea: 2000-2007". The conclusion of which reads:

    "HIV infection was primarily detected by voluntary testing with identification . . . It is important to encourage voluntary testing for early detection to decrease the prevalence of HIV infection and AIDS progression."
    http://www.biomedcentral.com/content/pdf/1471-2458-10-411.pdf

    If it could be shown that foreign teachers were unwilling to go for voluntary tests then perhaps the argument for mandatory tests would be stronger, but recall that it was their eagerness to be tested that cited as the cause to put the mandatory tests in place. Bill 3356, pending at the National Assembly, that would require mandatory testing notes that a high percent of foreign teachers were seeking voluntary tests.

    There used to be a voluntary testing center right in Itaewon but businesses didn't want it around so it relocated near Sunshin Univ.
    http://www.khap.org/Eng_Html/Contact.php

    You are obviously concerned with Korea's public health. As I understand you are interested in universal testing, but I don't think you're opposed to voluntary testing. Perhaps you could do a posting on voluntary testing centers in Korea. If you are interested I can provide you with a list. Unfortunately, there's not as many as there should be but there are options.

    ReplyDelete
  11. For all the gnashing of teeth against xenophobic Koreans, I wonder how many folks knew that the United States had an outright VISA ban for people entering the country that were HIV positive. In fact it was lifted just this year in January.

    http://news.bbc.co.uk/2/hi/americas/8438865.stm

    ReplyDelete

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