OpenForum – a blog by the Health and Human Rights community

Almost 20 years ago, Amartya Sen, in the New York Review of Books, explained how to calculate the number of “missing women” in a given country: determine the number of surplus women who should be alive in, for example, China – if China had the same ratio of men to women as do countries that provide comparable health care to both sexes. According to Sen’s math, there were more than 50 million missing women in China alone; added to the missing women in South Asia, West Asia, and North Africa, that number jumped to 100 million. “These numbers,” Sen wrote, “tell us, quietly, a terrible story of inequality and neglect leading to the excess mortality of women.” While Sen’s theory did not go unchallenged (see links at end of this post), the numbers are startling. And in 2005, the UN doubled the estimate, to 200 million. Last month the Toronto Star profiled the work of two economists who have gone a long way toward answering a simple but important question: What’s happening?

Siwan Anderson and Debraj Ray analyzed figures from the year 2000 from sub-Saharan Africa, China, and India, to better understand at what age the missing women are dying, and what they’re dying from. As they explain in their paper, Missing Women: Age and Disease, “The possibility of gender bias at birth and the mistreatment of young girls are widely regarded as key explanations. . . . While we do not dispute the existence of severe gender bias at young ages, our computations yield some striking new findings.”

Their news? Anderson and Ray found that the majority of missing women died as adults (older than 15), not from sex selection in utero or childhood gender bias, as previously thought. The authors’ suggested percentages of “excess female deaths” occurring later in life are striking: 66 percent in India, 55 percent in China, and 83 percent in sub-Saharan Africa. Read more

As many as 10,000 Chinese children may be HIV-positive, reports Reuters, with many of those going without specialty care or treatment. While China guarantees free AIDS treatment, a combination of prohibitive costs associated with complications from the disease, distance from a hospital, and a continued emphasis on four front-line drugs (to which some people are resistant), has deterred many patients from seeking treatment. More patients have gained access to care since 2003, when the Chinese government launched China CARES (China Comprehensive AIDS Response), a community-based HIV treatment and prevention program. According to AVERT, an international AIDS charity, the WHO estimated in 2007 that China was supplying 19% of those in need of treatment with antiretroviral therapy. Although the treatment itself is free, patients often have to pay for associated clinical tests and other expenses related to healthcare. In 2004, the government also launched a national program with the goal of actively testing certain high-risk groups, including intravenous drug users and prostitutes. In the Yunnan province, a hub for drug trafficking, 3.2%  of the individuals tested were found to be HIV-positive.

Despite China’s recently implemented HIV prevention and treatment efforts, the country has a long history of discrimination against HIV-positive individuals. The same Reuters article reported that many people “have been turned away from hospitals and schools that fear contagion from AIDS patients.” Although the government has attempted to incorporate mass HIV/AIDS education campaigns into local communities, AVERT notes that a lack of qualified teachers for HIV/AIDS prevention education (especially in rural areas) and lack of HIV/AIDS education material in minority languages may be hindering efforts.

More links below the fold. Read more

A paper recently published in the journal Mental Health, Religion, and Culture describes an innovative healing approach for monks who have suffered under China’s occupation of Tibet – innovative not in the sense that it tries anything new, but that it actually integrates Tibetan and Western medicine. The paper also demonstrates the challenges and need for expansion of cross-cultural treatment of refugees.

Dr. Michael Grodin of the Boston Center for Refugee Health and Human Rights tailored a treatment for eight Tibetan monks in Boston that includes both Western and Tibetan diagnoses, combining mainstream healthcare with alternative therapies. One patient, Yeshi Togden, was repeatedly imprisoned and tortured in the late 1980s for his participation in peaceful protests against China’s presence in Tibet. Dr. Grodin diagnosed Togden with post-traumatic stress disorder (PTSD), as well as srog-rlung, an imbalance of the life-wind; his treatment included Taoist breathing and musical bowl-playing concurrent with psychotherapy and antidepressants. Read more

A recent article on China’s “one country, two systems” policy reports on its sociopolitical implications for Hong Kong’s female migrant sex workers. The authors argue that current legislation is only increasing their vulnerability to human rights abuses, and that their situation can best be understood and improved using the concept of “structural violence.”

The policy allows regions like Hong Kong to operate on different economic and political systems from mainland China, with a large degree of autonomy. One of its unintended consequences, however, is the perpetuation of migrant sex workers’ disadvantaged status through the systematic denial of their right to social and economic progression and the failure to provide adequate health services or protection from exploitation and abuse. While prostitution is technically legal in Hong Kong, related activities such as soliciting, as well as traditional brothels, are not. Operating alone and without protection, prostitutes are vulnerable to abuse and lately, to a disturbing string of murders. Migrant sex workers are far more vulnerable given their illegal status, and feel they cannot report crimes committed against them or seek health services for fear of legal repercussions. Read more