Saturday, December 1, 2012

AIDS in Korea and Korea's Responses

The speaker of the night was a sister working for God, of whom I shall leave anonymous as she must work in high risk areas where prejudices are rampant and her identity must remain undisclosed. Even when she gave a seminar back in August, not with the open-minded researchers at the RASKB but with the typical people she was trying to raise recognition to of a social problem, she wore a beaded red mask so that she couldn't be inadvertently recognized later as the speaker and as the one who worked side-by-side and hand-in-hand with the PILWHA (People Living With HIV and AIDS). The sister is extremely compassionate and connected with her AIDS friends. Her voice caught at the end and she ended her presentation in near tears. She is a living witness to a lot of suffering in life, not only physcial suffering but the worst of all, the mental suffering and condemnation of people with AIDS, the social pariahs ... stigmatized ... outcasted ... and self-righteously judged by others.

The social prejudice and discrimination suffered by those living with HIV are indescribably serious. If their infection is made public, the deep-rooted social prejudice makes it impossible for sufferers to lead normal lives. The cuase may be complicated having to do with Korean traditional values which keep sexual matters very private and also the fear of AIDS which may be due to ignorance about HIV in general.

What led the sister to work with AIDS began in 1988 (the year of the Olympics) when she returned to Korea and was given the opportunity to seek out some area of real need in society. She was quickly led to the women sex workers (매춘부 or prostitutes but the word comes from Chinese and literally means "selling spring wife") and deeply challenged by what she saw. She found it heart-rending to work with the women who had little freedom in the many brothels. The women were exploited and abused by owners and customers alike. They were also exploited by others too: dry cleaners, hair dressers, even street vendors who sold them their goods at inflated prices to take advantage of the fact that they had little choice or mobility in who they bought from. The young women were not free to go out shopping like other women, and so life with choices was curtailed.

Picture of Miari Texas, which, when she started had 200 brothels and each had 5-20 prostitutes.
Taking this picture was only possible during the daytime as at night, the doors are well watched and picture
taking is very much prohibited.
Words appropriately describing these exploited women are: stigma, discrimination, violence, lack of freedom. These women are used by customers and pimps, money lenders and many others who profit from the sex industry. Their human dignity in most cases is seriously damaged. This leaves them feeling that there is no way out for them. And of course they are vulnerable to infections, including HIV.

What the sister hoped to achieve by her presence in and around Miari Texas was first and foremost to be friends. She wanted them to know that she was not there to exploit them or to force her will upon them in any way. Her approach was to visit the brothal area alone so that she was not a threat to anyone, but was in fact vulnerable and powerless herself. She set up a small house, and when the opportunity arose, she would give a young woman her phone number and invite her to come, and of course anyone who came, she would invite them to stay.

HIV/AIDS and Women Engaged in Sex Work

Back in 1988, AIDS in Korea was very rare. There were only 38 recorded cases in a population of 48 million. Aware, however, of the devastation AIDS was causing in the world and in others who did sex work, it seemed imperative that something must be done to lessen the spread in a society vulnerable but not yet afflicted. She knew she had to do two principle things:
  1. protect these women from HIV
  2. prevent the spread of HIV in Korea even before it took hold
She and other sisters and volunteers educated themselves on HIV and AIDS. They then gave seminars and lectures in churches and to nurses. The sister felt the nurses were more important to educate than the doctors, because (1) doctors have achieved higher education and don't listen to people with less, but most importantly (2) it is the nurses who do the most interacting with patients and so educating them so they could counsel and advise patients more informedly was considered very important. Then in 1990, the first booklet on HIV awareness was published.

Korean Catholic HIV/AIDS Committee

In 1995, there was the establishment of the Korean Catholic HIV/AIDS Committee, which is comprised of church members (lay, clergy and priests). All of the volunteers were engaged in other full time ministries. The doctor was running a free clinic offereing services to PLWH. A brother was visiting prisoners and took on helping prisoners living with HIV. A sister started visiting PLWHA in hospitals and at their homes. A dentist offered treatment at a Catholic run clinic. And another sister who had severe physical challenges wanted to help also but because of her lack of mobility started counseling one-on-one at her home or by phone.

The objectives of the committee was to set up a system of response for the basic needs of PLWHA; to network and support each other so as to ease the heavy burden of always being the one to provide succor; to encourage more people to become involved; and to educate ourselves while carrying out preventative education.

Back in Miari Texas, the public outcome and appreciation of their work was .... in 1990 (and even today), NO RESPONSE. They were avoided. Not until 1997, when they got a call from Korean Catholic HIV/AIDS Committee did they start getting some external support. The committee offered to stipend them W50,000/mth to help with the Miari Texas work. At that time the sister was converting a small store room into a prayer room, a quiet place for women to spend some time. This was the beginning of Samaria House. However, the first person to come to Samaria House was not a woman, but a man, and soon four men were staying in the tiny house. So in 1999, the sister and those working with her bought an eight-bedroom house for PLWHA. In 2000, Samaria House changed to New Light Community Shelter for Women Living with HIV/AIDS.

Facts of Korea and Its HIV and AIDS Population

The first known case of HIV/AIDS was in 1985. In 2011, there were over 8,544 PLWHA in a population of about 50 million. However, this number reflects the reported or known cases, but in actuality, in Korea there is a very large guestimated population modestly set at 25,000 but in reality, the number is likely to be higher because of shame and therefore underreporting. Men are the primary transmitters of the dreaded disease, and in 2011, men having AIDS was 7,544, eleven times higher than women who reported at 684. In 2011 new infections of AIDS in men was 827, while it was 61 for females. In 2011, there were 148 deaths resulting from AIDS. Since its presence in Korea in 1985 until 2011, 1,514 people in Korea have died from the virus.
The government documents a slow but constant increase in new infections, and on average, two new cases are diagnosed each day. At the UN level, UN Secretary General Ban Ki-Moon gives the quote in his High Level Meeting on AIDS address in June 2011:  "Today we have a chance to end this epidemic once and for all. This is our goal: zero new HIV infections, zero discrimination, and zero AIDS related deaths."
However, as the HIV/AIDS epidemic slows down in Africa, it is on the increase in Asia and the Pacific. There are also more young people being infected. The three zeros seem a long way off. But realistically, the hope can be achieved in Zero Mother to Child Infection set by 2015. [The sister thinks this is achieveable as Korea still has a relatively low HIV rate, and she has known of only two babies with it, one in 2010 and the other in 2011.]
In Korea, it is said that a person diagnosed with HIV has three choices: suicide, leave family and friends, and try to adapt. Many choose one of the former two, suicide probably accounting for more deaths of those with HIV than those dying of the disease. Many others are afraid to come forward for testing even though the first test is anonymous. Even those who knew they are at risk do not come forward. Those risk factors include:
  • men having sex with men (MSM)
  • sex workers
  • those having multiple partners
  • migrant workers
  • young people (because they are experimenting but not knowing "safe sex" measures)
Some world statistics on the outbreak of HIV/AIDS are:
  • 7,400 new infections every day
  • 1,150 children infected every day
  • half of all new infections are in the young, ages 15-24
Responses to HIV/AIDS 
The Korean government is starting to provide more education to enhance HIV/AIDS awareness. However, it seems that less is done at the preventative level than the medical treatment level. Free testing is provided for people at risk, and the first testing is done anonymously. For those diagnosed with HIV there is free Anti-Retroviral Therapy, as well as nurse counseling.
Other Christian groups are responding too: the Salvation Army, shelters and also various second-hand clothing shops. Christian Minister provides hospice and nursing care facilities; they also provide free dental care.
The development of the Catholic ministries started at the organizational level in 1995 with seminars on AIDS prevention. In 1997 the first shelter for AIDS patients was built (operated by our sister speaker). From 2000 to the present, three live-in shelters have been established, which evolved into three day centers offering various programs, which led to the establishment of 2 hospitals with limited beds for hospice care.
In 2009 the Korean Catholic Red Ribbon Corporation (한국가톨릭레드리본) was established by the Korean Catholic HIV/AIDS Committee. The Red Ribbon Corporation is now the central Catholic body working with HIV/AIDS and most brothers and sisters in Korea try to work through this organized body. So far, one group home has been established, three day centers, and three shelters. The activities in the shelters are to provide 24-hour care for a limited period and to make efforts to:
  • raise self confidence
  • provide spiritual and psychological healing
  • retrain, where necessary, for individuals to return to the work force and live independent and useful lives in mainstream society
The Treatment: HAART
The treatment often called HAART (HIV/AIDS Anti-Retroviral Therapy) is intended to recover the immune system and reduce the number of viruses in the blood. There are three important advantages to using this treatment, provided the virus is caught in time:
  • recovery of health
  • 95% reduction rate in the spread of the virus
  • reduction rate in mother-child infection
However, there are drawbacks in administering the medication. Not all indivuals can stomach this strong medication and taking it means following a regemented schedule to keep the antriviral drugs high in the blood to check the further spread of the disease. Also, over 60% of the people with HIV/AIDS are discovered when they come to the hospital for other ailments or when they are already seriously ill. The medication also is NOT a cure, but merely can keep the virus under control, but with the regular and timely use of the medication, HIV/AIDS can now be seen as a chronic condition like diabetes or high blood pressure instead of the destined-to-iminently-die disease it once signified.
Problems for PLWHA in regard to employment are the absolute need for annual/regular checkups and make frequent trips to the hospital. PLWHA fear others seeing them take their medication or will see them with the government-provided free medical card, which is labeling. PLWHA sometimes become too weak to work, don't respond to the medicine because they were diagnosed too late, develop other chronic conditions because of their weakened immune system, and find it very difficult to maintain the timely medication-taking schedule. PLWHA are often rejected by family and friends; they often have no one to talk with as they must keep their difficulties private or others fear or are shamed by the topic. PLWHA suffer from depression and often alcoholism, and then for the alcoholics going to AA for treatment, there would be great stigma to talk about their HIV/AIDS infection so their problems are never discussed or addressed and without identifying and treating the core problem, their social problems can never be resolved.
HIV/AIDS can be prevented. The first stage prevention methods are through safe sexual practices, abstenance before marriage, faithfullness after marriage, and the education and encouragement for people to delay sexual intercourse. Second stage prevention steps include male circumcision which reduces the passing of AIDS by 40%, the use of condoms although this is not 100% safe and because of alcohol and other factors, condoms are often used ineffectively.
Up until 2009 foreigners who tested positive with HIV were deported, and the outcome of that was the reluctance to come forward and yet the continual sexual practices furthering infection in society. When many foreigners did finally come forward, they were in the final stages of AIDS and many were too sick to return home and so died in Korea. In 2009, the policy on deporting foreigners with AIDS changed and the act of deportation was revoked. Though they are still reluctant to come forward, and many still wait till very ill, there is still effective treatment. And as they have no money when they are discharged from the hospital and have no place to go, the Shelter can take them in for a limited amount of time. They are given pocket money but after 6-9 months, they must return to their home country. The Shelter provides them with travel fare and puts them in contact with HIV/AIDS centers in their own country.
There is also an education program for migrant workers, KINHA, as the migrants are considered at very high risk. KINHA (Korean Interfaith Network on HIV/AIDS) was set up in April 2011 in a joint effort between the Salvation Army and the Catholic church, but it is not limited to Catholic volunteers but is rather interdenominational, being also represented by Protestants, Won Buddhist, Chogye Buddhists and others. This education movement was started to dispel fears and prejudices about HIV/AIDS, and the current research on the impact of the stigma and prejudice of PLWHA is being done through interviews of women LWHA, questionnaires filled out by social workers and students, and also questionnaires completed by PLWHA.
Some other facts the sister shared concerning HIV/AIDS are:
  • it takes 3-10 years before the symptoms appear but during that time a person can infect others
  • in sexual contact, according to research, 1 in 100 gets infected
  • in sexual contact with HIV-infected blood, about 100% chance of getting infected
  • sharing noodles, tattoos and body piercing, unless blood is involved, does not spread the infection; however, these behaviors are not recommended
  • mother-to-child infections by carrying the child, by vaginal birth, and by breast feeding register a 30% chance of infection
  • medical accidents (doctors or nurses getting stuck by needles) can result in the spread (the sister commented that as yet not one case in Korea has been the result of a medical accident)
  • HIV/AIDS cannot be transmitted by tears, sweat, saliva (if there are no cavities), cup sharing, bathing together, hand shaking, coughing or sneezing, or even by mosquitos
  • What is not recommended is the sharing of razors, toothbrushes, nail clippers (because of where the cuticle is cut and then the tool may not be sterilized)
In our immune system there are cells called CD4. These cells fight off infection and disease. The HIV virus directly attacks these cells. Therefore, a nourishing diet feeds and nurtures the body's cells, so eating well does ironically serve also as a kind of preventative.
The last piece of trivis is that today, Dec 1, is AIDS day in Korea. Hence, waiting for a few months to post this presentation on a most propitious day!

Dec 1 - AIDS day in Korea

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