Tag: CDC

We Beretta Do Something: Gun Violence, Public Health & Their Discontents

 

doctor-gun. Source: spacecoastdaily.com, Creative Commons

Continuing the Institute for Human Rights’ blog series on gun violence, this contribution illuminates a public health lens, offering an evidence-based analysis and pragmatic solutions to the U.S. gun violence epidemic.

Following the February mass shooting at Marjory Stoneman Douglas High School (Parkland, FL) that resulted in 17 fatalities, mainstream fervor on U.S. gun violence has, once again, returned. Parkland Students have utilized their recent tragedy as a platform to demand an end to gun violence and mass shootings, stressing why their lives matter. According to Amnesty International, the world’s largest grassroots human rights organization, U.S. gun violence is a human rights crisis. Human rights are protected and enforced by international and national policy, and with the U.S. government marshalling many of these treaties and laws, it is, too, culpable of upholding such rights.

The nation’s leading science-based voice for the public health profession, the American Public Health Association (APHA), claims gun violence is one of the leading causes of premature death in the U.S., killing over 38,000 people and injuring nearly 85,000 annually. Gun violence can not only affect people of all backgrounds but disproportionately impacts young adults, men and racial/ethnic minority groups. Recently, Parkland Students teamed with students in Chicago to address inner-city gun violence, a phenomenon commonly overlooked by the media while addressing its threat on young lives. Though most gun violence is not an agent to mass shootings, the APHA claims, in 2017, there were 346 mass shootings in the U.S., killing 437 as well as injuring 1,802.

Furthermore, the American Medical Association (AMA), who leads innovation for improving the U.S. health care system, labeled gun violence “A Public Health Crisis”. At their 2016 Annual Meeting of House Delegates, the AMA actively lobbied Congress to overturn legislation that averts the Centers for Disease Control and Prevention (CDC) from researching gun violence. The CDC is one of the leading institutions of the Department of Health Human Services (DHHS), working 24/7 to protect Americans from foreign and native health threats, whether they be chronic, acute, curable or preventable, accidental or intentional. Ultimately, the CDC protects U.S. national security and critical science is imperative to addressing health threats.

According to the Union of Concerned Scientists, a 1993 CDC-funded study published by the New England Journal of Medicine found that firearms in the home increased the risk of homicide in the household, as opposed to home protection. This galvanized the National Rifle Association (NRA), a major force in U.S. gun rights and education, to campaign against the CDC and its “anti-gun propaganda”.

In response to this 1993 publication and the NRA’s support, Congress in 1996 passed an appropriations bill known as the Dickey Amendment, named after former Arkansas congressman and NRA member Jay Dickey, which states, “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” Almost two decades and thousands of tragedies later, Dickey renounced these restrictions in 2015 by claiming, “Research could have been continued on gun violence without infringing on the rights of gun owners, in the same fashion that the highway industry continued research without eliminating the automobile.” Despite this humility, the Dickey Amendment persists, curtailing efforts to address gun violence in the U.S.

a picture of a Beretta handgun
Beretta 9000S. Source: James Case, Creative Commons

In the U.S., a common method to circumvent the argument that guns extrapolate acts of violence is to scapegoat people with mental illness. The American Psychiatric Association (APA), the leading voice and conscience of modern psychiatry in the U.S., recently published a book on gun violence and mental health. Specifically, they address the topic of mass shootings and mental illness.

Some popular misperceptions are:

  • Mass shootings by people with serious mental illness represent the most significant relationship between gun violence and mental illness.
  • People with serious mental illness should be considered dangerous.
  • Mass shooting will be effectively prevented with gun laws focusing on people with mental illness.
  • Gun laws focusing on people with mental illness, or a psychiatric diagnosis, are reasonable, even if they perpetuate current mental illness stigma.

On the other hand, it is evidence-based that:

  • Mass shootings by people with serious mental illness represent less than 1% of all annual gun-related homicides.
  • People with serious mental illness contribute to an overall 3% of violent crimes. An even smaller percentage of them are found to involve firearms.
  • Laws for reducing gun violence that focus on the previously mentioned 3% will be extremely low yield, ineffective, and wasteful of resources.
  • The myth that mental illness leads to violence is perpetuated by gun restriction laws focusing on people with mental illness, as well as the misunderstanding that gun violence and mental illness are strongly linked.

However, a significant caveat related to mental illness and gun violence is suicide. The American Foundation for Suicide Prevention (AFSP), who funds research and offers education on suicide, claims depression is one of the most treatable psychiatric illnesses yet is seen in over 50% of people who die by suicide. Suicide lays in the shadow of repetitive, media-frenzied mass shootings, while representing nearly two-thirds of gun-related deaths in the U.S. Harvard University T.H. Chan School of Public Health indicate a number of factors that define lethality of suicide methods, including inherent deadliness, ease of use, accessibility, ability to abort mid-attempt and acceptability — all attributable to gun ownership and usage, specifically in the U.S.  To strengthen civil discourse on gun-related deaths and injuries, we must uphold a national platform for suicide prevention, too. If you or a loved one is experiencing a suicidal crisis or emotional distress, the National Suicide Prevention Lifeline is 1-800-273-8255 (available 24/7).

Last year, researchers at Johns Hopkins University School of Medicine analyzed data from the Nationwide Emergency Department (ER) sample between 2006-2014 and concluded the U.S. accumulates an annual $2.8 billion in hospitals bills from gunshot wounds, with an average ER cost of $5,254 and approximately $96,000 in follow up care per patient. This study was limited because data was only used for gunshot victims who arrived at the hospital alive; people who did not seek medical treatment or were dead on arrival were not counted. Furthermore, after accounting for lost earnings, rehabilitative treatment, security costs, investigations, funerals, etc., a 2015 Mother Jones report estimated gun violence cost Americans $229 billion annually.

The APHA insists gun violence is not inevitable but preventable, and suggests core public health activities are capable of interrupting the transmission of gun violence. Notable ways to curb gun violence are:

  1. Better Surveillance
    • Increased congressional funding of The National Violent Death Reporting System which is currently employed in 40 U.S. states, D.C. and Puerto Rico.
  2. More Research
    • Lifting restrictions on federal funding for research on gun violence. There is barely any credible evidence on the effect of right-to-carry laws.
  3. Common-Sense Gun Policies
    • Criminal background check on all firearms purchases. This includes gun show and internet purchases.
  4. Expanded Access to Mental Health Services
    • Funding for mental health services has declined, so increased financial support for the Substance Abuse and Mental Health Services Administration (SAMHSA) is advised.
  5. Resources for School and Community-Based Prevention
    • Intervention and preparedness programming to prevent gun violence and other emergencies in communities, namely schools.
  6. Gun Safety Technology
    • Innovation that prevents illegitimate gun access and misuse such as unintentional injuries.

If the above prescriptions are not followed, the tragedies will likely continue. So, it is imperative we support leaders who will encourage gun policy that protects public health and our right to life. Tomorrow, March 24, 2018, people across the world will March For Our Lives, demanding the lives of kids and families, amidst the controversy circling around gun violence, become prioritized.

A march for our lives, your life and mine is exactly what the doctor ordered.

HIV and Human Rights

People and Places. Source: Ted Eytan, Creative Commons

The history of the HIV and AIDS epidemic started in illness, anxiety and mortality as the world encountered and handled a new and unidentified virus. It is commonly believed that HIV begun in Kinshasa, in the Democratic Republic of Congo around 1920 transmitted from chimpanzees to humans. The original earliest case where a blood sample could confirm the infection of HIV was from a blood sample taken in 1959 from a man living in the Kinshasa region.  Available records suggests that the rampant spread of HIV and contemporary epidemic started in the mid- to late 1970s. During the 1980s, the HIV pandemic spread across South America, North America, Australia, Africa and Europe. The progress and efforts made in the last 30 years to prevent the disability and mortality due to HIV have been enormous. Despite the tremendous improvements regarding HIV research and support, progress remains hindered by numerous challenges. Originally, HIV was identified and diagnosed in men who have sex with men, people who inject drugs, and sexually active people such as sex workers. HIV was perceived and declared a disease only deviant people get because they engage in inappropriate behavior; therefore, HIV and people infected with HIV have been subjected to a corresponding negative social image. Research and education has aided in countering the negative association of HIV transmittance. The CDC explains HIV transmittance takes place via “only certain body fluids—blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluids, vaginal fluids, and breast milk—from a person who has HIV can transmit HIV.” People impacted by HIV, regardless of how it was transmitted, withstand constant stigmatization, discrimination and violations of their basic human rights. There is an inseparable link between human rights and HIV is now extensively acknowledged and accepted.

“Protecting, promoting, respecting and fulfilling people’s human rights is essential to ensure that they are able to access these services and enable an effective response to HIV and AIDS.”

-Avert Society

Human rights treaties and laws play an essential role in protecting the rights of HIV positive populations. The Universal Declaration of Human Rights (UDHR), Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), and the International Covenant on Economic, Social and Cultural Rights (ICESCR) are all important documents that thoroughly elaborate the rights of all people, which include HIV positive individuals.  Article 25 of the UDHR, Articles 10 – 12, and 14 of the CEDAW, and lastly Article 12 of the ICESCR all secure the human right of healthcare and the prevention, treatment and control of diseases. Finally, the ICESCR and the UDHR secures employment, cultural and community participation rights for individuals regardless of age, disabilities, illness, or any form of discrimination.

Human rights violations in the context of HIV

Access to health care services

In 2015, 36.7 million people are currently living with HIV/AIDS, with the majority of HIV/AIDS positive individuals– 25.5 million – living in sub-Saharan Africa. Today, in 2017, only 46% of HIV positive adults and 49% of HIV positive children worldwide are receiving treatment, with large gaps in access to HIV testing and treatment in Africa and the Middle East. Individuals living in low-middle income locations face constant financial, social and logistical barriers to accessing diagnostic services and treatment. Some of the main obstacles individuals of lower income families’ face include the high costs of medical services, the lack of local and nearby health care facilities, and the inability to leave work to visit the doctor. vert Society asserts that stigma and discrimination from community and family influences the utilization of HIV healthcare services by HIV positive individuals. Additionally, the criminalization of HIV is also significantly affecting the access to HIV health care services. In 2014, 72 countries have implemented laws that allow HIV criminalization. Criminalization laws are usually either HIV specific, or either HIV is just one of the diseases covered by the law. HIV criminalization laws normalize, instigate and allow discrimination and stigma towards HIV positive individuals. HIV criminalization laws and socio-ecological barriers undermine HIV prevention efforts and do not decrease the rates of HIV.

Our Lives Matter !! Anti-LGBTI Laws Stall HIV Prevention. Source: Alsidare Hickson, Creative Commons

Criminalization of men who have sex with men (MSM)

Currently, 76 countries around the world continue to criminalize same-sex conduct. Having these laws set up really discourages MSM and the public to get tested for HIV, transition into treatment, and disclose their information due to possible discrimination and arrest. A comparison between nations with anti-homosexuality laws and nations without such law shows considerably higher HIV prevalence rates among MSM in countries with anti-homosexuality laws compared to nations without such legislation. For example, Jamaica has strict anti-buggery laws but has a prevalence of HIV in over 30% of MSM, compared to Cuba that lacks anti-buggery and has a prevalence of HIV in less than 5% of MSM. These laws also make it particularly problematic for organizations providing sexual health and HIV services to reach men who have sex with men. Further research is needed to clarify the correlation between the criminalization of same-sex conduct and rates of HIV.  The criminalization of MSM ultimately ignores the fact that HIV can be transmitted through various ways such as unintentional exposure, mother-to-child, and non-disclosure of HIV status which results in individuals not seeking health care services due to the fear of people assuming HIV was transmitted through a different route than how it was actually transmitted.

Gender Inequality

HIV disproportionately affects women and young girls because of unequal cultural, social, and economic standing in society. Gender based violence (GBV) is normalized in many societies. GBV such as rape, trafficking and early marriage makes it more difficult for women and adolescent girls to protect themselves against HIV. Women do not have power over sexual intercourse encounters. Women, in many cultures, are economically dependent on their male counterparts, making it increasingly difficult to choose their lifestyle choices. Additionally, due to the imbalanced gender power dynamic, women do not have control over family planning services, sex-based community rituals, or the choice to participate in safe sex. Studies reveal the impact of gender-based discrimination and HIV. According to one study, women living in Sub-Saharan Africa, on average have a 60% higher risk of HIV infection than their male counterparts. Another study analyzed the role of gender power imbalance on women’s ability to discuss self-protection against HIV/AIDS in Botswana and South Africa. Results concluded that “women with partners 10 or more years older than them, abused women, and those economically dependent on their partners who are less likely to suggest condom use to their partners. Gender power imbalance also influences men’s inclination towards refusing to use the suggested condom.” There is a great need to focus on women education, empowerment and self-confidence to suggest condoms, and lastly to educate and encourage men about safe sex. Gender inequalities towards women are addressed in the CEDAW; therefore, publicly and legislatively addressing the issues could significantly reduce HIV.

Millions of people have lost their lives fighting to make sure HIV positive people are able to live a long, healthy and quality filled lives. Even though we live in a country that does provide HIV healthcare services, the prevalence of HIV in the USA is still relatively high. The Human Rights Campaign reported in 2014 that Birmingham, Alabama had one of the highest rate of infection in the nation; however, the latest CDC report Birmingham is presently 12th, citing a myriad of reasons including a lack of sex education. We have and opportunity and need to stand up for each other, advocating for education and equality. There are various ways to get involved in advocating for human rights and HIV in our Birmingham community, including volunteering at local clinics: 1917 Clinic or Birmingham Aids Outreach.  If you’re sexually active, you can help prevent the spread of HIV by knowing your status, getting tested, and talking openly about HIV. Constructive conversations aid in removing the stigma and fear attached to HIV because it becomes a part of the social discourse. An HIV/AIDS prognosis is a life changing event, not a life ending moment.