This is a man who, as governor of Indiana, signed into law an abortion bill that is among the most restrictive in the country. He also permitted discrimination against the LGBTQ community in his state.
But wait, there’s more. He tried to block the resettlement of Syrian refugees in Indiana and cut off federal aid to existing refugees — and he believes in stripping judges of their discretion in drug-crime sentencing. His record as being anti-science is even more chilling.
Perhaps the only good that will come from this appointment and other missteps by the present administration is that President Trump is voted out of office in November.
Randy Farhi, Los Angeles
To the editor: On Wednesday, Trump put Pence in charge of the administration’s public health response to the coronavirus.
Autonomy for the Swazis of southern Africa was guaranteed by the British in the late 19th century; independence was granted in 1968. Student and labor unrest during the 1990s pressured King MSWATI III, the world’s last absolute monarch, to grudgingly allow political reform and greater democracy, although he has backslid on these promises in recent years. A constitution came into effect in 2006, but political parties remain banned. The African United Democratic Party tried unsuccessfully to register as an official political party in mid 2006. Talks over the constitution broke down between the government and progressive groups in 2007. Swaziland recently surpassed Botswana as the country with the world’s highest known HIV/AIDS prevalence rate.
Artifacts indicating human activity dating back to the early Stone Age 200,000 years ago have been found in the kingdom of Swaziland. Prehistoric rock art paintings date from ca. 25,000 B.C. and continue up to the 19th century.
The earliest inhabitants of the area were Khoisan hunter-gatherers. They were largely replaced by the Bantu tribes during Bantu migrations. Evidence of agriculture and iron use dates from about the 4th century, and people speaking languages ancestral to current Sotho and Nguni languages began settling no later than the 11th century.
The ruling Dlamini lineage had chiefships in the region in the 18th century. An enlarged Swazi (occasionally also written as Suozi) kingdom was established by King Sobhuza I in the early 19th century. Soon thereafter the first whites started to settle in the area. In the 1890s the South African Republic in the Transvaal claimed sovereignty over Swaziland but never fully established power. After the Second Boer War of 1899–1902, Swaziland became a British protectorate. The country was granted independence within the Commonwealth of Nations on 6 September 1968. Since then, Swaziland has seen a struggle between pro-democracy activists and the monarchy.
Swaziland has been under a State of Emergency since 1973.
Location: Southern Africa, between Mozambique and South Africa
Geographic coordinates: 26 30 S, 31 30 E
Map references: Africa
Area: total: 17,363 sq km
land: 17,203 sq km
water: 160 sq km
Area – comparative: slightly smaller than New Jersey
Land boundaries: total: 535 km
border countries: Mozambique 105 km, South Africa 430 km
Coastline: 0 km (landlocked)
Maritime claims: none (landlocked)
Climate: varies from tropical to near temperate
Terrain: mostly mountains and hills; some moderately sloping plains
Elevation extremes: lowest point: Great Usutu River 21 m
highest point: Emlembe 1,862 m
Natural resources: asbestos, coal, clay, cassiterite, hydropower, forests, small gold and diamond deposits, quarry stone, and talc
Land use: arable land: 10.25%
permanent crops: 0.81%
other: 88.94% (2005)
Irrigated land: 500 sq km (2003)
Total renewable water resources: 4.5 cu km (1987)
Freshwater withdrawal (domestic/industrial/agricultural): total: 1.04 cu km/yr (2%/1%/97%)
per capita: 1,010 cu m/yr (2000)
Natural hazards: drought
Environment – current issues: limited supplies of potable water; wildlife populations being depleted because of excessive hunting; overgrazing; soil degradation; soil erosion
Environment – international agreements: party to: Biodiversity, Climate Change, Climate Change-Kyoto Protocol, Desertification, Endangered Species, Hazardous Wastes, Ozone Layer Protection
signed, but not ratified: Law of the Sea
Geography – note: landlocked; almost completely surrounded by South Africa
The head of state is the king or Ngwenyama (lit. Lion), currently King Mswati III, who ascended to the throne in 1986 after the death of his father King Sobhuza II in 1982 and a period of regency. By tradition, the king reigns along with his mother or a ritual substitute, the Ndlovukati (lit. She-Elephant). The former was viewed as the administrative head of state and the latter as a spiritual and national head of state, with real power counter-balancing that of the king, but during the long reign of Sobhuza II the role of the Ndlovukati became more symbolic. As the monarch, the king not only appoints the prime minister — the head of government — but also appoints a small number of representatives for both chambers of the Libandla (parliament). The Senate consists of 30 members, while the House of Assembly has 82 seats, 55 of which are occupied by elected representatives, (elections are held every five years in November).
In 1968, Swaziland adopted a Westminster-style constitution, but in 1973 King Sobhuza suspended it under a royal decree backed by the royalist majority of parliament: in effect a coup by the government against its own constitution. The State of Emergency has since been lifted, or so the government claims even though political activities, especially by pro-democracy movements, are suppressed. In 2001 King Mswati III appointed a committee to draft a new constitution. Drafts were released for comment in May 2003 and November 2004. These were strongly criticized by civil society organizations in Swaziland and human rights organizations elsewhere. In 2005, the constitution was put into effect, though there is still much debate in the country about the constitutional reforms. From the early seventies, there was active resistance to the royal hegemony.
Despite calls for international solidarity against the oppressive royal regime, Swaziland’s human rights record remains largely ignored by the international community. The South African trade union COSATU has been the most vocal supporters of the rights of the Swazi people to govern themselves by democratic means, in line with the Freedom Charter adopted by democratic parties on the country.
In 2007 a film entitled Without the King about the political climate of Swaziland was released.
note: estimates for this country explicitly take into account the effects of excess mortality due to AIDS; this can result in lower life expectancy, higher infant mortality, higher death rates, lower population growth rates, and changes in the distribution of population by age and sex than would otherwise be expected (July 2008 est.)
Age structure: 0-14 years: 39.9% (male 226,947/female 222,922)
15-64 years: 56.5% (male 306,560/female 331,406)
65 years and over: 3.6% (male 15,594/female 25,385) (2008 est.)
Median age: total: 18.7 years
male: 18 years
female: 19.4 years (2008 est.)
Population growth rate: -0.41% (2008 est.)
Birth rate: 26.6 births/1,000 population (2008 est.)
Death rate: 30.7 deaths/1,000 population (2008 est.)
Net migration rate: NA (2008 est.)
Sex ratio: at birth: 1.03 male(s)/female
under 15 years: 1.02 male(s)/female
15-64 years: 0.92 male(s)/female
65 years and over: 0.61 male(s)/female
total population: 0.95 male(s)/female (2008 est.)
Infant mortality rate: total: 69.59 deaths/1,000 live births
male: 72.87 deaths/1,000 live births
female: 66.2 deaths/1,000 live births (2008 est.)
Life expectancy at birth: total population: 31.99 years
male: 31.69 years
female: 32.3 years (2008 est.)
Total fertility rate: 3.34 children born/woman (2008 est.)
HIV/AIDS – adult prevalence rate: 38.8% (2003 est.)
HIV/AIDS – people living with HIV/AIDS: 220,000 (2003 est.)
HIV/AIDS – deaths: 17,000 (2003 est.)
Major infectious diseases: degree of risk: intermediate
food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
vectorborne disease: malaria
water contact disease: schistosomiasis (2008)
Nationality: noun: Swazi(s)
Ethnic groups: African 97%, European 3%
Religions: Zionist 40% (a blend of Christianity and indigenous ancestral worship), Roman Catholic 20%, Muslim 10%, other (includes Anglican, Bahai, Methodist, Mormon, Jewish) 30%
Languages: English (official, government business conducted in English), siSwati (official)
Literacy: definition: age 15 and over can read and write
total population: 81.6%
female: 80.8% (2003 est.)
School life expectancy (primary to tertiary education): total: 10 years
male: 10 years
female: 10 years (2005)
Education expenditures: 7% of GDP (2005)
Country name: conventional long form: Kingdom of Swaziland
conventional short form: Swaziland
local long form: Umbuso weSwatini
local short form: eSwatini
Government type: monarchy
Capital: name: Mbabane
geographic coordinates: 26 18 S, 31 06 E
time difference: UTC+2 (7 hours ahead of Washington, DC during Standard Time)
note: Lobamba (royal and legislative capital)
Administrative divisions: 4 districts; Hhohho, Lubombo, Manzini, Shiselweni
Independence: 6 September 1968 (from UK)
National holiday: Independence Day, 6 September (1968)
Constitution: signed by the King in July 2005 went into effect on 8 February 2006
Legal system: based on South African Roman-Dutch law in statutory courts and Swazi traditional law and custom in traditional courts; accepts compulsory ICJ jurisdiction with reservations
Suffrage: 18 years of age
Executive branch: chief of state: King MSWATI III (since 25 April 1986)
head of government: Prime Minister Barnabas Sibusiso DLAMINI (since 16 October 2008)
cabinet: Cabinet recommended by the prime minister and confirmed by the monarch
elections: the monarch is hereditary; prime minister appointed by the monarch from among the elected members of the House of Assembly
Legislative branch: bicameral Parliament or Libandla consists of the Senate (30 seats; 10 members appointed by the House of Assembly and 20 appointed by the monarch; to serve five-year terms) and the House of Assembly (65 seats; 10 members appointed by the monarch and 55 elected by popular vote; to serve five-year terms)
elections: House of Assembly – last held 19 September 2008 (next to be held in 2013)
election results: House of Assembly – balloting is done on a nonparty basis; candidates for election are nominated by the local council of each constituency and for each constituency the three candidates with the most votes in the first round of voting are narrowed to a single winner by a second round
Judicial branch: High Court; Supreme Court; judges for both courts are appointed by the monarch
Political parties and leaders: the status of political parties, previously banned, is unclear under the new (2006) Constitution and currently being debated – the following are considered political associations; African United Democratic Party or AUDP [Stanley MAUNDZISA, president]; Imbokodvo National Movement or INM; Ngwane National Liberatory Congress or NNLC [Obed DLAMINI, president]; People’s United Democratic Movement or PUDEMO [Mario MASUKU, president]
Political pressure groups and leaders: Swaziland Federation of Trade Unions; Swaziland and Solidarity Network or SSN
International organization participation: ACP, AfDB, AU, C, COMESA, FAO, G-77, IBRD, ICAO, ICRM, IDA, IFAD, IFC, IFRCS, ILO, IMF, Interpol, IOC, ISO (correspondent), ITSO, ITU, ITUC, MIGA, NAM, OPCW, PCA, SACU, SADC, UN, UNCTAD, UNESCO, UNIDO, UNWTO, UPU, WCO, WHO, WIPO, WMO, WTO
Diplomatic representation in the US: chief of mission: Ambassador Ephraim Mandla HLOPHE
chancery: 1712 New Hampshire Avenue, NW, Washington, DC 20009
telephone:  (202) 234-5002
FAX:  (202) 234-8254
Diplomatic representation from the US: chief of mission: Ambassador Maurice S. PARKER
embassy: Central Bank Building, Mahlokahla Street, Mbabane
mailing address: P. O. Box 199, Mbabane
telephone:  404-6441 through 404-6445
FAX:  404-5959
Flag description: three horizontal bands of blue (top), red (triple width), and blue; the red band is edged in yellow; centered in the red band is a large black and white shield covering two spears and a staff decorated with feather tassels, all placed horizontally
The African nation of Swaziland, located in between South Africa and Mozambique, is an ancient land dominated by the Swazi people and ethnic Swazi music. They are known for a variety of folk music, as well as modern rock, pop and hip hop.
The two biggest ceremonies in Swaziland are Incwala, which takes place in December, and Umhlanga, which takes place in August. Umhlanga features a dance unique to Swazi women, who cut reeds as part of the five-day ceremony. There is also music for harvesting, marriages and other events. Traditional instruments include the kudu horn, calabash, rattles and reed flute.
Beginning in the 1990s, Swaziland became host to a burgeoning hip hop scene, led by bands like Vamoose. Neighboring South Africa has provided some of the impetus, since various kinds of hip hop are very popular there.
Economy – overview: In this small, landlocked economy, subsistence agriculture occupies approximately 70% of the population. The manufacturing sector has diversified since the mid-1980s. Sugar and wood pulp remain important foreign exchange earners. In 2007, the sugar industry increased efficiency and diversification efforts, in response to a 17% decline in EU sugar prices. Mining has declined in importance in recent years with only coal and quarry stone mines remaining active. Surrounded by South Africa, except for a short border with Mozambique, Swaziland is heavily dependent on South Africa from which it receives more than nine-tenths of its imports and to which it sends 60% of its exports. Swaziland’s currency is pegged to the South African rand, subsuming Swaziland’s monetary policy to South Africa. Customs duties from the Southern African Customs Union, which may equal as much as 70% of government revenue this year, and worker remittances from South Africa substantially supplement domestically earned income. Swaziland is not poor enough to merit an IMF program; however, the country is struggling to reduce the size of the civil service and control costs at public enterprises. The government is trying to improve the atmosphere for foreign investment. With an estimated 40% unemployment rate, Swaziland’s need to increase the number and size of small and medium enterprises and attract foreign direct investment is acute. Overgrazing, soil depletion, drought, and sometimes floods persist as problems for the future. More than one-fourth of the population needed emergency food aid in 2006-07 because of drought, and nearly two-fifths of the adult population has been infected by HIV/AIDS.
GDP (purchasing power parity): $5.364 billion (2007 est.)
GDP (official exchange rate): $2.936 billion (2007 est.)
GDP – real growth rate: 2.3% (2007 est.)
GDP – per capita (PPP): $4,700 (2007 est.)
GDP – composition by sector: agriculture: 11.8%
services: 42.5% (2007 est.)
Labor force: 300,000 (2006)
Labor force – by occupation: agriculture: NA%
Unemployment rate: 40% (2006 est.)
Population below poverty line: 69% (2006)
Household income or consumption by percentage share: lowest 10%: 1.6%
highest 10%: 40.7% (2001)
Distribution of family income – Gini index: 50.4 (2001)
Investment (gross fixed): 18.6% of GDP (2007 est.)
Budget: revenues: $1.13 billion
expenditures: $1.143 billion (2007 est.)
Fiscal year: 1 April – 31 March
Inflation rate (consumer prices): 8.1% (2007 est.)
Central bank discount rate: 11% (31 December 2007)
Commercial bank prime lending rate: 13.17% (31 December 2007)
Stock of money: $244.8 million (31 December 2007)
Stock of quasi money: $529.4 million (31 December 2007)
Stock of domestic credit: $204.1 million (31 December 2007)
Agriculture – products: sugarcane, cotton, corn, tobacco, rice, citrus, pineapples, sorghum, peanuts; cattle, goats, sheep
Industries: coal, wood pulp, sugar, soft drink concentrates, textiles and apparel
Industrial production growth rate: 1.1% (2007 est.)
Electricity – production: 460 million kWh (2007)
Electricity – consumption: 1.2 billion kWh (2007)
Electricity – exports: 0 kWh (2007)
Electricity – imports: 872 million kWh; note – electricity supplied by South Africa (2007)
Electricity – production by source: fossil fuel: 58%
other: 0% (2001)
Oil – production: 0 bbl/day (2005 est.)
Oil – consumption: 3,500 bbl/day (2005 est.)
Oil – exports: 0 bbl/day (2004)
Oil – imports: 3,530 bbl/day (2004)
Oil – proved reserves: 0 bbl (1 January 2006 est.)
Natural gas – production: 0 cu m (2005 est.)
Natural gas – consumption: 0 cu m (2005 est.)
Natural gas – exports: 0 cu m (2005 est.)
Natural gas – imports: 0 cu m (2005)
Natural gas – proved reserves: 0 cu m (1 January 2006 est.)
Current account balance: -$24 million (2007 est.)
Exports: $1.926 billion f.o.b. (2007 est.)
Exports – commodities: soft drink concentrates, sugar, wood pulp, cotton yarn, refrigerators, citrus and canned fruit
Exports – partners: South Africa 59.7%, EU 8.8%, US 8.8%, Mozambique 6.2% (2006)
Imports: $1.914 billion f.o.b. (2007 est.)
Imports – commodities: motor vehicles, machinery, transport equipment, foodstuffs, petroleum products, chemicals
Imports – partners: South Africa 95.6%, EU 0.9%, Japan 0.9% (2006)
Economic aid – recipient: $46.03 million (2005)
Reserves of foreign exchange and gold: $762.7 million (31 December 2007 est.)
Debt – external: $524 million (31 December 2007 est.)
Stock of direct foreign investment – at home: $NA
Stock of direct foreign investment – abroad: $NA
Market value of publicly traded shares: $196.8 million (2005)
Currency (code): lilangeni (SZL)
Currency code: SZL
Exchange rates: lilangenis (SZL) per US dollar – 7.4 (2007), 6.85 (2006), 6.3593 (2005), 6.4597 (2004), 7.5648 (2003)
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(Epoch Times is based in New York City and mainly focuses on China news)
At least 421 people have been sickened and 16 have been killed during an outbreak of Hepatitis A in San Diego as of Sept. 12, 2017.
Some 292 people of the 421 were hospitalized due to the illness, according to the San Diego County Health and Human Services Agency’s latest figures, released Tuesday.
“This is an outbreak of unprecedented proportion, and we have not seen an outbreak of this nature as relates to hepatitis A before,” said Dr. Wilma Wooten, San Diego County’s public health director, CNN reported.
Most of the infections—65 percent—are occurring among homeless people, those who use illegal drugs, or both. Another 23 percent of cases occurred in people who associate with homeless people, Wooten explained to the news network.
“Basically, if an individual is infected with hepatitis A and they use the bathroom and don’t wash their hands, and then they can spread or contaminate the environment: door handles, ATMs or whatever they touch,” Wooten said.
Symptoms of the illness—which can be “mild to severe”—can include “fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-colored urine, and jaundice,” according to the World Health Organization.
Wooten was forced to declare a state of emergency in the county on Sept. 1.
“The local emergency was declared to increase and heighten awareness of the seriousness of the outbreak,” she said.
As NPR reported, San Diego officials started washing down sidewalks down with bleach to kill off the bug. The areas sprayed down with bleach are frequented by homeless people.
Mike Saag, a professor of medicine at the University of Alabama, Birmingham, told the broadcaster that San Diego’s bleaching approach is a reasonable one.
Geographic distribution of Hepatitis A prevalence — Red: High : prevalence higher than 8%; orange: Intermediate : between 2% and 7%; grey: Low : less than 2% (Wikipedia)
“If there’s a sanitation problem, then the thing to do is clean up the area, and bleach is probably the best disinfectant that we have for this type of viral infection,” he said.
Wooten, meanwhile, added that more than 21,000 people have been vaccinated.
According to the World Health Organization, the risks are higher where there is:
lack of safe water;
use of recreational drugs;
living in a household with an infected person;
being a sexual partner of someone with acute hepatitis A infection; and
travelling to areas of high endemicity without being immunized.
According to San Diego officials, here is how it’s transmitted:
Touching objects or eating food that someone with HAV infection handled.
Having sex with someone who has a HAV infection.
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In an unexpected turn of events, cows are helping scientists better understand how to prevent HIV infections.
One of the biggest questions facing researchers developing a vaccine against HIV is why people who are infected do not efficiently make antibodies against the virus. Scientists estimate that only about 20% of people who are infected with HIV produce what are called broadly neutralizing antibodies (bNAbs): naturally occurring antibodies that can defend a cell against the virus. Even among people who do produce them, that production typically starts around two years after infection.
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“We are faced with a dilemma,” says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID) , whose agency is supporting the new research. “People infected do not seem to make really good antibodies in terms of potency and breadth.”
So far, scientists have been unable to successfully induce the creation of bNAbs in humans through an HIV vaccine. This is where the cows come in.
The researchers injected four calves with HIV immunogens, which are proteins designed to elicit an immune response to the virus. They discovered that the cows very rapidly developed bNAbs to HIV in their blood.
“I was shocked,” says study author Devin Sok, the director of antibody discovery and development at IAVI . “It was really crazy and very exciting. The responses developed very quickly — between one to two months — which is well beyond what we anticipated.”
The researchers were able to isolate antibodies from the calves and took a closer look. An antibody called NC-Cow 1 was revealed to be especially powerful when it came to attacking HIV.
“The kind of insight we get from studying this is an understanding ofthe mechanisms whereby the cows’ immune system is capable of creat ing these antibodies,” says Fauci.
Understanding how an immune system effectively develops antibodies against HIV, even if it belongs to a cow, is valuable information for scientists hoping to develop an HIV vaccine, especially if they can find a way to get the human body to mimic the creation of these antibodies. The new research also provides insight into how to develop new therapies or treatments for viruses that evade the human immune system.
“As a scientist, this is really exciting,” says Sok. “To put it into perspective, the first broadly neutralizing antibodies were discovered in the 1990s. Since then, we’ve been trying to elicit these antibodies through immunization, and we’ve never been able to do it until now. Until we have immunized a cow. This has given some information for how to do it so that hopefully we can apply that to humans.”
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(THIS ARTICLE IS COURTESY OF THE SAN FRANCISCO CHRONICLE)
The first hints of an uncertain future for the Presidential Advisory Council on HIV/AIDS came last year, when Donald Trump’s presidential campaign refused to meet with advocates for people living with HIV, said Scott Schoettes, a member of the council since 2014.
That unease was magnified on Inauguration Day in January, when an official White House website for the Office of National AIDS Policy vanished, Schoettes said.
“I started to think, was it going to be useful or wise or would it be possible to work with this administration?” Schoettes told The Washington Post. “Still, I made a decision to stick it out and see what we could do.”
Less than six months later, Schoettes said those initial reservations had given way to full-blown frustration over a lack of dialogue with or caring from Trump administration officials about issues relating to HIV or AIDS.
Last Tuesday, he and five others announced they were quitting Presidential Advisory Council on HIV/AIDS, also known as PACHA. According to Schoettes, the last straw – or “more like a two-by-four than a straw” – had come in May, after the Republican-dominated House of Representatives passed the American Health Care Act, which he said would have “devastating” effects on those living with HIV.
Photo: Evan Vucci, Associated Press
President Donald Trump speaks at an event in Miami.
“The Trump Administration has no strategy to address the on-going HIV/AIDS epidemic, seeks zero input from experts to formulate HIV policy, and – most concerning – pushes legislation that will harm people living with HIV and halt or reverse important gains made in the fight against this disease,” Schoettes wrote in a blistering guest column for Newsweek announcing the resignations.
The column also pointed out that Trump has still not appointed anyone to head the White House Office of National AIDS Policy, which former president Barack Obama had done 36 days after his own inauguration.
“Within 18 months, that new director and his staff crafted the first comprehensive U.S. HIV/AIDS strategy. By contrast, President Trump appears to have no plan at all,” Schoettes wrote. “Public health is not a partisan issue … If the President is not going to engage on the subject of HIV/AIDS, he should at least continue policies that support people living with and at higher risk for HIV and have begun to curtail the epidemic.”
The column was co-signed by the five other members of the council who had resigned, including Lucy Bradley-Springer, Gina Brown, Ulysses W. Burley III, Grissel Granados and Michelle Ogle. As of Monday morning, their bios remained on PACHA’s government website.
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(THIS ARTICLE IS COURTESY OF THE NEWS SITE POLITICO)
When former Indiana Gov. Mike Pence embraced Obamacare’s Medicaid expansion with conservative twists — such as requiring enrollees to contribute to their care — critics lamented poor people would be locked out while backers cheered the program’s focus on personal responsibility.
Neither side’s expectations were quite borne out. Two years later, as the program emerges as a national model thanks to Pence’s role in the Trump administration, the reality on the ground shows what happens when political philosophy collides with the practical challenges of providing health care to tens of thousands of people, many of them in crisis.
Advocates for the poor in Indiana argue that liberal fears of depressed enrollment were overblown. More than 400,000 Hoosiers are enrolled, despite state requirements that low-income residents make nominal monthly contributions to their care or face stiff penalties.
Likewise, Republicans’ contention that the system would promote personal responsibility and prod beneficiaries to ration their care and make better decisions about what treatments to seek also turned out to be overly optimistic.
By all accounts, the expansion — known as the Healthy Indiana Plan 2.0 — has made a difference. Health officials in Scott County, Ind., a poverty-stricken community about 30 miles from Louisville, Ky., paint a picture of a program that’s bolstered a patchy social safety net — especially during a major HIV outbreak triggered by the opioid epidemic — without bankrupting the Hoosier State or punishing enrollees.
To be sure, the program isn’t perfect, they say. But they overwhelmingly give more positive reviews than not.
“I feel that it has been a good success,” said Dawn Sanders, an outreach worker for Covering Kids & Families of Indiana, a statewide consumer group working in Scott County. “It’s working.”
Healthy Indiana’s influence is expected to increase in the months ahead whether or not Obamacare survives, as state officials and the Trump administration look to replicate some of its conservative features, potentially unleashing a wave of new state restrictions on how non-disabled adults get coverage without any action from Congress.
“The Healthy Indiana Plan has long been, and continues to be, a national model for state-led Medicaid reforms,” HHS Secretary Tom Price wrote in response to senators after his confirmation hearing.
“It is important that Medicaid’s design helps its members to transition successfully from the program into commercial health insurance plans, as [Healthy Indiana’s] consumer-driven approach and underlying incentive structures encourage,” he told lawmakers.
Seema Verma, meanwhile, a Pence ally who helped design the program before she was tapped to run CMS, now has the power to give states greater flexibility to reshape their own programs according to conservative principles.
Kentucky and Arizona have already borrowed aspects of Indiana’s plan while others, including Wisconsin, could move to enact new limits that resemble the approach.
Indiana’s plan also provides a measure of political cover to lawmakers in red states where supporting Obamacare’s coverage expansion is still deeply controversial. Republicans across the country have found it easier to back an expansion of government-funded health care for the poor if it more closely resembles a private insurance market. Yet liberals remain deeply skeptical because of the way the system is designed to cut people off who don’t make monthly payments, at least temporarily.
Both sides could find their assumptions challenged based on the experience in places like Scott County.
The Indiana plan does punish people above the poverty line who stop making monthly contributions by locking them out of coverage for six months. But because most enrollees have incomes below the poverty line, lockouts have been rare, according to state evaluations of the first year of the program. Instead, those below the poverty line who don’t pay are bumped from plans with more generous benefits — including coverage of vision and dental care and better prescription drug benefits — into skimpier plans with higher out-of-pocket costs.
“It sounds like, ‘Oh my gosh, people are going to have to pay.’ But people that were uninsured were paying for it already,” if they go to the doctor, said Beth Wrobel, who runs a federally qualified health center in Valparaiso, in the northern part of the state.
Diabetic patients who visited Wrobel’s clinic before the start of Healthy Indiana incurred significantly higher costs paying for their regular medical supplies and routine testing, she said. Now, under the more generous benefit package, “the most you have to pay is $26 a month, and that’s at the high end. Most of our patients pay between $1 and $10 a month,” Wrobel said.
“For the same amount that you were paying at that moment for your diabetic care, you could get medical, dental, behavioral health, optometry and pharmacy. [Healthy Indiana] treated the whole body,” she said.
Randy White, CEO of Fayette Regional Health System in Connersville, in the east-central part of the state, agreed that Healthy Indiana “is not harsh.”
If the liberal specter of a punitive system pushing out enrollees hasn’t quite materialized, neither has conservatives’ vision of a market-like system where patients with “skin in the game” make hard choices about their own health spending. That’s because family members, health workers and nonprofits are helping cover their out-of-pocket costs.
“With some people, I think [personal responsibility] might be a little bit lost,” Sanders said in her office at the Scott County Partnership,a nonprofit. “We try and do what we can in the little bit of time we have with them. But you can only give them so many pamphlets.”
About 2,100 of the enrollees who gained coverage through Indiana’s expansion live in Scott County, a poor, sparsely populated area that gained notoriety where an HIV outbreak took off two years ago, fueled by needle sharing and opioid abuse.
Sanders recalled how a man with substance abuse problems signed up for health coverage in the small town of Austin, Ind., which had set up a “one-stop shop” to get people enrolled and provide medical services like HIV screenings and vaccinations.
“He knew he had hit rock bottom. And he knew he needed help,” Sanders said. “He no longer lives in the area, but he had to be able to get away from this. He has stayed clean this whole time. He now has his children back. We have quite a few success stories, as far as that’s concerned.”
As of early April, there were 216 county residents with HIV, according to Scott County Health Department Administrator Michelle Goodin, but roughly three-quarters of the patients don’t have enough of the virus in their blood to spread it to others. New cases are still being diagnosed.
“We’ve got about 30 to 40 people usually that are HIV-positive in our facility,” said Sheriff Dan McClain, whose staff helps prisoners apply for Medicaid so that they can receive benefits, including mental health and substance abuse treatment, as soon as they are released. “We offer them a test for HIV and … we offer to sign them up for HIP 2.0,” he said.
With an ad-hoc support network fortifying the safety net, some liberal groups and Democratic lawmakers question whether the conservative tweaks are really adding value or simply burdening enrollees with unnecessary complications. Without those hurdles, they say enrollment would be even higher.
Progressives also fear that if the Indiana model is embraced in states that initially did traditional expansions of Medicaid, it would erode enrollment gains.
“Work requirements, lock-out periods, time limits and imposition of onerous premiums and cost-sharing on Medicaid families, who are generally living on a budget of roughly less than $15,000 per year, are not only punitive but also counterproductive in the long-term,” Sen. Ron Wyden (D-Ore.) and Rep. Frank Pallone (D-N.J.) wrote in a letter to HHS last month to discourage it from approving additional restrictions, many of which would be program firsts. “Requiring poor families to pay more than they can afford for care makes them less likely to access the care they need and less likely to maintain their coverage.”
State surveys of how Healthy Indiana is working present a fragmentary picture, and despite the program’s popularity in Indiana, there are some signs of hampered enrollment because of its complex structure and broader concerns about affordability. For example, roughly half of the enrollees in the more comprehensive benefit package worried about being able to afford their monthly payments. Left-leaning groups have used the data to raise flags about harmful implications for other states.
The first-year report also estimated that roughly 1,240 enrollees received financial help from nonprofits to pay their premiums, a paltry slice of overall enrollment. But residents here believe many more enrollees likely rely on family members, friends and others sources undetected by official surveys. Sanders and others pointed out that the premium cost of keeping someone covered in the program’s more generous benefit package — which includes vision and dental benefits as well as more robust coverage of prescriptions — is as little as $12 for an entire year.
“We’ve paid it out of our pocket many times at the office just to get them hooked up,” said Jeanni McCarty, a nurse at Foundations Family Medicine in Austin. McCarty said she has four family members affected by HIV and five relatives who have passed away from drug abuse-related problems.
Indiana officials by the end of the month will send CMS two more reports, including one that specifically examines the use of health savings-like accounts to help beneficiaries cover their costs. Pence’s successor, Republican Gov. Eric Holcomb, has already asked the Trump administration to extend the program through January 2021 with a handful of tweaks — though notably absent is a request to institute a work requirement as a condition of receiving benefits.
“We don’t want to put policies and programs in place that are not member-centric,” said Jennifer Walthall, secretary of Indiana’s Family and Social Services Administration. “Increasing barriers is not the name of the game.”
Beginning in 2020, the plan would eliminate an Affordable Care Act requirement that Medicaid cover basic mental-health and addiction services in states that expanded it, allowing them to decide whether to include those benefits in Medicaid plans.
The proposal would also roll back the Medicaid expansion under the act — commonly known as Obamacare — which would affect many states bearing the brunt of the opiate crisis, including Ohio, Kentucky and West Virginia. Thirty-one states and the District of Columbia expanded Medicaid under the ACA.
“Taken as a whole, it is a major retreat from the effort to save lives in the opiate epidemic,” said Joshua Sharfstein, associate dean at Johns Hopkins Medical School.
Advocates and others stress that mental-health disorders sometimes fuel drug addiction, making both benefits essential to combating the opioid crisis.
Nearly 1.3 million people receive treatment for mental-health and substance abuse disorders under the Medicaid expansion, according to an estimate by health care economists Richard G. Frank of the Harvard Medical School and Sherry Glied of New York University.
House Republicans confirmed the benefit cuts during a meeting of the House Energy and Commerce Committee on Wednesday. Republicans on the committee argue that the change would give states additional flexibility in coverage decisions, and believe they would continue to provide addiction and mental-health coverage to Medicaid recipients if needed.
During the committee meeting, Rep. Joe Kennedy (D-Mass.) asked a GOP staffer whether those benefits are “no longer essentially covered, or required to be covered, by this version of this text. Is that not correct?”
“The text before us does remove the application of the essential health benefits for the alternative benefit plans in Medicaid,” a lawyer for Republicans on the committee responded.
“Including mental health?”
Rep. Joe Kennedy (D-Mass.) said he and Rep. Peter Welch (D-Vt.) introduced an amendment during the committee meeting to include mandates for substance abuse and mental-health coverage, but it was voted down along party lines.
Several Republican senators expressed concern about removing the benefits. Sens. Rob Portman (Ohio), Shelley Moore Capito (W.Va.), Cory Gardner (Colo.) and Lisa Murkowski (Alaska) sent a letter to Senate Majority Leader Mitch McConnell (R-Ky.) stating that the plan does not “provide stability and certainty” for individuals and families enrolled in Medicaid expansion programs, or flexibility for states.
President Trump has made combating the nation’s drug-overdose problem a focal point of his campaign and his presidency.
“We will stop the drugs from pouring into our country and poisoning our youth,” he said in a speech before Congress last week, “and we will expand treatment for those who have become so badly addicted.”
Trump has endorsed the Republican plan to replace the ACA.
“States have already been strong leaders on the opioid crisis and know the crisis within their states better than the federal government,” said a White House spokesman who was not authorized to comment and spoke on the condition of anonymity. “We expect them to prioritize the needs in their states better than the federal government ever could.”
A record number of people — 33,000 — died of opiate overdoses in 2015, according to the Centers for Disease Control and Prevention. Opioids now kill more people than car accidents, and in 2015 the number of heroin deaths nationwide surpassed the number of deaths from gun-related homicides. Authorities are also grappling with an influx of powerful synthetic narcotics responsible for a sharp increase in overdoses and deaths over the past year.
The 15 counties with the highest death rates from opiate overdoses were in Kentucky and West Virginia, according to a group of public health researchers, writing in the New England Journal of Medicine. Both of those states expanded Medicaid. Taking away those benefits, they wrote, would affect tens of thousands of rural Americans “in the midst of an escalating epidemic.”
Medicaid pays for 49.5 percent of medication-assisted treatment in Ohio, 44.7 percent in West Virginia and 44 percent in Kentucky when the drug Buprenorphine, which is used to manage chronic opiate use disorder, is administered, according to Rebecca Farley, vice president of policy at the National Center on Behavioral Health.
Public health officials and advocates say there is a nationwide shortage of treatment programs to serve the growing problem of addiction and its effects, including diseases associated with long-term IV drug use such as hepatitis C and HIV.
Shawn Ryan, a doctor with Brightview Health in Cincinnati, which provides addiction treatment mainly to patients on Medicaid, said states are starting to increase drug addiction services to respond to rising needs, but the process could take years.
“The outpatient addiction treatment services that are starting to ramp up . . . they could be crushed by this if not done in a way that specifically protects the most vulnerable populations,” he said.
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Stripping away addiction treatment services from low-income people is especially harmful, Frank, of Harvard, said in an interview, because the prevalence of drug abuse is much higher for people living well below the poverty line. He said Medicaid recipients who are covered for addiction treatment and maintain their coverage through 2020 would not lose the benefit under the GOP proposal. But, he added, because addiction is a chronic-relapse disease, people may get clean, relapse, stop working and need to go back on Medicaid.
“It’s a disease that hits suddenly at various points in the life cycle,” Frank said.
Some GOP lawmakers advocate a full repeal of the ACA, a move that would result in loss of coverage for 2.8 million people, 222,000 of whom have an opioid disorder, Frank and Glied, of NYU, estimate.
Gary Mendell, founder of the anti-addiction organization Shatterproof, said the group plans to run campaigns against the rollback in eight states were Medicaid was expanded, urging people to contact their elected officials. Mendell, whose son battled addiction and died in 2011, said the drug-abuse battle has transcended party lines. Last year, Congress passed a landmark bill to fight opiate addiction.
“It’s been a bipartisan effort to attack the opiate epidemic,” he said, “and now Republicans are putting fighting the opiate epidemic in the back seat to politics.”
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Warning: the following article contains graphic descriptions of torture and killing as they were presented in court
Rurik Jutting, the 31-year-old British former banker who in the fall of 2014 tortured and murdered two Indonesian women in his luxury high-rise apartment in Hong Kong, has been found guilty of murder. He will be jailed for life.
Jutting, appearing healthier and many pounds lighter than he was when he was arrested just over two years ago, was stoic when the jury delivered its unanimous verdict in Hong Kong’s High Court on Tuesday afternoon. He had pleaded not guilty to murdering 23-year-old Sumarti Ningsih and 28-year-old Seneng Mujiasih, but guilty to manslaughter on the grounds of “diminished responsibility.” His defense attempted to bolster this claim by pointing to various disorders that supposedly impacted Jutting’s capacity to act rationally: narcissistic personality disorder, cocaine-and-alcohol-abuse disorders, and sexual-sadism disorder.
A smattering of applause went around the public gallery of the courtroom when the jury’s foreman read the verdict.
Justice Michael Stuart-Moore said: “You get prison for life. That is all. You can go now, thank you.”
In a statement he wrote that was read by his barrister, Tim Owen, Jutting expressed remorse.
“As has been commented on throughout the hearings, my actions in the deaths of Sumarti Ningsih and Seneng Mujiasih in the days preceding the deaths was horrific, even by the standards of homicide trials,” Jutting wrote. “The nine jurors were attentive and thoughtful. They have delivered a verdict to which I cannot have any objection”
He said he remained “haunted daily” by the crimes.
“We have been made to dredge the very depths of depravity in the defendant’s descriptions of what he did in three days of torture,” Justice Stuart-Moore said after the jury was read. “He describes himself as evil and a monster. Neither description is adequate to bring home the horror of what he did.”
In a statement released yesterday, Seneng’s family stressed the financial hardship her death had caused. “Our family hope the perpetrator can be punished as heavily as possible,” the statement read.
The verdict marks the end of a two-week trial that was alternatively gruesome, awkward and tedious. It was, Justice Stuart-Moore said on the first day of the trial on Oct. 24, a particularly strange legal affair: a murder trial in which the most incriminating evidence — the iPhone footage shot by Jutting both leading up to and immediately after the killings — was willfully created by the defendant himself.
It was in these videos that the nine members of jury became apprised of what happened on the 31st floor of the J Residence, a luxury apartment building in Hong Kong’s Wan Chai district, during the last week of October 2014.
In the early hours of Oct. 25, Jutting left his apartment and made his way into the thick of Wan Chai, a bustling neighborhood famous for neon-lit bars with names like Club Bunny, where scantily clad girls linger out front.
There, he met Sumarti, a single mother who, in 2011, had left her infant son with family in Indonesia and came to find work in Hong Kong as a domestic helper — one of hundreds of thousands of such women in the former British colony, many of them from the Philippines and Indonesia. Like some of her peers, Sumarti occasionally moon lighted as a sex worker for extra income.
Jutting, who had been transferred by Bank of America Merrill Lynch from London to Hong Kong in the fall of 2013 had paid Ningsih for sex before. On that occasion, he had become so violent that she had offered to refund half his money if he would let her go home. Following his arrest, Jutting told police that to bring her home on the night of Oct. 25, he had to offer a particularly large sum to coerce her. He contacted her on his cell phone, in which she was saved simply as “Indo,” for Indonesian.
She consented, and together they returned to his apartment. By Jutting’s account, things escalated quickly.
“I made her get naked,” he said to his iPhone camera shortly after her death. “I held her throat, then she tried to force me off her. But there’s nothing she could do.”
For three days, he kept her prisoner. He said he bound her, beat her, violated her sexually, and at one point forced her to eat his excrement. He finally killed her by slitting her throat as she licked his toilet bowl.
After killing her, he dragged her body into his shower, and later shoved it into a suitcase he put on his balcony, and began to record the hours of monologue that two years later would be used to incriminate him. Heavily under the influence of drugs, alcohol, and sleep deprivation, he babbled about his cocaine addiction, his history of sadistic fantasies, and Sumarti herself.
“I learned more about that girl over three days than I have about people I’ve worked with for years,” he said to the camera. “She is — was — a remarkable person. Many of the finest people I’ve known have been prostitutes.”
In the days that followed, Jutting continued to binge on cocaine and Red Bull as Sumarti’s body began to decay on his balcony. He did not leave his apartment, subsisting on Pizza Express delivery and spending “virtually every minute reading and watching pornography,” as he later told police. Eventually, he said, he “had a plan to torture.”
“I realized how much I enjoyed that combination of alcohol and cocaine and physical torture – it gave me a sense of enjoyment I’d never had with anything,” he later told police. “I knew I would do it again.”
Eventually, he left his apartment, going first to a sex shop in Lan Kwai Fong, a nightlife district near downtown that is popular with expatriates and tourists, to buy bondage rope and other items. On his way home, he stopped at a hardware store, purchasing nails, sandpaper and a blowtorch, which he planned to use for torture.
“Let’s be clear about these, I am going to use these to torture someone in the most inhumane way possible,” he said.
However, when he solicited Seneng on the night of Halloween, leaving his apartment and returning with her shortly after midnight, there was no prolonged period of torture, unlike with Sumarti. The court heard that Seneng began screaming after finding a knife on Jutting’s couch, prompting him to quickly cut her throat.
He was, at that point, reportedly delirious, hallucinating that police and “special forces” were outside his apartment, preparing to seize him. He eventually called 999, Hong Kong’s emergency hotline, and asked if he could surrender. The dispatcher evenly asked if they could instead send officers to his home, and he complied. He was arrested by dawn.
Jutting has spent the past two years in prison in Hong Kong, where he has been interviewed by several psychiatrists who have served as witnesses for the defense during the trial. On the stand, Dr. Richard Latham and Professor Derek Perkins have rendered a portrait of a man with incredibly high intelligence — he recorded an IQ score of 137 — but sadistic tendencies and a pathological narcissism that rendered him incapable of emotionally handling blows to his ego.
When, as an adolescent, he applied and was accepted to Winchester College, a prestigious boarding school in the U.K., he was reportedly devastated that he came sixth in the scholarship assessment, rather than first. Later, after graduating from Cambridge with a first-class degree in history but a second-class degree in law, he challenged university administrators regarding the latter, claiming the examiners “did not understand him well enough,” which Perkins attributed to an entrenched “sense of entitlement.”
After Cambridge, in 2008, he forewent plans to practice law and instead took a job at Barclays in London in the structured-capital-markets division, then moved to Bank of America Merrill Lynch in 2010. Around this time, the court heard, he began drinking excessively, going on long binges where he would solicit sex workers and do cocaine with them. (He would later admit that he had spent “more than a million dollars” on sex workers in the two years preceding the killings.)
His professional performance gradually began to suffer. In September 2013, Bank of America Merrill Lynch moved him from London to Hong Kong, allegedly to “get him out-of-the-way” after an investigation into a dubious tax product he had tried to sell in Luxembourg, the court heard.
The defense’s expert witnesses inferred that it was the move to Hong Kong that precipitated his final mental collapse. He had no social life, instead spending his time drinking copious amounts of liquor and wine in his luxury residential tower and seeing sex workers from the neon-lit bars nearby. He traveled to the U.K. for a friend’s wedding in March 2014, where he reportedly did so much cocaine that he missed a work meeting in London. He blamed his absence on having HIV.
His physical and mental atrophy continued upon his return to Hong Kong, and in September 2014, he found a cocaine dealer of his own, who was named to the court simply as Marvin. Marvin, the court heard, was bringing Jutting massive sums of cocaine on a regular basis; the defendant claimed he was doing several grams in a day.
From there, his apparent decline into instability was rapid. He rarely went to work; when he did, he did so erratically, showing up only for short stretches. He later described his rage and humiliation when his boss send a junior employee to look for him at home. He spent his days watching and reading violent pornography that trafficked in themes like rape, kidnapping and torture.
The defense concedes that parole for Jutting is highly unlikely to impossible. Asked outside the courtroom if he was surprised by the verdict, Michael Vidler, Jutting’s attorney, simply shrugged. “The jury has spoken,” he said.
Justice Stuart-Moore said that if Jutting applied for transfer to a British prison, “the English authorities will know exactly the type of person they are dealing with.”
— With reporting by Yenni Kwok / Hong Kong
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(This article is courtesy of the Shanghai Daily News)
Peace and harmony with Peng
Source: Xinhua | September 6, 2016, Tuesday | PRINT EDITION
Chinese first lady Peng Liyuan (center) and wives of leaders attending the G20 Hangzhou summit write the Chinese character “he,” which means peace or harmony, during their visit to the China Academy of Art in Hangzhou yesterday. — Xinhua
PENG Liyuan, wife of Chinese President Xi Jinping, invited the wives of leaders attending the G20 summit to visit the China Academy of Art in Hangzhou yesterday. She invited her guests to write the Chinese character “he,” meaning peace or harmony.
Peng also invited the wives to an anti-AIDS advocacy tour at Zhejiang University in the tourist city.
Peng, a World Health Organization goodwill ambassador for tuberculosis and HIV/AIDS, said such activities had been carried out in many Chinese universities to good effect and that the foreign guests’ attendance would have a positive influence.
Peng called on countries to work together in improving the level of HIV/AIDS prevention and the search for a cure.
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