In December 2006, Jeremiah S. Johnson, 25, began serving as a Peace Corps volunteer in Rozdilna, Ukraine, a town near the border with Moldova. When he started, he was HIV negative. In January of this year, he had a midservice medical exam in Kiev and agreed to an HIV test. It came back positive. The Peace Corps told him to pack his bags and return to the United States.

Johnson says the Peace Corps director for Ukraine told him he had to go home because Ukraine doesn't allow HIV-positive foreigners to work there. (If so, this isn't unique. As blogger Andrew Sullivan has pointed out repeatedly, the United States has its own fair share of restrictions on HIV-positive immigrants and tourists.)

Back in Washington, Johnson had an end-of-service medical exam and received written notification that he was being "medically separated" from the Peace Corps. He contacted the American Civil Liberties Union (ACLU), and the organization sent a demand letter to the Peace Corps saying that it is violating the Rehabilitation Act, which prohibits discrimination based on disability. (The State Department, by the way, changed its policies just this February to permit HIV-positive Americans, on a case-by-case basis, to work in the Foreign Service.)

Johnson doesn't have any physical symptoms of HIV. He and the ACLU say the Peace Corps did not assess him to determine if he could continue serving with reasonable accommodations. Additionally, his requests to be assigned to another country were denied.

What do you all think? A few questions come to mind:

• How easy would it be for Johnson to receive medical monitoring of his condition in a poor country (granted, the medical infrastructure in some Peace Corps countries, such as Romania and Bulgaria, is probably stronger than in, say, Burkina Faso and Guinea)?
• What if living in an underdeveloped country aggravated his condition -- would there be liability issues?
• Does how he contracted HIV -- for example, if he was injecting recreational drugs -- make a difference (the manner in which he became HIV positive hasn't been disclosed)?

For more on controversies about the Peace Corps, check out "Think Again: Peace Corps" and some of the reactions the piece prompted.

Justin Sullivan/Getty Images

Due to skyrocketing rice prices, Liberians are switching to pasta and learning how to twirl spaghetti on a fork. In India, the government has restricted rice exports, and moms are choosing between eating and paying for their children's schooling. Meanwhile in the United States, Wal-Mart's Sam's Club warehouse stores are limiting the sale of 20-pound (9 kg) bags of jasmine, basmati, and long-grain white rice to four per customer.

In the developed world, food shortages might be overhyped. The head of the California Rice Commission told Reuters, "Bottom line, there is no rice shortage in the United States. We have supplies." Plus, how many Americans buy 80 pounds of rice per shopping trip? (Apparently, it's restaurant owners and small-business owners who typically buy in bulk.)

But for people in developing countries, outrageous food prices and shortages are a serious reality. Josette Sheeran, executive director of the U.N. World Food Program, which provides food aid to the needy, told FP in this week's Seven Questions, "This is a silent tsunami." Video, audio, and prepared remarks from her recent talk on global food insecurity at the Center for Strategic and International Studies is also available here.

By the way, if you want to help hungry people get rice, play the Free Rice vocabulary game.

"Only one country in the world has eliminated the shortage of transplant kidneys," Tyler Cowen Alex Tabarrok reports. "Only one country in the world has legalized financial payments to kidney donors."

What country is that? You'll never guess. Click the link to find out.

www.miss-landmine.org

Dignity, a restored sense of beauty, and the spotlight on a serious issue: The goals for Angola's Miss Landmine pageant brought together 18 contestants, all land mine survivors, representing the southwest African nation's provinces. On a television special Wednesday night, the ladies posed in gowns and swimsuits -- and their artificial limbs.  The winner, Augusta Urica, was presented $2,500 USD by Angola's First Lady Ana Paola dos Santos, and will receive a customized artificial limb. You can see some of the contestants' profiles at the event's Web site. (Pictured above is Cuanza Sul, one of the runners-up.)

Each year, between three and four-hundred people are maimed by mines in Angola -- remnants of a 27-year civil war that ended six years ago. Even though significant effort has been put forward to get rid of them, the country remains one of the most mine-laden in Africa.  

There are 80,000 amputees in Angola, most as a result of landmines, according to the International Herald Tribune. Candida Celeste, Angola's minister of family, said, "They showed that they can, that they are able... This will provide encouragement to all those left invalid by the war."

The pageant came ahead of International Day for Mine Awareness and Assistance in Mine Action which falls on April 4 each year.  As the tens of thousands of Angolans can attest, mines are not weapons that can be easily and completely undeployed, and they continue taking lives and livelihoods for generations after hostilities cease. Though, as these women prove, there can be life after landmines as well.

The government of the Philippines wants its citizens to know that crucifixion can pose a health risk:

Philippine health officials Wednesday warned people taking part in Easter crucifixions and self-flagellation rituals to get a tetanus shot first and sterilise the nails to avoid infections.

Every Good Friday in this predominately Roman Catholic Southeast Asian nation dozens of men re-enact the crucifixion of Jesus Christ by having themselves nailed to wooden crosses.

Should we be worried that the Web site for Iraq's Ministry of Health has turned into a conglomeration of dating websites and online car-insurance deals?

The U.S. Department of Commerce and the Library of Congress still link to it, while the World Health Organization offers its own link farm of choice:

Warning: Passport recommends against exploring these Web sites, as your computer could become infested with spyware, or worse.

MARK RALSTON/AFP/Getty Images

Yesterday was a good day for the NIMBYs in Shanghai as Mayor Han Zheng announced that a controversial maglev train is not on the list of projects to begin construction in 2008. Protests in January reflected significant public opposition to the plan. Xinhua reported that the project had not passed evaluation and that there is still feedback pending from the public and "national experts." The train is off the table until at least next year.

In another case of protest yielding results, construction of a Xiamen chemical factory has been blocked due to public concern. Mayor Liu Cigui said:

Faced with the choice of becoming a chemical industry base or a coastal scenic city, we think we should stick to the latter."

So, are we seeing hints of local democracy in China? Liu's move could be seen as part of a growing trend to consider the public's views on big construction decisions. Zhou Shengxian, director of the State Environmental Protection Administration, has said that major projects will involve public input in the future. And beginning in May, new transparency laws will go into effect essentially mandating government release of environmental information within 15 days of a public inquiry. To what effect that mandate will be carried out remains to be seen, but the tone and direction of such a change is inarguably positive.

This all reflects a new emphasis in China on the quality of economic development. China is now aiming for 8 percent GDP growth in 2008 -- as opposed to the double-digit targets of recent years. Wang Xiaoguang, a Beijing-based economist, interpreted the change this way:

This is also a clear message to local governments: that they should focus their attention on the quality, rather than pace, of development."

TEH ENG KOON/AFP/Getty Images

Zhao Baige, the Chinese vice minister of family planning, announced yesterday that though the details still need to be ironed out, the government would like to gradually amend its controversial one-child policy. The system today is much more fluid than the original name intended. In practice, rural families and ethnic minorities can have more than one child, as can urban couples who are both from one-child familes. For the most part, so can families with money

In its desire to stay in power, perhaps the Communist Party is following Richard Cincotta's advice about mature populations giving rise to democracy. The more mature the Chinese population gets, the more stable society becomes which can yield a definitive, lasting transition to democracy. China seems to have missed the boat in multiple senses. The student protests of 1989 were a bit too early on the national democracy cosmic calendar, and according to Cincotta’s numbers, the People’s Republic passed the democracy threshold in 1998. 

This one-child policy amendment may be an attempt to assure a robust, young generation whose workforce wages will pay for the aging generation; but the higher proportion of youth would also create the unsettledness necessary to prevent democracy. It could be an act designed to draw diplomatic brownie points ahead of the Olympics by easing one of the most intrusive government policies still in place. As controversial as the system has been, population control has definitely been an important factor in curbing poverty and fostering development. It will be interesting to see what the Chinese government's new target will be for a sustainable population in the next century.

iStockphoto.com

Ireland may be one of the best places to be an immigrant, and now there are so many newcomers from right-hand-traffic countries that an Irish senator has proposed that the Emerald Isle switch to driving on the right, too.

Such a change would be "not even remotely feasible," the country's Automobile Association told the Independent. But the senator, Donnie Cassidy, cited the case of Sweden. It switched from left to right in 1967 after spending $120 million in preparations, and it was two entire days before a fatality ensued.

Senator Cassidy isn't all about changing the country's ways to accomodate foreigners' driving habits, however. He has also proposed a special lower speed limit of 80 kmh (50 mph) for noncitizens, compared with speed limits up to 120 kmh (75 mph) for the Irish.

But perhaps it's the senator who needs to slow down and think things through. He admitted to Reuters:

I know when I go to America it takes me five or six days to adjust.

To our U.S. readers: If you happen to see an Irish politician barrelling at you head-on at 75 miles an hour, please e-mail Passport.

When Mayor Mike Bloomberg raised New York city's tax on cigarettes from 8 cents a pack to $1.50 in 2002 (putting the total tax on a pack at about $3), a lot of my friends simply went out of state to buy cartons. But, faced with the prospect of $7 packs, a lot of them quit, too. Steep tax hikes on tobacco have always seemed to me to be the only way to depress smoking rates, a feat that smoking bans never really accomplish (though they do leave your clothes smelling far better at the end of an evening at the bar).

Bloomberg, a former smoker himself, has been a vocal anti-tobacco advocate since quitting more than two decades ago. He recently gave $2 million to finance the most comprehensive report on smoking around the world to date, which was unveiled by the WHO Thursday. He's also pledged $125 million more over the next two years for global anti-smoking efforts.

While progress has been made in many countries thanks to higher taxes and bans in public places (the unbelievable smoking ban in Paris cafes, for example), smoking is on the rise in the developing world. The WHO projects that one billion people, 80 percent of them in the developing world, will die of smoking-related illnesses by the end of the century if trends continue on their current trajectory.

Nearly two thirds of the world's smokers live in just 10 countries. In China, with about 30 percent of the world's smokers, perhaps 100 million men under the age of 30 will die of tobacco use unless they quit.

SEAN GALLUP/Getty Images

The excitement aroused by the World Cup soccer tournament in Germany in 2006 may have increased that country's birthrate as much as 15 percent nine months later. But the intensely emotional matches have now also been correlated with a spike in the number of cardiac emergencies.

A study published Thursday in the New England Journal of Medicine examined the number of cardiac emergencies in the greater Munich area in the summer of 2006. It compared that number with the numbers in similar periods in 2003 and 2005, and for several weeks before and after the 2006 World Cup.

On days when the German team played, the incidence of cardiac emergencies was 2.66 times higher than during the comparison periods. For men, the incidence was 3.26 times higher; for women, it was 1.82 times higher. People with a history of heart disease were particularly affected.

The study's authors say emotional stress was the main trigger, but they add that sleep deprivation, excessive consumption of junk food and alcohol, and smoking might also be contributing factors. They suggest that spectators with heart problems should take preventive measures, such as consulting their doctors about increased medication dosages during intense sports events.

So should Americans be worried about this weekend's Super Bowl? Study author Gerhard Steinbeck says:

It's reasonable to think that something quite similar might happen.

Though if the Vegas odds-makers have it right, the greater danger on Sunday may turn out to be irate New York Giants fans.

There's a sad new chapter in the sad story of the state of the U.S. military's mental health care, as I've been writing about here at Passport. Lt. Elizabeth Whiteside, the 25-year-old Army reservist who was facing a court martial for pointing a gun at a superior, then shooting herself last year in Iraq, attempted suicide again on Monday, as reported by the Washington Post Thursday. Her mental health had been in better condition lately, as she went public with her story, but she began to deteriorate as her case dragged on. Ironically, she learned on Wednesday, as she was recovering in the hospital, that all the charges against her were dismissed.

Record numbers of soldiers returning from Iraq and Afghanistan have committed suicide. Last year, 121 cases were recorded—20 percent more than 2006.  Thankfully, Whiteside has not been added to those numbers. Let's hope she never is. And let's hope that any soldier who needs quality one-on-one care gets exactly what America owes him or her.

CHRIS HONDROS/Getty Images

In previous posts, I've lamented the lack of proper health care (particularly mental health) for veterans returning from Iraq in Afghanistan, lauding both the Washington Post for its "Walter Reed and Beyond" series, and the New York Times for its "War Torn" series. The Post chose to tackle the story of vets from the beds of one hospital, whereas the NYT chose to report on veterans who had been charged with killing after returning home.

Now the NYT is under attack for its approach to the story. It is accused of more or less painting veterans as murderers and sensationalizing the plight of those suffering from post-traumatic stress disorder (PTSD). Lt. Col. Bob Bateman, normally a staunch defender of journalists, says that the NYT is playing a dangerous game with statistics, overstating the 121 cases that the newspaper uncovered as a "quiet phenomenon," when there is a population of 700,000 returning veterans from Iraq and Afghanistan. Moreover, of those 121 cases, 22 were DUIs, two were speeding accidents, and five cases resulted in exonerations of the accused killers. Hardly a trend. Bateman parses more numbers and says one could make an equally faulty argument: that veterans of active combat in Iraq and Afghanistan are, in fact, less likely to commit homicide than the population at large. (With the likely reasoning being that military training teaches young men and women to become more responsible citizens.) Bateman accuses the Times of "sloppy thinking... that does not help anyone." 

After much outcry, Clark Hoyt, the NYT public editor, basically agrees with the newspaper's critics in his Sunday column:

[T]he questionable statistics muddy the message. A handful of killings caused by the stresses of war would be too many and cause for action. Sometimes, trying to turn such stories into data — with implications of statistical proof and that old journalistic convention, the trend — harms rather than helps."

Both Bateman and Hoyt acknowledge that PTSD is a serious problem. But, Bateman concludes, "fear-mongering and drawing specious conclusions from incomplete data is no help."

Indeed, it's unfortunate that the the NYT's "creative" use of statistics opened the story up to valid criticism such as Bateman's. In effect, it undermines the point that most people will draw from its series: that seeing combat has very real effects on the mental health of veterans, and that there simply needs to be more effort put into their care. Witness the State of the Union address on Monday. President Bush got the most sustained applause from both sides of Congress when he mentioned honoring veterans. A new study released today finds that PTSD, depression, and stress (but not brain injuries, as previously thought) are drivers behind symptoms afflicting returning vets. The stigma needs to be removed. The real health problems need to be addressed. And there needs to be no more sensationalizing about what it all means.

Via Tyler Cowen, some grim news from Haiti:

At the market in the La Saline slum, two cups of rice now sell for 60 cents, up 10 cents from December and 50 percent from a year ago. Beans, condensed milk and fruit have gone up at a similar rate, and even the price of the edible clay has risen over the past year by almost $1.50. Dirt to make 100 cookies now costs $5, the cookie makers say.

Apparently, dirt cookies are a traditional remedy used by pregnant women to combat hunger pangs. But with food prices on the rise, more Haitians are eating the cookies—which are made by mixing clay with salt, flour, and vegetable shortening—to fill their bellies. More at this AP video:

JASON SMITH/Getty Images for NASCAR

Last month I blogged about the case of Lt. Elizabeth Whiteside, an Army reservist facing court martial because she tried to commit suicide while serving in Iraq. Her story was part of the Washington Post's outstanding series, "Walter Reed and Beyond," about the lives of vets returning from Iraq and Afghanistan.

Now, the New York Times is doing its part to cover the care of vets, this time from a different angle. The Times' series, "War Torn," is about veterans who have been charged with killings after returning home. The first part of the series discussed the trend in general, noting that there have been 121 cases of such tragic incidents and touching on some of those cases. The second part of the series appeared on the front page of Sunday's paper. It tells the tragic tale of the killing of 22-year-old Nicole Marie Speirs by 21-year-old Marine Lance Cpl. Walter Rollo Smith, the father of their infant twins, who was suffering from post-traumatic stress disorder (PTSD) from his war experiences in Iraq.

Speirs's parents view the situation as a fatal incident of domestic violence. They worry that people are using her death to make a statement against the war. They hold Smith responsible for his actions. He doesn't disagree:

I can't completely, honestly say that, yes, PTSD was the sole cause of what I did. I don't want to use it as a crutch. I'd feel like I was copping out of something I claim responsibility for. But I know for a fact that before I went to Iraq, there's no way I would have taken somebody else's life.”

Reading his account, it's hard not to wonder if Speirs's death could indeed have been prevented, if only Smith hadn't fallen through the cracks. A formerly squeaky clean Mormon, Smith returned to Utah smoking, drinking, doubting God, and distraught over having killed civilians in Iraq. The Marines sent him to Quantico for a marksmanship course, and while on the firing range, he began to hallucinate about his experiences in Iraq. He had what can only be described as a breakdown. The Marines diagnosed him with PTSD, then discharged him, leaving him to seek treatment from veterans' hospitals.

But it's hard for someone who's having mental difficulties to have the wherewithal to manage his or her own treatment. After Smith's discharge, he intermittently sought help. He attended a group therapy session at a VA hospital, but never returned because none of the other attendees had similar war experiences to his. For awhile he took medication for anxiety, but stopped taking the pills when they didn't work. He attempted suicide. He once called the cops and asked for help because he was having homicidal thoughts. But ultimately, he was left to deal with his mental health on his own. And so one day he disconnected, and drowned the mother of his children.

Read the entire story to learn more of the compelling details. But the bottom line is that this is a senseless tragedy. A young man with no history of violence, not even old enough to buy a beer, was sent into a war zone to fight for his country. And when he returned, troubled, he didn't get the care that he needed. Now, a young mother is dead, and he's in prison. There are no winners here.

FREDERIC J. BROWN/AFP/Getty Images

Countries around the world have banned smoking in public places, including France, where even lighting up in cafes and bars is now prohibited. China, which begins its 200-day countdown to the Olympics today, is committed to keeping the games "smoke-free." Along with cracking down on spitting and littering, the smoke-free promise is part of the country's effort to make a positive impression on the world.

In a country where 300 million men—equivalent to the size of the entire U.S. population—smoke, though, people have been putting up resistance in at least one location: Beijing's first smoke-free restaurant chain. Meizhou Dongpo, which sells spicy Sichuan food, banned smoking in October and since then, its occupancy rate has plunged to "about 80 percent of that enjoyed by other restaurants across the street," its manager told China Daily. Additionally, diners were locking themselves in private dining rooms so they could surreptitiously smoke. The restaurant now faces going out of business.

Few other restaurateurs are interested in following suit. When Beijing sent letters to 30,000 restaurants requesting that they ban smoking, not one chose to enforce a ban. They don't want their businesses to go up in smoke.

PLoS Medicine

How do you provide healthcare to citizens in a country where nearly 75 percent of the population lives in the country, and more than 75 percent of the country's doctors live in cities? India's answer: telemedicine.

The Indian government has been investing in the technology to make healthcare accessible and affordable for the country's rural population, according to The Lancet. Telemedicine works like a regular medical consultation—except the doctor is on a computer screen peering through a webcam, and the patient's vitals are monitored by traditional equipment such as stethoscopes hooked up to computers (a more precise explanation can be found here and here). Sometimes a general physician is present, but the specialist reading and interpreting the information is located remotely.

The country's first telemedicine center was established in the state of Andhra Pradesh in 2000, and since then many analysts have come to believe that telemedicine "could be the future for health care in India." Today, there are about 500 telemedicine centers across the country, linked to about 50 specialist hospitals. So far the centers have provided "teleconsultations" to an estimated 150,000 patients—a drop in the ocean in a country of more than 1 billion. According to anecdotal accounts, however, initial skepticism about "impersonal" health consultations is waning and patients who have been treated through telemedicine appear satisfied with the care. Meanwhile, public-private partnerships are continuing to expand the size and the scope of telemedicine facilities.

Telemedicine, like the use of cellphones for health, could be a revolutionary step in medical provision for the poor. Rural residents won't need to travel as great a distance in order to access sophisticated medical treatment, and doctors won't need to move to rural areas. As of now, telemedicine consultations cost around $22—still beyond the reach of most Indians. But the government is promising to provide the consultations free of charge for the poor, though it's not clear if this is entirely feasible since many clinics are operated privately.

But as revolutionary as it might be, the growth of long-distance medicine raises some questions about accountability. What happens if a patient is misdiagnosed, or sent away with a clean bill of health when there is actually an underlying problem? Can anyone fairly be held responsible? Nonetheless, it does seem like the benefits at the moment outweigh the risks. As one surgeon and hospital director argues:

In terms of disease management, there is [a] 99% possibility that the person who is unwell does not require [an] operation. If you don't operate you don't need to touch the patient. And if you don't need to touch the patient, you don't need to be there.

Come to think of it, there's no reason to think Indian specialists and doctors couldn't start treating patients in this manner who hail from anywhere in the world, including the United States. Indeed, Indian doctors are already providing diagnostic interpretation of radiological images, including X-rays, CTs and MRIs, for American patients from hospitals in places as far away as Bangalore.

Today India's Tata Motors unveiled the $2,500 Tata Nano, a tiny four-door "People's Car." Some industry analysts say it could revolutionize Indian society the way the Ford Model T did in the United States 100 years ago. Unsurprisingly, Thomas Friedman has already warned Indians not to follow the first world and turn their country into one filled with even more traffic congestion and air pollution. We'll have to wait and see how many takers there are for the Nano, but meanwhile, here's a Nano vs. Model T comparison:

Introductory Price	$2,500	$850 (about $19,000 in 2006)
Number of cylinders	2	4
Horsepower	33	20
Top speed	60 mph (97 km per hour)	45 mph (72 km per hour)
Fuel economy	50 miles per gallon (21 km per liter)	13-21 miles per gallon (5.5-9 km per liter)
Air conditioning	No	No
Power steering	No	No
Windshield wiper	Just 1	A vacuum-powered wiper could be added to the driver's side of the 1926 model for $3.50

Photos: RAVEENDRAN/AFP/Getty Images; INDRANIL MUKHERJEE/AFP/Getty Images

Last month, Christine noted the increase in "inverted sex tourism": wealthy foreign women heading to poor countries (for instance, Kenya) to purchase sex from younger and poorer men. But a BBC report on Kolkata in India reveals that it's not just rich foreign women who prey on male prostitutes. Indian women of means are also getting into the act:

[Male gigolos] offer some insight into the changing sexual mores of a growing number of Indian women who are ready to spend money on buying sex in a traditionally conservative society.

It is hardly a easy job to do - in the absence of male brothels, gigolos like Samrat cruise after dusk for prospective clients, mainly upper or middle-class and rich women who usually drive in their cars with dark tinted windows.

"It is not all fun and games as people think. Just as female sex workers face violence and get cheated, we face such situations from time to time too," says the son of a bank worker, who joined the sex trade after a short stint as an employee with a multi-national pharmaceutical firm in the capital, Delhi.

"I have often not been paid by clients, and when I have protested, they have threatened me with telling the police that I tried to rape them. And there are clients who love to stub out burning cigarettes on our bodies. These days I have begun to charge for a cigarette burn - 500 rupees ($11) per stub," he says.

As with female sex workers, technology such as mobile phones and the Internet has helped facilitate business. The men usually receive upwards of 1,000 rupees ($25) an hour from their clients, and when work from female clients slows, many of these workers sell sex to other men. Thankfully, the "gigolos," who constitute one of the highest risk groups for HIV/AIDS contraction, are beginning to bond together to speak out for HIV prevention. Whether that will be enough to curb the spread of the virus, of course, remains to be seen.

Another dispatch on the Freakonomics effect: University of Chicago economist Steven Levitt (Mr. Freakonomics himself) and his collaborator Sudhir Venkatesh, a Columbia University sociologist who previously worked with Levitt to measure the average wages of street-level drug dealers (pdf), have teamed up to study the economics of street prostitutes in Chicago.

Their recent working paper (pdf), which they presented at this weekend's ASSA conference (the yearly get-together where social scientists from around the world preview their research) in New Orleans, is based on surveys conducted with prostitutes and pimps in Chicago neighborhoods and incident data from the Chicago Police Department. The findings? Street prostitution yields an average wage of $27 an hour, hardly worth it considering the extraordinary occupational hazards.

What's particularly interesting is the authors' section on bargaining and the law. They estimate that roughly 3 percent of all tricks performed by prostitutes who aren't working with pimps are freebies given to police to avoid arrest. In fact, prostitutes get officially arrested only once per 450 tricks or so, leading the authors to conclude that "a prostitute is more likely to have sex with a police officer than to get officially arrested by one." When freebies given to gang members are factored in, about one in 20 tricks go solely for protection and the "privilege" of plying their trade. 

The most depressing news is the woeful lack of condom use. Just as with recent studies of Mexican and Indian prostitutes, Levitt and Venkatesh find that payments go up substantially when condoms aren't used. And plenty of johns are apparently happy to pay the premium: Condoms only get used about 20 percent of the time, the authors estimate. Some protection, it seems, is worth a freebie; others go out the window for a few extra dollars.