Drug Use, HIV and a Harm Reduction Model in Northern China

North Korea and China have long had a strong, unique, bond since the creation of the PRC and the DPRK, starting with Korean volunteers fighting with communist forces during the Chinese Civil War and becoming even stronger after the CCP intervened during the Korean War on the behalf of the North, preventing DPRK leader Kim Il Sung from being overthrown. This bond, once kept strong by a shared communist ideology and system, is now mostly maintained by strategic concerns and the need to maintain a buffer between US allied South Korea and China. This relationship comes with many costs for China, including the alarming rate of North Korean drugs being smuggled into Northeast China through the DPRK-PRC border.

The effects of North Korean drug smuggling are most acute in Jilin province, including the Yanbian Autonomous Prefecture where many ethnic Koreans live. For example, In 1991 there were only 44 registered drug addicts in the Yanbian Autonomous Prefecture, but by 2010 there were 2,090. In Jilin Province, there are more than 10,000 registered drug addicts, but actual numbers are estimated to be 5 or 6 times higher. The rising rate of addiction is not a risk only for the users, but for the entire community due to the link between use of drugs and the spread of HIV. This is because of a correlation between the use of synthetic drug use and risky sexual behaviors.

Methamphetamine use increases sexual performance and pleasure, but also lowers inhibitions, and has spread to commercial sex workers and their clients. There is a risk that those who engage in commercial sex or sex work will pass on sexually transmitted diseases to their partners, and spread the disease into the wider population. In Jilin province, signs of this effect are already present; the province has experienced a yearly increase in the rate of HIV positive cases since 1994. In 2010, there were 1,477 reported HIV infections, and sexual transmission accounted for 93.4% of those infected with HIV.

Fortunately, there is already a Chinese example, from Yunnan province, of how to confront this problem effectively. The first reported case of HIV in China was in Yunnan province in 1985, and Yunnan had the highest rate of HIV infections in China from 1989-2004. Yunnan province is in South West China and borders Myanmar, Laos, and Vietnam region known as the golden triangle for its drug production. It is estimated that 60-70 percent of drugs in China enter from this region.  Initially, the HIV cases in Yunnan were concentrated among intravenous drug users (IDU) near Ruili City, however over time HIV spread geographically and to the general population through sexual transmission.

In Yunnan province, drug use and risky sexual behavior were highly correlated during this time. A 2002 study found that in Yunnan 82 percent of drug users reported having sex with more than one partner, but only 18 percent in the rest of the population. At first, the government response to the spread of HIV focused on strengthening laws on prostitution and illegal drug use, as well as allowing authorities to isolate HIV positive individuals. However, this approach was ineffective in stopping the spread of the disease. Attempts to contain HIV positive individuals, and punish high-risk behavior increased the incentive to conceal these behaviors, or the disease, from authorities.

After the failure of early attempts to contain HIV, officials in Yunnan turned to harm reduction and preventive policies to deal with the public health problem. Examples of these programs included needle exchange programs and promotion of condom use and health education for commercial sex workers.  Another approach that Yunnan took to fight the spread of HIV was cooperation with NGOs. Because of the stigma of HIV, and the fear of punishment, NGOs can be more effective at reaching out to HIV positive individuals, or those engaged in high-risk activity. In 2014, the Yunnan provincial government allocated 1.5 million Yuan to NGOs to promote education and provide medical services to address HIV issues.

Yunnan province and Jilin province are similar in that both border drug-producing regions, and have both seen an increase in drug use and sexually transmitted diseases. Yunnan province’s harm reduction approach to HIV and drug use was ultimately more successful than its original police oriented methods, but it was too late to stop the spread of HIV to the general population. Jilin should learn from Yunnan’s previous experience, and apply the lessons of Yunnan’s harm reduction approach by targeting high-risk populations, including drug users and commercial sex workers. This will require cooperation between NGOs, the police, and high-risk communities, as well as the building of trust between all groups. In China, this can be a difficult task to achieve, but without police cooperation high-risk populations will not participate in NGO sponsored harm reduction programs due to fear of being arrested. If this trust can be built, it will be easier to track those at risk and give them the tools and knowledge to address their addictions and prevent risky sexual behavior, slowing the spread of HIV and drug use.

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New Ebook about the US-South Korea alliance

I’ve just published my first Kindle ebook based on a year of research and writing. It is called “Evolution of the US-South Korea Alliance: Looking to the Post Unification Future”

It is 58 pages and available for $4 here.

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How to Understand North Korea

I have been in DC for the past 3 months or so after graduating from Fletcher looking for work and learning about the city. This has included going to several events featuring lectures and panels on North Korea. The more I go to these events, the more I feel that many of the NK experts in the city have a fundamental misunderstanding of North Korea. This becomes especially evident when I hear people describing the need to engagement with North Korea, or to try and shape North Korea’s policies (especially toward nuclear issues) with economic engagement. In order to help clear things up in these regards, in this post, I will offer what I think are the two things key to understanding North Korea, and what they mean for policy towards North Korea.

  1. North Korea Vs. Kim Jong Un: At many of these events, the panelists talk about what North Korea does, or what North Korea wants, or what is in North Korea’s interest. This is a mistake, and a fundamental misunderstanding. North Korea’s interest involves things like economic growth, openness, and possibly giving up nuclear weapons, however that is largely irrelevant as long as Kim Jong Un maintains control, because all of these things are not in his interest. Understanding North Korean state behavior is much easier when you accept that the basic idea that the Kim family is greedy and does not actually care that much about the North Korean people, and things that benefit the North Korean people many times do not benefit the regime. Trying to offer inducements that benefit the people will not convince Kim Jong Un to give up nuclear weapons, human rights abuses or illicit behavior. Current status quo policy has resulted in Kim Jong Un having enormous private wealth and power, why assume that he is so interested in threatening this? China opened, USSR opened, and none of the outcomes of that look good to the Kim family, and from the point of view of a greedy man that is understandable.
  2. North Korea is a source of stability: This is counter-intuitive. The standard idea goes something like everyone in the region agrees that a belligerent North Korea has no place in a peaceful, stable, rich North East Asia, but this is incorrect, and the current stable, peaceful, rich North East Asia provides strong counter-evidence. It is true that North Korean provocations are harmful and worrying, but they have been coming at a steady pace for decades without other states escalating and punishing North Korea meaningfully. The honest conclusion is that the world community has decided that a North Korean collapse would be more destabilizing than the current state of affairs, and is thus willing to mostly respond to North Korean provocations and human rights abuses with bluster. (Don’t believe, than read this excellent piece by Joshua Stanton that shows how we sanction states like Iran and others much harshly than NK) This is also why the US, SK, China and others provide North Korea with aid without insisting on usual compliance measures to ensure it goes where it is most needed.

If you take these two main points together, the response to North Korea, and the panels about it, actually make more sense. I take it as almost a given that what benefits the North Korean people, and what benefits Kim Jong Un are almost never the same, however practically all engagement and aid goes through the Kim regime. I think that some aid groups that provide non-fungible things like medical aid to the North Korean people are great and should be continued, but they are the exception, not the rule. Almost every major engagement attempt has strengthened the Kim family and not the North Korean people (at least every major state sponsored engagement) and it takes a misreading of history or a willful suspension of disbelief to believe otherwise. However, if you accept the second idea, that North Korea is actually a force for stability, than the cognitive dissonance makes more sense. If you fear a collapse (which is reasonable), you will chose policies designed to prevent this. These policies inevitably strengthen the regime (how could they not?) However, saying you are strengthening the regime is unacceptable politically and morally, so in order to get around this, you suggest that economic enticements and engagement and patience will change the regimes behavior, and then somehow peaceful unification will occur. (A paraphase of an actual policy idea I heard at an event today from a speaker)

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Background reading for President Xi’s state visit

Here are some good links for people interested in learning more before China’s President Xi comes to the US for a state visit.

1- Born Red, Evan Osnos, The New Yorker: Great background piece on President Xi

2- China’s Elegant, Flawed, Grand Strategy, Leon Whyte, The Diplomat: Article that I wrote for the Diplomat looking at Chinese core interests, military tactics and strategic thinking, as well as an inherent flaw

3- China and the United States Core Interests, Common Interests, and Partnership, Wu Xinbo, USIP: (This is a PDF) Great report that explains the differences between US and CCP world views in terms of International Relations, and how both might be talking past each other

4- Xi eyes more enabling int’l environment for China’s peaceful development, Xinhua: Good Chinese media piece that lays out the strategic thinking behind China’s self declared peaceful development strategy

5- How China Can Defeat America, Yan Xuetong, New York Times: Op-ed from one of China’s top Foreign Policy scholars about his proposals for China strategy as it concerns the US. Frank and important.

Let me know if I have missed any.

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GOP 2nd Debate

Last night I watched the 2nd GOP debate, all 3+ hours of it. As an American, I find it interesting, but in many parts embarrassing. The squabbling was admittedly fun to watch, but  the real troubling parts were what passed as policy ideas. Below is a rough sketch of my overall impressions.

Positive Points

  • I, like a lot of others, appreciate Rand Paul’s voice on foreign policy issues. I agree with him on the futility of most of US policy in the Middle East. Also, it was nice to see several candidates repudiating the Iraq War, however dubious many of these candidates are in general. Too bad Paul’s fiscal policy makes him unacceptable.
  • Kaisch was good to have around to, if only to remind people that governance requires cooperation with the other party, as well as other countries.
  • Glad the drug war came up, and that candidates were open to decriminalization and reform. Carly’s personal anecdote was understandable, but dumb and unhelpful. We never hear from the parent’s whose kids lives are ruined by criminal records or jail time, as if these people don’t matter.
  • Trump is a pretty worthless candidate, but it is nice to hear someone speak up for progressive taxation, however how it is still controversial in the GOP is a disappointment.

Negative Points

  • Huckabee. This guy is regressive as all get out. I wish the moderators would ask the flat taxers how they will make up for the massive funding losses their arbitrary numbered consumption taxes would cost. Also, if our economy is based on consumption (it is, the idea that you should not tax production is just another part of supply side mythology) wouldn’t taxing consumption (especially state sales tax on top of federal sales tax, resulting in a tax rate of something approaching/over 20% on everything you buy) discourage consumption? War on Christians, how these idiots can say this with a straight faces is beyond me.
  • Trump.
  • Vaccine drama- read a book, look at studies, stop being the dumb party, do not encourage this idiocy which has real world consequences.
  • Ted Cruz/Global Warming- See above.
  • Carly- She is really good at this, but her actual ideas are terrible, so this is dangerous. Also, we talked to and worked closely with the USSR on a multitude of issues throughout the Cold War, but she wouldn’t talk to Putin, really?
  • Planned Parenthood- anyone who takes a partisan video seriously, especially after how many have been disproved, is either naive or a hack.

I am going to leave it here, I could add a at least a dozen more to the negative column but these were the ones that stood out the most to me.

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Decoding CCP Catchphrases

With Chinese President Xi Jinping coming to the United States for a visit later this month, I am sure that some of these stock CCP catchphrases will be used. I will be adding new phrases and meanings as I think of them. Also, I would welcome any contributions from readers.

CCP catchphrase                                                                    What it means

Core Interests                                                                         Things that the CCP considers                                                                                                            important, and would be willing to                                                                                                    go to war over (i.e. Taiwan)

New Great Power Relationship                                            This phrase has been used a lot                                                                                                          recently, and almost always in                                                                                                            regards to the US-PRC                                                                                                                        relationship. Basically it means                                                                                                          that China wants to be treated as                                                                                                      an equal, and for the US to not                                                                                                          interfere with its core interests.

Nuclear Free Korea                                                                 For the US, this means no North                                                                                                      Korean nuclear weapons, but the                                                                                                      CCP also wants to get rid of the US                                                                                                   nuclear umbrella over South Korea

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Evolution of the US-ROK alliance Series

Over this past summer, I have written a series for the Diplomat magazine about the US-ROK alliance looking at how it has evolved, and what the future might hold. This post has all of the links to the articles in the series in order.

  1. The Evolution of the U.S.-South Korean Alliance
  2. Evolution of the US-ROK alliance: Abandonment Fears 
  3. Evolution of the US-ROK Alliance: Restraining the ROK
  4. Evolution of the US-ROK Alliance: Anti-Americanism
  5. Evolution of the US-ROK Alliance: North Korea Threat Profile
  6. Evolution of the US-ROK Alliance: Who Pays for What?
  7. Evolution of the US-ROK Alliance: New Areas for Cooperation
  8. Evolution of the US-ROK Alliance: Is there a Post-Unification Future? Pt. 1
  9. Evolution of the US-ROK Alliance: Is there a Post-Unification Future? Pt. 2
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Deterring North Korea

Much of international security depends on maintaining credible deterrence. Effective deterrence relies on two key factors: capability and credibility. In order to prevent a hostile force from attacking, countries need to be able to show that they have the resources to respond with force, i.e. military power, alliances, and force projection capabilities. However, if a country is believed to lack the political will to respond to aggression with force, their military capabilities will not be effective in deterring hostile action. On the Korean Peninsula, the US-South Korea alliance has a mixed record of deterrence. The alliance, with its modern military might displayed in regular joint exercises, clearly has the capability to deter the North Korean threat. In addition, it has projected the necessary credibility to deter any large-scale North Korean invasion since 1953.  However, the alliance had proven to have little credibility in regards to responding to lower level provocations from North Korea, which has resulted in the current decades long cycle of North Korean brinksmanship.

North Korea has taken advantage of this situation to engage in a strategy of extortion from the international community- often demanding aid, apologies or changes in policy after each round of provocations. These small-scale aggressions over time have resulted in significant loss of US and South Korean lives. From 1953 to 2003, North Korea was responsible for 1,439 major provocations, as well as the deaths of at least 90 US and 390 ROK soldiers. Since 2010, North Korea has: sunk the Cheonan, a South Korean submarine, killing 46 seamen; shelled Yeonpyong, a South Korean Island, killing four South Koreans; and threatened to turn Seoul into a sea of fire. The cycle continued again on August 4th of this year, with South Korea blaming North Korea for planting mines in the DMZ that maimed two South Korean soldiers, and on August 20th exchanged fire across the DMZ. As this current crisis unfolds, it is important to evaluate the effectiveness of current US-South Korean strategy to stop the cycle of crises that have held South Korea hostage.

Since the Korean War, the United States has restrained its South Korean ally from responding with force to North Korea’s provocations and appeased rather than confronted Pyongyang. Two examples from 1968 demonstrate this trend. On January 21, 1968, a group of North Korean commandos infiltrated South Korea and the Presidential Blue House in an attempt to assassinate South Korean President Park Chung-hee and US Ambassador William J. Porter. Rather than responding forcefully to the attempted assassination of a US ambassador and an allied head of state, the United States, through Ambassador Porter, warned President Park that the US would strongly oppose any South Korean use of force. The second incident occurred two days later, when North Korea seized the USS Pueblo, a US Navy intelligence ship, and its crew from international waters.  North Korea held the 83 US crewmembers hostage for 11 months, and abused the men. In order to end the hostage crisis, the US Lyndon Johnson administration issued a written apology to North Korea. Both instances could have easily been considered an act of war and in both President Park wanted to respond forcefully but was restrained by its American ally, which worried about the possibility of a second Asian land war breaking out during the Vietnam War.

A second Korean War would be unquestionably devastating, and the US-South Korea alliance deserves commendation for preventing that outcome. However, as the economic and military gap increases between the South and the North, the chances of another invasion have decreased. Also, while the Kim family regime engages in behavior that many consider bizarre, its continued survival for more than seven decades, and its ability to outlast almost every other communist state, is a strong argument for its survival instinct and rationality. The US-South Korea alliance has endeavored to make it credibly clear that any large scale fighting on the Korean Peninsula will inevitably end North Korea and the Kim family’s dynastic chokehold on the North Korean people. There is no reason to expect that a proportionate response to North Korean provocations will result in all out war, or that the big deterrence will fail. However, by increasing the cost of each North Korean provocation, and refusing to give into Pyongyang’s extortionary practice with enticements, will decrease the value of North Korea’s brinksmanship strategy.

In 2011, South Korea developed a proactive deterrence policy that allowed South Korean forces to retaliate promptly and proportionately against the point of origin of North Korean attacks.  This strategy was put into place after the August 20th North Korean artillery firing across the DMZ, which resulted in South Korean forces returning fire an hour later. The South Korean response demonstrated seriousness, but was done in a manner to ensure that there would be no North Korean casualties. North Korea has responded with a show of force, mobilizing troops and artillery to the DMZ and sending out its submarine force, but has also agreed to a long series of talks with South Korean officials at Panmunjom. North Korea is an expert at raising tensions and making demands, but it is important to reassert deterrence against its provocations.

The current South Korean stance has the greatest chance of ending Pyongyang’s violence, but as North Korea raises the stakes in protest, pressure will increase to give into Kim Jong-un’s demands. The United States should stand strong with Seoul to show that North Korean actions will not intimidate it, nor will it accept violent attacks against a close ally. This is not a call for reckless retaliation that could destabilize the region, and it does require signaling to Beijing of the limited nature of any response, but for too long North Korea’s provocations have gone unanswered. Following and supporting South Korea’s proactive deterrence policy will reestablish the alliances credibility, and should not be abandoned despite North Korea’s bombastic threats.

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When People ask me what is happening in North Korea

Among several people that know me, I’ve developed a reputation as a North Korea “watcher”, so it has become common for people to ask me what is happening in North Korea, or what will happen in North Korea, or when do I think the regime will collapse, etc. This is especially common when North Korea is in the news (which is fairly often). Kim Jong Un hasn’t been seen for a month… what does it mean?

The honest answer in almost every case is simple, I do not know. I think that this is probably true for the majority of people, despite the number of stories written and theories advanced each time something happens, more often than not it is guesswork. This is not to say that North Korea is completely inscrutable, or that there are no meaningful patterns. In this sense North Korea can be understood on a macro-level far easier than in a micro one. The worst question people ask me is when I think that the regime will collapse. I think that this is inevitable, however, I do not wish to join the long list of people who made the foolish mistake of offering a number of years, a date, or a specific event that will bring the regime down. If forced, I would offer with many qualifications the guess of within 50 years, but that is just a guess and a number that sounds, but with enough time that the person who asked would forget what I said within that time frame.

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Graduation- No longer a student at Fletcher and looking for new opportunities

Greetings blog followers. You may have noticed that recently my blog posts have become more sporadic and mostly just links to outside published work. This is mostly due to the fact that I recently graduated from the Fletcher School of Law and Diplomacy. Graduating is a weird mix of feelings, at first I was (and still am) extremely glad to be finished with all my final papers, tests and thesis and enjoyed the chance to relax and be lazy. Now I am in a weird transition phase where I am not a student, but am still looking for a job which creates a strange sense of ennui, anticipation, boredom and happiness that I have time to catch up on my netflix list.

My two years in graduate school were immensely rewarding intellectually. I had a chance to work with some of the top people in my field at both Harvard and Tufts, and meet many influential people. My understanding of the world has noticeably deepened. It was also a difficult time in terms of amount of work, financial issues, and working while studying. It is hard to say if it was worth it or not without knowing what kinds of opportunities it will open for me in the future. I am confident, but waiting is hard.

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