Adrian Bonifacio, a second generation Filipino-American from Chicago, is one of the recipients of the Program on Human Rights and the McCoy Family Center for Ethics in Society's 2012 Human Rights Fellowship.  The Program on Human Rights at the Center on Democracy, Development, and the Rule of Law together with the McCoy Family Center for Ethics in Society offer four annual summer fellowships in human rights open to Stanford undergraduates interested in working for organizations, government agencies, NGOs or international organizations that promote or defend human rights.

This summer, Bonifacio will work with the Asian Pacific Mission for Migrants, a non-governmental organization based in Hong Kong that promotes and defends the rights of migrant workers, a majority of whom are Filipino. Filipino immigrants in Hong Kong work predominately as domestic workers. The situation of Filipino diasporas is very complex with more than 10% of the Filipino population abroad, and over 4,000 Filipinos leaving the country every day.

Passionate about Filipino and Filipino-American issues relating to human rights such as migration, exploitation, and servitude, Stanford undergraduate Bonifacio has joined Filipino groups such as Stanford’s Pilipino American Student Union (PASU) and Anakbayan Silicon Valley, a youth organization based in Santa Clara County. He is currently pursuing a major in international relations with a minor in economics as well as co-term masters degree in sociology.

In the 1970s, Filipino dictator Ferdinand Marcos began the Labor Export Policy (LEP), a deliberate policy to send Filipino workers abroad. “This became a vicious cycle, the Philippines tried to achieve economic development based on remittances but because it sends both high skill and low skill workers abroad, and because the remittances they send are not usually put towards investment and long term development, there is not much progress happening in the country," explained Bonifacio. "Every president since Marcos has continued to promote the LEP in the name of national development.”

Last summer, Bonifacio worked for HURIGHTS OSAKA, a human rights non-profit organization, where he conducted research related to Filipino migrants in Japan to understand the link between human rights and remittances. “Although it was difficult integrating with the community in such a limited timeframe, a lot of different opportunities presented themselves—celebrating Philippine Independence Day, cooking Filipino food for events, even performing traditional dances," said Bonifacio. "My supervisor at work and all the migrants I have come to know made my transition into life in Japan, as well as my research, much easier.”

Japan and agencies in the Philippines that facilitate labor migration are notorious for abusing “entertainment visas” which allowed young women to be trafficked into Japan. Many Filipino women were promised jobs in high-end hotels as singers or dancers, but upon arrival in Japan, were trafficked into bars, with some entering prostitution rings and red light districts... Starting in the mid-1980s, many Japanese men in rural areas began to “import” Filipino women as mail-order brides, to solve the demographic problem of low birth rates caused largely by women moving out to cities to pursue professional careers.

Although the mail-order bride phenomenon has died down and Japan has since abolished the entertainment visa in 2006, there are still cases of abuse and human trafficking. Moreover, Filipino men have a history of working in construction, often as day laborers with insecure sources of income and housing. According to Bonifacio, “It is hard to determine the proportion of remittances that come from exploitation, but if you look at general trends and the types of employment Filipinos have all over the world—for example as “entertainers” in Japan or domestic workers in Hong Kong, Saudi Arabia, and even the United States—one could say that remittances and exploitation are closely connected.”

In preparation for his fellowship in Hong Kong Bonifacio says, “I was humbled by what I saw in Japan. I think that one of the best things one can do to educate oneself - and something that does not always happen in a classroom - is to understand the community we want to serve. We need to learn about the issues these communities face before considering fighting for change.”

Students interested in applying to the human rights fellowship for the summer of 2013 should contact Nadejda Marques to learn about the selection process and deadline for submission.

Scarborough Shoal, a tiny rocky outcropping and lagoon off the west coast of the Philippines, sits at the center of the latest South China Sea tug-of-war. Protesters took to the streets in Manila on May 11 to criticize China’s support of fishermen who entered the disputed territory a month ago and sparked a yet unresolved naval standoff between the Philippines and China. On May 9, while ships from both sides maneuvered in the area, Manila's secretary of defense assured Filipinos that if Beijing attacked, Washington would come to the country’s defense.  

That expectation had been strengthened in Manila in November 2011 when the visiting American secretary of state, Hillary Clinton, referred to the South China Sea as the “West Philippine Sea.” Clinton’s slip of the tongue was not a major diplomatic incident. But some Flipinos saw it as a sign of U.S. support for their government's maritime claims.

Washington’s refusal to side with any of the claimant states had not changed. What had changed was the level of American concern. In the November 2011 issue of Foreign Policy Clinton had defended the idea of a “pivot” toward Asia, meaning a renewed U.S. focus on Asia after a decade of intense military activity in Afghanistan and Iraq.

The term “pivot” has fallen out of favor in Washington, but the Obama administration’s heightened interest in Asia is real and ongoing, says Donald K. Emmerson, director of Stanford’s Southeast Asia Forum. He recently discussed the nuances of what he describes as an important but “lopsided pivot.”

How does the pivot fit into the larger global picture?

In the continuing debate as to whether the United States is in decline, the key question is: relative to what? Certainly, if we compare the situation now with the period immediately after World War II, the United States is less powerful relative to the power of other states. But 1945 ushered in a uniquely unipolar moment in American history. Americans had escaped the physical devastation wreaked on Europe and much of Asia. Germany and Japan lay in ruins. Twenty million Russians were dead. China’s long-running civil war would soon resume. Suddenly America had no credible competitors for global power.

Today? Conventional wisdom holds that Asia has become the center of gravity in the global economy. Yet even if we use purchasing power parity rather than exchange rates to measure the American share of world GDP, that share has only modestly decreased. Meanwhile, China’s remarkable rise may be leveling off. The evidence is less that the United States is in secular decline than that the world is changing in ways to which Americans need to adapt if they are to regain economic health. If the pivot facilitates that adaptation, it will have been a success.

Do you interpret the pivot to the Asia-Pacific as more hype or reality?

The pivot is definitely a reality, but the reality is partly about symbolism and atmospherics. The pivot conveys reassurance, particularly to Southeast Asia, that the United States cares about the Asia-Pacific region and that it is willing to cooperate more than before with the Association of Southeast Asian Nations (ASEAN). Part of that is simply “showing up”—a willingness to attend ASEAN regional meetings. Another part of the pivot, however, involves raising the American security profile in the region, which has so far strengthened ASEAN’s diplomatic hand in dealing with China’s sweeping claim to the South China Sea.

How has the pivot been received and interpreted in Asia?

Generally speaking, the pivot has been welcomed in Southeast Asia, despite worries that if it becomes an effort to contain China, a Sino-American cold war could result. The specific responses of Southeast Asian governments have differed, however, on a spectrum from passive acquiescence to active support.

In Japan, the rotation of prime ministers in and out of office has understandably focused that country’s politics more on domestic concerns, and the still not fully resolved disposition of U.S. forces on Okinawa has drawn energy from the bilateral relationship.

As a “middle power,” South Korea has been supportive of multilateral frameworks and solutions. Seoul is pleased to see a renewed American interest in working with Asians in multilateral settings such as ASEAN and the East Asia Summit.

China’s response has varied between cool and hostile. The foreign ministry has treated the pivot with some equanimity compared with the hostility of those in the People’s Liberation Army who view increased American involvement in Asia as a threat to Chinese aims and claims, especially regarding the South China Sea. China’s foreign policy is the outcome of contestation between various groups inside the country that do not necessarily see eye to eye on how best to handle the United States.

What do you see as the main implications, repercussions, and complications of the pivot?

The pivot, as Hillary Clinton advertised it in her Foreign Policy article, signals a shift in U.S. priorities away from Iraq and Afghanistan. For a time following the 9/11 attacks on America in 2001, the United States tended either to neglect Southeast Asia or to treat it as a second front in the “war on terror.” Economically, the pivot implies an acknowledgment that if America is to prosper in this century it will have to pay closer attention to Asia as an engine of global economic growth. Diplomatically, the pivot implies that with regard to Asian states, Washington cannot merely manage its relations bilaterally as the hub where their spokes meet, but must cultivate multilateral diplomacy as well. Militarily, the pivot implies that even while the American global force posture is drawn down in some parts of the world, it needs to be upgraded in Asia in response to Asian and American concerns over the terms on which China’s rise will take place.

A major constructive repercussion of the pivot has been the evolution of China’s own diplomacy in Southeast Asia. Previously China had disavowed multilateral diplomacy with Southeast Asians over claims to the South China Sea—a bilateralist strategy that in Southeast Asian eyes resembled an effort to “divide and rule.” America’s willingness to reach out to ASEAN and take part in ASEAN events has helped diplomats in any one Southeast Asian country to resist having to face China alone. Multilateral discussions, involving China and meant to prepare the way toward an eventual Code of Conduct, are now underway.

But as we saw recently during Hillary Clinton’s visit to the Philippines, it is important for Washington to maintain its independence and impartiality while facilitating peace in the region.

Complications? Yes, there is a danger that Washington could be dragged into supporting, or appearing to support, the claims of one of the Southeast Asian parties to the dispute. The Obama administration is aware of this risk, however, and I strongly doubt that an American official will again refer to the “West Philippine Sea.” 

A more serious complication in the longer run may arise from the pivot’s emphasis to date on Asian-Pacific security, and its relative lack of attention to creating and cultivating American economic opportunities in Asia.

China’s economic footprint in Asia is large and growing. It has moved up to become the main trading partner of many countries that used to trade proportionally more with the United States. An unbalanced relationship in which China saves and lends what Americans borrow and spend is unhealthy for both countries, and it cannot last. The pivot should forestall an invidious division of labor whereby Washington through the Seventh Fleet subsidizes the regional peace that enables Asians to prosper doing business with China. A higher priority needs to be placed on promoting American trade and investment in Asia, including China.

The Obama administration is hoping to persuade more Asian economies to join an arrangement called the Trans-Pacific Strategic Economic Partnership (TPP), but the bar that it sets is high. The TPP’s strict protections for the environment, labor, and intellectual property rights and its comprehensive cuts in both tariff and non-tariff barriers to trade have raised its quality but lowered its appeal, especially to the region’s larger economies. Meanwhile, anticipated cuts in American budgets for defense will only intensify the need to refocus the pivot on economic as well as military access to Asia.

Related Resources

Foreign Policy: “America’s Pacific Century”
November 2011 article by Hillary Clinton introducing the concept of the "Asia pivot."

Stanford Daily: "Obama pivots policy toward Asia"
Summary of Donald K. Emmerson's May 1, 2012 talk.

LinkAsia: "Treat Scarborough Shoal Incident as a 'Wake Up Call'"

What do running a business and flying an airplane have in common?

“Starting a business is like takeoff and cruising,” says Yasunori Kakemizu, a Corporate Affiliates Visiting Fellow at Stanford’s Shorenstein Asia-Pacific Research Center (Shorenstein APARC). “But exiting from it is very difficult—like landing—because you need to try to make a profit.” 

Kakemizu should know. He has spent over a decade promoting business development at Japan’s Sumitomo Corporation and its affiliate company Jupiter Telecommunications (J:COM). He is also currently training in his free time for his pilot’s license.

Assistant to the general manager of the Cable TV Department in Sumitomo’s Media Division, Kakemizu has spent the past year at Stanford studying the strategies of major American cable companies in adapting to industry changes like the rise of online streaming media. He has examined, for example, the launch of Comcast’s Xfinity streaming service, and how the company has successfully grown it into a profitable part of its business.

“I’m looking for lessons J:COM and other affiliates can use in the next steps of their own streaming services, which is still relatively new in Japan,” Kakemizu says.

Kakemizu is also taking advantage of Stanford’s close ties to Silicon Valley by attending entrepreneurship seminars and enrolling in classes like cloud computing and investment finance. He is fascinated by the opportunities Stanford students have to work on projects with Silicon Valley companies, and the important role Stanford plays in the regional and global business world.

“This university gathers people from around the world and educates them on how to create new companies,” he says. “They then transmit this knowledge globally.”

During the academic year, Kakemizu has enjoyed taking part in the Corporate Affiliates Program site visits to cutting-edge local tech companies, such as Facebook. He found the visit to Cypress Envirosystems, a company that merges digital technology with older HVAC analog technology, especially intriguing.

“Most businesses are ‘forward thinking,’ but they’re focusing on older technologies,” Kakemizu says. “As a result, they don’t have any market competitors. From a business point of view, their strategy is very clever.”

As the academic year winds down, Kakemizu will wrap up his research project and present the results at a seminar. He and the other Visiting Fellows will have a chance to receive feedback and respond to questions from Shorenstein APARC faculty.

Kakemizu will also finish up his pilot’s license training before he returns to Japan. If you hear an airplane flying over campus one day this spring, it might just be him.

“The view of Stanford from the air is very beautiful,” he says.

A once-a-day pill to help prevent HIV infection could significantly reduce the spread of AIDS, but only makes economic sense if used in select, high-risk groups, Stanford researchers conclude in a new study.

The researchers looked at the cost-effectiveness of the combination drug tenofovir-emtricitabine, which was found in a landmark 2010 trial to reduce an individual’s risk of HIV infection by 44 percent when taken daily. Patients who were particularly faithful about taking the drug reduced their risk to an even greater extent – by 73 percent.

The results generated so much interest that the Stanford researchers decided to see if it would be cost-effective to prescribe the pill daily in large populations, a prevention technique known as pre-exposure prophylaxis, or PrEP.

They created an economic model focused on gay men, as they account for more than half of the estimated 56,000 new infections annually in the United States, according to the Centers for Disease Control and Prevention.

“Promoting PrEP to all men who have sex with men could be prohibitively expensive,” said Jessie Juusola, a PhD candidate in management science and engineering in the School of Engineering and first author of the study. “Adopting it for men who have sex with men at high risk of acquiring HIV, however, is an investment with good value that does not break the bank.”

For instance, using the pill in the general population of gay men would cost $495 billion over 20 years, compared to $85 billion when targeted to those at particularly high risk, the researchers found. The study will be published in the April 17 issue of the Annals of Internal Medicine.

Senior author Eran Bendavid, an affiliate of Stanford Health Policy at the Freeman Spogli Institute, said the results are a departure from a previous study. Earlier research found PrEP was not cost-effective when compared with other commonly accepted prevention programs.

The new Stanford study differs in a few important respects, taking into consideration the decline in transmission rates over time as more individuals take the pill. The Stanford team also assumed individuals would stop taking PrEP after 20 years, not stay on the drug for life, as the previous study had assumed.

The pill combination, marketed under the brand name Truvada, is widely used for treating HIV infection. But it wasn’t until a landmark trial, published in the New England Journal of Medicine in November 2010, that individuals and their doctors began to seriously consider using the drug as a preventive therapy. The drug’s maker, Foster City, Calif.-based Gilead Sciences Inc., has filed a supplemental new drug application to market it for prevention purposes.

The CDC issued interim guidelines on the drug’s use in January 2011, suggesting that if practitioners prescribe it as a preventive measure, they regularly monitor patients for side effects and counsel them about adherence, condom use and other methods to reduce their risk of infection.

In developing their model, the Stanford researchers took into account the cost of the drug – about $26 a day, or almost $10,000 a year – as well as the expenses for physician visits, periodic monitoring of kidney function affected by the drug, and regular testing for HIV and sexually transmitted diseases.

“We’re talking about giving uninfected people a drug that has some toxicities, so it’s crucial to have them monitored regularly,” said Bendavid, who is an assistant professor of medicine in Stanford’s School of Medicine.

Without PrEP, the researchers calculated there would be more than 490,000 new infections among gay men in the United States in the next 20 years. If just 20 percent of these men took the pill daily, there would be nearly 63,000 fewer infections.

However, the costs are substantial. Use of the drug by 20 percent of gay men would cost $98 billion over 20 years; if every man in this group took PrEP for 20 years, the costs would be a staggering $495 billion.

Given these figures, the researchers looked at the option of giving PrEP only to men who are at high risk – those who have five or more sexual partners in a year. If just 20 percent of these high-risk individuals took the drug, 41,000 new infections would be prevented over 20 years at a cost of about $16.6 billion.

At less than $50,000 per quality-adjusted life year gained (a measure of how long people live and their quality of life), that strategy represents relatively good value, according to Juusola.

“However, even though it provides good value, it is still very expensive,” she said. “In the current health care climate, PrEP’s costs may become prohibitive, especially given the other competing priorities for HIV resources, such as providing treatment for infected individuals.”

She said the costs could be significantly reduced if the pill is found to be effective when used intermittently, rather than on a daily basis. Current trials are examining the effectiveness of the drug when used less often.

Other co-authors are Margaret L. Brandeau, the Coleman F. Fung Professor of Engineering, and Douglas K. Owens, the Henry J. Kaiser, Jr. Professor at Stanford and senior investigator at the Veterans Affairs Palo Alto Health Care System. Owens also is director of Stanford’s Center for Health Policy and Center for Primary Care and Outcomes Research.

The study was funded by the National Institutes of Health and the Department of Veterans Affairs and supported by Stanford’s departments of Medicine and Management Science and Engineering.