On Thursday the New York Times reported the alarming and deeply troubling news that Malawi sentenced Tiwonge Chimbalanga and Steven Monjeza, a gay couple, to 14 years in prison and hard labor. The sentence was handed down as a punishment after the couple decided to throw a party to celebrate their engagement–an event that made front-page headlines in local news publications there. The couple was arrested two days later.

Human rights organizations have widely condemned this decision as a violation of the couple’s basic and fundamental human rights. As the Times article pointed out, homosexuality is illegal in at least 37 African countries, including Malawi. After the latest good news coming out of Uganda, where an anti-homosexuality bill is likely to be withdrawn from Parliament, this is a sad reminder that LGBT people still face severe persecution and human rights violations in other African countries and beyond.

There are options for people in countries with draconian laws against homosexuality. LGBT people who have a well-founded fear of persecution in their native country due to their sexual orientation or gender identity may be eligible for asylum in the US and other countries.

Every year, PHR’s Asylum Network volunteers help people just like Tiwonge and Steven–people whose human rights have been violated simply because they defy cultural norms–to change their lives by gaining safe haven from their persecutors.

Asylum claims made on the basis of sexual or gender-based persecution, however, face major obstacles, making the powerful evidence provided by health professionals all the more crucial. Health professionals in the US can help fight injustices and gross human rights violations committed worldwide by supporting the efforts of those being persecuted to gain asylum in the US.

Take the case of J.C., an asylum seeker from Jamaica whose life was threatened because of his sexual orientation and his HIV+ status. He and his friends were attacked for being gay, and he had been forced to be closeted his entire life. He was diagnosed with Major Depression and panic attacks. Thanks in part to the powerful evidence provided by a psychiatrist in the Asylum Network, J.C. was granted asylum this year, giving him the chance to start a new life and recover in the US.

Put your medical expertise to good use and help promote human rights by joining the Asylum Network today!

Want to learn more about the challenges facing the AIDS community right now??Checkout this recent segment from WAMU Radio's?The Diane Rehm Show, "Setback in the Fight Against AIDS"?(May 18), which features global health luminaries and PHR friends:

• Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases/NIH
• Stephen Lewis, HAA supporter, Former? Special Envoy for HIV/AIDS in Africa and Co-Director of AIDS-Free World
• Dr. Peter Mugyenyi, HAA colleague and one of the world’s foremost specialists on HIV/AIDS,? founder and director of Uganda’s Joint Clinical Research Center
• Ambassador Eric Goosby, Former HAA Advisor and Ambassador at large and Global Aids Coordinator with the U.S. Department of State

On May 10th, The New York Times published a heartrending story on the faltering fight against AIDS in Uganda — a story that has sparked a firestorm of controversy and criticism of the Obama Administration's global AIDS strategy.

The Times identified a deep funding gap for combating AIDS in Uganda, including a freeze on new funds from the United States and a lack of commitment to AIDS spending by the Ugandan government (which evidently has no problem finding $300 million to spend on Russian fighter jets). The Times also outlined the devastating human toll this funding gap is taking on people living with—and dying of—AIDS.

Sadly, this news is not new. In March 2009, PHR invited Dr. Peter Myugenyi, Founder and Director of the PEPFAR-supported Joint Clinical Research Centre in Uganda, to Washington, DC to talk about the emerging funding gap for AIDS in Uganda. Said Dr. Mugyenyi:

After urging people to get tested and enter care, we now have to tell them there is no treatment available when they need it. We created hope and now we are returning to the days when one member of a family can get treatment and the others cannot.It is a recipe for chaos as patients start to share doses or skip treatment altogether. I fear that we will soon start to see more drug-resistant strains of HIV and rising death rates.

As The Times notes, one year later, Dr. Myugenyi remains fearful:

Dr. Peter Mugyenyi, the hospital’s founder, helped the Bush administration form its AIDS plan and sat beside Laura Bush during the State of the Union address as it was announced.

The loss of donor interest “makes me frantic with worry,” Dr. Mugyenyi said.

He offers copies of e-mail messages he exchanged with American aid officials. One reminds him that he has been instructed to stop enrolling new patients and asks for an explanation of reports that he is treating 37,000 when only 32,000 are authorized. Another asks him not to announce publicly that his funds have been frozen.

He admits slipping pregnant women and young mothers like Ms. Kamukama into treatment slots “contrary to instructions.”

“Morally, I can’t turn them away,” he said.

This story gained traction worldwide, and was followed by a New York Times editorial, The Wavering War on AIDS, which outlined a $13 billion deficit in AIDS spending, and a series of letters to the editor, including one by PHR Global Health Action Campaign advisor Pat Daoust.

Dr. Mugyenyi won't turn away patients. And we won't turn away from this issue.

PHR, in conjuction with other global health groups, sent this letter to Secretary of State Clinton last week, urging her to end the AIDS funding freeze and ensure Ugandans have access to life-saving AIDS treatment.

PHR members have spent years advocating for more global AIDS funding and health programming based on science and human rights. We will continue to fight for greater global health funding, a strong US global health strategy, and to ensure people living with AIDS worldwide have access to drugs and quality care.

Want to help? Encourage your Representative to co-sponsor the Global HEALTH Act, which will provide $2 billion for health system strengthening and support a comprehensive US global health strategy, both of which will help in the fight against AIDS.

[Special Note: PHR medical student activists from New York just spent a day in Albany educating policy makers on this bill. We have the momentum–take action today!]PHR has been working for years to stop torture by US forces. Especially important to us is ending the use of the healing professions to design, supervise and implement a regime of abuse intended to break the bodies and minds of detainees.Now, New York State has an amazing opportunity to establish accountability for health professionals who engage in torture or ill treatment of detainees—and we need your support to make it happen.Sign the petition TODAY urging New York lawmakers to stop torture.Legislation has been proposed in New York State by New York State Assemblyman Dick Gottfried and New York State Senator Tom Duane that would prohibit the participation of health care professionals in torture and improper treatment of prisoners. The bill is needed to ensure that the well-documented complicity and direct participation of physicians and other health professionals at Guant?namo Bay and elsewhere will not be repeated.Thanks to the hard work of doctors, psychologists, psychiatrists, nurses, students, lawyers and activists like you, we expect the New York House and Assembly to vote on this bill in the next few months.Now, we need your voice to make this a reality.

• If you are from New York, Email your Senator and Assembly-person directly to show your support of the bill.
• If you are not from New York, sign the petition in support of this bill.
• If you have already signed on, thank you. Now help spread the word: send this to six friends so we can build momentum for this crucial bill.

If passed, New York would be the model for all other states on ending health professional complicity in torture. Let New York State and the world know that you support this legislation by signing the petition today.

Some good news out of Uganda: A few weeks after the US Senate passed a resolution condemning Uganda's Anti-Homosexuality Bill, a special committee in Uganda has recommended the anti-homosexuality bill? be withdrawn from Parliament.Minister of Local Government Adolf Mwesige, chair of the special committee, called almost all of the clauses in the legislation either unconstitutional or redundant — a great win for health, human rights and the rule of law in Uganda.The bill is still up for consideration, but this is a major blow, and as the New York Times reports, is a strong signal the bill will be dropped.

Uganda’s president, Yoweri Museveni, has publicly shown concern about the legislation and formed the review committee in February in response to international scrutiny. Though the panel’s ruling is not the final word, analysts saw it as a strong sign that the bill would eventually be dropped.

The New York Coalition Against Torture (NYCAT) — a group of concerned doctors, psychologists, lawyers, students and citizens — was formed in response to the shocking human rights abuses and gross violations of health professional ethics that have taken place during the "war on terror." The well-documented participation of doctors, psychologists and other health care professionals in the torture, abuse and interrogation of prisoners in US custody raises serious concerns about the integrity and the future of health care professions in this country.Working in conjunction with the Center for Constitutional Rights, The Bellevue/NYU Program for Survivors of Torture, and Physicians for Human Rights, NYCAT has been at the forefront of education and advocacy efforts intended to address this issue at the state level. One of the group's primary goals is to see the passage of the Gottfried-Duane Anti-Torture Bill (S. 4495-A /A. 6665-B), which is pending in the New York State Legislature. This bill is the first of its kind in the nation and explicitly addresses the role of health professionals in the abusive treatment of prisoners.The bill explicitly states that NY-licensed health professionals’ duty to do no harm applies to their relationships with all patients and employers, and affirms that they are prohibited from any involvement in torture or other abuse of prisoners. This can be a way to help health professionals resist unlawful instructions that may expose them to risk of criminal prosecution and civil damages lawsuits.“As future doctors, we are committed to restoring trust in our profession and respect for the rule of law. We look forward to garnering additional support for the bill and to raising awareness about this critical ethical and human rights issue,” says Hana Akselrod, medical student and member of PHR’s active student chapter at Mt. Sinai School of MedicineToday, NYCAT and interested medical students will go to Albany to meet with legislators to advocate for the Gottfried-Duane Anti-Torture Bill. They have been gathering signatures for the petition to demonstrate widespread support for the legislation, including at the PHR National Conference in February, and will present the petition today.Show your support by sign the petition now. MEDIA ADVISORY: Medical Students Advocate Against Health Professional Participation in Torture(Cross-posted from the PHR Student Blog)

Today, as we celebrate International Nurses Day, the health workforce crisis remains one of the greatest hurdles to realizing the right to health for all in developing countries.The Global HEALTH Act can help. The GHA, introduced in Congress by Representative Barbara Lee on March 24, would provide $2 billion over five years to increase the number of doctors, nurses, pharmacists and other health workers in developing countries, and to improve primary health care for all. The bill not only authorizes new resources, it also calls for the creation of a US Global Health Strategy that will complement the goals of developing countries and ensure our aid money is effectively used to save the lives of hundreds of thousands of people.That is why PHR is uniting with more than 15 other US organizations to hold a national Call-in Day TODAY to support the Global HEALTH Act. Be part of the movement. Tell your Representative to support Global Health by co-sponsoring this bill.It’s easy. Call the Congressional Switchboard at (202) 224-3121 and ask to be connected to your Representative’s office (if you don't know who your Rep. is, find out). Then, make your case. Use the script below, and/or bring your own experiences into the call:

Hi, my name is XXX and I live in Town, State. I am calling to encourage Representative XXX to co-sponsor HR 4933, The Global HEALTH Act, which will help fix broken health systems in developing countries. The Global HEALTH Act calls for the development of a US Global Health Strategy to harmonize aid, and provides $2 billion over 5 years to help countries in Africa hire, train and retain more doctors, nurses and other health workers. The Global HEALTH Act will save lives: I hope Rep. XXX will consider co-sponsoring this bill today.

As of today, the global health community has secured nine co-sponsors: Reps. John Conyers (MI), Lynn Woolsey (CA), Raul Grijalva (AZ), Keith Ellison (MN), John Garamendi (CA), Fortney Pete Stark (CA), Diane Watson (CA), Jesse Jackson, Jr. (IL) and Eleanor Holmes Norton (DC). Help us secure more. Commemorate International Nurses Day by taking action. Join thousands around the country today who are making a difference. Call your Representative and encourage them to co-sponsor the Global HEALTH Act today.UPDATE, May 17: The Global HEALTH Act has garnered six new co-sponsors: Jesse Jackson, Jr. (IL), Eleanor Holmes Norton (DC),?Sam Farr (CA), Maxine Waters (CA), Bobby Rush (IL) and James McGovern (MA).

When President Obama signed an Executive Order on his second day in office mandating a uniform standard for all US interrogations, the human rights community was relieved and gratified. Years of advocacy to end torture and abuse of detainees had finally paid off. There was still a lot of work to be done on accountability for past abuses but at least we could be confident no new abuses would occur.Well, here we are 16 months into the Obama Administration, still dealing with serious allegations of abuses of detainees in Afghanistan. Disturbing reports about a second, undisclosed US detention facility at Afghanistan’s Bagram Airbase have been circulating for many months. Now they have taken on a new level of concreteness with confirmation from the International Committee of the Red Cross that they have been notified of prisoners detained in the separate facility by US authorities since August 2009. While the ICRC has not made any public comments about abuses taking place at the second facility, a BBC reporter has interviewed a number of former prisoners from the facility who have described a now familiar litany of abuses: Isolation in cold cells; sleep deprivation; and beatings by US soldiers. One detainee says he was denied sleep for 24 days by noise-making machines and constant lights. He also reports that he spent 5 days shivering in a cold cell.The most troubling aspect of these allegations is that the US officials using these techniques may believe they are in compliance with interrogation guidelines. The Army Field Manual's Appendix M [PDF] explicitly allows the use of isolation and uses sleep manipulation as an integral part of an interrogation program. As surmised here by the BBC’s Hilary Andersson, the officials at the second, secret site may believe what they are doing is perfectly legal under the cover of the Army Field Manual:[display_podcast]In reality, as PHR has demonstrated in several reports in recent years, the techniques used in Appendix M can easily cross the line into torture and cruel and inhuman treatment. The profoundly harmful mental health effects of isolation and sleep deprivation are documented in PHR’s report Leave No Marks (with Human Rights First) at pages 30-33 and in PHR’s Break Them Down at pages 59-69.Appendix M itself acknowledges the danger of abuse posed by separation and requires special safeguards and notification while urging officials to “mitigate the risks associated with its use.” It is not clear that Appendix M is being explicitly relied on as authority for the alleged abuses at Bagram. What is clear is that even the existence of Appendix M signals that sleep manipulation and isolation are appropriate techniques for use on prisoners. Once a permissive environment is created in which subjecting detainees to these approaches is seen as acceptable or even routine, the safeguards included in Appendix M can easily be ignored. As PHR has previously described (see reports above) attempts to calibrate how much pain and stress a detainee can stand very easily cross the line into torture and cruel treatment. PHR believes that the risks associated with Appendix M are unacceptable. The prohibition against torture is absolute and interrogation guidance must clearly and unambiguously reflect that rather than relying on ineffective “safeguards.” US personnel should not be put in a position to engage in potential violations of US and international law and detainees must be afforded the protections enshrined in applicable anti-torture law. Appendix M should immediately be rescinded.The Obama Administration has made repeated pledges to end torture and abuse and to conduct detainee operations in as transparent a manner as possible. Yet, here we are again with familiar denials and a lack of transparency about US detention operations. Again there are evasive answers from US officials that obscure the purposes of facilities and fail to identify agencies responsible for operating them. Senior officials in the Obama Administration need to live up to their commitments by completely investigating the Bagram allegations, providing clear and transparent information about detention operations worldwide and establishing effective oversight mechanisms for DoD and other agencies' screening, detention and interrogation programs.

In an immigration detention system known for its disregard of even basic needs, Francisco Castaneda’s case stands out as a prime example of the US government’s indifference to health and human rights.In March 2006, Mr. Castaneda, an immigrant from El Salvador, was detained by immigration officials of the US Department of Homeland Security.? At that time he had a small lesion growing on his penis, for which he promptly requested medical attention from detention authorities.? Over the course of the next year, as the lesion grew larger and more painful and Mr. Castaneda additionally developed a lump in his groin, no fewer than four health professionals who examined him ordered a biopsy to determine definitely whether Mr. Castaneda suffered from the cancer they suspected he had.By late 2006, the lesion frequently bled and produced discharge, and caused Mr. Castaneda difficulty urinating and even sleeping. Despite this, US Public Health Service officials, who had the final say on referring Mr. Castaneda for specialist care outside the detention center where he was held, refused to authorize the biopsy. Their reason?? They said it was an “elective” procedure.Tragically, and outrageously, a biopsy was finally approved after a fifth recommendation. Before it could be performed, however, Mr. Castaneda was suddenly released from detention. This action freed the US Department of Homeland Security from responsibility for Mr. Castaneda’s care.Access to health care came too late for the former detainee. Despite receiving treatment after his release for what was, in fact, penile cancer, Mr. Castaneda passed away in February 2008.The United States Supreme Court this week released a decision in the case that Mr. Castaneda’s family has pursued against the officials who callously denied him care.? Despite the government’s acknowledgement in March 2008 that its officers’ decisions were medically negligent, the Court agreed with the government that US law does not permit the Castaneda family to sue the individual medical personnel who were responsible for denying the biopsy requests.The Supreme Court’s timing is ironic, coming as it does within weeks of the US Congress passing landmark health care legislation designed to enhance the public’s access to health care services. More than 30 years ago, the Court held that health care for prisoners is a Constitutional right – protection that exceeds anything that the Court has recognized for those of us who walk freely on the street. A systematic disregard for a detainee’s health that puts his life at risk also violates US obligations under human rights treaties, an issue not before the Court in this case and therefore not addressed.There are two critical lessons to take away from this senseless loss of life: there is a dire need for a robust program of community-based alternatives to immigration detention, and health care delivery to immigration detainees must be reformed.If Mr. Castaneda had been released into a community-based detention-alternatives program much sooner, he could have obtained medical care that could have saved his life, or at least have had more time with his family. Release under safeguards, into community-based, cost-effective programs that provide counseling and help with immigration proceedings, best serves the interests of both the government and immigrants with no history of violence and well-established roots in the community.Reform of immigration detention health care must also occur without delay. While the Obama Administration works on comprehensive reform to civil detention health care, immigration officials should look to the correctional community for an interim health care model. Immigration detention centers should be required to obtain and maintain professional accreditation for medical operations from an entity such as the National Commission on Correctional Health Care.? Monitors from the community—either state health authorities or other organizations with expertise—should participate in ongoing oversight over medical care provided by immigration detention centers in their jurisdictions.As Mr. Castaneda himself said in testimony to a House committee in October 2007, he and his allies sought justice

for the many others who are suffering and will never get help unless [Immigration and Customs Enforcement] is forced to make major changes in the medical care provided to immigrant detainees.

Health professionals can and must do more to speak out against the conflicting loyalties to which detention health authorities are subject, and the failure of detention medical personnel to uphold their ethical duties toward patients such as Mr. Castaneda. Health professionals can also authoritatively advocate release on appropriate safeguards, and access to care in the community, for immigrants in deportation proceedings. While the law has failed the Castaneda family, the health professions must not.