You people are amazing! I've been tweeting calls as @phrTweets for you to ask your networks of friends and colleagues on Twitter to support PHR's work. You could be tweeting about Avatar, Nick Jonas's guitar pick or the news that AT&T has stopped selling iPhones in NYC, like the rest of twitter—but you thought it was more cool and more important to tweet about human rights. Below is just a small cross section of the friends of @phrTweets who are sparks of hope for health and justice.You, too, can be a spark of hope for health and justice. There's still an hour left to make a tax deductible donation in 2009. Make a donation in 2009 while you still can.If you've already made a donation or you can't make one yourself, click on the tweet this link above or share this link on Facebook and help make sure Physicians for Human Rights has?the resources to advance the health and dignity of the world's most vulnerable people.Thank you for your commitment to health and human rights. Happy New Year from everyone at PHR!

1. RT @JonHutson: Pls RT! Spark hope: Help PHR deliver concrete results for health, dignity & justice around the globe http://bit.ly/4pK9c1 23 Dec 2009 from web
2. Pls RT! Send words of hope to our sisters in #Darfur: http://darfuriwomen.org Then spark hope here: http://bit.ly/4pK9c1 23 Dec 2009 from web
3. RT @JonHutson: Pls RT! Send words of hope to our sisters in #Darfur: http://darfuriwomen.org Then spark hope here: http://bit.ly/4pK9c1 23 Dec 2009 from TweetDeck
4. RT @JonHutson: Pls RT! Send words of hope to our sisters in #Darfur: http://darfuriwomen.org Then spark hope here: http://bit.ly/4pK9c1 23 Dec 2009 from web
5. RT @JonHutson: Pls RT! Spark hope: Help PHR deliver concrete results for health, dignity & justice around the globe http://bit.ly/4pK9c1 23 Dec 2009 from TweetDeck
6. RT @phrTweets: Make a difference in the world: support PHR with a year end donation http://tr.im/IPOF 28 Dec 2009 from web
7. RT @phrTweets: 3,500 villages destroyed by the military junta. Help end war crimes in #Burma. #warcrimes #donate http://bit.ly/5AeyxF P … 29 Dec 2009 from web
8. Make a difference in the world: Support PHR w/ a year-end donation. http://tr.im/IPOF #humanrights Do it!!! 29 Dec 2009 from web
9. RT @phrTweets: 3,500 villages destroyed by the military junta. Help end war crimes in #Burma. #warcrimes #donate http://bit.ly/5AeyxF P … 29 Dec 2009 from web
10. RT @phrTweets: Accountability 4 US #torture & the use of medicine in its service is not over. Support PHR. #donate http://bit.ly/5AeyxF 29 Dec 2009 from UberTwitter
11. RT @phrTweets: Accountability 4 US #torture & the use of medicine in its service is not over. Support PHR. #donate http://bit.ly/5AeyxF 29 Dec 2009 from HootSuite
12. RT @phrTweets: 3,500 villages destroyed by the military junta. Help end war crimes in #Burma. #warcrimes #donate http://bit.ly/5AeyxF 29 Dec 2009 from HootSuite
13. RT @phrTweets: Help us protect, support & seek justice for Darfuri women in #Sudan and #Chad http://bit.ly/5AeyxF #donate 31 Dec 2009 from UberTwitter
14. RT @JonHutson RT @phrTweets: Help us protect, support & seek justice for Darfuri #women in #Sudan and #Chad http://bit.ly/5AeyxF #donate 31 Dec 2009 from web
15. RT @JonHutson: RT @phrTweets: Help us protect, support & seek justice for Darfuri women in #Sudan and #Chad http://bit.ly/5AeyxF #donate 31 Dec 2009 from TweetDeck
16. RT @JonHutson: RT @phrTweets: Help us protect, support & seek justice for Darfuri women in #Sudan and #Chad http://bit.ly/5AeyxF #donate 31 Dec 2009 from TweetDeck
17. RT @JonHutson: RT @phrTweets: Help us protect, support & seek justice for Darfuri women in #Sudan and #Chad http://bit.ly/5AeyxF 31 Dec 2009 from TweetDeck
18. RT @phrTweets: Today is the deadline for tax-deductible gifts to Physicians for Human Rights this year. http://bit.ly/5AeyxF #donate Pls RT! 31 Dec 2009 from TweetDeck
19. Help bring #justice and #accountability to #Burma and end 50 years of mass atrocities. http://bit.ly/5AeyxF #donate Pls RT! 31 Dec 2009 from Seesmic
20. RT @phrTweets: Today is the deadline for tax-deductible gifts to Physicians for Human Rights this year. http://bit.ly/5AeyxF #donate Pls RT! 31 Dec 2009 from Tweetie

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Ending HIV-related stigma and discrimination is critical for prevention, treatment and care for millions. PHR?has analyzed the four completed PEPFAR country partnership framework agreements, plus a late-stage draft of Kenya's agreement, to determine how they address several issues related to stigma and discrimination:

1. whether they promote legal and policy changes required to create a protective legal environment for women, people living with HIV/AIDS and other marginalized populations;
2. whether they address health sector stigma; and
3. whether they acknowledge people with disabilities as a population at heightened risk for contracting HIV.

The partnership framework agreements, and more specific five-year implementation plans that will follow, will guide PEPFAR's work in each country with an agreement over the next phase of PEPFAR.So how did PEPFAR do?PHR found that although PEPFAR's newly released five-year strategy incorporates the vital goals of stigma-free HIV programs and reaching even the most marginalized populations, the initial partnership framework agreements inadequately address these issues. Most of the agreements reviewed failed to address the need for legal and policy reform with respect to curtailing stigma and discrimination and securing the equal rights of women. Those that did were incomplete with respect to issues or populations covered, or were vague as to the extent of the commitments being made. Similarly, the majority of agreements did not address stigma and discrimination within the health sector, and the approach of the several that did specifically address this concern did not appear to be comprehensive. Only one agreement recognized people with disabilities (in particular, people with mental disabilities) as a group at heightened risk of contracting HIV.The overview of PHR's findings and recommendations, and the full analysis, are available on our website.PHR urges that future partnership framework agreements, as well as the implementation plans, much more fully address these issues. We recognize that progress in some cases requires addressing deep, culturally-rooted stigma and may not always be possible within the context of these agreements. Yet the US government must actively and vigorously use all sources of leverage and planning, including these agreements, to promote respect for human rights of all people. Part of any strategy to do so should include increased support for women's organizations and organizations comprised of and representing marginalized populations. Such organizations will have a central role in helping societies overcome stigma, in advocating for legal and policy changes and in holding governments accountable for enforcing policies that protect human rights.

That is the tune being sung through harm reduction networks. I write to share very exciting news.Yesterday Congress ended the 22-year-old ban on federal funding of syringe exchange. Following on the heels of a House vote last week, the Senate yesterday ended the ban by a 57-35 vote. PHR has been at the core of this battle for 3 years, making sure Congress, the administration and the public understand that the ban’s impact extends beyond our national borders.The ban has been applied to foreign assistance and has prohibited US global AIDS funding from addressing this important intervention in resource-poor countries facing rapidly-expanding injection-driven HIV epidemics. The original House language passed last summer included an onerous restriction on where needle exchange programs could operate. I’m thrilled to report that the language passed by both the House and Senate has removed that troubling restriction. With passage of this legislation, the Office of the Global AIDS Coordinator is prepared to revise previous global AIDS funding guidelines to allow funding for needle exchange services. This is a huge victory for HIV and viral hepatitis prevention and a sign of hope for human rights.We did it! Now it’s up to the President to sign it into law and finally make good on his campaign pledge.

There has been considerable progress since my last update on needle exchange and appropriations. The Senate-House conference committee released a 2010 spending package which includes language ending the ban on federal funding of needle exchange and doesn’t include the troubling 1,000-foot restriction that was in the original House language. After a failed attempt earlier in the week to reinsert the full ban, the House of Representatives yesterday passed the spending package with the new language, which will allow cities and states to use federal HIV prevention dollars for needle exchange programs. The Appropriations website? summarizes the progress:

Modifies a prohibition on the use of funds in the Act for needle exchange programs; the revised provision prohibits the use of funds in this Act for needle exchange programs in any location that local public health or law enforcement agencies determine to be inappropriate.

As Rep. Jose Serrano (D-NY) said in his press release following the vote:

I congratulate my colleagues on ending a senseless funding ban that was hindering our efforts to stamp out HIV/AIDS and other transmissible diseases….The science has been clear for years—syringe exchange works. There were so many states and localities already running syringe exchange programs; it was the national politicians that were behind the curve. Today the national politicians have caught up with local government and scientific research, and lives will be saved as a result.

The House lifting of the ban is because of strong leadership by Speaker of the House Nancy Pelosi, Congressman David Obey (D-WI), Congressman Jose Serrano (D-NY), Congresswoman Eleanor Holmes Norton (D-DC) and others. The Senate vote is expected over the weekend. PHR can't thank you all enough for your efforts to end this harmful ban—a great victory for health and human rights!

In June 2009, the UN Human Rights Council adopted a landmark resolution recognizing that maternal death and injury are preventable, unacceptable and a matter of fundamental human rights.Today, on December 10—Human Rights Day—please join us in committing to end maternal mortality, so that women everywhere can enjoy their right to life, health, equality and non-discrimination.PHR is a is a member of the Steering Committee of the International Initiative on Maternal Mortality and Human Rights (IIMMHR), which has issued this call to commit to end maternal mortality as a crucial human rights challenge of our time.Learn the facts about maternal mortality and human rights and see ways that you can take action by visiting the IIMMHR at?http://righttomaternalhealth.org.Further Reading

• Deadly Delays: Maternal Mortality in Peru (PHR report)

Physicians for Human Rights is pleased to invite you to a training for health professionals on how to diagnose, evaluate and document the physical and psychological after-effects of torture and other severe human rights violations.

Aiding Survivors of Torture:

Physical and Psychological Documentation

of Asylum Seekers

Saturday, February 6, 2010

7:30 a.m.-4:30 p.m.

Tulane University

School of Medicine

New Orleans, LA

This is a great opportunity to gain a thorough introduction to working with torture survivors or to enhance your skills. This course is free of charge to all attendees.

Not able to make it to New Orleans? Please tell a friend or colleague who may be interested.

Registration is required so please register today! We look forward to seeing you in New Orleans.

On World AIDS Day 2009 (December 1), the Office of the Global AIDS Coordinator (OGAC) released its second 5-year PEPFAR strategy.?Months ago, OGAC officials told NGOs that the strategy was not going to be very detailed—more of a 30,000 feet overview—and they meant it. This strategy is focused on broad directions, which include sustainability, integration, country leadership and ownership, efficiency and more emphasis on health system strengthening.These are generally very positive directions.?Below are a few of my thoughts on this initial strategy, and on where you and PHR can have impact on AIDS policy for the next half decade:A Question of Ownership: Country ownership and local empowerment is critical for AIDS programming to succeed. But the question remains: what qualifies as “the country?" ?Is it only the government, or also civil society?? What are the implications for marginalized populations who might be the subject of official discrimination, such as the case of men who have sex with men in countries that criminalize homosexuality, or the implications for injecting drug users in countries that treat addiction as a crime? PHR works with both government and local civil society, and PEPFAR must think about both levels as they move forward.Health Workforce: One of PHR’s signature issues receives several mentions in the strategy, while the strategy highlights PEPFAR’s new, more deliberate emphasis on health system strengthening. The target of at least 140,000 new health workers is referenced as one of the PEPFAR targets, and training and retaining health workers is included as one of the planned HSS activities, but with virtually no additional detail.? Also on the health worker front, strategy says: “PEPFAR’s prevention, care and treatment activities are planned with consideration of how they may impact the overall health system, particularly human resources for health.” This focus on health workers and health systems more broadly is good news for ensuring the overall right to health is promoted through PEPFAR, but we will have to stay vigilant and support the administration to fill in the details of how to reach this critical goal.Prevention–Women and IDU: Prevention remains paramount in PEPFAR II—but prevention programs this time around are based more firmly in science, and less in ideology. The strategy includes services for IDU as an example of high-impact prevention interventions for which PEPFAR is expanding investments, and the strategy refers to having services responsive to needs of marginalized populations, such as IDU.? It does not say more about these services, however, such as whether they will include syringe exchange.? While federal legislation to end the ban on the use of federal funds for domestic needle exchange is currently stalled in the Senate, we will need your help soon to ensure US laws reflect the best knowledge of science for IDUs.To its credit and very significantly, OGAC is now committed to integration, with a particular focus on integration of HIV services with family planning and reproductive health services. ?The strategy also includes several references to stigma, including as an area that can be addressed in partnership frameworks (though a new PHR analysis of partnership framework agreements has found that the framework agreements developed thus far could do a much better job of addressing stigma and discrimination).? PEPFAR programs will address particular vulnerabilities of women, especially gender-based violence.? The strategy also notes that PEPFAR, as part of the Global Health Initiative, is working to implement women centered-care. ?And in a shift to evidence-based prevention, the strategy includes the target that all youth who are “in PEPFAR prevention programs” should have “comprehensive and correct knowledge of the ways HIV/AIDS is transmitted and ways to protect themselves.” None of this is surprising, but it is all to the good.? The question will be how this plays out in more detailed guidance and, ultimately and most significantly, on the ground.Treatment and timing: Amidst limited detail, a few things did stand out.? One was the treatment goal of 4 million people, an increase from the 3 million target that had been part of PEPFAR’s messaging previously.? While this increase is welcome, it nonetheless represents a slower paced scale up than in the past – adding not much more than 300,000 people per year to treatment over the next five years, building from the 2.4 million people that PEPFAR had on treatment by the end of September 2009.? This compares to an increase of more than 500,000 people from FY’06 to FY’07, and an increase of more than 600,000 people from FY”07 to FY’08.? We have already seen the slowed pace of treatment scale up that has come with flat-funding – the increase from FY’08 to FY”09 fell to about 400,000.? This comes even as WHO has recommended that people receive treatment earlier, which will further add to the number of people who need treatment.? Under the previous guidelines, in the end of 2008 nearly 10 million were in immediate need of treatment, a number that increases each year.Another point of note is timing – targets are for fiscal years 2010-2014, even though PEPFAR was reauthorized for FY’09-FY’13.? The FY’10-FY’14 dates align with the Global Health Initiative and account for the fact that FY’09 is over.? These dates give PEPFAR an extra year to meet its targets, such as the new treatment goal.? This may also explain why the strategy describes the target for new health workers as “more than” 140,000 new health care workers, even as the legislation calls for “at least” this number of new health workers..Coordination and Mission Expansion: While the strategy was quite positive on PEPFAR’s efforts, it was self-critical of some operational aspects with respect to inter-agency coordination, incorporating (or not) field perspectives, and burdensome reporting requirements.? And reflecting the wavering global commitment to AIDS funding, and the growing interest in health system strengthening and other health issues, including maternal and child health, the strategy includes points about the broader positive health impact of PEPFAR and AIDS investments generally, particularly with respect to reducing child mortality overall and from non-HIV causes.Funding: The strategy includes little discussion of future funding – even as global AIDS budgets have been more or less flat-funded in FY’09 and FY10 – and there is a real risk of flat-funding again in FY’11.? In some countries, flat funding is already leading to ARV stock-outs, treatment freezes, and reduced voluntary testing and counseling efforts for fear that if HIV-positive people are identified, money wouldn’t be available to treat them.? Inadequate funding is costing lives.? And it will make goals like training and retaining at least 140,000 new health workers and reaching the treatment target of 4 million people – while also expanding prevention and other efforts – significant challenges.? Securing increased and sufficient funding for global AIDS and other global health needs will clearly remain a major priority for health advocates – and a significant challenge, an uphill struggle – in the years ahead.? We will need your help.Global Responsibility, Local Mentoring: Perhaps because of the funding situation, the strategy includes some emphasis on how fighting AIDS and improving global health is a shared global responsibility, and on collaboration with other donors and partners.? The strategy does say that in its next phase, PEPFAR will work “with countries and international organizations to develop a shared global response to the burden of treatment costs in the developing world, and assisting countries in achieving their defined treatment targets.”? Read one way, this could be quite meaningful – figuring out what the treatment costs are and developing some agreed to formula to ensure that these costs are met.? That would however be too optimistic a reading, probably; more likely, this is simply about getting other non-US government sources to pick up more of the cost of treatment.Interestingly, in several places the strategy references technical assistance and mentoring country governments.? Looking ahead, this could create advocacy opportunities with respect to certain things we would like to see included in such TA and mentoring, such as on policies addressing stigma and discrimination, rights-based policies more generally, and ways to increase domestic health spending.Rights and Responsibilities: Speaking of rights, the last point I will note here is that according to the strategy, PEPFAR is ”facilitating partnerships between governments and a strong civil society, to ensure that citizens can work to provide support to and demand accountability from governments.”? This is a potential entry point increased US government focus – through PEPFAR and perhaps other parts of the Global Health Initiative – to give significant focus on – and make investments in – developing rights-based health systems, for which accountability is a central element.? For more on what the United States could do to help countries develop rights-based health systems, you can have a look at our recommendations on the Global Health Initiative.

Right now, in Uganda, the Parliament is considering an "Anti-Homosexuality" Bill that, if passed, would be one of the world's most draconian laws against homosexuality—and a horrifying violation of human rights. Uganda, once the darling of international AIDS circles for its efforts to stop the pandemic, is now becoming a pariah for even considering this bill, which includes the death penalty for "aggrevated homosexuality."So what is behind this bill–and how will US policy makers, who sent about $300 million to Uganda last year alone in AIDS funding– respond?

Background

Uganda’s “Anti-Homosexuality” Bill sponsored by Hon. Bahati was tabled in Parliament on October 14, 2009. The public outcry has been global in scope, as governments, human rights organizations, churches, and other activist community groups and individuals have voiced severe criticism of the draft Bill.At present, Section 145 of Uganda’s Penal Code, states that an individual who has “carnal knowledge of any person against the order of nature” engages in an “unnatural offence” and is liable to criminal charges. Section 2.1 in the Bill’s Memorandum refers to Section 145 of the Penal Code, as a provision that does not effectively “charge, investigate, prosecute, convict and sentence” homosexuals. The proposed Bill heightens the severity of criminal charges against homosexuality, prohibiting the free expression of gay and lesbian life in Uganda. The Bill’s objectives prohibit the licensing of human rights organizations that “promote homosexuality” and the ratification of international treaties that promote freedoms contrary to the Bill’s provisions. The Bill legalizes the death penalty in cases of “aggravated homosexuality,” and considers individuals who fail to report of fences and uphold their "duty" to report suspected cases to be complicit in fostering homosexuality and thus liable to criminal charges.Hon. Bahati, a member of the U.S. "fundamentalist group" The Family, has proposed a Bill that would require Uganda to withdraw from many UN agreements including the Universal Declaration of Human Rights. He has drafted a document that violates multiple articles of Uganda’s 1995 Constitution, such as Article 20 that states “fundamental rights and freedoms are inherent and not granted by the State.” Ugandan President?Yoweri Museveni's unresponsiveness to criticisms of the Bill, sponsored by a member of his own political party, has signaled to the international community that Uganda’s obligation to uphold international human rights standards is not merely lacking in substantive practice yet not taken seriously as the universal standard to which all countries should realize in drafting domestic law.

Commonwealth Response

The Prime Ministers of Canada and Britain have publically opposed the Anti-Homosexuality Bill at this year’s Commonwealth Heads of Government Meeting (CHOGM), where President Museveni served as Chairman. The CHOGM, which closed on November 29, has released a list of meeting outcomes which includes the “Trinidad and Tobago Affirmation on Commonwealth Values and Principles”.?? In Section 5, the Commonwealth countries reaffirm their “belief in the inalienable right of the individual to participate by means of free and democratic political processes in shaping the society in which they live”.? Uganda can be suspended or expelled from the Commonwealth if its Parliament passes the Anti-Homosexuality Bill.

PEPFAR

Uganda’s Parliament took another public hit, as U.S. Secretary of State, Hillary Clinton, made a statement on the Obama Administration’s efforts to combat HIV/AIDS in anticipation of World AIDS Day. Clinton remarked,

Obviously, our efforts are hampered whenever discrimination or marginalization of certain populations results in less effective outreach and treatment…We have to stand against any efforts to marginalize and criminalize and penalize members of the LGBT community worldwide. It is an unacceptable step backwards – (applause) – on behalf of human rights. But it is also a step that undermines the effectiveness of efforts to fight the disease worldwide.

Ambassador Eric Goosby, commented on Clinton’s statement in the State Department's Official Blog, considering her words to “affirm America’s leadership in the fight against global AIDS”. According to Metro Weekly, Goosby remarked at the same White House event that “[PEPFAR will] support policy change to address discrimination, including – as the Secretary noted earlier – the situation in Uganda”. ?While Goosby failed to provide a response strategy if Uganda passes the Anti-Homosexuality Bill, when prompted by a reporter in a Special Briefing the next day, there is well-founded speculation that Uganda’s PEPFAR funding will be under review if the Anti-Homosexuality Bill is passed.In that event, no one wins. The Ugandan people are at risk of being subject to a law that wholly disregards the universal standard of an individual’s freedoms and rights—a law that breeds stigma and discrimination, which in turn fuels the AIDS epidemic. As a result, Ugandans may very well ALSO suffer from the international community’s decision to review and potentially suspend aid that would otherwise support both good AIDS programs and ones founded on discriminatory practices. It is the ultimate catch-22–with people living with AIDS caught in the middle of the Ugandan government's bigotry and donor government's need to take a stand against that same bigotry—by possibly cutting off services for the most vulnerable.We'll keep you posted on this bill, and the US and international response. In the meantime, take a stand. Leave Secretary? Clinton a message at 202-647-6575? or send her a text at 90822 and tell her to hold the Ugandan government to account for this discriminatory bill, and to demand the nation's leaders to shelve the horrific "anti-homosexuality" bill.

To the more than 2,200 of you who have urged your Senators to protect women's rights and women's health by Ratifying CEDAW: Thank You!We are more than halfway through the 10,000 in 10 Campaign, and really need your help to reach our goal of 10,000 signatures to support CEDAW.

• To those of you who have not yet signed, take action today and help us reach 10,000 signatures by December 10, International Human Rights Day!
• To those of you who have already?signed on: forward this action to 6 more friends now and help build the movement. If you each get 6 friends, family or colleagues to sign on, we'll surpass our goal of 10,000 in 10!

CEDAW (the Convention on the Elimination of all Forms of Discrimination against Women) was introduced 30 years ago. The US remains one of only 7 UN member states who have yet to ratify the treaty — alongside Sudan, where rape is used as a weapon of war, and Somalia, where female genital cutting is commonplace.With 2010 around the corner and new support in the Congress and Administration for CEDAW, we are in a new era of hope for US ratification. Help us leverage this new opportunity to remind the Senate that women's health in the US and abroad depend on the protection and promotion of women's rights.

Commemorate World AIDS Day TODAY by joining a nation-wide movement to protect women's rights and promote women's health.

Today, World AIDS Day, marks the first day of the 10,000 in 10 Campaign, a joint effort of Physicians for Human Rights, the American Medical Student Association, Advocates for Youth, Americans for Informed Democracy and the Association of Nurses in AIDS Care.

Between World AIDS Day (Dec. 1) and International Human Rights Day (Dec.10), join the campaign to mobilize 10,000 Americans to support US ratification of the Convention to Eliminate All Forms of Discrimination Against Women (CEDAW) in 2010.

Be one of 10,000 strong. Sign the petition here and forward to 6 friends.

Human rights violations such as widespread gender-based violence, systematic stigma and discrimination, and economic, social, health and educational inequalities put women at a disproportionately high risk of HIV/AIDS. Protecting women's rights is essential to halting the feminization of AIDS.

CEDAW is the top international treaty that sets the standards for critical women's rights issues, including equality in civil, political, and economic life, protection from sexual violence, and reproductivefreedom-all key to the fight against AIDS.

After 30 years of failed attempts at US ratification, CEDAW finally has the strong support within the Senate Foreign Relations Committee and Administration needed to make ratification in 2010 possible.

Let's make the most of this new opportunity: Visit www.humanrightsforwomen.org and sign on.

If you are on facebook, spread the word and use this as your status today:

Celebrate World AIDS Day (Dec 1) and Human Rights Day (Dec 10)—join 10,000 Americans calling on senators to stop AIDS by protecting women’s rights at www.humanrightsforwomen.org

Or Tweet:

Celebrate #WorldAIDSDay—join 10,000 Americans calling on Senators to stop AIDS by protecting women’s rights at www.humanrightsforwomen.org

Let your Senator know now is the time to ratify CEDAW and show that the US is serious about global health and women's rights worldwide! thanks for your support!