OpenForum – a blog by the Health and Human Rights community

A human rights victory emerged from the White House last week when President Obama announced that he would end the ban restricting entry of HIV-positive travelers and immigrants into the US. The 22-year ban, first instated in 1987 when AIDS was thought to spread by respiratory or physical contact, has reinforced barriers to reducing stigma and improving identification and treatment of the disease. The statute has been considered a human rights violation with no medical or scientific basis, carried out by a nation that boasts values of equality, non-discrimination, and the protection of human rights.

The last failed attempt to repeal the ban occurred in the early 1990s, when the Centers for Disease Control recommended that “only active tuberculosis remain on the list of excludable conditions,” according to a chronology of the ban on AIDS.org. During the comment period following the CDC proposal in the Federal Register, 35,000 postcards and letters were received by right-wing religious leaders, and the Republican Study Committee generated a letter opposing the recommendation that was signed by 67 members in the House of Representatives.

In 2003, the tide started to change. Former President George W. Bush authorized PEPFAR, the President’s Emergency Plan for AIDS Relief, which allocated $15 billion over five years to combat AIDS globally and made the US a world leader in the effort. The reauthorization of PEPFAR in 2008 included an important provision favorable to the repeal of the travel ban. The Senate and the House both voted in support of the repeal and gave clearance to Health and Human Services to omit HIV from the list of communicable diseases denied entry into the US. The US was on track to giving HIV-positive travelers and immigrants the rights they deserved.

President Obama announced his intention to repeal the ban on Friday, October 30, while signing the fourth reauthorization of the Ryan White CARE Act, which has funded HIV/AIDS treatment and prevention programs in the US since 1990. The new rule appeared in the Federal Register on November 2 and will now undergo a two-month commentary period before going into effect in early 2010. The Health and Human Services department confirmed this action in a press statement released Monday. The press statement concedes that “although the United States has been a leader worldwide when it comes to ending the stigma of HIV/AIDS, we’ve been one of only 12 countries who, by their policies, still enable the myth that HIV/AIDS is a threat.”

The Associated Press and NPR note that, among other consequences, the ban “has kept out thousands of students, tourists and refugees and has complicated the adoption of children with HIV.” The law has also prevented international conferences and meetings about HIV/AIDS from occurring in the United States, another obstruction in the global initiative to control the disease through collaboration, education, and stigma reduction.

As Joe Amon, director of the Health and Human Rights division at Human Rights Watch, states, “Lifting a policy that so clearly violates both human rights and public health needs is long past due. Countries around the world that still have bans should follow this example.” Read more

Two new studies suggest promising methods of detecting and treating TB despite discouraging reports about the increasing global prevalence of multi-drug resistant tuberculosis (MDR-TB) and extensively-drug-resistant tuberculosis (XDR-TB). The first study underlines the importance of follow-up visits in detecting TB among immigrants and asylum seekers entering the US. While screening is crucial in preventing the spread of TB, identifying TB-infected persons can be difficult; blood or sputum smear testing can take weeks to complete and has only a 50% accuracy rate. Screening of immigrants and asylum seekers is especially important, as the TB rate in foreign-born persons is 9.7 times higher than in US-born persons. Researchers found that follow-up visits with immigrants after their entry into the US were effective in identifying and reducing the number of TB patients in the US.

The World Health Organization estimated 9.27 million cases of TB in 2007, a significant increase from 6.6 million cases in 1990. The majority of these cases are found in the South-East Asia region, which accounts for 34% of all new cases, and sub-Saharan Africa, which has the highest TB mortality rate in the world. People with health conditions that weaken the immune system like HIV infection, substance abuse, or malnutrition are more susceptible to the disease. A recent study showed that one-fourth of all TB-related deaths were in patients who were also HIV-positive.

No new classes of TB drugs have been created since the 1960s, and few clinical trials have been conducted using modern regulatory standards. To address this need, research groups are focusing on novel approaches to TB therapeutics. The Global Alliance for TB Drug Development (TB Alliance) recently announced four research partnerships that will explore new methods of treating drug-resistant TB. One of these collaborations, led by Anacor Pharmaceuticals, will provide any new compounds developed to the TB Alliance royalty-free. Read more

[Editor's note: This is a guest post written by Ms. Katherine Moloney.]

On 17th June the Federal Government announced changes to its Support for Victims of People Trafficking Program, to take effect as of 1 July. The government has radically reformed its policy with regards to victims of trafficking after years of campaigning by non-government organizations and advocacy groups.  Previously based on the victim’s usefulness to criminal proceedings, the system recognizes the complex needs and vulnerabilities of victims and their difficulties, however willing, in providing a “significant contribution” to a criminal investigation. The program is therefore afforded to all victims regardless of their instrumentality.  Taking a human rights-based approach, the new legislation removes the temporary visa entirely and bases permanent visa attainment on any “contribution” (including a police statement) and a risk of harm if returned home.  Furthermore, the reflection period has been increased to 45 days, with the possibility of extension to 90 days to provide an adequate period over which to seek assistance and make an informed choice about their future. Read more

The international advocacy group Human Rights First has published a study documenting the increasing difficulties asylum seekers face when entering the US. Refugees seeking entry often spend months or even years in jails or other detention facilities before being granted asylum. In 2003, the Department of Homeland Security took responsibility for immigration processing and generated new policies requiring detainment of significantly more asylum seekers. Under the control of DHS, the number of beds in these detention facilities has increased by 62%, while the number of asylum seekers released has dropped by 42%. These facilities are strikingly similar to actual prisons – asylum seekers are brought into them with handcuffs and chains, wear prison uniforms, and have limited visits from family and friends. Detainees are not provided with sufficient physical or mental health care – care that is often urgently needed. A 2003 report in the Lancet found that of 70 research participants detained in detention centers or local jails, 86% showed symptoms of depression and 50% of post-traumatic stress disorder. Additionally, length of detention time was found to significantly exacerbate their psychological symptoms.

Many of these asylum seekers are human rights advocates forced to flee their own countries to avoid persecution. As one such man, Jean-Pierre from West Africa, describes, “They handcuffed me like a criminal…It was like reliving my jail in Guinea.” Because immigration courts follow different procedures than criminal ones, trials do not have to be made public and often require a lower burden of proof for conviction. Asylum seekers who cannot afford lawyers face further difficulties in detention, as immigration courts are not required to provide legal representation to defendants, even for mentally ill or mentally incompetent individuals. The hazards of these policies can be seen in the case of Xiu Ping Jiang, a Chinese woman with no past criminal record, who has spent over a year in jail. According to her lawyer (who agreed to work on her case pro bono), she is currently “suicidal, emaciated, and deprived of proper medical treatment.” Read more

“Airborne” Highlights MDR-, XDR- TB Cases

Airborne: A Journey into the Challenges and Solutions to Stopping MDR-TB and XDR-TB is a powerful new book written by John Donnelly that features interviews and images to put a human face on the TB epidemic across the world. In her foreword, WHO Director-General Margaret Chan wrote, “I urge you to read the personal stories collected in AIRBORNE. These are human tragedies that should never have happened. But these are also stories about the uplifting success possible when the right elements are in place.”

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Australian Abortion-Aid Ban Lifted

A thirteen-year ban in Australia on providing foreign aid for abortions has been lifted and Australia will provide  funding of up to $15 million for reproductive health activities to help reduce maternal deaths across the world.

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$50 Million US Contribution to UNFPA

President Obama has recently signed legislation to provide $50 million to the United Nations Population Fund (UNFPA) to improve the health of women and children and reduce poverty throughout the world.

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US Capital Blighted by HIV/AIDS

The U.S. Capital has an HIV/AIDS rate on par with or worse than some African nations the city’s health department reports.

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US Urged to Fix Iraqi Refugee ‘Mess’ It Created

As the Iraq war enters its 7th year, the United States is urged to provide aid to Iraqi refugees displaced by the fighting.

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Immigration detainees held under the custody of the U.S. Immigration and Customs Enforcement (ICE) are being denied the proper medical treatment they are entitled to by law and regulation. As immigration policies have grown stricter and federal agencies’ resources have grown increasingly strained since 9/11, the agency has lowered its healthcare standards to keeping immigrants healthy enough for deportation. The consequences for the health and rights of female detainees are especially appalling.

Recently, Human Rights Watch released a report that documents the unique struggles women face in accessing health care in detention. It documents reports of women who suffered from affronts to their health and dignity during detention, including inadequate care during pregnancy, having to beg and plead to get enough sanitary pads not to bleed through their clothes, or not being offered counseling after testing positive for pregnancy. In “Access Denied,” The Texas Observer highlights the denial of reproductive rights for the large number of detainees who are sexually assaulted; they are not identified when they come into ICE’s custody, nor are they informed of their options if they become pregnant. Read more