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.”

For more information and responses:

A History of HIV/AIDS in the US

Immigration Equality FAQ

Washington Post Editorial from May 2008

UNAIDS Press Center

The Lancet

International Gay and Lesbian Human Rights Commission call for ban

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.

Another recent study has found that in an eight week exploratory trial with MDR-TB patients in South Africa, the experimental drug TMC207, in combination with the standard MDR-TB drug cocktail, cleared TB bacterial traces in the sputum of 48% of patients, as compared to 9% of patients given only the standard cocktail. The experimental drug appeared to work faster than standard MDR-TB drugs in clearing TB, possibly because of its unique mechanism of action. Current treatment courses last for at least 18 months because MDR-TB drugs take more time to effectively clear the disease. For example, 81% of MDR-TB patients in Peru treated with DOTS-Plus therapy were cured after four months, versus only 40% after two months. Further proof-of-efficacy studies are being conducted with TMC207 now, and will demonstrate if it is effective as a long-term treatment for various types of TB. If approved, this drug could be a significant advance over current treatments, which can be lengthy and toxic.

Related TB links:

Airborne: A Journey into the Challenges and Solutions to Stopping MDR-TB and XDR-TB

Improving tuberculosis care in low income countries – a qualitative study of patients’ understanding of “patient support” in Nepal

Global tuberculosis control – epidemiology, strategy, financing

Global Health Delivery Online – Drug-Resistant TB

TB Alliance Annual 2008 Report

Stop TB Partnership

South Africa leads hunt for killer TB vaccine

South Africa: TB Vaccine trials for babies

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.

The Australian Federal Minister for Immigration and Citizenship summarized the legislative changes in a media release on 17 June:

• extending the initial stage of the Support for Victims of People Trafficking Program from 30 to 45 days, and making it available to identified victims irrespective of whether they are willing to assist police. This will provide all victims with an opportunity to recover and seek advice about their future options
• providing up to 90 days assistance for victims who are willing but not able to assist police, due to factors such as trauma. Where the victims do not hold a valid visa they can be granted a second Bridging F visa
• access to the Support for Victims of People Trafficking Program will be available to identified victims who hold any kind of valid visa so victims do not have to relinquish existing visas in order to receive support
• providing up to 20 days transitional support so victims assisting law enforcement can consider their future options, seek legal advice, arrange travel and find support networks after involvement  in the Support for Victims of People Trafficking Program
• removing the temporary visa stage in  the Witness Protection (Trafficking) visa process, and starting the process before the completion of a prosecution. This will reduce the pathway to a permanent visa for eligible victims by at least two years
• reducing the threshold for a Witness Protection (Trafficking) Certificate from having made a “significant contribution” to making “a contribution”
• enabling immediate family members who are outside Australia to be included in an application for a Witness Protection (Trafficking) visa.

This is amazing news and represents a monumental shift forward in the federal government’s policy for trafficking victims.  Indeed, this makes the Australian response an example of global good practice in addressing this issue.  More importantly, Australians can now wait expectantly for the practical implications of this legislation, in the hope that it will be better able to support victims of human trafficking.

For further information see:

Restrictions eased for sex trafficking victims

Overhaul of human trafficking visas ‘will help victims’

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.”

Jiang fled China after being forcibly sterilized by Chinese officials for violating the one-child policy when she gave birth to her second son. For over ten years she remained in the US as her mental health deteriorated. In 1997, Jiang attempted suicide following a failed effort to bring her youngest son to the US. Her two sisters believe that the stress of living in the country undocumented and seeking asylum, while being separated from her children, significantly worsened her already poor mental health. Now that she is in prison, frequently in solitary confinement and without any access to psychological care, both her family and her lawyer fear that she will again attempt suicide. A habeas corpus petition seeking her release was recently filed by her lawyer. It maintains that the severity of her mental illness, magnified by a lengthy imprisonment, makes her incapable of managing her own case. An experience from earlier this year seems to support this: Jiang’s mental health had deteriorated to the point where she was unable to recognize her older sister during a visit to the prison.

Jiang’s experience of detention and lack of medical treatment despite mental illness is unfortunately not an exceptional case. The number of detainees needing treatment for psychological illnesses is not recorded, and many asylum seekers fail to receive the care they need. As Sunita Patel, a lawyer at the Center for Constitutional Rights, told the New York Times, “…more and more people with mental illnesses are being put into the detention system. And sometimes these people disappear.”

More links:

Human Rights First

Report Finds U.S. Often Greets Asylum Seekers with Prison, not Protection

US Detention of Asylum Seekers and Human Rights

Immigration Detention and In-Custody Deaths

Another Jail Death, and Mounting Questions

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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In Reversal, US to Engage with Human Rights Council

President Obama’s decision to become actively involved in the U.N. Human Rights Council raises hope that the administration will take a multilateral, human rights approach to international diplomacy.

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Living in a Sea of Mud and Drowning in Dread

Hurricane season has left Haitians to navigate mud-covered towns; without clear evacuation and reconstruction plans, Haitians fear an even worse situation this year.

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Chad: Fighting Violence Against Women — But How?

Violence against women is endemic in Chad, where in December dozens of women took part in a protest march against the legal gaps and cultural norms that allow for rampant domestic violence, sexual abuse, and underage marriages.

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In Iraq, A Story of Rape, Shame and ‘Honor Killing’

Killing of a pregnant rape victim by her brother reveals the terrible frequency of ‘honor killings’ in Iraq.

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Mentally Ill and in Immigration Limbo

Xiu Ping Jiang, an illegal immigrant from China, faces the harrowing choice of deportation  or detention in a facility where she has, allegedly, received inadequate care for her mental condition.

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Women’s Health Insurance Fairness Act

U.S. Senator John Kerry has introduced a bill that would prohibit health insurance companies from charging women higher premiums and from discriminating against women based on whether they are pregnant.

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.

According to Human Rights Watch, the failures of the detention medical system to adequately respond to women’s health issues “implicates fundamental human rights, including international legal protections to the right to health, the right to non-discrimination, and the rights of detained persons.” The U.S. government has a responsibility to provide quality medical care to the thousands of immigrants it has chosen to take into its custody while they wait for their hearings. Human rights advocates also suggest a long-term solution to the crisis: using an alternative to the costly process of detention, such as intensive supervision appearance programs. In being detained, immigrants should not be denied their right to health.

See also:

Dying for Decent Care: Bad Medicine in Immigration Custody – Florida Immigrant Advocacy Center (FIAC), Mar 2009

Careless Detention – four-part series in Washington Post, May 2008

U.N. Special Rapporteur Denounces U.S. Immigration Detention System – National Immigrant Justice Center, Mar 2008

Briefing Materials Submitted to the U.N. Special Rapporteur on the Human Rights of Migrants – National Immigrant Justice Center, August 2007