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The U.S. Government and Global LGBT Health: Opportunities and Challenges in the Current Era

Introduction
  1. Ilan H Meyer, “Why Lesbian, Gay, Bisexual, and Transgender Public Health?,” American Journal of Public Health 91 (2001):856-859.

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  2. Simon Lewin and Ilan H Meyer, “Torture, Ill-treatment, and Sexual Identity,” Lancet 358 (2001): 1899 - 1900.

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  3. Nils Daulaire, “The Importance of LGBT Health on a Global Scale,” LGBT Health 1 (2013): 8-9.

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  4. World Health Organization, “Improving the Health and Well-being of Lesbian, Gay, Bisexual and Transgender Persons,” EB133/6 (2013). http://apps.who.int/gb/ebwha/pdf_files/EB133/B133_6-en.pdf.

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  5. Institute of Medicine, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: National Academies Press, 2011. http://www.iom.edu/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx.

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  6. USAID, The USAID Vision for Action: Promoting and Supporting the Inclusion of Lesbian, Gay, Bisexual, and Transgender Individuals, Draft (2013). http://www.usaid.gov/sites/default/files/Draft_USAID_LGBT_Vision_for_Public_Comment.pdf.

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  7. State Department, Country Reports on Human Rights Practices for 2013, (2014). http://www.state.gov/j/drl/rls/hrrpt/humanrightsreport/index.htm#wrapper.

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  8. UN General Assembly, Human Rights Council, “Discriminatory Laws and Practices and Acts of Violence against Individuals Based on their Sexual Orientation and Gender Identity”, A/HRC/19/41 (2011). http://www2.ohchr.org/english/bodies/hrcouncil/docs/19session/A.HRC.19.41_English.pdf.

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  9. UNAIDS, “Overcoming Discriminatory Barriers to Health Services”, March 14, 2014. http://www.unaids.org/en/resources/presscentre/featurestories/2014/march/20140314discriminationbarriers/.

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  10. Rachel L. Kaplan, Glenn J. Wagner, Simon Nehme, Frances Aunon, Danielle Khouri and Jacques Mokhbat, “Forms of Safety and their Impact on Health: An Exploration of HIV/AIDS-related Risk and Resilience among Trans Women in Lebanon.” Health Care for Women International, epub ahead of print (2014).

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  11. Sexual orientation is defined as “an enduring pattern of or disposition to experience sexual or romantic desires for, and relationships with, people of one’s same sex, the other sex, or both sexes” (see, Institute of Medicine, 2011).  This definition incorporates elements of attraction, behavior, and identity.

    Gender Identity refers to “an individual’s internal sense of being male, female, or something else.  Since gender identity is internal, one’s gender identity is not necessarily visible to others” (see, National Center for Transgender Equality. Transgender Terminology, 2014).

    Gender expression refers to how “a person represents or expresses one’s gender identity to others, often through behavior, clothing, hairstyles, voice or body characteristics” see, National Center for Transgender Equality. Transgender Terminology, 2014).

    Transgender refers to individuals whose “gender identity, expression or behavior is different from those typically associated with their assigned sex at birth” see, National Center for Transgender Equality. Transgender Terminology, 2014).

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  12. UN General Assembly, Human Rights Council, “Discriminatory Laws and Practices and Acts of Violence against Individuals Based on their Sexual Orientation and Gender Identity”, A/HRC/19/41 (2011). http://www2.ohchr.org/english/bodies/hrcouncil/docs/19session/A.HRC.19.41_English.pdf.

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  13. UNAIDS, “Homophobia and Punitive Laws Continue to Threaten HIV Responses and Human Rights,” August, 28, 2012. http://www.unaids.org/en/resources/presscentre/featurestories/2012/august/20120828punitivelaws/.

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  14. Pew Research Center, A Survey of LGBT Americans Attitudes, Experiences and Values in Changing Times, June 13, 2013. http://www.pewsocialtrends.org/2013/06/13/a-survey-of-lgbt-americans/.

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  15. Mikel L. Walters, Jieru Chen, and Matthew J. Breiding, The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Findings on Victimization by Sexual Orientation. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2013. http://www.cdc.gov/violenceprevention/pdf/nisvs_sofindings.pdf.

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  16. State Department, Country Reports on Human Rights Practices for 2013, (2014). http://www.state.gov/j/drl/rls/hrrpt/humanrightsreport/index.htm#wrapper.

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  17. ILGA, State-Sponsored Homophobia-A World Survey of Laws: Criminalisation, Protection and Recognition of Same-Sex Love, 8th Edition (2013). http://ilga.org/ilga/en/article/o5VlRM41Oq.

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  18. This includes the 76 countries identified by ILGA, as of May 2013 (see, ILGA, State-Sponsored Homophobia,2013), as well as India, whose Supreme Court reinstated a law criminalizing consensual same sex behavior between adults in December 2013. Not included in the total is Russia which decriminalized same sex behavior between consenting adults in 1993, but criminalized “the propaganda of nontraditional sexual relations to minors” in June 2013. (See, State Department, Country Reports on Human Rights Practices for 2013 for additional information on India and Russia).

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  19. Defined as laws which criminalize same-sex activity between consenting adults.

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  20. These laws vary by country, ranging in terms of the severity of sentence (e.g., length of imprisonment), whether they are part of the penal code or common law, whether regularly enforced, and other factors. For more information see, IGLA, State-Sponsored Homophobia (2013).

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  21. ILGA, State-Sponsored Homophobia-A World Survey of Laws: Criminalisation, Protection and Recognition of Same-Sex Love, 8th Edition (2013). http://ilga.org/ilga/en/article/o5VlRM41Oq.

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  22. UN General Assembly, Human Rights Council, “Discriminatory Laws and Practices and Acts of Violence against Individuals Based on their Sexual Orientation and Gender Identity”, A/HRC/19/41 (2011). http://www2.ohchr.org/english/bodies/hrcouncil/docs/19session/A.HRC.19.41_English.pdf.

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  23. Council for Global Equality and Human Rights First, How to Protect LGBTI Persons around the World from Violence: Blueprint For the Next Administration, (2012).  http://www.globalequality.org/storage/documents/pdf/hrf_lgbti_blueprint.pdf.

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  24. Institute of Medicine, The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: National Academies Press, 2011. http://www.iom.edu/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx.

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  25. Gregorio A Millett, William L Jeffries 4th, John L Peterson, David J Malebranche, Tim Lane, Stephen A Flores, Kevin A Fenton, Patrick A Wilson, Riley Steiner, and Charles M Heilig, “Common Roots: A Contextual Review of HIV Epidemics in Black Men who have Sex with Men Across the African Diaspora,” Lancet 380(2012):411-23.

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  26. Stefan Baral, Gift Trapence, Felistus Motimed, Eric Umar, Scholastika Iipinge, Friedel Dausab, and Chris Beyrer, “HIV Prevalence, Risks for HIV Infection, and Human Rights among Men Who Have Sex with Men (MSM) in Malawi, Namibia, and Botswana,” PLoS ONE 4(2009): e4997.

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  27. Stefan Baral, Darrin Adams, Judith Lebona, Bafokeng Kaibe, Puleng Letsie, Relebohile Tshehlo, Andrea Wirtz and Chris Beyrer, “A Cross-sectional Assessment of Population Demographics, HIV Risks and Human Rights Contexts Among Men who have Sex with Men in Lesotho,” Journal of the International AIDS Society 14 (2011):36.

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  28. Heather Fay, Stefan D. Baral, Gift Trapence, Felistus Motimedi, Eric Umar, Scholastika Iipinge, Friedel Dausab, Andrea Wirtz, and Chris Beyrer, “Stigma, Health Care Access, and HIV Knowledge Among Men Who Have Sex With Men in Malawi, Namibia, and Botswana,” AIDS and Behavior 15 (2011):1088–1097.

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  29. Tonia Poteat, Daouda Diouf, Fatou Maria Drame, Marieme Ndaw, Cheikh Traore, Mandeep Dhaliwal, Chris Beyrer, and Stefan Baral, “HIV Risk among MSM in Senegal: A Qualitative Rapid Assessment of the Impact of Enforcing Laws That Criminalize Same Sex Practices,” PLoS ONE 6(2011): e28760.

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  30. Stefan Baral Paul Semugoma, Daouda Diouf, Gift Trapence, Tonia Poteat, Marieme Ndaw, Fatou Maria Drame, Mandeep Dhaliwal, C. Traore, N Diop, S. Bhattacharya, T. Sellers, Andrea Wirtz, and Chris Beyrer, “Criminalization of same sex practices as a structural driver of HIV risk among men who have sex with men (MSM): The cases of Senegal, Malawi, and Uganda,” Paper presented at the International AIDS Conference, Vienna, Austria, July 18-23, 2010.

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  31. Wolfgang Hladik, Joseph Barker, John M. Ssenkusu, Alex Opio, Jordan W. Tappero, Avi Hakim, and David Serwadda, “HIV Infection among Men Who Have Sex with Men in Kampala, Uganda–A Respondent Driven Sampling Survey among Men who have Sex with Men in Kampala, Uganda–A Respondent Driven Sampling Survey,”  PLoS ONE 7(2012), e38143.

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  32. UNAIDS, Global Report: UNAIDS Report on the Global AIDS Epidemic 2013, Geneva: UNAIDS, 2013.

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  33. Chris Beyrer, Stefan D Baral, Frits van Griensven, Steven M Goodreau, Suwat Chariyalertsak, Andrea L Wirtz, and Ron Brookmeyer, “Global Epidemiology of HIV Infection in Men who have Sex with Men”, Lancet 380 (2012): 367-377.

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  34. Chris Beyrer, Stefan D Baral, Frits van Griensven, Steven M Goodreau, Suwat Chariyalertsak, Andrea L Wirtz, and Ron Brookmeyer, “Global Epidemiology of HIV Infection in Men who have Sex with Men”, Lancet 380 (2012): 367-377.

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  35. Chris Beyrer, Patrick Sullivan, Jorge Sanchez, Stefan D. Baral, Chris Collins, Andrea L. Wirtz, Dennis Altman, Gift Trapence and Kenneth Mayer, “Global Epidemiology of HIV Infection in Men who have Sex with Men, AIDS 27 (2013): 2665–2678.

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  36. Stefan D Baral, Ashley Grosso, Claire Holland, and Erin Papworth, “The Epidemiology of HIV among Men who have Sex with Men in Countries with Generalized HIV Epidemics,” Current Opinion in HIV and AIDS 9 (2014): 156–167.

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  37. UNAIDS, Global Report: UNAIDS Report on the Global AIDS Epidemic 2013, Geneva: UNAIDS, 2013.

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  38. Tonia Poteat, Daouda Diouf, Fatou Maria Drame, Marieme Ndaw, Cheikh Traore, MandeepDhaliwal, Chris Beyrer, and Stefan Baral, “HIV Risk among MSM in Senegal: A Qualitative Rapid Assessment of the Impact of Enforcing Laws That Criminalize Same Sex Practices,” PLoS ONE 6(2011): e28760.

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  39. State Department, Press Statement by Marie Harf, “Raid on the Makerere University Walter Reed Project by Ugandan Authorities”, April 4, 2014. http://www.state.gov/r/pa/prs/ps/2014/04/224431.htm.

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  40. White House, Office of the Press Secretary, Presidential Memorandum, “International Initiatives to Advance the Human Rights of Lesbian, Gay, Bisexual, and Transgender Persons,” December 6, 2011. http://www.whitehouse.gov/the-press-office/2011/12/06/presidential-memorandum-international-initiatives-advance-human-rights-l.

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  41. UN General Assembly, Human Rights Council, “Human Rights, Sexual Orientation and Gender Identity”, A/HRC/RES/17/19 (2011). http://daccess-dds-ny.un.org/doc/UNDOC/GEN/G11/148/76/PDF/G1114876.pdf?OpenElement.

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  42. State Department, Fact Sheet, “The Department of State's Accomplishments Promoting the Human Rights of Lesbian, Gay, Bisexual and Transgender People,” December 6, 2011. http://www.state.gov/r/pa/prs/ps/2011/12/178341.htm.

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  43. Tristan McConnell, “Uganda's New Anti-Gay Law: Part of a Broader Trend in Africa,” National Geographic, February 28, 2014. http://news.nationalgeographic.com/news/2014/02/140228-uganda-anti-gay-law-smug-homophobia-africa-world/.

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  44. Gabe Joselow, “After Uganda, Kenya Gears up for Gay Rights Debate,” Voice of America, March 5, 2014. http://www.voanews.com/content/after-uganda-kenya-gears-up-for-gay-rights-debate/1864600.html.

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  45.  Valérie Bah, “Congo-Kinshasa: DRC Looks to Follow in Uganda's Footsteps With Anti-Gay Bill,” Think Africa Press, March 11, 2014. http://allafrica.com/stories/201403111646.html?viewall=1.

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  46. Emmanuel Muga, “Dar plans to introduce tougher anti-gay Bill,” East African, March 29, 2014. http://www.theeastafrican.co.ke/news/Dar-plans-to-introduce-tougher-anti-gay-Bill--/-/2558/2262374/-/iq7xix/-/index.html.

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  47. J. Lester Feder, “Russian-Style "Gay Propaganda" Law Introduced In Kyrgyzstan,” Buzzfeed, March 27, 2014. http://www.buzzfeed.com/lesterfeder/russian-style-gay-propaganda-law-introduced-in-kyrgyzstan.

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U.S. Government Efforts to Address Global LGBT Health to Date
  1. White House, Office of the Press Secretary, Presidential Memorandum, “International Initiatives to Advance the Human Rights of Lesbian, Gay, Bisexual, and Transgender Persons,” December 6, 2011. http://www.whitehouse.gov/the-press-office/2011/12/06/presidential-memorandum-international-initiatives-advance-human-rights-l.

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  2. State Department, Bureau of Public Affairs, Fact Sheet, “Advancing the Human Rights of Lesbian, Gay, Bisexual and Transgender Persons Worldwide: A State Department Priority,” June 28, 2013. http://www.state.gov/r/pa/pl/2013/211478.htm.

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  3. USAID, Press Office, “USAID Announces New Partnership to Promote LGBT Human Rights Abroad,” April 8, 2013. http://www.usaid.gov/news-information/press-releases/usaid-announces-new-partnership-promote-lgbt-human-rights-abroad

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  4. State Department, Press Statement, Hillary Rodham Clinton, “In Recognition of Gay and Lesbian Pride Month 2009,” June 1, 2009. http://www.state.gov/secretary/20092013clinton/rm/2009a/06/124176.htm.

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  5. State Department, Remarks by Hillary Rodham Clinton, “Remarks on the Human Rights Agenda for the 21st Century,” December 14, 2009. http://www.state.gov/secretary/20092013clinton/rm/2009a/12/133544.htm.

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  6. State Department, Bureau of Public Affairs, Fact Sheet, “Advancing the Human Rights of Lesbian, Gay, Bisexual and Transgender Persons Worldwide: A State Department Priority,” June 28, 2013. http://www.state.gov/r/pa/pl/2013/211478.htm.

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  7. UN General Assembly, Human Rights Council, “Human rights, sexual orientation and gender identity,” A/HRC/RES/17/19, July 14, 2011. http://daccess-dds-ny.un.org/doc/UNDOC/GEN/G11/148/76/PDF/G1114876.pdf?OpenElement.

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  8. State Department, “The Department of State's Accomplishments Promoting the Human Rights of Lesbian, Gay, Bisexual and Transgender People,” December 6, 2011. http://www.state.gov/r/pa/prs/ps/2011/12/178341.htm.

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  9. White House, Office of the Press Secretary, “Remarks by President Obama in Address to the United Nations General Assembly”, September 21, 2011. http://www.whitehouse.gov/the-press-office/2011/09/21/remarks-president-obama-address-united-nations-general-assembly.

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  10. White House, Office of the Press Secretary, Presidential Memorandum, “International Initiatives to Advance the Human Rights of Lesbian, Gay, Bisexual, and Transgender Persons,” December 6, 2011. http://www.whitehouse.gov/the-press-office/2011/12/06/presidential-memorandum-international-initiatives-advance-human-rights-l.

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  11. White House, Office of the Press Secretary, Fact Sheet, “Working to Advance the Human Rights of Lesbian, Gay, Bisexual, and Transgender (LGBT) Persons Globally,” December 6, 2011. http://www.whitehouse.gov/the-press-office/2011/12/06/fact-sheet-working-advance-human-rights-lesbian-gay-bisexual-and-transge.

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  12. State Department, Remarks by Hillary Rodham Clinton, “Free and Equal in Dignity and Rights”, December 6, 2012. http://www.humanrights.gov/2011/12/06/remarks-in-recognition-of-international-human-rights-day/.

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  13. Current GEF partners, in addition to the U.S. government, include the governments of Denmark, Finland, France, Germany, Iceland, the Netherlands, Norway, and Sweden; the Arcus Foundation, the John D. Evans Foundation, LLH: the Norwegian LGBT Organization, the M∙A∙C AIDS Fund, and Deloitte. See, http://www.state.gov/globalequality/about/index.htm.

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  14. State Department, Global Equality Fund. http://www.state.gov/globalequality/.

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  15. State Department, Media Note, “The State Department Welcomes New Private Sector Support for the Global Equality Fund,” December 10, 2013. http://www.state.gov/r/pa/prs/ps/2013/218569.htm.

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  16. State Department, Remarks by Anne C. Richard, “Strengthening Protection for LGBT Refugees,” May 17, 2012. http://www.state.gov/j/prm/releases/remarks/2012/190280.htm.

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  17. U.S. Customs and Immigration Services, “Guidance For Adjudicating Lesbian, Gay, Bisexual, Transgender, And Intersex (LGBTI) Refugee And Asylum Claims,” Training Module, December 28, 2011. http://www.uscis.gov/sites/default/files/USCIS/Humanitarian/Refugees%20%26%20Asylum/Asylum

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  18. USAID, USAID Policy Framework 2011-2015 (2011). http://www.usaid.gov/sites/default/files/documents/1870/USAID%20Policy%20Framework%202011-2015.PDF.

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  19. USAID, Strategy on Democracy, Human Rights and Governance (2013). http://www.usaid.gov/sites/default/files/documents/1866/USAID%20DRG_%20final%20final%206-24%203%20(1).pdf.

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  20. USAID, Youth in Development Policy (2012). http://www.usaid.gov/sites/default/files/documents/1870/Youth_in_Development_Policy_0.pdf.

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  21. USAID, Country Development Cooperative Strategy (CDCS) Guidance Version 3 (2013). http://www.usaid.gov/sites/default/files/documents/1870/CDCS_Guidance_V3.pdf.

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  22. USAID, Global Health Strategic Framework for FY 2012-2016 (2012). http://www.usaid.gov/sites/default/files/documents/1864/gh_framework2012.pdf.

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  23. USAID, “Award Provisions Encouraging More Comprehensive Nondiscrimination Policies by USAID Contractors and Recipients: A Mandatory Reference for ADS Chapter 302.” June 19, 2012. http://www.usaid.gov/sites/default/files/documents/1868/302mbf.pdf.

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  24. USAID, The USAID Vision for Action: Promoting and Supporting the Inclusion of Lesbian, Gay, Bisexual, and Transgender Individuals, Draft (2013). http://www.usaid.gov/sites/default/files/Draft_USAID_LGBT_Vision_for_Public_Comment.pdf.

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  25. USAID, Press Office, “USAID Announces New Partnership To Promote LGBT Human Rights Abroad”. Partners include the Swedish International Development Cooperation Agency, Astraea Lesbian Foundation for Justice, the Gay & Lesbian Victory Institute, the Williams Institute, and Olivia Companies,” April 8, 2013. http://www.usaid.gov/news-information/press-releases/usaid-announces-new-partnership-promote-lgbt-human-rights-abroad

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  26. USAID, The USAID Vision for Action: Promoting and Supporting the Inclusion of Lesbian, Gay, Bisexual, and Transgender Individuals, Draft (2013). http://www.usaid.gov/sites/default/files/Draft_USAID_LGBT_Vision_for_Public_Comment.pdf.

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  27. White House, Blog Post by Samantha Power, “US Leadership to Advance Equality for LGBT People Abroad”, December 13, 2012. http://www.whitehouse.gov/blog/2012/12/13/us-leadership-advance-equality-lgbt-people-abroad.

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  28. Millennium Challenge Corporation, Selection Indicators. http://www.mcc.gov/pages/selection/indicators.

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  29. See, for example: Millennium Challenge Corporation, Press Release, “MCC Finalizes $350 Million Compact with Malawi”, April 1, 2011, http://www.mcc.gov/pages/press/release/mcc-finalizes-350-million-compact-with-malawi; Millennium Challenge Corporation, Congressional Notification, “Report on the Determination by the Chief Executive Officer that the Government of Malawi has Engaged in a Pattern of Actions Inconsistent with the Eligibility Criteria of the Millennium Challenge Corporation”, March 26, 2012, http://www.mcc.gov/documents/cn/cn-03262012-malawi.pdf; Millennium Challenge Corporation, “Report on the Determination by the Chief Executive Officer that the Government of Malawi has Taken Sufficient Corrective Action to Address Each Condition for Which Assistance Was Suspended,” June 26, 2012, http://www.mcc.gov/documents/cn/cn-062712-malawi.pdf.

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  30. Institute of Medicine. Evaluation of PEPFAR. Washington, DC: The National Academies Press, 2013. http://www.nap.edu/catalog.php?record_id=18256.

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  31. PEPFAR, Technical Guidance: Prevention for Men Who Have Sex With Men (2011). http://www.pepfar.gov/reports/guidance/combinationprevention/combprevmsm/index.htm.

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  32. Ibid, p. 4.

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  33. PEPFAR, PEPFAR Blueprint: Creating an AIDS-free Generation (2012). http://www.pepfar.gov/documents/organization/201386.pdf

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  34. State Department, Remarks by Hillary Rodham Clinton, “Remarks at the 2012 International AIDS Conference,” July 23, 2012. http://www.state.gov/secretary/20092013clinton/rm/2012/07/195355.htm.

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  35. State Department, DipNote by Eric Goosby, “Reaching Key Populations: Essential to Achieving an AIDS-Free Generation”, June 20, 2013. http://blogs.state.gov/stories/2013/06/20/reaching-key-populations-essential-achieving-aids-free-generation. The countries and regions are: Cambodia, Ghana, Nepal, Senegal, Swaziland, and Zimbabwe – and Asia and Central America.

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  36. State Department, Remarks by Hillary Rodham Clinton, “Remarks at the 2012 International AIDS Conference,” July 23, 2012. http://www.state.gov/secretary/20092013clinton/rm/2012/07/195355.htm.

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  37. Robert Carr Fund, http://www.robertcarrfund.org/donors/donors/.

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  38. PEPFAR, PEPFAR Blueprint: Creating an AIDS-free Generation (2012). http://www.pepfar.gov/documents/organization/201386.pdf.

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  39. USAID, “Linkages Across the Continuum of HIV Services For Key Populations Affected By HIV (“Linkages”)”, Request For Application (RFA), RFA Solicitation Number: Sol-Oaa-14-000013, November 5, 2013.

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  40. Ibid.

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  41. Personal communication with Ron MacInnis, Futures Group, March 27, 2014.

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  42. Global Fund to Fight AIDS, Tuberculosis and Malaria, The Global Fund Strategy in Relation to Sexual Orientation and Gender Identities (2009). http://www.theglobalfund.org/documents/core/strategies/Core_SexualOrientationAndGenderIdentities_Strategy_en/.

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  43. Global Fund to Fight AIDS, Tuberculosis and Malaria, The Global Fund Strategy 2012-2016: Investing for Impact (2011). http://www.theglobalfund.org/en/about/strategy/.

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  44. Global Fund to Fight AIDS, Tuberculosis and Malaria, Newsflash, Issue 23, 2013. http://www.theglobalfund.org/en/blog/33316/.

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  45. Nils Daulaire, “Bringing LGBT Health Care to the World Health Organization,” Huffington Post, June 13, 2013. http://www.huffingtonpost.com/nils-daulaire/world-health-organization-lgbt_b_3430849.html.

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  46. World Health Organization, “Improving the Health and Well-being of Lesbian, Gay, Bisexual and Transgender Persons,” EB133/6, May 14, 2013.

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  47. PAHO, “Addressing the Causes of Disparities in Health Service Access and Utilization for Lesbian, Gay, Bisexual and Trans (LGBT) Persons,” September 30, 2012. http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=23145&Itemid=270&lang=en.

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  48. PAHO, “Health authorities pledge to improve access to health care for LGBT People,” October 3, 2013. http://www.paho.org/hq/index.php?option=com_content&view=article&id=9056&Itemid=1926.

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  49. Nils Daulaire, “A Victory for LGBT Health in the Americas,” Huffington Post, November 12, 2013. http://www.huffingtonpost.com/nils-daulaire/a-victory-for-lgbt-health_b_4262367.html.

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  50. It is important to note that preliminary analysis of USAID transaction data indicates that in most of these countries, a very small share of funding is provided directly to recipient country governments (KFF analysis of data from www.foreignassistance.gov).

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  51. The seven major program areas include: PEPFAR (HIV); malaria; TB; maternal and child health; family planning and reproductive health; nutrition; and water.

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  52. Kaiser Family Foundation analysis of data from www.foreignassistance.gov.

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  53. ILGA, State-Sponsored Homophobia-A World Survey of Laws: Criminalisation, Protection and Recognition of Same-Sex Love, 8th Edition (2013). http://ilga.org/ilga/en/article/o5VlRM41Oq.

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  54. Council on Global Equality, “The Facts on LGBT Rights in Russia,” http://www.globalequality.org/newsroom/latest-news/1-in-the-news/186-the-facts-on-lgbt-rights-in-russia.

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  55. UNAIDS, Press Release, “On the Eve of Zero Discrimination Day, UNAIDS Calls for the Protection for the Health and Human Rights of Vulnerable Populations,” February 28, 2014. http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2014/february/20140228zerodiscrimination/.

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  56. State Department, Travel Alerts & Warnings, Russia, http://travel.state.gov/content/passports/english/country/russia.html.

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  57. Office of Congressman Jerrold Nadler, Press Release. “Rep. Nadler Leads Bipartisan Letter to Protect LGBT Rights at 2014 Olympic Games in Russia,” August 2, 2013. http://nadler.house.gov/press-release/rep-nadler-leads-bipartisan-letter-protect-lgbt-rights-2014-olympic-games-russia.

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  58. White House, Office of the Press Secretary, “Remarks by the President in a Press Conference,” August 9, 2013, http://www.whitehouse.gov/the-press-office/2013/08/09/remarks-president-press-conference.

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  59. State Department, “Remarks by Ambassador Samantha Power, U.S. Permanent Representative to the United Nations, at a Roundtable Strategy Session on International LGBT Rights,” December 10, 2013. http://usun.state.gov/briefing/statements/218567.htm.

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  60. State Department, Country Reports on Human Rights Practices for 2013, (2014). http://www.state.gov/j/drl/rls/hrrpt/humanrightsreport/index.htm#wrapper.

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  61. State Department, Country Reports on Human Rights Practices for 2013, (2014). http://www.state.gov/j/drl/rls/hrrpt/humanrightsreport/index.htm#wrapper.

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  62. UNAIDS, Press Release, “UNAIDS Calls on India and all Countries to Repeal Laws that Criminalize Adult Consensual Same Sex Sexual Conduct,” December 12, 2013. http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2013/december/20131212psindia/.

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  63. UNAIDS, Press Release, “On the Eve of Zero Discrimination Day, UNAIDS Calls for the Protection for the Health and Human Rights of Vulnerable Populations,” February 28, 2014. http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2014/february/20140228zerodiscrimination/.

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  64. Faine Greenwood, “Indian government asks Supreme Court to review anti-gay law,” Global Post, December 20, 2013. http://www.globalpost.com/dispatch/news/regions/asia-pacific/india/131220/indian-government-asks-supreme-court-review-anti-g-0.

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  65. "Supreme Court Refuses Overruling its Verdict on Section 377 and Homosexuality," IANS Biharprabha News, January 28, 2014, http://news.biharprabha.com/2014/01/supreme-court-refuses-overruling-its-verdict-on-article-377-and-homosexuality/.

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  66. Akila R. S, “Section 377: The way forward,” The Hindu, March 1, 2014. http://www.thehindu.com/features/magazine/section-377-the-way-forward/article5740242.ece.

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  67. State Department, Daily Press Briefing, Jen Psaki, Spokesperson, December 11, 2013. http://www.state.gov/r/pa/prs/dpb/2013/12/218597.htm#INDIA.

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  68. State Department, Travel Alerts & Warning, India, http://travel.state.gov/content/passports/english/country/india.html.

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  69. Nigerian Government, Same Sex Marriage (Prohibition) Act, 2013.

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  70. State Department, Travel Alerts & Warning, Nigeria, http://travel.state.gov/content/passports/english/country/nigeria.html.

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  71. Adam Nossiter, “Nigeria Tries to ‘Sanitize’ Itself of Gays, New York Times, February 8, 2014. http://www.nytimes.com/2014/02/09/world/africa/nigeria-uses-law-and-whip-to-sanitize-gays.html.

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  72. Erika Eichelberger, “You Thought It Was Tough Being Gay in Uganda. ‘It's Hell in Nigeria,’” Mother Jones, March 13, 2014. http://www.motherjones.com/politics/2014/03/nigeria-anti-gay-law-hiv.

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  73. UN News Center, “Nigeria: Ban Voices Concern as New Anti-homosexuality Law Takes Effect,” January 15, 2014. http://www.un.org/apps/news/story.asp?NewsID=46935&Cr=lesbian&Cr1=#.U11VVvldX4s.

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  74. United Nations, Press Office, “UN Human Rights Chief Denounces New Anti-homosexuality Law in Nigeria,” January 14, 2014. http://www.ohchr.org/FR/NewsEvents/Pages/DisplayNews.aspx?NewsID=14169&LangID=E.

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  75. UNAIDS, Press Release, “On the Eve of Zero Discrimination Day, UNAIDS Calls for the Protection for the Health and Human Rights of Vulnerable Populations,” February 28, 2014. http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2014/february/20140228zerodiscrimination/.

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  76. UNAIDS & the Global Fund, Press Release, “UNAIDS and the Global Fund Express Deep Concern about the Impact of a New Law Affecting the AIDS Response and Human Rights of LGBT People in Nigeria,” January 14, 2014. http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2014/january/20140114nigeria.

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  77. State Department, Remarks by John Kerry, “Deep Concern with Nigeria's Enactment of the Same Sex Marriage Prohibition Act,” January 13, 2014. http://www.state.gov/secretary/remarks/2014/01/219587.htm.

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  78. State Department, Country Reports on Human Rights Practices for 2013, (2014). http://www.state.gov/j/drl/rls/hrrpt/humanrightsreport/index.htm#wrapper.

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  79. State Department, Travel Alerts & Warning, Nigeria, http://travel.state.gov/content/passports/english/country/nigeria.html.

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  80. State Department, Travel Alerts & Warning, Uganda, http://travel.state.gov/content/passports/english/country/uganda.html.

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  81. Amnesty International, Press Release, “Global Day of Action against Uganda’s Anti-Homosexuality Bill,” February 10, 2014. http://www.amnestyusa.org/news/news-item/global-day-of-action-against-uganda-s-anti-homosexuality-bill.

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  82. “Ugandan Tabloid Prints List of 'Top 200 Homosexuals',” The Guardian, February 25, 2014. http://www.theguardian.com/world/2014/feb/25/ugandan-tabloid-prints-list-top-200-homosexuals.

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  83. State Department, Press Statement by Marie Harf, “Raid on the Makerere University Walter Reed Project by Ugandan Authorities”, April 4, 2014. http://www.state.gov/r/pa/prs/ps/2014/04/224431.htm.

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  84. Martin Plaut, “Uganda Donors Cut Aid after President Passes Anti-gay Law,” The Guardian, February 25, 2014, http://www.theguardian.com/global-development/2014/feb/25/uganda-donors-cut-aid-anti-gay-law.

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  85. J. Lester Feder, “World Bank Delays $90 Million Loan To Uganda As Bank President Blasts Anti-Gay Laws,” Buzzfeed, February 27, 2014, http://www.buzzfeed.com/lesterfeder/world-bank-delays-90-million-loan-to-uganda-as-bank-presiden.

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  86. UNAIDS, Press Release, “UNAIDS Expresses Deep Concern Over Impact of Ugandan Bill on the Rights of Gay men,” February 18, 2014, http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2014/february/20140218psuganda/.

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  87. UNAIDS, Press Release, “On the Eve of Zero Discrimination Day, UNAIDS Calls for the Protection for the Health and Human Rights of Vulnerable Populations,” February 28, 2014. http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2014/february/20140228zerodiscrimination/.

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  88. Global Fund to Fight AIDS, Tuberculosis and Malaria, Announcement, “Global Fund Deeply Concerned over Anti-Gay Law in Uganda,” February 24, 2014. http://www.theglobalfund.org/en/mediacenter/announcements/2014-02-24_Global_Fund_Deeply_Concerned_over_Anti-Gay_Law_in_Uganda/.

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  89. White House, Office of the Press Secretary, “Statement by the President on the Anti-Homosexuality Bill in Uganda,” February 16, 2014, http://www.whitehouse.gov/the-press-office/2014/02/16/statement-president-anti-homosexuality-bill-ugandaObama.

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  90. State Department, Remarks by John Kerry, “Enactment of Ugandan Anti-Homosexuality Bill,” February 24, 2014, http://www.state.gov/secretary/remarks/2014/02/221987.htm.

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  91. See, for example: “Comments Of Senator Patrick Leahy (D-Vt., President Pro Tempore, Chairman Of The State Department And Foreign Operations Appropriations Subcommittee) On Uganda President Museveni’s Signing Of The Anti-Homosexuality Bill, February 25, 2014, http://www.leahy.senate.gov/press/comments-of-senator-patrick-leahy-d-vt-president-pro-tempore-chairman-of-the-state-department-and-foreign-operations-appropriations-subcommittee-on-uganda-president-musevenis-signing-of-the-anti-homosexuality-bill; “Senator Coons Condemns Enactment of Anti-Homosexuality Bill in Uganda,” February 24, 2014, http://www.coons.senate.gov/newsroom/releases/release/senator-coons-condemns-enactment-of-anti-homosexuality-bill-in-uganda; Congressional Black Caucus, March 18, 2014, http://lee.house.gov/sites/lee.house.gov/files/Rep.%20Lee%20CBC%20letter%20re%20Uganda%20LGBT%20law%203.18.14.pdf.

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  92. USAID Uganda, “USAID Response to Enactment of Anti-Homosexuality Bill,” Memo to USAID/Uganda Implementing Partners, February 28, 2014.

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  93. White House, Blog by Grant Harris and Stephen Pomper, “Promoting Regional Security and Protecting Human Rights in Uganda,” March 24, 2014. http://www.whitehouse.gov/blog/2014/03/24/promoting-regional-security-and-protecting-human-rights-uganda.

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  94. State Department, Travel Alerts & Warning, Uganda, http://travel.state.gov/content/passports/english/country/uganda.html.

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  95. State Department, Press Statement by Marie Harf, “Raid on the Makerere University Walter Reed Project by Ugandan Authorities”, April 4, 2014. http://www.state.gov/r/pa/prs/ps/2014/04/224431.htm.

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  96. State Department, Press Release, “Statement from Ambassador Deborah Birx, M.D., U.S. Global AIDS Coordinator, on the Principles of PEPFAR's Public Health Approach”, April 11, 2014. http://www.pepfar.gov/press/releases/2014/224738.htm.

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Key Challenges, Opportunities, and Potential Next Steps
  1. Tonia Poteat, Daouda Diouf, Fatou Maria Drame, Marieme Ndaw, Cheikh Traore, MandeepDhaliwal, Chris Beyrer, and Stefan Baral, “HIV Risk among MSM in Senegal: A Qualitative Rapid Assessment of the Impact of Enforcing Laws That Criminalize Same Sex Practices,” PLoS ONE 6(2011): e28760.

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  2. Michael Gerson, “Making the AIDS Crisis Worse,” Washington Post, March 13, 2014. http://www.washingtonpost.com/opinions/michael-gerson-africa-is-making-the-aids-crisis-worse/2014/03/13/274578e2-aae4-11e3-adbc-888c8010c799_story.html.

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  3. U.S. Global Health Initiative, U.S. Government Interagency Paper on Country Ownership. 2012. http://www.ghi.gov/principles/docs/ownershipInteragencyPaper.pdf.

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  4. Meeting Report, Advancing Country Ownership: Civil Society’s Role in Sustaining Public Health. 2013. http://www.amfar.org/uploadedFiles/_amfarorg/On_the_Hill/Country-Ownership-Meeting-Report-June-2013.pdf.

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  5. State Department, Press Release, “Statement from Ambassador Deborah Birx, M.D., U.S. Global AIDS Coordinator, on the Principles of PEPFAR's Public Health Approach”, April 11, 2014. http://www.pepfar.gov/press/releases/2014/224738.htm.

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  6. Chris Beyrer and Stefan D Baral, “MSM, HIV and the Law: The Case of Gay, Bisexual and other men who have sex with men (MSM)”, Working Paper for the Third Meeting of the Technical Advisory Group of the Global Commission on HIV and the Law, 7-9 July 2011.

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  7. Civil Society Coalition on Human Rights and Constitutional Law, “Guidelines to National, Regional, and International Partners on how to Offer Support Now that the Anti-Homosexuality Law has been Assented To,” March 3, 2014.

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  8. Solidarity Alliance for Human Rights, “Advisory to Allies and Partners on Providing Support to Nigeria’s Sexual/Gender Minorities in the Aftermath of the Same-Sex Marriage [Prohibition] Act 2013,” March 28, 2014.

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  9. The Global Fund to Fight AIDS, Tuberculosis and Malaria, “Special Initiatives,” Board Decision GF/B31/08A, March 6-7, 2014. http://www.theglobalfund.org/documents/board/31/BM31_08-SpecialInitiatives_Paper_en/.

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  10. State Department, Press Release, “Statement from Ambassador Deborah Birx, M.D., U.S. Global AIDS Coordinator, on the Principles of PEPFAR's Public Health Approach”, April 11, 2014. http://www.pepfar.gov/press/releases/2014/224738.htm.

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  11. Josh Michaud and Jen Kates, Raising the Profile of Diplomacy in the U.S. Global Health Response: A Backgrounder on Global Health Diplomacy, Menlo Park: Kaiser Family Foundation, 2012.

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  12. Josh Michaud and Jen Kates, “Global Health Diplomacy: Advancing Foreign Policy and Global Health Interests,” Global Health: Science and Practice 1 (2013):24-28.

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  13. State Department, Office of Global Health Diplomacy, http://www.state.gov/s/ghd/.

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  14. See, for example, GBC Health, http://www.businessfightsaids.org/.

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  15. See, for example: David Schwartz, “Arizona Governor Vetoes Bill Widely Criticized as Anti-gay,” Reuters, February 27, 2014, http://www.reuters.com/article/2014/02/27/us-usa-gays-arizona-idUSBREA1Q02420140227.

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  16. See, for example: Thomas Gryta, “AT&T Criticizes Russia's Antigay Law on Eve of Olympics,” Wall Street Journal, February 4, 2014, http://online.wsj.com/news/articles/SB10001424052702303442704579363190709990288.

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  17. See, for example: Georgetown University, “HIV/AIDS Summit Draws International Faith Leaders,” July 25, 2012, http://www.georgetown.edu/news/aids-summit-faith-leaders.html; Christian Medical Fellowship, “Faith Matters - The Contribution of Faith to Health and Healthcare in the Post 2015 agenda”; CSIS, “The American Faith Community’s Contributions to Global Health,” January 31, 2012, http://www.smartglobalhealth.org/blog/entry/the-american-faith-communitys-contributions-to-global-health; The Global Fund to Fight AIDS, Tuberculosis and Malaria, Report on the Involvement of Faith-Based Organizations in the Global Fund: 2010 Update. Geneva: Global Fund, 2011, http://www.theglobalfund.org/documents/civil_society/CivilSociety_InvolvemenOfFaithBasedOrganizationsInTheGlobalFund_Report_en/

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  18. See, for example: Fredrick Nzwili, “Uganda's anti-gay bill refocuses attention on US evangelical influence,” Christian Science Monitor, February 25, 2014, http://www.csmonitor.com/World/2014/0225/Uganda-s-anti-gay-bill-refocuses-attention-on-US-evangelical-influence-video; Christiane Amanpour, “How American Evangelicals may be Responsible for Uganda’s Anti-gay Law,” CNN, February 24, 2014, http://amanpour.blogs.cnn.com/2014/02/24/how-american-evangelicals-may-be-responsible-for-ugandas-anti-gay-law/; Sarah Pulliam Bailey, “U.S. evangelicals on the defense over Uganda’s new Anti-Homosexuality Act,” Washington Post, March 4, 2014, http://www.washingtonpost.com/national/religion/us-evangelicals-on-the-defense-over-ugandas-new-anti-homosexuality-act/2014/03/04/e91c3b56-a3e9-11e3-b865-38b254d92063_story.html; United States District Court for the District of Massachusetts, “Sexual Minorities Uganda v. Scott Lively”, Memorandum and Order Regarding Defendant’s Motions to Dismiss, C.A. No. 12-cv-30051-MAP, August 14, 2013; Inter-Religious Council of Uganda, “ICRU Press Statement on Anti-Gay Bill”, February 19, 2014.

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