Trump Policies Could Erase Gains in HIV Epidemic

The global gag rule could hurt progress made in fighting HIV.

A policy known as the global gag rule will erase the recent gains against the HIV epidemic, a recent editorial in The Lancet HIV. The so-called gag rule is officially named the Mexico City policy, and it limits aid from the United States to international non-governmental organizations (NGOs) that offer or provide information about abortions.

Campaigns, such as the National Women and Girls HIV/AIDS Awareness Day, a program sponsored by the Office of Women’s Health within the US Department of Health and Human Services, have contributed to the decline of HIV diagnoses in the last decade, the editorial suggests. However, the researchers behind the report also cite some sobering statistics:

  • More than 280,000 women have HIV in the US
  • 8,500 women with HIV give birth each year
  • 62% of new HIV cases IN 2014 were in black women
  • The HIV epidemic is concentrated in one region—the South

The campaigns have helped reduce the number of new cases by providing resources to these most at-risk populations. Such programs are also targeted to specific goals like reducing perinatal HIV transmission. Along with targeted initiatives, advances in research have helped lower the perinatal transmission rate which, in turn, has helped lower the overall rate of infection. “However, pregnant women with HIV still need specialized prenatal care and advice to lower the risk of perinatal transmission,” the editorial said, and that access to such care may be limited by a variety of factors.

This year, National Women and Girls HIV/AIDS Awareness Day is March 10—two days after a national strike by women and two months following The Women’s March, on January 21, which marked the largest protest in US history. The protest was in response to the inauguration of Donald Trump as the nation’s 45th president. Trump reinstated the Mexico City policy on January 22. Many people, including the authors, believe that this reinstatement is a method of retaliating by deliberately attempting to suppress reproductive health services for women.

Any NGO that offers advice about abortion, including those that provide other services such as malaria care or HIV/AIDs care, may lose all funding from the US. Within the nation’s borders, Planned Parenthood could lose funding for a year as part of the repeal of the Affordable Care Act (ACA), although that would be conditional if the organization ceased to offer abortions. Currently, it is illegal for government funds to pay for abortion. The defunding would occur simply because abortions are available through Planned Parenthood, along with HIV testing and contraception, as well as a slate of other women’s services.

The authors further noted that Trump has so far been silent regarding the US President’s Emergency Plan for AIDS Relief (PEPFAR), which has lost funding over the last several years. Approximately 11.5 million people with HIV depend on PEPFAR for access to antiretroviral therapy (ART). Additionally, HIV testing for 74 million people has been provided through the program. Experts estimate that 2 million babies have been born without infection thanks to PEPFAR. The Trump administration recently sent a survey to the State Department which included the question, “Is PEPFAR becoming a massive, international entitlement program?”

The authors say that limiting women’s access to healthcare both in the US and in the world is against the core idea behind National Women and Girls HIV/AIDS Awareness Day. “Restricting access to reproductive healthcare services could turn the clock back on years of progress made, in no small part, through the integration of services for HIV and reproductive health,” they concluded.

The editorial, “Gag rule at odds with progress in HIV/AIDS,” can be found in The Lancet HIV.

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