Soon after he became president in 2017, Trump reinstated and expanded the Mexico City Policy, also known as the global gag rule. It forbids the U.S. health funding of any non-U.S.-based group that performs abortions or provides referrals to, information about or advocacy around abortion. Under the expansion, these restrictions now apply to HIV funding, including the President’s Emergency Plan for AIDS Relief (PEPFAR).
Has this expanded rule affected HIV/AIDS programs? A confidential survey of global groups with which PEPFAR works (implementing partners, or IPs) seeks to answer this question. The survey was launched by amfAR, The Foundation for AIDS Research, in collaboration with Johns Hopkins University in Baltimore; amfAR published the results in an eight-page issue brief, which you can read and download here.
First, some background. Established by President George W. Bush in May 2003, PEPFAR helps over 14 million people access HIV treatment. Traditionally, the global gag order mostly applied to funding for groups that provided family-planning services. Different restrictions on funding have been in effect since the 1970s, but Trump significantly expanded them.
The key takeaways from the survey “strongly suggest” that the delivery of comprehensive sexual reproductive health information has been disrupted by the expanded Mexico City Policy. Specifically, one third of providers representing 31 of the 45 countries surveyed said they’re altering their operations and services. Their organizational changes include reducing the amount of non-abortion-related information—on topics such as HIV and contraception—that they provide to clients.
What’s more, groups that serve pregnant women and key populations (KPs) at higher risk for HIV said they’re likely to alter their operations because of Trump’s expanded policy.
“Key-informant interview findings suggest that the [expanded policy] is affecting the ability of PEPFAR IPs to provide full [sexual reproductive health] information to their clients, to the detriment of patient care,” states the brief. “Interviews further reveal that the [expanded policy’s] greatest effect is on service delivery to already vulnerable populations such as youth and KPs.”
As POZ reported last summer, researchers with Kaiser Family Foundation tried to estimate how the gag rule would affect groups receiving PEPFAR money. They identified 470 foreign nongovernment organizations (NGOs) that receive $873 million from PEPFAR in addition to 274 U.S. NGOs that receive $5.5 billion from the program. For more details on that report, click here.
For a look at PEPFAR and its accomplishments as of May 2018 (its 15th anniversary), click here.