On April 23, Judge Michael McShane of Federal District Court in Oregon issued a preliminary injunction against a federal “gag rule” written to forbid health care providers from even talking about abortion to patients who have questions about it.
The two parallel suits before him were filed by the American Medical Association, Planned Parenthood of America and a coalition of over 20 states (along with numerous other plaintiffs) to oppose this gag rule.
Scheduled to go into effect on for May 3, the rule would have directly affected the four million people who receive Title X-funded health care services, including contraception, cancer screening and testing for sexually transmitted infections (STIs), including HIV. At present, 92% of family planning providers in the United States offer HIV testing and 97% test for and treat other STIs, including HPV (associated with cancer).
Title X was created by Congress in 1970 so that “no American woman should be denied access to family planning assistance because of her economic condition.” In 2017, four million people received services funded by Title X providers who administered, among other services, 1.2 million HIV tests.
The gag rule remains an active threat to all who care about HIV prevention, treatment and rights. Health care providers across the United States depend on Title X funding to help keep their doors open.
If the gag rule ever goes into effect, providers will have to choose between depriving their patients of legitimate health information or losing their Title X funding. At present, 92% of family planning providers in the US offer HIV testing and 97% test for and treat other STDs, including HPV (associated with cancer).
Most heterosexually active cisgender women and some transgender men spend about 25 years of our lives (from teen years to our 40s) managing the realities of pregnancy and contraception. Only a minority of us are living with HIV, but the Trump administration’s gag rule is emblematic of other challenges we have already countered with activism.
Consider the following:
They want to buy silence. Health care providers refusing to be silenced by the gag rule would be barred from accessing any part of the $286 million allocated to Title X.
- Remember when just talking about syringe exchange as HIV prevention could get your Ryan White CARE Act money threatened?
It hurts low income populations the most. Nearly 4,000 health care centers get Title X money and use it to serve 400 million clients annually. Their patients are not affluent people with private doctors.
- Remember the struggle in the 1980s to get the Ryan White CARE Act because some Congress members saw it as funding immorality? People who use services funded by Ryan White aren’t rich either.
More Black women proportionally rely more on family planning clinics. In 2016, 21% of the Title X clinic users were Black women while 54% were white and 16% did not identify their race. In the U.S. national population, 61% of all women are white and 14% of women are Black.
- 59% of all women living with HIV in the United States are Black
It’s just harder for women in the South, especially in rural areas, to find family planning providers. And most of the states already imposing a state-wide gag rules are in the South.
- The same circumstances are also resulting to more Southern women having HIV — less health care, more stigma and governmental contempt.
Refilling one’s contraception prescription has a different level of urgency than does — for example — going to the dentist or going for an annual check-up. Sixty percent of U.S. women who get their care from publicly funded family planning centers identify the local family planning provider is their “usual form of health care.”
For almost half (41%), the clinic was their only source of health care. Avoiding unintended pregnancy reliably motivates clinic visits which, in turn, can include HIV testing, counseling and support.
Because they are seen as safe spaces, most women are willing to accept HIV testing and prevention education in a family planning clinic. Staff can then link people to ongoing HIV care and support as needed. Especially to women living in communities without other affordable and accessible HIV information and care, they are essential.
As HIV activists and advocates, we have a duty to stop the Trump administration’s efforts to attach a gag rule to Title X. It is our fight, just as demanding culturally appropriate HIV outreach, prevention, care and services for people of all genders is our fight. Additional hearings on the rule are coming up in Maine and Washington state.
The directive on this is clear in the Denver Principles. It says that people living with HIV are entitled to “quality medical treatment and quality social service provision without discrimination of any form including sexual orientation, gender, diagnosis, economic status or race.” That includes women.
Anna Forbes, MSS, is an independent consultant.