The US Government’s Mexico City Policy, also known as the “Global Gag Rule” is having devastating effects on the fight against HIV, the AIDS 2018 delegation heard. The Aids International Society Conference hosted in Amsterdam, the Netherlands, ran from the 23rd – 28th of July.
Researchers shared shocking evidence of the far-reaching consequences of the policy, especially in Africa. There is no way to sugar coat it. The policy sees the progress made around access to healthcare and reproductive rights rolled back to a previous era of bigotry dressed up as conservatism. First put in place by President Ronald Reagan and reinstated last year by President Donald Trump, the policy denies US Aid to organisations that provide information, referrals or services related to legal abortion or advocate for abortion. This, even with their own money.
Speaking at the conference, US Representative Barbara Lee said:
“The Trump-Pence Global Gag Rule is an ideological crusade that denies lifesaving care to women around the world and threatens decades of progress in the global HIV response… The healthcare of women and children shouldn’t be used as a pawn to placate right-wing extremists.”
Past iterations of the policy applied solely to US family planning assistance. Now, under the Trump Administration, it applies to almost all US global health bilateral assistance, including the President’s Emergency Plan For AIDS Relief (PEPFAR).
The research presented at the conference revealed that hundreds of organisations receiving PEPFAR support will be negatively impacted. Results, as presented by Jennifer Kates of the Kaiser Family Foundation, were that more than half of the countries that receive PEPFAR support allow for legal abortion. The authors identified 470 foreign NGO prime recipients of PEPFAR bilateral HIV funding, which received $873 million. In addition, they identified 274 US NGO prime recipients, accounting for $5.5 billion, which would be required to ensure that any foreign NGO sub-recipients complied.
image courtesy of www.FLAS.org.sz
Research that looked at the effect of the Gag Rule on organisations in Ethiopia and Zimbabwe that provide a combination of HIV and sexual and reproductive health services (SRHR), revealed grimmer news. Preliminary findings point to funding loss because of the Global Gag Rule. It is likely that SRH and HIV services will no longer be offered in an integrated manner, resulting in reduced access to HIV prevention, testing and treatment services. This jeopardises the health of key and vulnerable populations by restricting the package of services they can receive. The efforts to maintain abortion laws were also noted as under threat due to ensuing confusion and fragmentation of civil society.
The Family Life Association of Swaziland (FLAS) defines abortion as the expulsion or removal of an embryo or foetus from the uterus before it has developed sufficiently to survive outside the mother (before viability). “Abortion may refer to induced and spontaneous abortion (referred to as miscarriage). Unsafe abortion,” on the other hand, “is a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or performed in an environment lacking the minimal medical standards, or both. Unsafe abortion also includes the inappropriate management of spontaneous abortion.”
Speaking to Maxwell Dlamini, the Communications and Marketing Manager of FLAS, he admits that “unsafe abortions are a major killer of women in Swaziland. Recognising this as a health problem and designing preventive measures is essential.” At the clinics, FLAS comes across several women each day with unwanted pregnancies. There is a need to promote the use of contraceptives or family planning as well as addressing the high levels of gender-based violence, which also contribute to unwanted pregnancies.
Dlamini is quick to reiterate that Eswatini’s (Swaziland) FLAS operates within the ambits of the country’s laws. “All our conduct and activities are done within the prevailing legal framework and requirements of the law. Clinical services provided are according to the guidelines provided by the Ministry of Health.”
image courtesy of www.FLAS.org.sz
He says: “The loss of the projects resulted in loss of income and means to reach and provide services and information to young people and the populations above. Just for 2017 alone, these projects would have brought (in) 10.7 Million Emalangeni.”
There is a study that looked at the historical implications of various iterations of the Global Gag Rule. The authors assessed lessons learned from the Global Gag Rule from 2001-2009. Findings were that the policy had a number of harmful impacts. These included the United States Agency for International Development (USAID) being forced to end condom shipments to Lesotho at a time when one in four women in the country was infected with HIV. This, because Lesotho Planned Parenthood Association, the primary conduit for condoms in the country, could no longer receive US funding under the Global Rag Rule.
Another example is the termination of critical activities run by the Family Planning Association of Kenya and Marie Stopes International Kenya between 2002 and 2006. These are the leading providers of healthcare to people living in poor and rural communities in the country.
At FLAS the organisation had four projects that were supported by USAID or PEPFAR and these related to providing integrated SRH and HIV services to vulnerable, hard-to-reach populations. These projects targeted young men; Key Populations (KPs) such as men having sex with men (MSM), sex workers, and adolescents living with HIV, among others. With these funds FLAS circumcised over 2 800 men and reached over 600 KPs with HIV and SRH services per month in just one year.
Due to their complexity it has taken time to understand the challenges facing the HIV arena. The advances that have been made both medically and socially have been hard earned. The threat that a policy like the Global Gag Rule poses to the health and dignity of KPs seems almost unimaginable considering the history that saw it defeated. Only to be reinstated. So in the midst of all this progress the reality remains that good work can be undone.
May the spirit of protest and resistance that showed up in full armour at AIDS 2018 be sign of many victories to come.
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