U.$. – Undue Influence on Global HIV and Sexual reproductive health and rights

At the International AIDS Conference in Munich, Germany, a satellite session on Undue influence: The outsized role of U.S. policy in global HIV and sexual reproductive health and rights was organized by amfAR. The session conducted on July 24, 2024 concerned the policies the U.S. government exports all around the world and its outcomes, both the intended and unintended. Featured speakers at the session (Figure 1) focused on impacts on sex workers, doctor-patient relationships, and the anti-gender movement. My focus was on the specific ways anti-abortion policies, namely the Mexico City Policy, impacts HIV programming and this is the theme of my article.

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Figure 1

Introduction

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Sixty-eight percent of all international funding for the global HIV response comes from the United States federal government (Figure 2).

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Figure 2

While its programs, like PEPFAR, have led to massive improvements in outcomes for people living with HIV around the world, this support often comes with strings attached (Figure 3).

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Figure 3

Mexico City Policy

The Mexico City Policy (hereinafter referred to as Policy) also known as the Global Gag Rule (GGR) restricts how organizations accepting funds from the U.S. can provide reproductive healthcare services. The Policy has come in and out of place since 1984, depending on the U.S. president. Under the GGR, performing or “actively promot[ing]” abortion is strictly prohibited, even if those activities are paid for with other donor’s funds.

Research shows that the impacts are twofold. First, the Policy leads to a reduction in support for key sexual and reproductive health organizations. This loss of funding leads to the closure of clinics, reduced scope of activities such as contraception and HIV services, and fewer staff at those clinics that remain in operation. Second, the Policy also requires censorship of information about sexual and reproductive health and rights.

Less access to services and reduced information about health lead not only to a decrease in contraception access and increase in unsafe abortions and maternal deaths, but also to increased HIV incidence. This is not supposition, but has been well established in the research, an example of which is given below.

Figure 4

While the Policy was last in place from 2017-2020, it was projected that the Policy was responsible for 90,000 new HIV infections per year in highly impacted countries – a total of 360,000 during the 4 year term. Tragically, researchers also projected that during this time the Policy was responsible for 10,800 maternal deaths and 96,000 child deaths.

But it isn’t just that the Policy leads to unnecessary harm and suffering, it also fails to achieve its explicit goal: research showed a 40% increase in abortion rates during years in which the Global Gag Rule was in place. If U.S. lawmakers who’ve argued in support of the Global Gag Rule were truly interested in limiting abortions, they would advocate for access to a full range of reproductive health and family planning services.

Conclusion

American money has given the U.S. considerable influence around the world, and it is imperative that that influence is evidence-based and health-focused. Anti-abortion policies have never been about health, but rather control. There is no evidence to suggest that limiting access to healthcare has ever led to an increase in overall health. And in the case of the Global Gag Rule, this policy has actively undercut U.S. investments in HIV by contributing to thousands of new HIV infections each year in its place. While we may not know the full effects of policies, the evidence available does point to harm. It is to be noted that the magnitude of these effects will be known when they take place, but endure beyond whether those policies remain or not. Hence, the only way out is to repeal these restrictive laws. Continued inaction will eventually cost lives and runs counter to global health and HIV goals.