Unprecedented extension of Global Gag Rule puts HIV programmes at risk

The Alliance has criticised the decision by the United States to include HIV programmes in an unprecedented extension of the controversial Mexico City Policy.

The decision was confirmed in a US State Department document detailing plans to expand the Global Gag Rule to all US global health funding, including the US President’s Emergency Plan for AIDS Relief (PEPFAR).

It was always feared the gag rule could have implications beyond family planning services, but this is the first time any US administration has extended the restrictions on funding to include HIV. Previously initiatives such as PEPFAR were exempt.

The move threatens to end the global consensus on the need to integrate HIV and sexual and reproductive health and rights (SRHR) programmes, and potentially undermines the achievements of the Sustainable Development Goals, which emphasise the importance of delivering HIV services alongside family planning services.

Do they ignore the evidence underlying the needs of young women they see daily, or choose not to serve those young women at all?

It will also have a chilling effect on the ability of HIV organisations to deliver comprehensive HIV and sexual health services to women and adolescent girls.

In 2016, the Alliance globally reached almost one million people with integrated HIV and SRHR services. However, the extension of the Global Gag Rule to all ‘global health assistance’ effectively bans organisations that receive US funding from continuing to provide comprehensive SRHR and HIV services, as a condition of receiving US government funding.

Christine Stegling, Executive Director of the Alliance, said:

“It is important to put this into context with respect to adolescent girls. In Africa, AIDS remains the number one killer of young women. In some areas of sub-Saharan Africa young women are up to eight times more vulnerable to HIV than young men. In some settings up to 45% of adolescent girls report that their first sexual experience was forced.

"Meanwhile, numerous studies demonstrate that intimate partner violence increases the risk of HIV infection and unwanted pregnancies. A study in South Africa found that young women who experienced intimate partner violence were 50% more likely to have acquired HIV than women who had not experienced violence. This also puts them at greater risk of having an unintended pregnancy: nearly half of adolescent pregnancies in Africa are unintended, out of which over half are terminated through safe abortion.

“This is the context in which young women seek SRHR and HIV services and advice from organisations like those who are part of the Alliance. While the US remains the single biggest donor to the HIV response, its decision to include HIV programmes within its Global Gag Rule puts those organisations in an impossible position.

“Do they ignore the evidence underlying the needs of young women they see daily, or choose not to serve those young women at all?”

The consensus on integrated SRHR and HIV is an important part of the Sustainable Development Goals, which aim for evidence-based integrated health responses.

This integrated approach forms the backbone of the services that many organisations who are part of the Alliance provide, despite not being ‘core’ to their work as HIV organisations.

In implementing this controversial policy, the US government will force organisations to choose between either women’s right to comprehensive health services and advice, or vital support for tens of millions of people living with HIV. This is an impossible dilemma for organisations like ours.

We urge the US government to re-evaluate its stance, to ensure that we stay on target to end AIDS by 2030.