PEPFAR partners reveal HIV prevention service cuts from expanded "Mexico City Policy," as organizations endorse act to end its restrictions

"Protecting Life in Global Health Assistance" policy, also known as the Global Gag Rule, is hitting services for young women the hardest, survey finds

When the Trump administration State Department began to enforce a newly reinstated, and greatly expanded version of the restrictions on health information provided by U.S.-funded overseas organizations known as the "Mexico City Policy" the restrictions had never before been applied to the President's Emergency Plan for AIDS Relief. But under the newly named "Protecting Life in Global Health Assistance" policy, rules against providing information, counseling or referrals to safely terminate a pregnancy have been applied for the first time across the board, to any foreign organization contracted by the U.S. to provide health services -- including for maternal and child health, for Zika prevention and testing, and for HIV responses. With stakes that included the effectiveness of PEPFAR, and of its budget of about $5.2 billion a year, researchers with amFAR, The Foundation for AIDS Research, and the Johns Hopkins University Bloomberg School of Public Health investigated the impacts on services provided by the U.S.'s largest global health program. Starting with confidential electronic survey answers from organizations identified through the program's Country Operational Plans as having contracted to provide HIV-fighting services during the last two fiscal years, researchers followed up with interviews in four of the countries where PEPFAR services are most intensive: Kenya, Mozambique, South Africa, and eSwatini (fomerly Swaziland).

 Among the findings from the 286 organizations completing the survey were that one-third reported changing their operations as a result of the policy,  through reductions in non-abortion related services including for HIV, and for contraception (considered a critical component of prevention of mother-to-child HIV transmission efforts). Organizations providing services to the most vulnerable, including adolescents with HIV, men who have sex with men, and pregnant women were among the most likely to reduce services. Cuts included discontinuation of mobile outreach  for adolescents living with HIV, and to integrated "one-stop-shops" combining HIV prevention and treatment with other healthcare services for populations facing obstacles to services. A report on the survey: The Effect of the Expanded Mexico City Policy on HIV/AIDS Programming: Evidence from the PEPFAR Implementing Partners Survey, details more of the findings. The report notes that the Helms amendment already had prevented U.S. foreign aid money from being used to fund abortion services since the 1970s. The report also notes, as noted here recently as well, that higher rates of abortion and unintended pregnancy and lower rates of contraception access have accompanied the policy's previous iterations (it was launched under President Reagan, revoked under Presidents Clinton and Obama, and reinstated under President George W. Bush). More than 70 organizations, including the Infectious Diseases Society of America and the HIV Medicine Association, which produce this blog, have endorsed the Global Health, Empowerment and Rights (HER) Act to end the global gag rule, expected to be reintroduced in the House and Senate next week by Rep. Nita Lowey (D-NY) and Sen. Jeanne Shaheen (D-NH).