A Catch-22 for Women and Girls: How the Global Gag Rule Attacks the HIV/AIDS Response
By Chloë Cooney and Caitlin Horrigan
Earlier this year, the global health community waited with tense anticipation for the results of the ECHO (Evidence for Contraceptive Options in HIV Outcomes) study. The clinical trial sought to determine what, if any, relationship exists between hormonal contraception use and HIV risk — a potentially terrifying thought given the high rates of HIV, unintended pregnancy, and maternal mortality in young women around the world. While this groundbreaking research found that hormonal contraception did not increase risk of HIV, an alarming fact emerged: young women in Eastern and Southern Africa were found to have a much higher rate of HIV than we previously understood.
In other words, the current global HIV response is failing women. Sadly, the Trump-Pence global gag rule is exacerbating the problem.
In 2018, women accounted for a majority of all adults living with HIV and young women faced 55% higher rate of new infections compared to young men. In Sub-Saharan Africa, young women’s risk is jaw dropping: they account for 80% of new infections in young people overall.
Preventing new HIV infections in adolescent girls and young women is vital to ending the pandemic. Global health care professionals advocate for HIV prevention and treatment as part of comprehensive sexual and reproductive health and rights. This is not always the case as both stigma and funding have kept these health services separate until recently. But just as young women come to Planned Parenthood for contraception and can leave better understanding HIV prevention, health organizations around the world recognize that reproductive health care sites — and interactions with healthcare workers — is where there is often the best opportunity to engage young women with comprehensive sexual health information, including HIV prevention, testing, and links to care.
Additionally, tackling gender injustice — especially in healthcare — is essential. We cannot make sustainable progress to prevent HIV without addressing the entrenched laws and social norms that systematically discriminate against women and keep them from controlling their own bodies. For example, some communities do not provide sex education to unmarried girls, fearing it will lead to promiscuity. Health care organizations try to fill the gap and provide a safe space for girls and young women to access information and care.
Yet these are the NGOs that are typically disqualified from U.S. global health assistance by the global gag rule because they provide information, services, or referrals for abortion or to advocate for safe and legal abortion rights in their own countries. The gag rule directly undermines the work of global and community-based HIV and family planning organizations by forcing them to forgo U.S. government funding or take the assistance but tell young women their bodily autonomy only goes so far.
It’s a catch-22 and young women and girls are its victims.
For the first time in the history of the policy, the global gag rule under President Trump specifically targets PEPFAR, the U.S. global AIDS program and largest single disease program in the world. In 2015, PEPFAR launched the DREAMS program to prevent new HIV infections in adolescent girls, recognizing the need for programs that are cross-sectoral and evidence-driven. Recent data from UNAIDS shows that we’re making progress. But then the global gag rule was dragged out of the garbage heap to undermine those gains.
Our own research found that the global gag rule disrupts the delivery of health services in areas of the world that are most in need, rolls back progress made in countries that have fought to advance access to health care and human rights and weakens national coalitions by breaking up long-standing partnerships and making it harder for groups to collaborate.
An HIV advocate from East Africa we interviewed shared, “Who suffers most is the woman who cannot speak for herself. She cannot afford to pay for health services. She lives in a hard-to-reach area and now she cannot be reached by the services that she needs because they have been cut. She doesn’t even know about the global gag rule… She doesn’t care what is discussed at the national level, but what is provided in her village and at the facility near her.”
Recently, global health professionals released a statement calling for the prioritization of comprehensive sexual and reproductive health and rights. And at the launch of UNAIDS’ 2019 World AIDS Day report last week, Executive Director Winnie Byanyima professed, “It is our urgent duty to ensure that all women and girls, of all ages, have unrestricted access to sexual and reproductive health services.” It’s only in the dedication to fully meeting the needs of young women, that an effective HIV response can succeed.
There is no path to an AIDS-free generation without reaching adolescent girls and young women. As global leaders have devoted this past week to re-doubling their commitments to the fight against HIV/AIDS, one fact remains unavoidable: The global gag rule undermines progress.
Chloë Cooney is the Senior Director, Strategy and Programs for Planned Parenthood Global.
Caitlin Horrigan is the Director of Global Advocacy for Planned Parenthood Federation of America.
