Pol­icy threat­ens HIV/AIDS funding across Africa

As much as $6 bil­lion could be lost, af­fect­ing ef­forts to end epi­demic

The Washington Post Sunday - - THE WORLD - BY KEVIN SIEFF kevin.sieff@wash­post.com

nairobi — A Trump ad­min­is­tra­tion or­der took ef­fect re­cently bar­ring U.S. aid for global health or­ga­ni­za­tions that dis­cuss or pro­vide re­fer­rals for abor­tion. But the pol­icy put an­other pro­gram in the crosshairs: Amer­ica’s global HIV/AIDS ef­fort.

Since 2003, the U.S. gov­ern­ment has spent more than $70 bil­lion to com­bat the global epi­demic, with tremen­dous re­sults. The an­nual num­ber of AIDS-re­lated deaths has fallen by more than 40 per­cent. Un­der Pres­i­dent Trump’s ex­pan­sion of the global “gag rule,” how­ever, many HIV/AIDS or­ga­ni­za­tions funded by the United States stand to lose that money, put­ting at risk the pos­si­bil­ity of elim­i­nat­ing the epi­demic by 2030, a com­mit­ment es­tab­lished at the U.N. Gen­eral As­sem­bly last year. About $6 bil­lion in U.S. HIV/ AIDS funding could be af­fected.

“Reach­ing those am­bi­tious tar­gets could now be placed in real jeop­ardy,” said Divya Bajpai, the di­rec­tor of pro­grams at the In­ter­na­tional HIV/AIDS Al­liance. HIV/AIDS or­ga­ni­za­tions could lose their U.S. funding not be­cause they pro­vide abor­tions, but be­cause they of­fer coun­sel­ing that in­cludes the men­tion of abor­tion, or a re­fer­ral to an abor­tion provider. The health or­ga­ni­za­tions — most of which are in Africa, the re­gion most af­fected by AIDS — will be able to keep their U.S. as­sis­tance only if they agree not to men­tion abor­tion ser­vices to their pa­tients.

Past Repub­li­can pres­i­dents im­ple­mented ver­sions of the global gag rule, but they af­fected only about $600 mil­lion in fam­ily-plan­ning funds and did not ap­ply to groups fight­ing HIV/ AIDS. Pres­i­dent Ge­orge W. Bush, whose ad­min­is­tra­tion launched the multi­bil­lion-dol­lar Pres­i­dent’s Emer­gency Plan for AIDS Re­lief (PEPFAR), is cred­ited across much of Africa for his role in tack­ling the epi­demic.

The In­ter­na­tional HIV/AIDS Al­liance, which con­sists of 32 lo­cal or­ga­ni­za­tions, of­fers a win­dow into how the new pol­icy will play out. The al­liance re­ceives $130 mil­lion in an­nual funding — 20 per­cent of which comes from the United States. Each of the al­liance’s mem­bers will have to de­cide whether to keep its U.S. as­sis­tance by cut­ting any men­tion of abor­tion from its ser­vices.

“This is go­ing to drive girls and young women away from treat­ment,” Bajpai said.

Thanks in large part to U.S. funding, hun­dreds of com­mu­nity health or­ga­ni­za­tions treat­ing HIV/AIDS have emerged across the de­vel­op­ing world. Many of them, such as Fam­ily Health Op­tions Kenya, of­fer ser­vices that in­clude an­tiretro­vi­ral treat­ment, con­tra­cep­tive dis­tri­bu­tion and abor­tion coun­sel­ing.

With 17 lo­ca­tions, Fam­ily Health Op­tions Kenya treats hun­dreds of HIV-pos­i­tive women in some of the most re­mote parts of the coun­try. But nearly half of its $400,000 bud­get comes from the United States. Al­ready, the or­ga­ni­za­tion is try­ing to de­cide which ser­vices to cut and which lo­ca­tions to close.

“We are be­ing forced to re­duce our op­er­a­tions,” said Amos Sim­pano, the ex­ec­u­tive di­rec­tor for clin­i­cal ser­vices. “That means women won’t have ac­cess to ser­vices. And for those on an­tiretro­vi­rals, what will hap­pen to them? Will they die?”

Sim­pano says the or­ga­ni­za­tion has tried to look for a new funding stream, but with­out suc­cess.

“There’s a lot of pres­sure on us now,” he said.

Ex­perts say Trump’s pol­icy could par­tic­u­larly af­fect girls and young women, who are now the most likely to con­tract the dis­ease. “Girls and young women ac­count for 74 per­cent of new HIV in­fec­tions among ado­les­cents in sub-Sa­ha­ran Africa,” ac­cord­ing to PEPFAR’s fact sheet.

Some of those girls and young women con­tract the dis­ease af­ter a vi­o­lent sex­ual en­counter, which in some cases also re­sults in a preg­nancy. A re­cent U.N. study said that in some re­gions, women who had ex­pe­ri­enced phys­i­cal or sex­ual abuse by their part­ners were 1.5 times more likely to ac­quire the dis­ease than those who had not.

The Trump ad­min­is­tra­tion has said that the new pol­icy does not ban re­fer­rals for end­ing a preg­nancy caused by rape or in­cest.

“The Trump ad­min­is­tra­tion is dead set on deny­ing women the ben­e­fit of sci­en­tific ev­i­dence that shows for high­est im­pact, HIV treat­ment and preven­tion should be de­liv­ered along­side sex­ual and re­pro­duc­tive health ser­vices,” said Asia Rus­sell, the ex­ec­u­tive di­rec­tor of Health GAP, a group that cam­paigns for ac­cess to HIV/AIDS treat­ment.

The ad­min­is­tra­tion has named the ex­panded pol­icy “Pro­tect­ing Life in Global Health As­sis­tance.” Of­fi­cials said they don’t ex­pect the over­all amount of health as­sis­tance to de­cline but that funding would be “redi­rected” to or­ga­ni­za­tions of­fer­ing sim­i­lar health ser­vices.

“This ex­ec­u­tive or­der does not cut a sin­gle penny from U.S. aid; rather, it sim­ply en­sures our hard-earned tax dol­lars are used by other health-care en­ti­ties that act con­sis­tently to save lives, rather than pro­mot­ing and per­form­ing abor­tion. Abor­tion is not health care,” said Mar­jorie Dan­nen­felser, pres­i­dent of the Su­san B. Anthony List, which backs politi­cians who op­pose abor­tion.

But given the ru­ral en­vi­ron­ments in which many health or­ga­ni­za­tions op­er­ate in Africa — where there is of­ten only one HIV/AIDS treat­ment provider in a par­tic­u­lar place — it’s un­clear how ex­ist­ing providers would be eas­ily re­placed.


In 2015, an HIV-pos­i­tive girl re­counted her ex­pe­ri­ences at a cen­ter in Nairobi.

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