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Trump’s Global Gag Rule Is Making It Harder to Fight the AIDS Crisis

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President Trump’s State of the Union speech kicked off the year with some dramatic gestures toward “global leadership,” promising to put the United States at the forefront of a crusade to end the AIDS crisis worldwide. But between the lines, Trump’s global humanitarian agenda is actually undermining health care in the communities most deeply afflicted by HIV/AIDS.

Trump’s boasts about tackling the AIDS crisis fly in the face of one of his key foreign-aid policies: the so-called Global Gag Rule. As one of Trump’s first executive orders, issued just after the 2017 Women’s March in Washington, the rule expanded a Reagan-era policy barring US funding for family-planning services that could be deemed to be supporting, referencing, or even explaining abortion in any way. Under previous Republican administration, organizations receiving State Department aid had to agree to anti-abortion speech restrictions, regardless of the host country’s abortion laws, in an effort to extend the anti-abortion agenda of US conservatives overseas. Groups would either have to censor the medical advice they gave to clients or face devastating funding cuts if they could not—or were unwilling to—comply with Washington’s directives.

In recent weeks, Trump has doubled down with a domestic version of the gag rule—a newly issued rule that restricts all care and counseling related to abortion through health programs for low-income communities, known as Title X. The cumulative impact of the global and domestic gag rules has been a worldwide frontal assault on medical ethics, gender equality, and HIV/AIDS care in vulnerable populations, at home and abroad.

Studies on the long-term impact of the gag rule, under both the Trump and Bush administrations, link the policy to devastating impacts on local health-care infrastructures, including the closure of clinics and cutbacks to distribution of contraceptives. Though the gag rule is primarily aimed at abortion, the restrictions it places on health-care provision have also been linked to an ongoing erosion of HIV/AIDS-related public-health aid in the Global South.

Trump’s version of the gag rule is even more sweeping than previous iterations, since it impacts not just USAID family-planning programs, but all US government aid programs that support service organizations abroad. According to the Center for Health and Gender Equity (CHANGE), Trump’s expanded gag rule jeopardizes funds for a range of aid efforts: “HIV and AIDS…maternal and child health; malaria; tuberculosis; nutrition; non-communicable diseases; water, sanitation and hygiene,” and other community needs—cumulatively affecting “nearly $9 billion in U.S. funds annually.” About $6 billion of the impacted funding streams are dedicated to HIV/AIDS assistance, which is primarily provided through the President’s Emergency Plan for AIDS Relief (PEPFAR). The overlap of reproductive-health care and HIV/AIDS care is crucial: According to an analysis of the impact of the gag rule on PEPFAR by the research group amFAR, “contraception coverage is a known contributor to HIV prevention, averting an estimated 173,000 infant infections each year in sub-Saharan Africa alone,” and recent research on the gag rule shows that “countries where [it] was most likely to disrupt HIV and [family-planning] service integration were also those with the highest HIV prevalence.”

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