African HIV Responders’ Funding Hit Hardest by US Abortion “Gag Rule”

    Organizations working to end the HIV/AIDS epidemic in Africa have been the most impacted by President Donald Trump’s 2017 revival of the “gag rule,” which prohibits overseas public health grants to entities that offer abortion services, referrals or advocacy. HIV/AIDS organizations are losing millions of dollars in funding—even more than those dedicated specifically to reproductive health.

    In the 2018 fiscal year, $153 million in Global Health Program funds were withheld from international non-governmental organizations (NGOs) because they would not agree to “neither perform nor actively promote abortion as a method of family planning” as required by the funding’s Protecting Life in Global Health Assistance (PLGHA) policy, according to a March 2020 Government Accountability Office (GAO) report. HIV/AIDS programs comprise two-thirds of the usual Global Health Program recipients, and NGOs providing such services in Africa saw the greatest losses.

    The two organizations hit hardest—Marie Stopes International (MSI) and the International Planned Parenthood Foundation⁠—provide both family planning and HIV/AIDS services across multiple continents, including . In total, $54 million was withheld from the two. Both have publicly stated that abortion services are “a right to which their patients are entitled,” GAO reported.

    MSI’s loss of funds due to the gag rule left at least 275,000 pregnant women without MSI-provided antiretroviral treatment and 725,000 HIV tests unused by MSI patients who didn’t know their status, according to a 2017 estimate by the organization.

    The next most-impacted NGOs were in sub-Saharan Africa, and conduct work tailored to the needs of people already living with HIV or at risk of contracting the disease. For example, the Southern Africa HIV and AIDS Information Dissemination Service was no longer able to access nearly $12 million in funding that would have gone toward reducing HIV infections among girls and young women. An unnamed organization in Ethiopia that provides HIV services to commercial sex workers lost $8.4 million.

    The global gag rule has been United States policy on-and-off for the past 36 years. During that time, it has repeatedly proven harmful to HIV prevention and treatment. Under President George W. Bush’s iteration, some Ethiopian organizations ended their HIV/AIDS programs as a result of the conditions, while programs elsewhere altered their distribution of condoms⁠—which are shown to prevent the majority of HIV infections⁠—because of the ban, according to a 2019 study in Global Health Research and Policy.

    USAID stated in its comments on the GAO report that “the vast majority” of NGOs receiving USAID funding agree to the gag rule and “shift to other partners the activities the organization would have undertaken with our funding, while minimizing any disruption.”


    Photograph of a patient receiving an HIV test in Uganda by Arne Hoel/World Bank via Flickr/Creative Commons

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