Resisting the Rule
amfAR’s Title X Brief Seeks to Protect Reproductive Rights & HIV Prevention Sites
by Jeannie Wraight
Earlier this year in a highly debated and controversial move, the Trump Administration banned all recipients of Title X funding from conducting any type of abortion services. The Rule dubbed “the Domestic Gag Rule” states that Title X recipients must be financially, as well as physically, separate from entities that provide these services. In addition to reproductive health, Title X also funds HIV prevention, testing, referrals, education and care. Although this Rule, at its core, is intended to reduce abortion rates, it will subsequently have a substantial effect on HIV prevention and care by reducing the number of facilities receiving and thus providing Title X funded services and, in other cases, the quality and breadth of services. AmfAR has released a Brief on how the Rule could affect people at high risk for HIV as well as those already living with HIV.
The effects of this Rule are expected to have substantial consequences on the provision of HIV services throughout the country including PrEP, HIV testing, HIV counseling and HIV treatment referrals. “As a country we cannot view HIV and family planning services as separate. Diverting funding from trusted family planning providers also harms their ability to provide HIV services. These reductions could destabilize wider HIV testing and service provision in the communities that need these services the most.” stated Jennifer Sherwood, amfAR Policy Associate.
According to the amfAR brief, a 2012 analysis found that 14% of all women and 20% of women below the federal poverty level who received an HIV test did so at a Title X-supported clinic. The brief further states “In 2016, Title X-supported clinics administered 1.2 million HIV tests and diagnosed 2,824 people with HIV, accounting for 7.1% of the 39,782 diagnoses that year”.
This summer, Title X grantees received a letter directing them to outline how they will restructure their services in compliance with the Gag Rule. However, some recipients refuse to discontinue their abortion related services.
Planned Parenthood serves 40% of the country’s 4 million Title X recipients. Through Title X funding, they are an important national provider of HIV education, prevention efforts, testing, counseling, case management and treatment referrals. Instead of complying with the Rule and discontinuing their abortion services, Planned Parenthood has opted to forfeit the totality of their Title X funding and continue their current programming. In doing so, they also sacrifice their HIV funding. If Planned Parenthood is unable to make up the loss through separate funding streams, their HIV services will be lost or substantially decreased. The amfAR Brief refers to a case where a Planned Parenthood closure in 2014 due to budget cuts left Scott County, Indiana, with no source of free HIV testing. A year later, the area experienced an HIV outbreak among injection drug users with 200 new HIV cases reported with over a 90% rate of hep C co-infection. The county normally experience 5 new HIV infections per year.
Public Health Solutions, the largest public health nonprofit in New York City has also declined further Title X funding due to the Gag Rule restrictions. They previously received $4.6 million a year in federal Title X funding which serviced six health centers and thirteen service sites. The Gag Order severely jeopardizes the services Public Health Solutions offers including sexual and reproductive health services such as HIV testing, care and education.
On a global level, in 2017 the Trump administration reinstated and expanded a foreign policy that refused funding to overseas organizations that advocate for or provide services for abortion. This includes information and referrals. As a great deal of work has been done to integrate sexual and reproductive health services, many of the health providers with programming related to reproductive services including abortion, are also PEPFAR (Presidents Emergency Plan for AIDS Relief) providers. $6 billion of the $9 billion dollar (annual) funding stream affected by this rule are directed to HIV services. As such, the Global Gag Rule has dramatically effected the quality of and availability of HIV services in many high-risk countries.
In January of 2019, amfAR and John Hopkins University released a report on a survey of PEPFAR providers which sought to determine the effects of the Global Gag Order on HIV services. The report states “Organizational changes include a reduction in the provision of critical non-abortion-related information, including for contraception and HIV, as well as altering advocacy, technical assistance, and research protocols to comply with the EMCP.”
The Trump administration’s Ending the AIDS Epidemic: A Plan for America proposes to reduce new HIV infections by 75% by 2015 and 90% by 2019. However the Gag Order is predicted to facilitate the same results domestically as it has globally with the closing of health care providers and organizations and/or the reduction of essential reproductive and sexual health services which could have a visible effect on rates of HIV transmissions as well as services for people living with HIV.
Jeannie Wraight is the former editor-in-chief and co-founder of HIV and HCV Haven (www.hivhaven.com) and a blogger and writer for TheBody.com. She is a member of the Board of Directors of Health People, a community-based organization in the South Bronx and an advisor to TRW (Teach me to Read and Write), a community-based organization in Kampala, Uganda. She lives with her husband in New York City.