AIDS 2018: Expanded Mexico City policy built barriers to HIV services, researchers say

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Science Speaks is covering the 22nd International AIDS Conference this week live from Amsterdam, the Netherlands, with breaking news, updates and analysis of new research findings, evidence-based responses, and community action for global access to HIV treatment and prevention.

AMSTERDAM – Shards of glass, hot oil, sticks – those are some of the tools women and girls are reportedly using to terminate unwanted pregnancies in Kenya now that many have lost access to comprehensive sexual and reproductive health services. They are on their own now thanks to the Trump Administration’s reinstatement and expansion of the Mexico City policy – which prohibits U.S. global health funding from going to foreign nongovernmental organizations that use any funding, including non-U.S. funding, to provide information, referrals or services related to legal abortion – researchers said here on Friday.

President Trump’s expansion of the policy applies to all U.S. global health funding, while under previous iterations the policy applied to U.S. funding for family planning only. The Kaiser Family Foundation found that 470 foreign nongovernmental organizations and 274 U.S. organizations have been affected, the Foundation’s Vice President Director of Global Health and said.

While it’s too early to quantitatively measure health outcomes from the expanded policy, researchers said, there’s evidence of programs and clinics shutting down because nongovernmental organizations that provide abortion services or counselling and information as part of reproductive health and family planning services have lost funding since the reinstatement and expansion of the policy in January 2017. This means that people who are at higher risk of HIV infection, including young girls in sub-Saharan Africa, men who have sex with men, sex workers, and other already marginalized populations, have less access to condoms, contraception, HIV testing, counseling, and other essential health services, researchers said.

Already at one site in Cambodia that provides HIV services to men who have sex with men and people who inject drugs, Luisa Orza of the HIV/AIDS Alliance said, the number of people who have been reached with HIV and sexual and reproductive health integrated services has plummeted from over 50,000 in 2016 to just over 6,000 in 2017.

The closing of such centers, most often the only places members of marginalized communities can access quality HIV and sexual health care without facing judgment, stigma or discrimination, is particularly harmful for communities at higher risk of HIV infection like sex workersBrian Honerman of amfAR said.

“When clinics that have built up trust with a community close, those people have nowhere else to go,” he said.

Researchers have faced difficulty in assessing the impacts of the expanded policy, Chloe Cooney of the Planned Parenthood Federation said, because organizations are reluctant to share information or even discuss if they’ve complied with the policy for fear of facing stigma themselves within civil society communities and of losing other funding sources. Shortly after championing the She Decides campaign, which provides funding for sexual and reproductive services to organizations that have lost funding and was established in response to the policy, the government of Sweden declared that they would no longer fund organizations that chose to comply with the policy, Asa Anderson of the Swedish International Development Agency said.

During the last iteration of the policy under the Bush administration – when it only applied to U.S. family planning assistance and not to all U.S. global health funding as it does now – USAID was forced to stop shipping condoms to Lesotho at a time when one in four women in the country was infected with HIV, because the Lesotho Planned Parenthood Association was no longer eligible to received U.S. funding, Cooney said.

By the time the impacts of the expanded policy will become clear – after two or three years – Cooney said, it will be too late to reverse course and undo the damage that’s been done.

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