Trump’s gag rule jeopardizes preventative care for women

President Trump declared at the 2019 State of the Union that his administration was starting an initiative to end the HIV epidemic by 2030. However, these bold words have not been proceeded by similarly bold action. Over 1.1 million people in the United States live with HIV — 270,000 of those people are women, and African American women are disproportionately affected. In the United States black women account for 59 percent of all women living with HIV.

Treatment improves health outcomes and those Americans that are on medications, adherent and virally undetectable are living healthy lives and reducing transmission. However, the number of Americans that are in treatment and adherent represent less than half of the total population.

{mosads}HIV transmission continues apace, and in 2017, there were 38,500 new cases. Of the 1,100,000 Americans living with HIV it is estimated 15 percent of those individuals have not received a diagnosis.

This makes early detection and swift access to treatment critical to any comprehensive plan to address the HIV epidemic. On the surface, the Trump administration’s “Ending the HIV Epidemic” plan recognizes this fact, as well as other key considerations like prevention strategies and prioritizing access to care. But if you look beyond the grand announcement, you will see a systematic dismantling of federal programs to further the Trump administration’s ideological agenda — and that thwarts any real hope for the president’s initiative.

A prime example of this ideological agenda in action is the Trump administration’s Title X gag rule, which is set to go into effect in the beginning of May. The Title X program is essential in helping ensure that every person regardless of their income, identity, or whether or not they have insurance — can access basic, preventative reproductive health care, such as birth control, cancer screenings, STI testing and treatment, and annual gynecological exams.

Four million individuals, who otherwise could not afford it, receive care at Title X-funded health centers across the country for contraceptives and preventative services. In 2017 alone, the Title X program funded nearly 1.2 million confidential HIV tests.

Title X-funded health centers also serve as the point of entry into the health care system for millions of Americans – the majority of women cite these health centers as their sole source of care, and the number of men participating in the Title X program has nearly doubled since 2006. Therefore, it should come as no surprise that Title X-funded health centers play a vital role in HIV prevention and treatment, and therefore Trump’s overall “Ending the HIV Epidemic” strategy.

However, Trump’s gag rule will cut off access to millions of patients who rely on Title X for critical preventative health services — including HIV screening. The gag rule is specifically designed to prevent reproductive health providers, like Planned Parenthood, from participating in the program. Considering the fact that Planned Parenthood alone serves over 40 percent of the Title X patient population, the gag rule will most certainly lead to gaps in coverage, and by extension, low income individuals who are living with or at risk of contracting HIV will be unable to access screenings and care that they desperately need.

This is not theoretical. In 2015, an HIV outbreak in Scott County, Indiana, was seemingly exacerbated by the closure of a Planned Parenthood health center two years prior, which was the only regular source of HIV testing in the county. Studies show that an increase in HIV testing can lead to a decrease in transmission in some populations.

The inability to quickly identify the outbreak resulted in many more cases that could have been prevented. We face many future crises like this one if Planned Parenthood and other health centers across the country are blocked from the Title X program because of this seemingly unethical.

The “Ending the HIV Epidemic” plan appears to rely on a number of core principles, such as greater access to care, addressing health disparities among communities of color and members of the LGBTQ community (in which new cases of HIV and HIV/AIDS-related deaths are increasingly concentrated) and adequate federal funding. But at every turn, the Trump administration has taken harmful actions and pursued damaging policies that violate each of the aforementioned core principles.

Women do not live one dimensional lives, and thus their health care cannot be spliced in order to meet the ideological agenda of the president and anti-choice interests. Many of the people who benefit from services provided under the Title X program identify as people of color. Given the history of reproductive coercion and injustice against black women and women of color, the domestic gag rule is a sobering reminder of the exacting ways regressive policies such as this continue to disparately impact health outcomes for our communities.

If the Trump administration is serious about ending the HIV epidemic, they must stop the dangerous gag rule. Patients deserve unbiased, non-directive information regarding their reproductive health care without undue interference from government.

Sequoia Ayala, JD, MA is Policy Counsel and directs the Policy and Advocacy Program at SisterLove, Inc. At SisterLove, Inc., Sequoia works collaboratively with community members, elected officials, researchers, and policymakers in advancement of the health, well-being, and human rights of black women and women of color.