When it comes to women's health, a little political cowardice goes a long way. House Republicans, in their zeal to balance the budget in any way possible other than asking rich people and corporations to pay their fair share of taxes, have proposed putting the one-quarter of 1 percent of the U.S. budget for global health on the chopping block. The Democratic leadership won't oppose these cuts or call them what they are: crowd-pleasing maneuvers that won't dent the deficit. And ultimately, it's HIV-positive women and children who will pay a disproportionate share of the price.
The human cost of Congress' theatrics is spelled out in an issue brief [PDF] from the Foundation for AIDS Research (amfAR). HIV is the leading cause of death globally among women of reproductive age, and rollbacks to programs that prevent mother-to-child transmission could leave 32,560 more infants infected with HIV each year. Nearly half a million children affected by the HIV-related deaths of adults in their lives could lose their food, education, and livelihood assistance. Funding for AIDS treatment for over 315,000 HIV-positive people could be eliminated.
As if trying to soften the blow in advance, the U.S. global AIDS coordinator has already pledged to keep HIV-positive people on antiretroviral therapy (ART), which is absolutely the right thing to do from a human-rights perspective. Still, shifting diminished resources to treatment will, as Jirair Ratevosian, deputy director of public policy at amfAR notes, "mean even steeper cuts to existing and emerging prevention initiatives and critically needed care programs."
Which is where the effect on women doubles down. Keeping HIV-positive people on their ART is vital. But nearly three decades into the pandemic, women are still worthy of notice primarily as child-bearers to most funders and policy-makers -- and many nonprofit organizations as well. The attention and funding devoted to preventing mother-to-child transmission far exceeds all other programming for women. Already, too few resources go to preventing women from contracting HIV in the first place, a problem that will only worsen with Congress' proposed funding cuts.
The importance of maintaining and expanding prevention services for women should be obvious. According to the Joint United Nation Programme on HIV/AIDS (UNAIDS), up to 70 percent of women worldwide have been forced to have unprotected sex. Young women are especially at risk for sexual assault; high percentages of girls report a coerced first sexual experience: 24 percent in Haiti, 25 percent in Uganda, and 63 percent in the Democratic Republic of Congo. Another study found that 52 percent of clients who sought post-rape care in Rwanda were under the age of 15, while 87 percent were under the age of 20.
With access to "morning after" ART, which can protect someone who has been exposed to HIV from contracting it, life might be different for Annah Irungu of Kenya. "I was gang-raped and hacked," said Irungu, speaking from Washington, D.C., where she was attending a two-day advocacy training hosted by the Center for Health and Gender Equity (CHANGE). "I have machete marks all over my body. I didn't know there was anything known as post-exposure prophylaxis. Had I known, I might not be positive today." But availability for that kind of preventative counseling and treatment will become even scarcer in the current funding climate.
If the budget deficit were truly at the heart of the current D.C. showdown, and if the U.S. truly wanted to bring down the cost of HIV prevention and treatment abroad, we could reconfigure current U.S. programming mandates to save costs and reflect best practices. For example, we could put pressure on pharmaceutical companies to allow poor countries that have been hard hit by HIV to produce generic versions of their ART drugs. We could stop forcing countries to allocate 50 percent of all U.S. funding for prevention to "ABC" programs that stress "Abstinence" and "Being faithful" before grudgingly admitting that using a "Condom" might be the best option for people who, despite our best efforts, still want to have extra-marital sex. That would be a better way of fulfilling our responsibility to women all over the globe whose primary risk of contracting HIV is marriage and the assumption of spousal fidelity. And it would loosen up a nice chunk of change for countries to spend on programs or prevention methods that seem more promising. They could, for example, put more funding toward developing microbicides that have performed well in recent trials instead of continuing to foist the burden of condom use on women.
"Family planning is a critical part of HIV and maternal health intervention," says Serra Sippel, the president of CHANGE. "It's not a political bargaining chip." But this lucid thought might not be able to penetrate the fog that surrounds the 112th Congress, which appears to consider no billionaire too insignificant to be favored, and no public health, education, or welfare program too vital to be spared. In honor of today being National Women and Girls AIDS Awareness Day, try calling them and telling them that anyway. Hey, someone around here needs to advocate for us.