The Global Gag Rule, also known as the Mexico City Policy, was reinstated in 2001. This policy restricts U.S. family planning assistance to foreign non-governmental organizations (NGOs) that provide or promote abortion services. However, U.S. HIV/AIDS assistance is exempt from these restrictions.
The President’s Emergency Plan for AIDS Relief (PEPFAR) was established in 2003 to combat HIV/AIDS globally. PEPFAR represents a major shift in U.S. HIV/AIDS policy, with 80% of new bilateral assistance directed towards AIDS treatment and care. The remaining 20% is allocated for HIV prevention activities, with at least one-third dedicated to “abstinence until marriage” programs.
In August 2003, the Bush Administration clarified that PEPFAR funds are exempt from the Global Gag Rule restrictions. This means that U.S. HIV/AIDS assistance is not subject to the gag rule, and foreign NGOs providing HIV/AIDS-related services are eligible to receive U.S. HIV/AIDS assistance, regardless of their eligibility for U.S. family planning assistance.
USAID’s Guidance on the Definition and Use of the Child Survival and Health Programs Fund, issued in July 2004, suggests that family planning counseling and referral services may be supported with HIV/AIDS funds as part of a comprehensive approach to preventing mother-to-child transmission (MTCT) of HIV. However, activities that are jointly supported with family planning and HIV/AIDS funds are subject to the gag rule.
Foreign NGOs that refused the Global Gag Rule restrictions on U.S. family planning assistance are eligible to receive HIV/AIDS assistance. Family planning NGOs providing relevant HIV/AIDS services as part of a package of sexual and reproductive health care can also receive U.S. HIV/AIDS assistance. A foreign NGO’s eligibility to receive U.S. family planning assistance is irrelevant to its eligibility for HIV/AIDS assistance.
The U.S. Global AIDS Coordinator, USAID country missions, U.S. Cooperating Agencies, or foreign NGOs may provide HIV/AIDS assistance to foreign NGOs otherwise ineligible for U.S. family planning assistance. Programmatic discretion is provided to U.S. officials, and decisions can be based on whether the nature and quality of an organization’s HIV/AIDS services and its history of involvement make it a logical partner for U.S. government-supported efforts in a given country.
In many developing countries, family planning and reproductive health NGOs are experienced providers of HIV prevention and screening services to women and youth. These NGOs have extensive networks of community-based volunteers to provide HIV education, referrals, and condoms. Many possess the clinical capacity and infrastructure to provide basic HIV counseling and testing, while others are participating in national programs to prevent mother-to-child transmission through existing obstetric care services, or providing home-based care to clients.
The Global Gag Rule does not apply to U.S.-donated condoms and other commodities purchased with HIV/AIDS funds. Foreign NGOs, even those no longer receiving U.S. family planning assistance because they refused the terms of the gag rule, are eligible to receive male and female condoms purchased through USAID’s Commodity Fund or with PEPFAR funds for purposes of HIV/AIDS prevention.
U.S. and foreign NGOs receiving HIV/AIDS assistance may engage in lawful abortion-related activities with their private, non-U.S. funds. NGOs do not jeopardize their U.S. HIV/AIDS funding if they provide legal abortion services, counsel, and refer women about abortion, or engage in lobbying or advocacy campaigns to legalize or to “continue the legality” of abortion in accordance with host-country laws and policies. These activities must be paid for with private, non-U.S. funds.
U.S. and foreign NGOs receiving HIV/AIDS assistance may also engage in post-abortion care and certain types of research on abortion supported by U.S. funds.