U.S. Global AIDS Coordinator Ambassador Deborah Birx played down the potential impact of the reinstated “global gag rule” will have on PEPFAR programs. While the exact implications remain unclear, she told Devex that the agency’s focus on data has it well positioned to track and plan for whatever budget it gets.
The global gag rule prevents all non-U.S. nongovernmental organizations that provide services or information relating to abortion from receiving U.S. funds. When a previous version of the policy was in place, former President George W. Bush exempted PEPFAR, the President’s Emergency Plan for AIDS Relief, which he founded. That is not the case this time around.
“PEPFAR is [in] a very different place than we were when it was exempted, because we have very mature partners,” she said. PEPFAR works with a large number of partners from small local organizations, to international NGOs in the implementation of its programs.
How many partners, and specifically how many of the subcontractors, will not be able to work on programs because of the global gag rule will be revealed as it is implemented but because PEPFAR has data down to every site where they work will allow the agency to know exactly what the impact is, Birx said.
“We need to just start implementing so we can see who is it impacting, who do we have to move around. We have a real large partner base, highly trained in implementation that could substitute partners who feel like they can’t sign [on to the policy].”
The global gag rule may have a limited effect on PEPFAR because abortion — except in the case of rape or incest, or the mother’s health — is illegal in most of the countries PEPFAR works. PEPFAR operates under the local government’s laws.
Further, Birx said the U.S. pulling back in the family planning space might not be all bad; the last time the gag rule was in effect, European donors increased their portfolios. A group of countries and philanthropists have already committed $190 million to the “She Decides” fund to make up for some of the gaps in funding expected as a result of the rule.
With regards to PEPFAR funding, Birx said the agency will be ready for the budget it gets, although she has not yet seen projections. PEPFAR has seen a flat budget since 2009, but the program has found a way to do more without more funding, she said.
“We're lucky we have comprehensive data now so if there are budget cuts, we will be able to make them in the areas that won't impact our ability to control this epidemic. And that's our job,” she said. “That's our job as Americans, at a time when there's a need to free up resources, to really focus ourselves and use our data to do more with less.”
Birx told Devex she has not been told that — if she proves efficiency and outlines what she needs to control the epidemic — the agency won’t get the resources it needs, she said.
She repeatedly stressed to Devex that PEPFAR’s specific, granular data can track any potential issues and project needs.
“We’ll be a group that can really answer,” she said. “I think this White House is very responsive to data.”
Among PEPFAR’s priorities going forward will be tackling infection among young girls, a population that often faces significant risk. Agency research has found that many 9 to 14 year-olds’ first sexual experience was rape. Thus programs need to be targeted to appropriately address a risk they may not be able to prevent and control.
“We’re at a different place from where the [abstinence, be faithful] programs were, and so I think we’ll see us talking about risk avoidance for very young girls,” including gender-based sexual violence prevention, Birx said. “You’ll see a comprehensive discussion of what does risk reduction look like in that subset of girls that we know are out there that are particularly vulnerable to HIV.”