HIV/AIDS & ANTI-ABORTION INTERFERENCE – Epidemics of signification and global health policy: From the end of AIDS to the end of scale-up of the global AIDS response

by Richard Parker

Global Public Health, March 2024;19(1)


“Over the past four and a half decades, the history of the HIV and AIDS pandemic has gone through a number of different phases, which can be thought of as distinct waves in terms of the social and political response that the pandemic has generated. Over the course of this history, there have been important battles over the meanings and interpretations that the response to the pandemic has produced. But especially over the past decade, there seems to be a growing disconnect between claims of success made by many global health agencies and policymakers and the empirical reality that these claims cover up. This commentary argues that the ‘scale-up’ of the response to the pandemic has essentially come to an end and emphasises the importance of a more honest policy debate about the current state of the global HIV response. It argues that this requires us to think critically about the ways in which this response has developed historically, to recognise the significant advances achieved in recent decades, but also to acknowledge the important crossroads that it has reached in the mid-2020s, in order to better define the directions that it should take in the future….”

“This significant increase in the Core Secretariat funding gap in 2021 coincided with the fourth periodic review of UNAIDS on the part of The Multilateral Organization Performance Assessment Network (MOPAN), comprised of representatives of the major donor countries, and the first major reduction of the Secretariat’s core operating budget, which was reduced from US$ 242 million to US$ 210 million in 2021. In spite of the significant core budget cut, only US$ 165.5 million was in fact received from donors, leaving a funding gap of US$ 44.5 million in 2022 (MOPAN, Citation2023, p. 32). The MOPAN assessment process, completed in mid-2023, was highly critical of the Secretariat’s performance, and the funding gap has continued to plague the organisation, creating what appears to be a kind of on-going crisis in relation to the Secretariat’s work which came to a head in June of 2023 at the time of the 52nd meeting of UNAIDS’ Programme Coordinating Board (PCB) (UNAIDS Press Release, Citation2023a).”

“Together with the increasing dependence of the global AIDS response on the financial support on a single, dominant donor, the apparent lack of donor support for the lead agency charged with coordinating this response globally is clearly cause for major concern (Parker et al., Citation2024). This concern about excessive reliance on a single major donor is also further magnified by the ongoing confusion caused by right-wing political attacks against the reauthorization the U.S. government’s PEPFAR programme (Jaffe, Citation2021), the major source of support from the single major donor providing public funding for the global HIV and AIDS response (Abdool Karim et al., Citation2023; Coester et al., Citation2023; Gostin, Citation2023). Opponents of sexual and reproductive health and rights (SRHR) are engaged in a campaign of disinformation, harassment and misrepresentation of both the laws that govern PEPFAR and the legal activities of organisations that implement U.S.-funded HIV programs. These opposition efforts aim to slow and derail a ‘clean’ or straightforward PEPFAR reauthorization, which would simply ‘roll over’ (or extend) existing programmatic parameters for another five years. Conservative critics have attempted to insert their anti-abortion agenda into the reauthorization discussion, aiming to force the acceptance of anti-abortion legal restrictions that they have been unable achieve through the regular legislative process. World AIDS Day, on 01 December 2023, was the first time since PEPFAR was created in 2003 that the U.S. Congress had not passed a new five-year statutory authorisation governing PEPFAR’s policy and programs by December 1, with the most recent authorising statute technically expiring on 30 September 2023….”

Editor’s Note by Marge Berer: This journal article, a detailed and lengthy history and commentary on the progression of the HIV/AIDS epidemic and how it has been defined and treated as a major global public health problem over many decades now, is compelling reading for everyone interested in the long-term progression of epidemics and their public health, social and political consequences. I am sharing the abstract here because it includes several crucial sentences in which the topic of US anti-abortion influence on maintaining funding for HIV/AIDS work is raised, underlined above in the abstract, which I discuss here:

Richard Parker’s in-depth analytical commentary is especially appropriate because he has been involved in global HIV&AIDS issues from the beginning and remains one of the most important interpreters and advocates of the needs of people living with HIV. His entire commentary is crucial reading for an understanding of how specific diseases and related healthcare and treatment issues are addressed by science, research, medical and health services, pharmaceutical companies, governments and international donors – as well as by those who have suffered from epidemic and pandemic diseases and those who have become advocates fighting for the rights of those who need treatment, care and support. Dealing with unwanted pregnancy is an essential part of those needs, along with the range of medical and other care that is required, which includes the right to safe, legal and accessible abortion. The interference of the vicious US anti-abortion movement in US government support and funding for people living with HIV and AIDS, is therefore highly unwelcome and condemnable.

In this context, Parker rightly expresses grave concern about the increasing importance of the US government as the main and now almost only significant major government donor to global funding for international HIV/AIDS programmes – which he contrasts with multiple governments’ involvement and funding in earlier phases of the epidemic. He shows that this narrowing of support in the context of, among other things, the violent civil war on abortion in the United States, being fought in state after state, is affecting the base of support for Joe Biden, as the Democratic Party candidate for president in 2025-2028. Biden’s candidacy has been increasingly compromised not only by his personal unwillingness to give wholehearted support for safe, legal abortion but also his outspoken and unyielding verbal and military support for Israel’s genocide in Gaza. The latter support makes the US deeply complicit in that genocide, which are both undermining support for him among members of the Democratic Party, even though he is the only candidate who can stop Trump from winning the election in November 2024. No matter what the outcome, which is far from clear at this stage, this is a disaster waiting to happen.