Trump is a threat in fight against AIDS, but we must hold the line

The return of a Donald Trump presidency in the United States is a body blow to the global HIV response, to universal sexual and reproductive health and rights, and to the people and communities who are most impacted by HIV and AIDS. It severely threatens global efforts to eradicate AIDS by 2030 — which is why the role of civil society and partners across the globe involved in the fight against the disease is more important now than ever.

Project 2025 and the hardening of the global gag RUle

Project 2025 is a manifesto led by the hard-right Heritage Foundation and authored by Trump’s allies that takes aim at a swathe of core constituencies and strategies that have contributed to the progress made in the fight against HIV and AIDS.

While Trump has distanced himself from Project 2025, it’s worth noting that many of his former advisers and administration officials were involved in creating it and may be part of the next administration. And the advanced planning set out in it means that this time around, Trump and his allies are more likely to deliver on their agenda than was the case under his first administration.

Project 2025 includes numerous attacks on the LGBTQ+ community, and on sexual and reproductive health and rights, which are likely to become a part of official policy.

Building on the U.S. Supreme Court’s overturning of Roe v Wade, Project 2025 proposes strategies to restrict access to medical abortion within the U.S. and to undermine abortion and other sexual and reproductive health services around the world.

It includes the proposition to reinstate the Mexico City Policy, known as the global gag rule, a U.S. executive order that prevents any international organisation that performs abortion services, referrals, information, or counseling, or engages in abortion-related advocacy, from accessing U.S. funding for global health.

The global gag rule has been found to detrimentally impact reproductive health outcomes and services — 1 in 3 women could have their reproductive health and rights impacted if it is reinstated. Research by Frontline AIDS has shown that it had an indirect but extremely disruptive impact on essential HIV services, hitting marginalised populations hardest.

Attacks on LGBTQ+ people’s rights and a new ‘trans gag’

Project 2025  also aims to roll back hard-earned rights to marginalised communities that don’t conform to their vision of family values. Kevin Roberts, president of the Heritage Foundation, links pornography and the propagation of transgender ideology and the “sexualisation of children” in the introduction. It recommends replacing pro-LGBTQ+ policies with ones that support heterosexual marriage, and advocates doing away with comprehensive sexuality education for young people in favour of curricula that look only at heterosexual relationships.

A focus on promoting abstinence-only messages echoes the failed ideologically-driven U.S. policies of the past that undermined efforts to meet the support needs of people affected by HIV. Trump has promised an aggressive attack on LGBTQ+ rights with a particular emphasis on the trans community.

In his first term, Donald Trump banned trans people from the U.S. military. Now he plans to target transgender people and trans youth saying he will ban surgical intervention and restrict information or services relating to gender transition, leading to speculation that his administration will develop a version of a ‘trans gag.’

US foreign assistance, including PEPFAR and humanitarian aid, at risk

The incoming Trump administration’s foreign policy, although currently lacking in detail, threatens to deepen the suffering of conflict-affected communities, from Sudan to the Middle East and Ukraine. The humanitarian aid that the U.S. provides in these and other contexts looks likely to be further compromised by the expanding policy ambitions of Project 2025. Some estimates from commentary following the election results put the potential for aid to be cut by 10% to 15%.

The combination of the global gag rule and aid cuts means that organisations may be forced to choose between providing reproductive health services to women and girls and supporting the needs of key populations in conflict and other crisis situations or providing other desperately needed emergency aid.

Proponents of Project 2025 and conservative members of the U.S. Congress are also mobilising against PEPFAR, a vital US government initiative that has transformed the global HIV response. Without PEPFAR funding, millions of people will lose access to lifesaving HIV treatment, and HIV prevention services, with devastating consequences.

Together, we are stronger

Trump’s return to power is a major setback to the movement fighting for the health and human rights of women and girls, LGBTQ+ people, and other marginalised communities, and ultimately to end AIDS.

Huge progress has been made over the past three decades. Whilst a second Trump presidency bolsters the efforts of the groups pushing back on the rights gained, through our work at Frontline AIDS with partners to provide HIV and sexual and reproductive rights services to marginalised communities for 30 years, we know that the fight against HIV has many allies across governments, funders and within wider civil society movements.

At this time of uncertainty, civil society partners across the U.S. and the global stage must strengthen our relations and continue to forge relationships with new friends and alliances.

We must deepen our efforts to hold governments to account for the promises they have made — both directly to their citizens and in the international arena. We must continue to challenge donor partners to step up to ensure adequate support for global health and HIV needs. And we must forge new alliances to counter the anti-rights movement and achieve our goal of ending AIDS for everyone, everywhere.

This opinion piece by John Plastow, Executive Director, Frontline AIDS , was first published on Devex, an independent news organisation covering global development, on 7 November 2024.

Photo by Gayatri Malhotra on Unsplash