A 16-year-old HIV-positive Kenyan girl whose mother died from AIDS-related complications recounts her experiences Feb. 16, 2015, at a center run by a Kenyan nongovernmental organization in the Korogocho slum neighborhood of Nairobi, Kenya. (Ben Curtis/AP)

A Trump administration order took effect this week barring U.S. aid for global health organizations that discuss or provide referrals for abortion. But the new policy put another program in the crosshairs: America’s global HIV/AIDS effort.

Since 2003, the U.S. government has spent more than $70 billion to combat the global epidemic, with tremendous results. The annual number of AIDS-related deaths has fallen by more than 40 percent. Under President Trump’s expansion of the so-called global gag rule, however, many HIV/AIDS organizations funded by the United States stand to lose their funding, putting at risk the possibility of eliminating the epidemic by 2030, a commitment established at the U.N. General Assembly last year. About $6 billion in U.S. HIV/AIDS funding could be affected.

“Reaching those ambitious targets could now be placed in real jeopardy,” said Divya Bajpai, the director of programs at the International HIV/AIDS Alliance.

HIV/AIDS organizations could lose their U.S. funding not because they provide abortions, but because they offer counseling that includes the mention of abortion, or a referral to an abortion provider. The health organizations — most of which are in Africa, the region most affected by AIDS — will be able to keep their U.S. assistance only if they agree not to mention abortion services to their patients. 

Past Republican presidents implemented versions of the global “gag rule,” but they affected only about $600 million in family-planning funds and did not apply to groups fighting HIV/AIDS. President George W. Bush, whose administration launched the multibillion-dollar President’s Emergency Plan for AIDS Relief (PEPFAR), is credited across much of Africa for his role in tackling the epidemic.   

(Sarah Parnass/The Washington Post)

The International HIV/AIDS Alliance, which consists of 32 local organizations, offers a window into how the new policy will play out. The alliance receives a total of $130 million in annual funding — 20 percent of which comes from the United States. Each of the alliance’s members will now have to decide whether to keep its U.S. assistance by cutting any mention of abortion from its services.

“This is going to drive girls and young women away from treatment,” said Bajpai. 

Thanks in large part to U.S. funding, hundreds of community health organizations treating HIV/AIDS have emerged across the developing world. Many of them, such as Family Health Options Kenya, offer a range of services, from antiretroviral treatment to contraceptive distribution and abortion counseling.   

With 17 locations, Family Health Options Kenya treats hundreds of HIV-positive women in some of the most remote parts of the country. But nearly half of its $400,000 budget comes from the United States. Already, the organization is trying to decide which services to cut and which locations to close.

“We are being forced to reduce our operations,” said Amos Simpano, the executive director for clinical services. “That means women won’t have access to services. And for those on antiretrovirals, what will happen to them? Will they die?”

Simpano says the organization has tried to look for a new funding stream, but without success. 

“There’s a lot of pressure on us now,” he said.  

Experts say Trump’s policy could especially affect girls and young women, who are now the most likely people to contract the disease. “Girls and young women account for 74 percent of new HIV infections among adolescents in sub-Saharan Africa,” according to PEPFAR’s fact sheet

Some of those girls and young women contract the disease after a violent sexual encounter, which in some cases also results in an unwanted pregnancy. A recent United Nations study said that in some regions, women who had experienced physical or sexual abuse by their partners were 1.5 times more likely to acquire the disease than those who had not.  

The Trump administration has said that the new policy does not ban referrals for ending a pregnancy caused by rape or incest.

“The Trump administration is dead set on denying women the benefit of scientific evidence that shows for highest impact, HIV treatment and prevention should be delivered alongside sexual and reproductive health services,” said Asia Russell, the executive director of Health GAP, a group that campaigns for access to HIV/AIDS treatment.

The administration has named the expanded policy “Protecting Life in Global Health Assistance.” Officials said they don’t expect the overall amount of health assistance to decline but that funding would be “redirected” to other organizations offering similar health services.

“This executive order does not cut a single penny from U.S. aid; rather, it simply ensures our hard-earned tax dollars are used by other health-care entities that act consistently to save lives, rather than promoting and performing abortion. Abortion is not health care,” said Marjorie Dannenfelser, president of the Susan B. Anthony List, which backs politicians who oppose abortion.

But given the rural environments in which many health organizations operate in Africa — where there is often only one HIV/AIDS treatment provider in a particular place — it’s unclear how existing providers would be easily replaced.