You’ve probably heard at some point this week about the global gag rule that Donald Trump signed on Monday. The rule bans U.S. funds from going toward international health organizations that provide abortions or that even mention abortion as a family planning option, even though American money already wasn't paying for abortion-related services. Now, several organizations are pointing out that the gag rule can have a devastating impact on HIV/AIDS patients as well.

Global reproductive health organization PAI notes on its website that previous gag rules had a direct impact on HIV/AIDS prevention services around the world, and even shut down some clinics in Kenya and Ethiopia, which were often the only access some rural men and women had to contraceptives and education on HIV/AIDS.

Past global gag rules made foreign organizations stop any involvement with abortion in order to receive family planning funding from the U.S., but the new gag order expands this to include all health funding, Ronald Johnson, vice president of policy and advocacy at AIDS United, tells SELF. According to Slate, this difference means that instead of influencing $600 million in U.S. foreign aid, Trump's version of the global gag rule will impact $9.5 billion.

What's more, the last time a global gag rule was instated was under George W. Bush’s administration, but the then-president exempted the President’s Emergency Plan for AIDS Relief (PEPFAR), a U.S. government initiative to combat HIV/AIDS around the world, from the rule. Failure to allow that exemption would make it difficult for the program to meet its prevention and treatment targets without, for example, counseling pregnant women with HIV about all their choices, Slate reports. However, Trump did not include this exemption, which Johnson says is a “very, very disturbing move.” “Reinstating the gag rule is bad in and of itself, but the extension of this to HIV/AIDS programs and all global health assistance provided by the U.S. is just horrendous,” he says.

Amesh A. Adalja, M.D., a board-certified infectious disease physician at the University of Pittsburgh and an affiliated scholar at the Johns Hopkins Bloomberg School of Public Health Center for Health Security, tells SELF that this expansion will make it nearly impossible for global HIV/AIDS providers to be able to inform their clients of all of their options. “If someone becomes pregnant when they’re HIV-positive, you need to be able to talk about what the options are,” he says. “When you inject something like the global gag rule into it, you’re automatically walling off certain avenues of discussion, and that makes it difficult to provide comprehensive care.”

Margaret Hoffman-Terry, M.D., chair of the national board of directors for the American Academy of HIV Medicine, agrees. "It’s a sacred bond between providers and patients, and you should be able to talk about [health care] fully," she says. "To say that America unilaterally decides this—or a single person decides this—is terrible for the world."

Organizations will be forced to either provide bad or incomplete health care or lose funding—and many will choose the latter. Losing that funding for providing care to HIV/AIDS patients will have a devastating effect. Adalja says care for HIV/AIDS patients has come a long way since the 1980s. Now, if someone is put on anti-retroviral medication, which can lower the virus' presence in someone's system to undetectable amounts, they can expect to have a normal lifespan. “HIV is not something people die from anymore, so long as they’re put on anti-retroviral medication early [so it cannot progress to AIDS],” he says. “We’ve been able to keep the virus at bay.” Many major agencies that help combat HIV and AIDS worldwide will have to comply with this extended gag rule and, as a result, will offer what Adalja calls “subpar care.”

Johnson is concerned that the rule may impede access to HIV treatment and education for many—and that can have a major impact on the spread of the disease. “We are on a path to end the epidemic,” he says. “This gag rule has the potential to severely curtail the movement forward—it’s bad public policy that can have a serious impact on the lives of people.”

Ultimately, the rule's impact on HIV/AIDS treatment defies science, Adalja says. “What this does is the equivalent of when Galileo was told to say that the sun revolves around the Earth rather than the other way around,” Adalja says. “You’re trying to rewrite reality to placate a religious viewpoint.”

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