Trump’s drastic funding cuts could reverse the progress made on HIV in Africa, where many different healthcare organisations also offer family planning

Celeste is a 30-year-old widow mother of two from the poor suburbs of Maputo, Mozambique’s capital. She is HIV-positive, and since her husband died from an Aids-related illness last year, she has no way of supporting herself, though she tries to help her mother work her small vegetable patch. One organisation is helping her through the darkest times, giving her advice and help, and ensuring that she takes her medication: Amodefa – the Mozambican Association for Family Development.

“If it wasn’t for Amodefa’s visits, I wouldn’t be here,” says Celeste, now pregnant again, as she sits in the dusty yard in front of her mother’s house where she has lived since last year.

The lives of the poorest women in southern Africa depend on organisations such as this. Yet they will be among the worst affected by Donald Trump’s crackdown on family planning groups around the world. Advocates across the region say the move risks undermining progress in tackling HIV and Aids in southern Africa, one of the areas hardest hit by the epidemic.

What is the 'global gag rule'? The rule, otherwise known as the Mexico City policy, requires NGOs to certify that they will not perform or promote abortions anywhere in the world as a condition for receiving US family planning funds. Every Republican president since 1985 has implemented it. But Donald Trump has adopted a stringent version of the rule, under which NGOs that refuse to sign will be refused all health assistance, including for HIV, primary care, nutrition, tuberculosis and malaria programs. As much as $8bn in US funding could be affected – money that developing world health budgets can ill afford to do without.









Trump’s re-introduction of the Mexico City policy, known as the “global gag rule”, bans US government funds from going to organisations with any links to abortion. It jeopardises a wide range of healthcare clinics in dozens of countries because family planning advice is often bundled up with other provision.



In all, nearly $9bn (£7bn) is at stake, and hundreds of thousands of women could be affected.

“The global gag rule, this time round, is the most expansive and the most tragic,” says the director general of the International Planned Parenthood Federation (IPPF), Tewodros Melesse. “It seeks to restrict the rights of millions of women. It asks us, as a health provider, to stop providing services [through our members] that are entirely legal, in countries where some of the poorest women depend on them.”

Women like Maria Domingos*, a 28-year-old mother of four, who lives in Maputo, close to Celeste.

Domingos is HIV-positive, as is her husband and three of their four children. They live with her husband’s father and stepmother, who don’t know they are infected. Domingos fears her in-laws could kick them out if they discover the truth.

The family has been receiving support from Amodefa since 2011, and is taking part in a pilot scheme run by the organisation to help parents explain to their children why they have to take the medicines they do.

Many children grow up without knowing they are HIV-positive, which can mean they become sexually active unaware of their status.



Amodefa, a member association of IPPF, was closely involved in the campaign to legalise abortion in Mozambique, says its director Santos Simione, so it will not sign the gag rule. USAid currently provides $2m (£1.5m) of the organisation’s $3m annual budget.

Facebook Twitter Pinterest Santos Simione, director of family planning association Amodefa. Photograph: Tom Bowker/The Guardian

Such drastic cuts will inevitably mean the end of programmes that have nothing to do with abortion but which provide vital support to people living with the physical, psychological and social implications of HIV. The cuts will particularly target Amodefa’s work with young people. Figures from 2015 show that about 110,000 children aged 14 and under were living with HIV in Mozambique.

“We have various social projects on HIV, tuberculosis, malaria, sexual and reproductive health, and sexual rights,” Simione says. “Projects already approved run the risk of being cancelled, and those that are already ongoing run the risk of not being renewed when they come to an end in September.

“More than 130 workers will lose their jobs – the staff on the affected projects, and other administrative staff, due to the need to restructure the organisation in the face of these new developments,” he says. Almost half a million people served by the projects could be affected.

Domingos found out she was HIV-postive when she was pregnant with her first child, Amelia, in 2008. Her husband didn’t believe the virus existed and forbade her from taking treatment that could have prevented her from transmitting the virus to her baby.



When Domingos got pregnant again, two years later, she took the drugs in secret and her second child, Alice, was not infected. After the couple’s third and fourth children were born HIV-positive, her husband was tested.

The family receives regular visits from Amodefa’s Elinda Tomas, herself HIV-positive and a beneficiary of the organisation’s programmes. She helps the family keep up their regular doses of antiretrovirals, as well as their programme of checkups at the local hospital.

Facebook Twitter Pinterest Paula and her baby: she believes her husband caught HIV while working in mines in South Africa. Photograph: Tom Bowker

Amodefa is still waiting to find out the exact impact of the global gag rule on its programmes. But it is already preparing to transfer some of its vital work to other organisations in Mozambique that are still eligible for US money.

Other IPPF members in southern Africa have already calculated the cost. The Botswana Family Welfare Association (Bofwa), expects to lose about 84% of the funding it currently receives from the US, and will have to close clinics in three of the eight districts it works. More than 30% of the population of Botswana are HIV-positive. Bofwa is the only health NGO working across the country.

Lesotho Planned Parenthood Association expects a third of its services to be hit, and about 10,000 young people in one district left without HIV, family planning and sex education services. Almost a quarter of people in Lesotho have tested positive, giving the country the third highest prevalence rate in the world.

In Mozambique, more than 10% of 15- to 49-year-old Mozambicans are HIV-positive, giving the country the eighth highest infection rate in the world. In the south, near Maputo, most infections are among migrant labourers working in mines in South Africa. That’s where Paula Luisa, 28, believes her husband got the virusthat has left her a widow.

Paula has never missed taking her medicines, she says, sitting on the sand outside her house in rural Maputo province. Nor has she missed one of her regular checkups at the hospital in the local administrative post named after the founder of the anti-colonial liberation movement, Eduardo Mondlane.

Mozambique today is a far cry from the country he must have envisaged. The country is the seventh poorest in the world, ranking level with South Sudan on the UNDP’s human development index, after an unprecedented financial scandal. The government hopes oil and gas reserves will reap billions of dollars, but it is unlikely that these megaprojects will change the day-to-day lives of the people helped by Amodefa.

Paula’s neighbour, Florinda, supports her three children by selling locally brewed pineapple liquor. The father of her first two girls died, and the father of her 19-mont- old baby left while Florinda was still pregnant. She has to scrape together 100 Mozambican meticals – £.128 – every week for a return journey standing on the back of a flatbed truck to the clinic in the nearby town of Boane to pick up her medicines.

Florinda and Paula both participate in a micro-saving scheme run by Amodefa, which helps them save for the harder times. The saving schemes are aimed at people with HIV but are open to all – partly in order to preserve the confidentiality of those with HIV, which still comes with stigma in Mozambique.

Amodefa’s support, though, makes people like Paula feel less alone, she says. Aside from the practical support the organisation provides, just being able to talk to someone about living with HIV can make all the difference. That lifeline is now in danger of being switched off.

*Name changed to protect identity

