Ugandan Physician on Global AIDS Prevention: “Reproductive Health Is Not a Dirty Word”

Brian Ackerman

The former Global AIDS Coordinator whose program was the basis for PEPFAR recently said that "reproductive health is a clean word," and that the "integration of reproductive health services with HIV" programming should be a priority.

On Wednesday, March 18, I attended a
presentation entitled "It’s not Over: Global AIDS Funding in an Era of
Uncertainty," sponsored by Physicians for Human Rights (PHR) and
Georgetown University. The speaker, Dr. Peter Mugyenyi, Executive
Director of Uganda’s Joint Clinical Research Center, pioneered the
administration of anti-retroviral (ARV) therapy on the continent of
Africa.

During his introduction of Dr.
Mugyenyi, former U.S. Global AIDS Coordinator, Ambassador Mark Dybul
and current co-Director of the O’Neill Institute for National and
Global Health Law at Georgetown University, cited Dr. Mugyenyi’s ARV
treatment and care delivery strategy as the model for the President’s
Emergency Plan for AIDS Relief (PEPFAR).

Dr. Mugyenyi expressed gratitude to
both Ambassador Dybul and the American people in the opening sections
of his speech. He also noted that PEPFAR’s immense successes,
particularly in terms of treatment access, had made an enormous
difference. He stressed that the difference between people accessing
life-saving interventions and not, was really a question of political
will and not simply one of resource availability. 

But it was his statement about
prevention that really gave me goosebumps. He called for a redesigned
prevention strategy that would address the realities of the epidemic in
2009. Mugyenyi noted that women are at a higher risk of infection, not
just for biological reasons, but particularly because of the social and
political marginalization that they face caused by a system of gender
inequality. "The epidemic has changed," Mugyenyi said.
"Many people say that reproductive health is a dirty word. It becomes
even dirtier when you call it ‘family planning.’ But it is not a dirty
word. It is a clean word. And integration of reproductive health
services with HIV testing and care services is critical for women’s
health." 

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

Let’s take a moment to reflect! The
doctor whose program was the basis for the President’s Emergency Plan
for AIDS Relief (at least according to former U.S. GAC Dybul), said
that "reproductive health is a clean word," and that the "integration
of reproductive health services with HIV" programming should be a
priority for the future of PEPFAR’s implementation. 

Feels good, doesn’t it? Having spent
the last two years fighting for improvements to PEPFAR’s prevention
policies toward young people and women, Dr. Mugyenyi’s statements
really made my day.
There was just one down side –  while
Dr. Mugyenyi focused on the specific vulnerabilities of very young
children and women to infection, he did not elaborate on the particular
needs of adolescents. According to UNAIDS, young people under the age
of 25 comprise 45 percent of all new infections. Young people must be
at the core of any new strategy. The stigma of sex blocks the
information and resources critical to the prevention of transmission
among youth.  Dr. Mugyenyi’s point, that reproductive health care must
be integrated with HIV testing and care services, would not only serve
women, but also young people. Adequate sexual and reproductive health
care resources for young people would serve to help normalize sexual
health among adolescents and young adults, thus weakening the power of
stigma to fuel new infections transmitted through unprotected sex. 

As Dr. Mugyenyi is a pediatrician, I
am sure that he is aware of the epidemic among youth. But we must all
ensure that the realities of HIV among adolescents are never an
afterthought when we discuss prevention strategies.
Fifteen years after the International
Conference on Population and Development (ICPD) in Cairo, Egypt, where
participating country delegations established that young people have
the right to medically accurate information and evidence-based care for
their sexual and reproductive health, the inclusion of adolescents and
young adults in HIV prevention strategies should be a given. Well, here
we are fifteen years later and we are still fighting for inclusion.

Let’s take full advantage of this
political springtime – this new beginning –  in the United States by
demanding a change in U.S. global AIDS policies.
Just as we knew that ARVs saved lives
and used our "political will" to make the impossible possible (their
delivery in low-resource settings), we can garner that same "political
will" to ensure that comprehensive, medically accurate information
about the prevention of HIV – especially for young people – also be
available. 

In a closing anecdote, Dr. Mugyenyi
noted that, before PEPFAR was a household acronym, he sat in a meeting
of public health officials in Uganda. The group collectively stated
that anti-retroviral delivery could never take place in Uganda on the
same scale and with the same efficacy as it had in the United
States. Dr. Mugyenyi said he got up and left the meeting, never to
return. He had decided not to waste his time with the naysayers, but to
invest in making antiretroviral therapy a reality in his country.
Today, Dr. Mugyenyi proudly noted, anti-retroviral delivery and
adherence to treatment in Uganda is "just as good" and in some cases
"better" than in the United States.  

This is a strategy I have not yet
employed in my fight to have U.S. global HIV prevention policy reflect
the realities of young people’s lives, but it sounds like it’s a tactic
waiting for the moment. Next time policy makers smugly tell me that
young people cannot handle comprehensive HIV prevention education, or
do not need access to sexual and reproductive health services, I’ll be
sure not to let the door hit me on the way out.

This post first appeared at Amplify.

News Politics

Debbie Wasserman Schultz Resigns as Chair of DNC, Will Not Gavel in Convention

Ally Boguhn

Donna Brazile, vice chair of the DNC, will step in as interim replacement for Wasserman Schultz as committee chair.

On the eve of the Democratic National Convention in Philadelphia, Rep. Debbie Wasserman Schultz (D-FL) resigned her position as chair of the Democratic National Committee (DNC), effective after the convention, amid controversy over leaked internal party emails and months of criticism over her handling of the Democratic primary races.

Wasserman Schultz told the Sun Sentinel on Monday that she would not gavel in this week’s convention, according to Politico.

“I know that electing Hillary Clinton as our next president is critical for America’s future,” Wasserman Schultz said in a Sunday statement announcing her decision. “Going forward, the best way for me to accomplish those goals is to step down as Party Chair at the end of this convention.”

“We have planned a great and unified Convention this week and I hope and expect that the DNC team that has worked so hard to get us to this point will have the strong support of all Democrats in making sure this is the best convention we have ever had,” Wasserman Schultz continued.

Just prior to news that Wasserman Schultz would step down, it was announced that Rep. Marcia Fudge (D-OH) would chair the DNC convention.

Donna Brazile, vice chair of the DNC, will step in as interim replacement for Wasserman Schultz as committee chair.

Wasserman Schultz’s resignation comes after WikiLeaks released more than 19,000 internal emails from the DNC, breathing new life into arguments that the Democratic Party—and Wasserman Schultz in particular—had “rigged” the primary in favor of nominating Hillary Clinton. As Vox‘s Timothy B. Lee pointed out, there seems to be “no bombshells” in the released emails, though one email does show that Brad Marshall, chief financial officer of the DNC, emailed asking whether an unnamed person could be questioned about “his” religious beliefs. Many believe the email was referencing Sen. Bernie Sanders’ (I-VT).

Another email from Wasserman Schultz revealed the DNC chair had referred to Sanders’ campaign manager, Jeff Weaver, as a “damn liar.”

As previously reported by Rewire before the emails’ release, “Wasserman Schultz has been at the center of a string of heated criticisms directed at her handling of the DNC as well as allegations that she initially limited the number of the party’s primary debates, steadfastly refusing to add more until she came under pressure.” She also sparked controversy in January after suggesting that young women aren’t supporting Clinton because there is “a complacency among the generation” who were born after Roe v. Wade was decided.

“Debbie Wasserman Schultz has made the right decision for the future of the Democratic Party,” said Sanders in a Sunday statement. “While she deserves thanks for her years of service, the party now needs new leadership that will open the doors of the party and welcome in working people and young people. The party leadership must also always remain impartial in the presidential nominating process, something which did not occur in the 2016 race.”

Sanders had previously demanded Wasserman Schultz’s resignation in light of the leaked emails during an appearance earlier that day on ABC’s This Week.

Clinton nevertheless stood by Wasserman Schultz in a Sunday statement responding to news of the resignation. “I am grateful to Debbie for getting the Democratic Party to this year’s historic convention in Philadelphia, and I know that this week’s events will be a success thanks to her hard work and leadership,” said Clinton. “There’s simply no one better at taking the fight to the Republicans than Debbie—which is why I am glad that she has agreed to serve as honorary chair of my campaign’s 50-state program to gain ground and elect Democrats in every part of the country, and will continue to serve as a surrogate for my campaign nationally, in Florida, and in other key states.”

Clinton added that she still looks “forward to campaigning with Debbie in Florida and helping her in her re-election bid.” Wasserman Schultz faces a primary challenger, Tim Canova, for her congressional seat in Florida’s 23rd district for the first time this year.

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”