Mean Streets

mtct 2

 

NPR reports that Trump’s proposed budget will cut over $2 billion dollars from global healthcare spending. It will, for example, eliminate U.S. aid for international family planning. And programs to combat HIV/AIDS in the world’s poorest countries will be slashed by 17 percent. One notable program on the chopping block is the Presidential Emergency Plan for AIDS Relief (PEPFAR) which funds life-saving drugs for infected people as well as prevention efforts.

There will be harm. Reduction in family planning services alone will result in about 3.3 million more abortions, 15,000 more maternal deaths, 8 million more unintended pregnancies, and 26 million fewer women and couples receiving services per year.

Condemnation was swift. This excerpt from a Washington Post op-ed explains why it’s even in America’s best interest to continue these programs and to fully fund them:

 

It is clear that the generosity of the American people has had a huge impact — one that reflects the view that all lives are precious, and to whom much is given, much is required. This lifesaving work also has a practical purpose for Americans. Societies mired in disease breed hopelessness and despair, leaving people ripe for recruitment by extremists. When we confront suffering — when we save lives — we breathe hope into devastated populations, strengthen and stabilize society, and make our country and the world safer …

Saving nearly 12 million lives is proof that PEPFAR works, and I urge our government to fully fund it. We are on the verge of an AIDS-free generation, but the people of Africa still need our help. The American people deserve credit for this tremendous success and should keep going until the job is done.

 

An example of how the cuts will hurt is seen with the effort to prevent mother-to-child transmission (MTCT) of HIV: an HIV-positive woman transmits the virus to her child during pregnancy, childbirth or breastfeeding. MTCT accounts for the vast majority of new infections in children. In 2015, 150,000 children – 400 children a day – became infected this way.

If HIV is caught in time and with appropriate lifelong treatment the child and the mother can manage the virus and prevent it from developing into AIDS. But there’s an often-overlooked catch: the people closest to the mother will punish her for having transmitted the virus to her child, and this can have lifelong consequences.

AVERT, an HIV and AIDS charity based in the UK, has documented this. For instance, because HIV is so stigmatized, a mother will not want her friends and neighbors to know for fear of being shunned. To the point where she’ll even avoid going for necessary treatment if she thinks she’ll be found out.

For women who disclose their HIV, they’ll find most husbands won’t accompany them to the prenatal clinic. As men who do are perceived as “weaklings” by their peers. Or worse, men will physically abuse or abandon their wives.

There’s even cases where women are abused by healthcare workers. This is what one woman was told by her doctor:

 

How can you even think about getting pregnant knowing that you will kill your child because you’re positive?!!!’ He threatened not to see me again if I got pregnant. He told me that I was ‘irresponsible’, a bad mother, and that I was certainly running around infecting other people.

 

We all internalize messages from those closest to us. As these mothers have. And therefore, AVERT says, they’ll sentence themselves to a lifetime of self-blame and punishment for “not fulfilling traditional gender roles of wife and mother,” and for having been abandoned by friends, family, or their husband.

One more thing: these mothers live with the dread of having to one day answer their child’s question that they know will surely come: Mother, how did I get HIV? And the fear of being pushed away – again – when they tell the truth.

It doesn’t take much to figure this stuff out – if you care to. But these days, the men – and they are mostly men; elderly, white and wealthy – patrolling the mean streets of Washington have turned a blind eye to the lives of others, not just abroad but at home too. It wasn’t always like this: the humane Washington Post op-ed above, and PEPFAR, are both authored by the same person – former president George W Bush.

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