Department of Defense

This Report detailed the progress and impact of the U.S. government’s investments in global health security during fiscal year 2020, including efforts led by DoD. The Report detailed the distribution of Congressional appropriations to advance global health security efforts in 19 partner countries to respond to disease outbreaks and prevent future outbreaks whenever possible. The Report did not include any information about the DoD’s efforts to promote global health security through programs or activities funded through global health assistance, which was not responsive to need and negatively affected transparency . Though the Report focused on global health security, SRHR and other cross-cutting issues such as gender-based violence (GBV) were not mentioned. The exclusion of these cross-cutting issues was not based in evidence as the inclusion of SRHR and gender equity promotes global health security. This exclusion was also not responsive to need as SRHR services are often the first set of “essential services” to be neglected in a health emergency, as evidenced by the initial global response to COVID-19. This action moderately hindered SRHR in the HIV and AIDS domain.

The Women, Peace, and Security (WPS) Congressional Report provided Congress with an overview of progress specific U.S. government agencies have made in implementing the WPS Agenda globally since 2019. The Report evaluated progress in advancing the WPS Strategy's four lines of effort across the Department of State, DoD, Department of Homeland Security (DHS), and the United States Agency for International Development (USAID): participation, protection, internal capabilities, and partnerships. The Report emphasized the importance of evidence-based implementation and decision-making, which was rooted in evidence and best practices. The Report included specific and actionable milestones to measure each agency’s progress toward the WPS Strategy Lines of Effort, which was responsive to need. While improved health outcomes were included as a positive impact of implementing the WPS Agenda across agencies, HIV and AIDS and the needs of people living with HIV (PLHIV) were not meaningfully included in relation to DoD activities. The Report stated that the DoD hired gender advisors and developed networks of gender focus point staff to coordinate the implementation of WPS activities across the Department, which was responsive to need. However, this action did not outline any other steps that the DoD undertook to support WPS efforts through programs funded by global health assistance. These actions reinforced a gender binary by only referring to “women,” which was gender accommodating. The Report neither hindered nor promoted SRHR in the HIV and AIDS domain.

This report discussed the U.S. government's efforts to end trafficking in the United States and globally. This strategy prioritized the needs and perspectives of those who have been trafficked, called for innovations in data gathering, and promoted education and public awareness activities related to human trafficking. While the health impacts of trafficking were mentioned, the Report centered on domestic efforts to combat trafficking even though the actions described in this whole-of-government report would impact global health assistance programs and activities. The Report described its carceral approach to combating trafficking including prosecution, which relies heavily on law enforcement to prevent trafficking even though these systems do not consistently protect the rights of marginalized groups. This report did not define or provide the evidence base for the “victim-centered and trauma-informed approach” it purported to take in its approaches to combating human trafficking, which was significantly lacking. The Report did not integrate international human rights standards as it conflated commercial sex work and trafficking for the purposes of sex, which ultimately denies sex workers their rights and can impede efforts to prevent trafficking. The carceral approach outlined in this report posed additional risks and barriers for sex workers that needed to access health services due to the fear of prosecution or being targeted by law enforcement. While this report briefly mentioned gender, it was largely gender blind and made no mention of how trafficking impacts people in the LGBTQI+ community. The Report did not sufficiently distinguish which actions were undertaken with U.S. global health funds, which was a transparency issue. The Report moderately hindered SRHR in the HIV and AIDS domain.

In 2020, the Department of State, in collaboration with other U.S. implementing agencies including DoD, released the Strengthening Health Security Across the Globe annual report that identified the U.S. government’s contributions to global health security by country and U.S. government actor. Though several areas of global health were mentioned throughout the report, HIV and AIDS was noticeably absent. There was no mention of the role played by DoD in implementing global HIV and AIDS programs related to global health security in partnership with foreign militaries. SRHR is a critical aspect of health security. Neglecting sexual and reproductive health in security discussions can contribute to negative health impacts and human rights violations for women, girls, gender-diverse people, and other marginalized groups. The exclusion of SRHR throughout the report contributed to the increased development of siloes that exclude SRHR from other areas of global health. The Report was largely gender blind, as it ignored the fact that health security is unattainable without gender equity and the countering of harmful norms that affect women, girls, and gender diverse people. This Report moderately hindered SRHR through the HIV and AIDS domain.

The United States released this Strategy in accordance with the Global Fragility Act of 2019 to promote “peaceful, self-reliant nations.” The Department of State was identified as the lead agency to oversee and implement this Strategy with the assistance of other supporting U.S. government agencies (like DoD) to create impactful and sustainable programs in fragile settings. While the Strategy was responsive to need, it did not adequately address SRHR and the broader health needs of people in conflict settings. The Strategy failed to explain its engagement with specific global health areas, even though HIV and AIDS, MCH, voluntary FP, and other cross-cutting SRHR issues are vital to promoting stability and security. Notably, it did not include gender-based violence (GBV), which is often a greater risk to women, girls, and gender-diverse people in fragile settings and conflict areas, particularly settings where foreign militaries might be engaged. The Strategy stated that it was grounded in evidence and human rights, but it did not include an explanation of the evidence base or human rights framework that informed it. Additionally, it was not gender transformative. Instead, the language in this action promoted a gender binary, ignored the role of gender inequalities on experiences of violence, and only mentioned women in the context of the Women, Peace, and Security (WPS) Strategy. This action moderately hindered SRHR in the HIV and AIDS domain.

This directive discussed the DoD HIV and AIDS Prevention Program and its efforts to protect foreign armed forces from the threat of HIV and AIDS. The program provided funding for the development of programs and interventions to protect foreign nation armed forces from HIV and AIDS. This directive was originally written in 2013 and was revised in 2018 to extend it indefinitely. By doing so, this directive allows the DoD to continue minimizing the threat of HIV and AIDS among the U.S. and foreign militaries. This directive was responsive to need, evidence-based, and human rights based; however, it did not discuss gender norms which are particularly relevant in the armed forces.